8/26/2016. Coma Arousal. Practitioner. My playground

Transcription

1 The Healing Powers of Music: Sound Choices for the Nurse Practitioner David Horvath, Ph.D, PMHNP-BC New York State Nurse Practitioner Association 2016 Annual Conference My playground Coma Arousal Comatose 15 year old train victim responds to Roy Orbison s music and taped message of hope (March 1978). 1

2 Music and mood: a doctoral study: (Horvath, 1998). Music was used as a controlled treatment at 2 VA alcohol rehab centers. N = 80 The experimental group demonstrated a significant improvement in overall mood after 3 applications of music when compared to control group. Music selections were decided by the individual according to their preference. The four main components of music: RHYTHM: the beat, the pulsation, the kinetic energy of music MELODY: the signature of the piece HARMONY: the emotional landscape of the melody TIMBRE: the texture of the sound How do humans hear music Musical appreciation begins at develop pre-natally The BABYPOD an intra-vaginal ipod speaker Infants able to discriminate between consonance/dissonance 2

3 The development of a musical IQ Harmonic appreciation begins in childhood. Musical tastes level usually level off in early adolescence, although plasticity is possible. Musical tastes are typically a function of all of the music you ve ever been exposed to, the experiences relative to those hearing episodes, and other psychological/cognitive and environmental factors. Music therapy throughout the ages 6 th century BC: Pythagoras used music to treat body and mind ailments 4 th century BC: Hippocrates played music for his patients 19 th century: King(s) Ludwig II of Bavaria and Phillip V of Spain used music to help treat their anxiety and depression. 1800s Nightingale used flute and vocal music to ease the pain of injured soldiers. 3

4 Current uses of music in clinical settings: Pain management Dementia units Developmental disabilities treatment centers Cardiac rehabilitation units Psychiatric units OB/GYN/Post-partum venues Gil Shaham: Music to drive away loiterers Penn Station, NYC Coral Gables, FL Other locations Advantages of using music in clinical practice Everybody likes music Music is safe Music is widely available Music can communicate in ways that word cannot Music can be used as an environmental buffer or as a direct treatment Music has intrinsic properties which can promote healing (regularity, resolution, tonal properties that potentiate optimism hope, etc.) 4

5 CARDIAC (Patients with CHD) (26 trials, N = 1369) Listening to music may have a beneficial effect on: systolic blood pressure heart rate anxiety in people with myocardial infarction pain respiratory rate From Cochrane, 2016 PRE-OPERATIVE (26 trials, N = 2051) Listening to music may have a beneficial effect on: Pre-operative anxiety May even be a viable alternative to using anxiolytics prior to surgery* *Typical pre-operative anxiolytics are associated with postponing the start of surgery and /or slowing down postop recovery. UNITS WITH MECHANICALLY VENTILATED PATIENTS (14 trials, N = 805) Listening to music may have a LARGE beneficial effect on: Anxiety Respiratory rate Systolic B/P The amount of sedative and analgesic medications used, 5

6 PATIENTS WITH CANCER: (52 trials, N = 3731) Listening to music may have a beneficial effect for patients with cancer who have: Anxiety Fatigue Pain Quality of Life PATIENTS UNDERGOING SCREENING FOR CERVICAL CANCER INCLUDING COLPOSCOPY (No data available) Listening to music may have a beneficial effect for patients undergoing screening for cervical cancer who have: Anxiety PARKINSONS DISEASE (Institute for Music and Neurologic Function, NYC) Along with movement, music therapy can help patients with articulation if their speech becomes slurred and unclear. Music therapy also helps Parkinson s patients who exhibit shaking. Slow, rhythmic movement can slow down overactive body rhythms and induce relaxation and sleep. 6

7 This is accomplished by: Breathing exercises Articulation Melodic phrasing Rhythmic vocalization Rhythmic movement to music Conversational phrases are embedded into melodic phrases to support speech. IMNF, 2016 Music and feelings. How does music affect feelings? Is there such a thing as sad music? Is there such a thing as happy music? Can we learn about life by listening to music? Do certain kinds of people like certain kinds of music? When you listen to a song, does the music alone, (all by itself and not the words) convey the meaning of the song accurately? Music and the emotions Musical forms possess the same temporal structure as human emotion in terms of patterns of motion/rest, tension/resolution, agreement/disagreement Even a key change may convey a new world-view two note intervals may convey feeling (Langer, Budd, et. al) 7

8 What to do and how to do it. Determine if patients in your clinical practice could benefit by listening to music. Ambient or patient-specific music? Speakers or individual headsets (earphones)? Playback equipment? How would you regulate volume? Who would determine the selection of music? Wagging the dog? Music preference studies reveal interesting correlations between preferred types of music and personal temperaments. Preference for hard rock was correlated with excitement seeking and high levels of psychoticism and impulsiveness as well as a dislike of other forms of music. Adolescent preference for rock/metal correlated with suicidal thoughts, depression, SIB, drug use, and delinquency. Preference for classical, jazz, soul and folk music was correlated with high levels of intuition. Preference for reflective and complex music had more active imaginations, and viewed themselves as intelligent and tolerant; people who preferred upbeat and conventional music were more extroverted, but less open to new experiences. What to do? Blend in more evolved forms of music into your local environment, i.e. classical and jazz radio stations, internet channels. Upgrade your musical menu: for example, if you like the Three Tenors try an opera. If you like New Age music, try Debussy or Ravel. Limit your diet of top 40 songs in favor of popular music with more harmonic and melodic attributes (usually older pop). Don t be swayed by popular trends in music. Support your local orchestras and radio stations that feature quality music. The next time you re in NYC go to the Metropolitan Opera or New York Philharmonic. 8

9 Other suggestions Good headsets are important. You can get them for $10-$20 at Marshalls, T.J. Maxx. Don t be duped into spending hundreds of dollars. Don t assume your patient likes a particular kind of music because of their age, national origin, or any other personal attribute. If your patient can t communicate, talk to family members. Get music free from local libraries. Upgrade your personal inventory of recorded sound. Keep classical or jazz on in the background where you work. You ll be surprised at how it impacts your co-workers and patients! Food for thought How could you incorporate the clinical application of music into your practice? What s music do you have in your smartphone or tablet now? What would a symphony about your life sound like? What musical experience would you like to attempt but have been afraid to? Thank you and happy listening! dhorvath08@gmail.com 9