Mechanisms by Which Music Therapy Operates
Mechanisms by Which Music Therapy Operates
As mention earlier in this paper, pain is described in term of bodily injury, and thus the extent to which pain is felt is proportional to the extent of tissue damage. Therefore, traditional treatments have been designed to diagnose the causes by which pain is elicited. As a result, pain-relieving medication is often prescribed for symptomatic relief. However, when the injury has healed but the person continues to have pain, some physicians refers to this as being a psychogenic problem and refers patients to psychiatric services (for review, see Melzack, 1974).
Research in neurophysiology implies that there is not only a direct relationship with the central nervous system but that additional influences from the neocortical activity of the brain which may include processes such as suggestion, attention, anticipation, anxiety, and past experiences of the individual, also plays a role in chronic pain (for review, see Livingston, 1953; Melzack, 1961, 1973, 1974). Pain perception and immune responses are now known to be subjective to both form of stimulus-response learning (i.e. classical conditioning and operant conditioning) (for review, see Achterberg & Lawlis, 1980; Ader & Gordon, 1981; Leventhal et al., 1984; Levine et al., 1978). As a result, a wide range of cognitive-behavioral treatment strategies, including progressive muscle relaxation, verbal rehearsal, operant conditioning, psychotherapy, and hypnosis have been effectively demonstrated as behavioral medicine (for review, see Agras, 1984). Music has been found to be effective in stimulating imagery and in facilitating physiological relaxation responses (Prickett, C & Standley, J, 1994). Music / relaxation / and imagery paradigms have also been shown to be effective in treating chronic stress and chronic diseases (for review, see Rider & Kibler, 1985).
The mechanism by which music affects pain responses appears to be as varied as the research paradigms. Music has been shown to elicit analgesia through distraction or dissociation, as a relaxation cue, through stimulation of acupuncture points, and the production of endorphins in thrills (Pricket, C & Standley, J, 1994). Thus, to understand how music can reduce pain, lets look at some important properties of music.
Music has often been referred to as the "language of the soul". Music can have a strong influence on the body as well as well as the emotion, since the vibrations of music can penetrate through our skin, ears, bones, and viscera to get to us (Steckler, 1998). For instance, certain vibrations clam us, while others energize us and some trigger our emotions and unleash a variety of response from crying to bursting with joy (Steckler, 1998). Furthermore, studies on the neurological effects of music indicates that at least three processes are stimulated (for review, see Bush, 1995):
a. Music moves from the ears to the center of the brain and the limbic system,
Which governs the emotional responses of pain and pleasure as well as such involuntary processes as body temperature and blood pressure.
b. Music may activate a flow of stored memories across the corpus callosum.
As a result, the recall of association is greatly enhanced.
c. Music can excite peptides, which release endorphins and produce a Ônatural highÕ and also serve as a natural deterrent to the experience of pain.
In a logical sense, we are like musical organs and our physical bodies are like resonators in the sense that we are always responding to the vibrational patterns around us. For example, when resonators are in close contact with each other, and their energy patterns interact, they will eventually become synchronize with each other. Similar effect is observed when two pendulums are in close contact. This phenomena is known as entrainment, and it accounts for why our heartbeat and our breathing tend to synchronize with the beat of music we listen to (for review, see Merritt, S., 1996). Hence, letÕs look at the elements of music and see how each can affect the body.
There are five elements that make up music: rhythm, tone, melody, harmony, and timbre. Of these five elements, rhythm has the most intense and fast acting effect on us (Steckler, M., 1998). Rhythm affects both our body and our emotions. Body rhythms such as heart rate, respiration and brain waves are influenced by the vibratory rhythms of music; music may either stimulate or clam them, harmonize, or create discord. In terms of tone, every note, though produce by distinctive rate of vibration, has both physical and psychological effects. Melody refers to the combination of rhythms, tones and accents of music. Melodies produces many intense effects on the listener by stimulating the emotions as well as images, and has been shown to have a great influence on the nervous system (for review, see Merritt, S., 1996). Harmony is produced by the simultaneous vibration of several tones that blends together to form a chord. Depending on the rates of vibration of these sounds, the response will be either a harmonious blending or a jarring discord, both of which have definite physiological and psychological effects (Steckler, M., 1998). Finally, timbre is describe as the difference in the nature and structure of the various musical instruments, the human voice included, which gives to sound a unique quality that is easily recognizable because it elicit different emotional responses. Having established the fundamental principles of music, letÕs talk about the theoretical explanation for the mechanisms involved in the interaction of music and pain.
It has been theorized that pain is a sensory discriminative experience affected by cognitive activities such as anxiety and past experiences ( for review, see Melzack, 1963). Thus, focusing on an esthetic experience could lessen an individualÕs perception of pain. Furthermore, the psychological component of pain has been recognized as an important element and can be utilize for modifying pain through psychological techniques. In addition, studies have shown that music might alter pain through affective and cognitive effects that stimulate endorphin production and other endogenous mechanism for pain modulation (Magill-levreault, 1993). Hence, through a process of engaging the affective, cognitive, and sensory, music therapy can be used to alter the perception of pain in patients by distraction, alteration of mood, enhancing control, use of prior skills, and promoting relaxation (Magill-levreault, 1993). LetÕs look at these theoretical explanations for the mechanisms in which music interacts with pain in greater depth.
Theoretical explanations for the mechanisms involved in the interactions between music and pain have been proposed. The theoretical framework for the utilization of music therapy as a mean for pain management is based on the premise that music may alter the components of the total pain experience and thus decreases pain perception. There are four theoretical perspectives that have been propose that support why many patients report reduced pain sensation after music therapy (Magill-levreault, 1993; for review, see OÕCallahan, C., 1996) [See model Ñ Figure 1):
a. Cognitive - The psychological relationship between music and pain. The associative qualities of music provide a means for distracting attention away from pain (often creating images and carrying a personÕs thoughts away from the noxious stimuli). Music in this case, also provides a mechanism for enhancing a personÕs sense of control. Furthermore, music also provides a means for engaging familiar skills (e.g. prior music skills).
b. Affective - The psychophysiological theory. Music may alter the mood disturbances associated with long-term and life-threatening illness such as anxiety, depression, fear, anger, and sadness. Music can relief depressive symptoms, induce relaxation, and thus reduces tension and anxiety.
c. Sensory - Spinal mechanisms involved in pain modulation. The sensory component of music may have an effect on the sensory component of pain through counter-stimulation of the afferent fibers.
d. The role of endorphins. This mechanism involves the interactive pathways through which music may activate the endogenous system of pain modulation.
On the contrary, it has also been demonstrated that music, which is inappropriately use, can aggravate pain sensation (for review, see OÕCallahan, C., 1996). Thus, increasing pain perception and pain experience.
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Conclusion