MAKING MUSIC VIDEOS HELPS YOUNG CANCER PATIENTS CONNECT

Reuters Edition: U.S.
by Genevra Pittman

MONDAY, Jan. 27, 2014 (HealthDay News) -- Jefri Franks says one of the things that helped her 12-year-old daughter Heather cope with the challenges of having cancer was music therapy -- in particular, making a music video.

"I was relieved during the time she was doing the video because she had something she had to do and enjoy," Franks said. "She was busy in a good way. I think she got to tell her story the way she wanted to."

A new study from Indiana University appears to back up what Franks learned more than a decade ago. Researchers found that adolescents and young adults undergoing cancer treatment in the hospital who participated in a music therapy program that included writing song lyrics and producing videos increased their ability to cope and boosted their resilience.

For the study, published online Jan. 27 in the journal Cancer, researchers tested a music therapy intervention in 113 patients, aged 11 to 24, who were undergoing stem cell transplants for cancer. The treatment involves infusions of healthy stem cells that help replace diseased ones.

"The kids are usually very sick during stem cell transplants. They require a lot of supportive care," said study co-author Joan Haase, a professor of pediatric oncology nursing at the Indiana University School of Nursing. "Depending on the type of transplant, up to 50 percent of these kids undergoing stem cell transplant don't survive, so being able to say how they feel about that is important."

The patients were randomly assigned into either a therapeutic music video-making group or to a comparison group in which everyone received audio books. There were six sessions over three weeks.

The music therapist's role was to offer structure and support, and to help the young patients reflect on their experiences and identify what was important to them, said study lead author Sheri Robb, an associate professor at Indiana University School of Nursing and editor of the Journal of Music Therapy.

"It may seem counterintuitive to be asking kids to do things during this time, but in actuality it's helping them to move through their treatment in a better way," Robb said. Music therapists encouraged their patients to tap into important parts of their lives, including their spirituality, family and other relationships, she explained.

The phases of the intervention included writing song lyrics, making sound recordings, collecting video images and storyboarding. Patients could work independently or involve family, friends and health care providers in their projects, the authors noted.

Haase said the therapeutic music video group reported significantly better "courageous coping" skills. Even 100 days after the stem cell transplant treatments, the music video group reported significantly better social integration and family-environment experiences.

Lisa Gallagher, a clinical music therapist at the Cleveland Clinic, said the study is well done.

"They did a lot of research into how to put this together, what measures to use," Gallagher said. "It's a tough population, adolescents who have this type of stem cell transplant. It is a high-risk treatment and so anything that can be done for patients who undergo this is great."

Working with a therapist to create music videos may help young cancer patients feel better about themselves and their situation, a new study suggests.

Teenagers and young adults who made the videos reported feeling more supported by family and friends and coped with their cancer in more positive ways.

"They're going through an experience that their peers don't really understand a lot of times," Joan Haase said. She worked on the study at the Indiana University School of Nursing in Indianapolis. "There's a lot of issues that they deal with."

Finding a way to express their feelings - and share how they feel with people around them - might help them work through those issues, the researchers found.

They studied 113 young people, ages 11 to 24, who were being treated for cancer with intravenous infusions of stem cells. Most of them had leukemia or lymphoma.

The preparation for those infusions is grueling. First, patients have to go through chemotherapy or radiation to wipe out cancerous cells. During the treatments, their immune systems become very weak and they can be in the hospital for weeks at a time, with symptoms like nausea and mouth sores.

All of the patients in the study met with a music therapist six times over about three weeks while they were in the hospital. Half were randomly assigned to work with the therapist on making a music video - writing lyrics, recording a song and selecting art - and the others listened to audiobooks instead.

The music video program was designed so that young people would be most involved in the project at the beginning and end, and have less demanding parts to work on while their symptoms were at their worst.

"It really targeted them writing, having an opportunity to write about what's important to them," said co-author Sheri Robb, also from Indiana University.

"A lot of these kids as they're going through treatment, they tend to not talk about these things," Robb told Reuters Health.

At the end of the study, young people in the music video group could invite their family and friends to a video premiere.

The researchers found that directly after making the videos, young people were coping with their cancer in a positive, optimistic way more often than those who had listened to audiobooks. A few months after treatment, they felt more support from doctors, friends and family and reported a better family environment than the other patients, based on their responses on questionnaires.

Making a music video didn't affect young people's distress related to their illness, however, or their use of more negative coping mechanisms, the researchers wrote in Cancer.

Brad Zebrack, who has studied adolescent cancer survivors, said the findings suggest the video project helped build on young people's internal resources and improve their self-confidence.

"It's not so much the cancer that stresses them, it's the fallout," Zebrack, from the University of Michigan in Ann Arbor, told Reuters Health.

"One of the biggest challenges they face is the social isolation. Having to spend a lot of time at home, not being able to be with their friends for a lot of time. The disruption of cancer comes at a time in life when that type of social interaction is so important."

But, he added, "We know that most people bounce back. Most people are resilient."

Zebrack, who was not involved in the new research, said the benefits of working with a music therapist are likely to extend to young people with any kind of cancer, not just those receiving stem cell transplants.

Music therapists are increasingly considered part of standard care at children's hospitals, the researchers noted.

But most people in their late teens and 20s with cancer are treated in private oncology groups, which typically don't have a social worker or therapist on staff, according to Zebrack.

"The big challenge is how we can move this type of intervention from the hospitals and the academic treatment centers out into the community and out into the places where more young adults are treated," he said.

 

To view article in original http://www.reuters.com/article/2014/01/27/us-music-videos-cancer-idUSBREA0Q06R20140127

SOURCE: bit.ly/1jJpr1Q Cancer, online January 27, 2014.

WHEN PATIENTS HAVE 'MUSIC EMERGENCIES'

 
Brian Jantz, a music therapist at Boston Children's Hospital,
plays with a patient, Yaneishka Trujillo.
Jantz uses music to engage with children.

By Elizabeth Landau, CNN

updated 1:55 PM EDT, Fri August 23, 2013

Carlos H. Costa and Joana Christina Brito de Azevedo perform at the Interdisciplinary Society for Quantitative Research in Music and Medicine meeting in Athens, Georgia. Researchers looking at the effects of music on the body and mind presented at the conference. Music therapist Eric Miller performs with David Akombo, assistant professor of music education at Jackson State University, at the conference. Miller also demonstrated how biofeedback can be used in music therapy sessions.

STORY HIGHLIGHTS

• There are about 5,000 board-certified music therapists in the United States
• They help many different populations, from children in hospitals to Alzheimer's patients
• Scientific research has shown that music has healing properties

(CNN) -- Brian Jantz marched down the hallway of the hospital with his guitar, accompanying a 4-year-old oncology patient with a maraca and a drum. He remembers they were singing their own creative version of "Itsy Bitsy Spider."

The girl had been anxious about an upcoming X-ray, he said, and resisted going to the procedure. Hospital staff paged Jantz to help. He kept the music going even on the elevator; the girl's parents, a nurse and a child-life specialist sang, too.

 

"I'm not completely sure that she realized when it was happening ... because before you knew it, we were back on the elevator, back in the room, and the music just continued straight through," Jantz said.

 

Jantz is one of two music therapists at Boston Children's Hospital, where the idea of using music to help patients as young as premature babies in the neonatal intensive care unit has taken off in the last decade. Jantz and his colleague have scheduled visits with patients in almost every unit but will come to a melodic rescue in urgent situations.

 

"We kind of joke around, 'It's like a music emergency,' but it really is," Jantz said. "It really can be like, 'This patient needs music therapy right now.' "

 

Music therapy formally began in the 20th century, after musicians went to play for World War I and World War II veterans at hospitals across the United States. Today, there are about 5,000 board-certified music therapists in the United States, according to the American Music Therapy Association. Over the last decade, the group's membership has expanded, particularly among students.

Music therapy has many uses, from treating individuals in private practice to elderly care settings.

"We're not huge, but are slow growing -- but a mighty -- group," said Barbara Else, senior adviser for policy and research at the American Music Therapy Association.

 

Why it works

There is scientific research to back up the idea that music has healing properties. A 2013 analysis by Daniel Levitin, a prominent psychologist who studies the neuroscience of music at McGill University in Montreal, and his colleagues highlighted a variety of evidence: for instance, one study showed music's anti-anxiety properties, another found music was associated with higher levels of immunoglobin A, an antibody linked to immunity.

 

The brain's reward center responds to music -- a brain structure called the striatum releases the chemical dopamine, associated with pleasure. Food and sex also have this effect. The dopamine rush could even be comparable to methamphetamines, Robert Zatorre, professor of neurology and neurosurgery at Montreal Neurological Institute, told CNN last year.

Beyond that, music presents a nonthreatening tool for interventions that is already attractive to patients, Jantz said.

 

"On the surface it works because, in some way, everyone relates to music," Jantz said. "Music really is universal."

 

Music therapists often work nonverbally, which is why the method is particularly effective for individuals with verbal expression difficulties, such as children with autism, Else said. The profession helps people at every age, from babies to Alzheimer's patients.

 

For individuals with autism in particular, music therapy has shown to be a positive reinforcement of appropriate behaviors and a motivator to reduce negative ones, according to the American Music Therapy Association. Music can also help with the development of language skills, and the identification and expression of emotions, which are characteristic challenges in autism. Some children with autism have superb musical abilities, and music therapy can help them focus on their strengths.

 

Alzheimer's patients, who have memory and thinking impairment, may still recognize songs of their youth or respond emotionally to music. Music can also be used in elderly care settings to calm or stimulate residents.

Music: It's in your head, changing your brain

 

Music as a tool

Singing with someone when you feel anxious, or expressing emotions through songwriting, are more than just casual activities in music therapy. Therapists always have specific goals in mind, such as helping patients overcome a fear.

 

One fundamental of music therapy is called the "Iso principle," the idea that the therapist takes cues from the client when choosing what music to play. This can inform the improvised music that therapists and clients play together. If the client feels hyped up, the therapist and client might play vigorous drum beats together, but if the goal is to relax, they might begin energetically and then tone down.

 

Therapists are conscious of rhythm, tempo, texture and melody of the music as clients express themselves. In a hospital setting such as Jantz's, such components of music can also distract a patient who is in pain.

 

In Else's private practice, she has been helping a college student with an anxiety disorder called agoraphobia; the young woman, who was homeschooled, has been fearful of leaving her house.

The student writes song lyrics when she meets with Else, and also learns guitar from the therapist in the process. By discussing the lyrics and other elements of the music that the student generates through improvisation, the client and therapist uncover clues about what is fueling the woman's anxieties.

 

"We are using music as a mechanism. One, for motivation, but also as a mechanism so she can express herself and we can figure out what are some of these things that are driving her fears," Else said. "We've made a lot of progress."

 

Having worked through her issues with music, the young woman became more open to going out in public, Else said. She accompanied Else to a rehearsal for an opera, and then to an actual opera performance.

 

She has now started junior college and is doing well, Else said. The young woman still sees Else for follow-up maintenance.

 

"Part of that therapeutic process working with her ... was building a high level of trust," Else said. "Developing trust with someone so she could understand that the world isn't quite so scary out there, to get to the root cause."

 

Music as a lifesaver

Going through music therapy isn't always relaxing, fun or easy.

 

Cpl. Demi Bullock, 25, a former Marine, experienced post-traumatic stress disorder after her second deployment in Afghanistan. In summer 2011, music therapy was part of her treatment program.

At first, Bullock, who had played the guitar since she was 15, hated music therapy. Her therapist, Rebecca Vaudreuil, would organize activities such as a drum circle, lyric analysis, listening exercises or instrumental playing for service members in the program.

 

Impatience, and a desire to withdraw from emotion, quickly overtook Bullock. She refused to participate.

 

"I did not like playing music, having something make me feel that pain and that sadness, that can be completely overwhelming," she said.

 

Such resistance isn't unusual among returning military, Vaudreuil said. Some people can connect with music more than others, but in some cases it takes time and "soul-searching" for music to become a beneficial part of recovery.

 

Bullock rediscovered music therapy more than a year after her initial encounter with it. In January, Vaudreuil invited her to join the Semper Sound Band, a musical program through the nonprofit Resounding Joy Inc. that helps service members reintegrate into the community and promotes group cohesion. Vaudreuil was the band director at that time.

 

The invitation came at a particularly dark moment. Bullock was in the process of getting evicted and continued to struggle with PTSD and depression. She had also recently attempted suicide.

Bullock came to discover that jamming on a guitar, keyboard or drum set helped her cope with stress or intrusive thoughts. The band also provides a social support system and an outlet for self-expression.

"The songs that come out of it, and the process they go through, is so genuine," Vaudreuil said. "The songs are a direct reflection of their emotions, their trials, what they've been through, their experiences, and it's completely cathartic for them."

 

Bullock continues to play with the band, and works as an intern at Resounding Joy. Her job allows her to be on the facilitator side of music therapy, and connect with other veterans.

"If I hadn't gotten into it (music therapy), I'd literally be dead or still be homeless," Bullock said. "It literally did save my life."

 

Measuring calm

Other therapists are exploring technologies that allow them to see what effect music has on the human body, and use that information to guide clients. This is called biofeedback.

Eric B. Miller, a music therapist in Phoenixville, Pennsylvania, uses real-time data about patients' physiological responses to inform how he runs sessions. He recently discussed a biofeedback method at the Interdisciplinary Society for Quantitative Research in Music and Medicine conference in Athens, Georgia.

 

"The idea is that this information is informing me as a music therapist how I want to be playing my guitar, what tempo I'm going for," he said at the conference.

 

Conference attendees took turns listening to music while wearing a finger sensor. Through a computer program, a graph appeared on a projector screen showing relative heart rate, heart rate variance and skin conductivity in real time. The computer program then translated the readings from the sensor into tones, which could be heard overlayed with music.

 

Independent researcher Elijah Easton listened to another conference attendee (full disclosure: it was the author of this article) improvise on the piano. Easton said he found the activity relaxing; Miller noted that Easton's heart rate had decreased after the music stopped.

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In a real session, Miller would create a physiological profile of a client by looking at his or her responses to sitting naturally, doing a cognitive task, relaxing and envisioning something emotional. After more relaxation, he would set up the biofeedback system of tones, and challenge the client to lower the tone, an indication of relaxation. Different tones can be assigned to different variables such as heart rate.

 

The point is helping clients learn the art of self-regulation, of adjusting their own bodies, Miller said.

"The music and the data are both co-therapists," Miller said.

Biofeedback-oriented music therapy can be used in a variety of conditions, including high blood pressure and seizures -- not necessarily instead of mainstream medicine, but in concert with it, Miller said.

 

"Western doctors may recommend it to complement existing treatment or as a trial in cases of adverse reaction to typical pharmacological remedies," he said.

 

In a more subtle way, Jantz also uses biofeedback with patients who are already hooked up to monitors at Boston Children's Hospital for medical reasons. When he plays music in the neonatal intensive care unit, he can see what impact strumming his guitar has by observing the heart rate graph.

 

Fun is part of it

Jantz sees music itself as having an intrinsic therapeutic value, in addition to the positive experience that a person can have with a music therapist. For children in particular, it can encourage them to learn a new skill; sometimes patients who stay at Boston Children's Hospital for longer periods get good at guitar.

 

Occasionally Jantz has to dress in a surgical gown and gloves, but for the most part the kids don't view what he does as a therapy -- they're just relieved that instead of poking and prodding, he's there to play music with them.

 

"There's nothing wrong with having fun," he said. "That's part of how it works."

He's prepared for a full repertoire of traditional children's songs, but he has also worked with young kids who love The Beatles. And some teens would rather hear music from their earlier childhood than Justin Bieber.

 

The phone that pages him, though, doesn't beep or ring to alert him to his next destination.

 

It vibrates, so as to not interrupt the music.

 

To view original post visit http://www.cnn.com/2013/08/23/health/music-therapy/index.html

 

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