Music Therapy

1. Music Therapy Presented by R2 康庭瑞

2. Music Decreases Sedative Requirements During Spinal Anesthesia • Purpose: • This prospective study measured whether music can influence anxiety and perioperative sedative requirements in outpatients undergoing surgery with spinal anesthesia • Method: • Fifty unpremedicated patients were randomly assigned to listen to music of their choice via headset during the perioperative period (Group I) or to have no music (Group II) • All participants used patient-controlled IV midazolam sedation and underwent repeated evaluations of their anxiety level with the STAI (State-Trait Anxiety Inventory test ) and the VAS 0–10 Anesthesia & analgesia, Oct, 2001

3. Music Decreases Sedative Requirements During Spinal Anesthesia • Result: • Midazolam requirements during surgery (Group I, 0.6 ± 0.7 versus Group II, 1.3 ± 1.1 mg;P < 0.05) • The whole perioperative period (Group I, 1.2 ± 1.3 versus Group II, 2.5 ± 2.0 mg;P < 0.05) • Conclusion: • patients listening to music require less midazolam to achieve a similar degree of relaxation as controls and that measures of anxiety obtained from the STAI and the VAS 0–10 Anesthesia & analgesia, Oct, 2001

4. Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery Acta Anaesthesiologica Scandinavica, 2003 Mar.

5. Background • This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperative in daycare surgery Acta Anaesthesiologica Scandinavica, 2003 Mar.

6. Methods • 182 unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anesthesia • Randomly assigned to (a). listening to music (b). music in combination with therapeutic suggestions or (c). blank tape in the immediate postoperative period • The surgical technique, anaesthesia and postoperative analgesia were standardized • Analgesia, the total requirement of morphine, nausea, fatigue, well-being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables Acta Anaesthesiologica Scandinavica, 2003 Mar.

7. Result • Pain intensity (VAS) was significantly lower (P = 0.002) in the M (2.1), and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P < 0.001, were found • No differences were noted in the other outcome variables Acta Anaesthesiologica Scandinavica, 2003 Mar.

8. Conclusion • Music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients' experience of analgesia • The improvement in analgesia is modest in the group of patients with low overall pain levels Acta Anaesthesiologica Scandinavica, 2003 Mar.

9. Medical Resonance Therapy Music affect autonomous innervation of cerebral arteries • Purpose: • To study the effects of Medical Resonance Therapy Music (MRT-Music) upon autonomous innervation of cerebral arteries by examining slow spontaneous oscillations of cerebral blood flow (SSO) using transcranial Doppler ultrasound (TCD) Integrative Physiological & Behavioral Science, 2000 Jul-Sep

10. Medical Resonance Therapy Music affect autonomous innervation of cerebral arteries • Method: • TCD detects SSO with 3-9 cycles per minute (M-waves) and 0.5-2 cycles per minute (B-waves), the SSO are caused by rhythmic diameter changes of the medium and small cerebral arteries • Six patients aged 24-65 years suffering from tension headache were treated with MRT-Music • Twelve additional patients were examined with TCD only to register SSO for further spectral analysis Integrative Physiological & Behavioral Science, 2000 Jul-Sep

11. Medical Resonance Therapy Music affect autonomous innervation of cerebral arteries • Method: • After fast Fourier transformation four groups of peaks were registered on the SSO spectra, divided into four rhythms: A. 0.0-0.02 Hz, B. 0.02-0.033 Hz, C. 0.06-0.09 Hz, D. 0.09-0.15 Hz • Spectral analysis of the SSO showed changes between initial and final amplitude peaks in all patients Integrative Physiological & Behavioral Science, 2000 Jul-Sep

12. Medical Resonance Therapy Music affect autonomous innervation of cerebral arteries • Result: • In contrast to A-, B-and D-rhythms, the reduction of peaks in the C-diapason was statistically significant (31-60%, P 3D0.04, CI 3D95%) for patients treated with MRT-Music • All patients treated with the MRT-Music reported a relief of headache while and after treatment Integrative Physiological & Behavioral Science, 2000 Jul-Sep

13. Medical Resonance Therapy Music affect autonomous innervation of cerebral arteries • Conclusion: • The MRT-Music affects the functioning of the brain structures concerning autonomous nervous system and works as a non-chemical sympatholytic • Registration of the SSO is a useful tool to prove an influence of the MRT-Music upon the autonomous regulation of cerebral vessels Integrative Physiological & Behavioral Science, 2000 Jul-Sep

14. What is music therapy? • Music therapy is an established health service similar to occupational therapy and physical therapy • Using music therapeutically to address physical, psychological, cognitive and/or social functioning for patients • A powerful and non-invasive medium, unique outcomes are possible

15. 歷史發展 • 古希臘傳說中，阿波羅神是掌管音樂和醫療的神－音樂和醫療本為一體 • 西元前五百五十年，希臘哲人（醫師）畢達哥拉斯首先提出將音樂用在治療病人的觀念 • 應用音樂來進行治療的最早紀錄為Kahum papyrus，其內容則敘述咒語對治療疾病的用途；現存各原始民族的巫醫或民俗療法的治療者，其實也多運用不同形式的音樂來治療各種心理及生理問題

16. 歷史發展 • 十五世紀的文藝復興時期，現代西方醫學突飛猛進，朝向純粹科學發展；而音樂則朝向純粹藝術方面進展 • 十九世紀初期，歐洲精神科醫師發現，有些病患對於種種刺激都沒有反應，唯獨對音樂有感受力 • 音樂在臨床醫學的價值的系統性研究是從二十世紀後開始的 • 音樂治療成為正式學門始於第二次世界大戰期間，在音樂被注意到能促進復原及治療「戰壕休克」病人之際

17. 歷史發展 • 為提昇音樂治療的科學性及提供學者們有關的準則與支持，美國的國家音樂治療協會（National Association for Music Therapy）成立於一九五零年，美國音樂治療協會（American Association for Music Therapy）則創始於一九七一年 • 從文獻上可以看出，音樂療法於現代精神醫學之應用，早於一九五零及六零年代即被重視；自一九八零年代起，則更推廣到其他身體醫療上之應用

18. 定義 • 藉由某些音樂特有的節奏、音調、旋律等，與人體內生的韻律協調而產生共鳴，進而調節人的身心與生理反應 • 運用一切與音樂有關的活動型式作為手段，如聽、唱、演奏、創作、舞蹈等，治療過程中需包括有音樂、被治療者和受過訓練的音樂治療師，三者缺一不可

19. 音樂治療的原理 • 音樂對於人的身心具有明顯的影響，某些特有的旋律與節奏能使人的血壓降低，基礎代謝和呼吸的速度減慢，使在受到壓力時的反應較為溫和 • 透過音波的物理作用，直接對體內器官產生共振效果（聲音本身是一種震動，而人體本身也包含許多內生性的節率與震波） • 音樂具有主動、積極的作用，不同的音樂可引導出不同的腦波（α、β、θ波），如α波主宰人體安定平靜的情緒，透過音樂的加強，達到身心鬆弛、心境平和的效果

20. 基本理論 • 音樂治療的效果至今仍沒有一致性的定論；不過已有一些源自經驗性研究結果的理論性概念被發展出來，其中有部份概念更可被引以作為支持音樂治療為一種獨特的治療模式的證據 • 音樂可引發生理反應；但很難預料這些反應的方向 • 音樂可引發心理（情緒/情感）反應 • 音樂或許能引發想像及聯想 • 音樂可引發認知反應 • 音樂有引發生理及心理「共鳴」的潛力 • 每一個體對音樂之生理的、心理的與認知的反應均是獨一無二的

21. 音樂在治療中的角色 • 音樂在不同的領域中所起的作用是不一樣的，根據臨床治療實踐情況來看，可分為兩大類： • 治療中的音樂（Music in therapy）－在臨床治療過程中為輔助之作用，配合其他的治療共同達到幫助病人康復的目的，在此處音樂治療不能被單獨使用 • 作為治療的音樂（Music as therapy）－在某些領域的治療中作為唯一的基本的治療手段，不需依靠其他醫療而單獨起作用

22. 音樂治療的適應症 • 精神病：如精神分裂症、憂鬱症、狂躁症 • 老年疾患：如老人癡呆症、帕金森氏症 • 兒童疾患：如發展障礙、學習障礙、生理或智力的殘疾 • 戒毒 • 婦產科分娩 • 慢性疼痛、頭痛 • 外科手術的減痛 • 正常人的心理治療 • 復健

23. Taylor (1973) 所指出的，基本上不可能概化（generalize） 人對某種音樂的反應 • 在解讀音樂治療的相關文獻時常會遇到一個重要缺陷，那就是缺乏標準化之研究模式 • 對音樂之反應，是複雜又多元的，且同時間發生於數方面（同時作用於生理、心理、認知等方面） • 大多數此類研究已過時且無法被重新檢證，除非有更多一致性的、系統化的研究發現，實在無法概化現有的研究結果 • 研究發現之差異也可能來自在各種統計方法上、實驗上及樣本數目上之差異

24. 參考文獻 • Abeles, H. F. (1980): Responses to music. In D. A. Hedges (Ed.), Handbook of Music Psychology. Lawrence, KS: National Association for Music Therapy. • Boxberger, R. (1962). Historical bases for the use of music in therapy. In E. H. Schneider (Ed.), Music Therapy 1961: Eleventh book of proceedings of the National Association for Music Therapy. • Bruscia, K. E. (1989): Defining Music Therapy. Spring City, PA: Spring House Books. • Pratt, R. R., & Jones, R. W. (1987). Music and Medicine: A Partnership in History. In R. Spintge & R. Droh (Eds.), Music in Medicine. • Saperston, B. M. (1989): Music-based Individualized Relaxation Training (MBIRT): A stress-reducing approach for the behaviorally disturbed mentally retarded. Music Therapy Perspectives, 6. • Scartelli, J. P. (1989). Music and Self-management Methods: A Physiological Model. St. Louis: MMB Music.

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