Applying the ‘East Kent Outcomes System’ (EKOS) in music therapy

Introduction This essay presents a reflexive exploration of othering music in music therapy, examining ethical implications in practice, supervision, and education. While othering of people, cultures, and groups has been addressed in music therapy literature as a contributing factor to marginalization, bias, and discrimination, the focus on othering music has had little attention. With music being the unique feature of music therapy practice, a full and reflexive examination of bias regarding music, as evidenced in othering music, is critical in assuring ethical and professional practice and individually meaningful experiences for all participants. Method Reflexivity was used to openly and fully explore my own othering of music in music therapy practice, supervision, and education. Results Following my reflexive exploration, I propose that othering music in the practice and profession of music therapy can and does cause harm. Harm to the participant, their community, and culture through dismissing, devaluing, and oppressing their music. Harm to the individual music therapist whose practice, career, and sense of professional worth can be limited by the othering. Harm to the profession through othering large groups of people and their musics, who might otherwise be a vibrant part of the music therapy community. Discussion The essay concludes with my proposed definition of othering music in music therapy, outlines potential areas of harm, suggests prompts to promote deeper discussion and introspection, and recommends further areas of inquiry for practitioners, educators, and leaders of the profession.

The aim of this study is to compare the effect of group music therapy practices on test anxiety and the effectiveness of the music lesson taught in accordance with the united annual lesson plan in high school seniors who are preparing for the university entrance exam. Two months before the exam, 49 students studying in the last year of Osmangazi Anatolian High School in Afyonkarahisar province in the 2022-2023 academic years participated in the research. Students were randomly assigned to “Music Therapy” and “Music Lesson” groups. The music therapy group was included in the group music therapy process for 8 weeks, while the music lesson group took only the elective music course in the curriculum. “Westside Exam Anxiety Scale” was used as a data collection tool in the study, and comparisons between groups were made with independent sample t-test, chi-square analysis and factorial mixed design analysis of variance methods. In addition, semi-structured interviews were conducted with the students and the effect of the music therapy sessions was evaluated with the opinions of the participants. In conclusion; it has been observed that students can control their test anxiety through music therapy practices and strengthen their internal audit-based motivation by developing a foresight through affirmation. Moreover; it was stated by the students in the therapy group that peer interaction, music culture and music-based expression skills improved, and that music therapy sessions had a positive effect on them. It was determined that the students in the Music Lesson group experienced a certain increase in their anxiety levels with the approaching of the exam date, and it was difficult for the students to make sense of the music lesson outputs for the curriculum. In this study, it was determined that goal-oriented music therapy practices performed in the school environment were effective in reducing test anxiety. It is thought that the results of the study will contribute to the national and international literature.

As a music therapy clinician who worked for many years in a rehabilitation hospital for people with traumatic brain injury, I found working with people who are minimally responsive (vegetative state) the most challenging aspect, but also the most rewarding part of my music therapy practice. My experience has been that music therapy can often reach these people, and small signs of connection and attempts to communicate are felt by the practitioner. At the same time, I was often asked to explain how I knew the client's small movements or facial expressions were intentional and not random or reflexive responses. Without audio-visual recordings that were then studied and described, it is hard to argue against sceptics, particularly those without an understanding of music structure, musical communication, and the connection between internal organization and music's organizational properties. The music therapy profession has needed examples of this work thoroughly analyzed and explained for a long time now. Gilbertson and Aldridge's book addresses this need.

Objective To systematically review the effect of the music therapy on physiology and anxiety state in the mechanical ventilation patients .Methods The databases including the PubMed , Cochrane Library, EMbase, Google, CBM, VIP, CNKI, EMbase and WanFang Data were searched from January 1998 to June 2013.The randomized controlled trails （RCTs） of the music therapy on physiology and anxiety state in the mechanical ventilation patients were chosen , and at the same time the related references in the literatures were also searched .The literatures were chosen according to the determined criteria , and the literature quality was assessed by the GRADEprofiler3.6 recommended by the GRADE system.The data was collected, and the Meta-analysis was carried out through the RevMan 5.2.Results A total of seven studies were included in this analysis.The analysis showed that the differences were found in the heart rate , respiration, systolic blood pressure and anxiety state between two groups after the intervention [WMD（95%CI） =-4.08（ -5.36,-2.79）,-2.50（-3.06,-1.94）,-5.45（ -9.52,-1.38）,-0.66（ -1.24,-0.07）, respectively], and no differences were found in the diastolic blood pressure and blood oxygen saturation [WMD（95%CI） =-1.76（-5.65,2.13）,-0.01 （ -3.53,3.51）, respectively].Conclusions The music therapy can effectively improve the heart rate , respiration, systolic blood pressure and anxiety state in the patients , and the effects on diastolic blood pressure and blood oxygen saturation in the patients are not significant .The large-sample, high-quality and standard RCTs should be further carry out so as to test the effect of music therapy in view of the low methodological quality in some included studies . Key words: Music therapy; Mechanical ventilation; Physiology; Anxiety state; Meta-analysis

Adopting a knowledge-based controversy perspective, this article considers critically the ‘fit’ or appropriateness of the so-called ‘gold standard’ of assessment – the Randomised Controlled Trial. It sets the growing dominance of this method within music therapy in the contexts of medical work and the changing social relations of medical expertise, the importance of local practice in music therapy (and healthcare more widely), and the politics of representation as they apply to medical modes of accounting and measurement. I then consider what is overlooked when experimental models are used as the prime mode of perceiving the music therapeutic process and suggest that they may not provide a good or appropriate way of observing, accounting for and assessing music therapy. I suggest that they are not amenable to the observation and documentation of temporal and local craft practices and that these practices provide the active ingredients of music therapy's effectiveness. I conclude that music therapy is poised to highlight the radical performative and social features of health status and that these features have far-reaching implications for our concepts of illness and the aetiology of illness and, most importantly, for the ways in which we conceptualise and implement therapeutic procedures of all kinds.

According to the World Culture Report of UNESCO (2000), cultures are not fixed, bounded and crystallized containers. Instead they are “transboundary creations, exchanged through the world […]. We must now regard culture as a process rather than as a finished product” (UNESCO 2000: 15, as cited in Thomson 2005: 11). A similar view is adopted by Stige (2002) in his seminal book Culture-Centered Music Therapy. Stige writes that culture is not a fixed entity. In contrast, he thinks of culture as something flexible, as “continuously developing ways of life and practices of meaning-making, ranging from the individual to the regional to the global level of social organization” (Stige 2002: 1). From this perspective, the constant flow of culture, as an embodied everyday experience, is made up by the subtleties and complexities of individual and collective life histories. The article and interviews included in this issue of Approaches, illustrate these various levels of ‘cultural stories’, as well as their mutual interaction. In the article Music Therapy and Culture: An Essential Relationship? Daisy Morris explores the role of culture in music therapy practice. Taking Aigen’s (2001) premises on music, culture and therapy as a starting point, Morris discusses how our therapeutic awareness and receptiveness as music therapists interrelates with our cultural awareness. She explores how music therapy work can be affected by both the therapist’s and the client’s cultural backgrounds and histories, as well as the wider cultural framework within which therapy takes place. The interview section of Approaches, which is inaugurated in this issue, starts with an interview of Pauline Etkin who reflects on the development of policies and practices in music therapy. Etkin, whom I had the honour to interview, draws on her rich personal experience in Nordoff Robbins, London. She interweaves creatively historical facts with politico-economic aspects, while she brings in the foreground personal stories which often stay ‘behind the scenes’. Etkin reflects on aspects of the music therapy development in the UK, as well as Nordoff Robbins’ role in this development, while she discusses their potential relevance to the development of music therapy profession in other countries, such as Greece, where music therapy is in its initial stage. The next interview is with Diane Austin who was interviewed by Evangelia Papanikolaou. This interview explores the use and significance of voice in music therapy, and more particularly the pioneering voice-based model of psychotherapy that has been developed by Austin: Vocal Psychotherapy. This exploration reflects on Austin’s (2008) recent book The Theory and Practice of Vocal Psychotherapy: Songs of the Self by drawing on her own personal life history, but also from her extensive clinical experience as a vocal psychotherapist. This issue of Approaches concludes with two new sections: i) New Publications in Greece, and ii) Upcoming Events. Both sections are dedicated to the fields of music therapy and special music education, while they draw from the international community with an emphasis on Greece. These sections aim to provide useful information and raise the readership’s awareness of relevant news and developments. This raise of awareness is linked directly with Approaches’ vision (Tsiris 2009) for advancement of scientific dialogue, for fertile connection of practice, theory and research, as well as for reliable public update through the free dissemination of its articles and resources. Approaches, like many other online peerreviewed journals (e.g. Voices: A World Forum for Music Therapy, see Stige 2009), follows the wider international movement of Open Access publishing. This open access to scholarly journals is vital to research progress and public advancement (COPE 2010), especially during the recent economic downturn that both Greece and other European, but not only, countries face. This downturn has already brought consequent challenges on healthcare and educational services, as well as on the funding resources for research and publishing. Approaches hopes to support effectively the work of practitioners and researchers in the fields of music therapy and special music education by promoting a culture where evidence-based practice is balanced with practice-based evidence.

This chapter presents an overview of the developments of feminist perspectives in music therapy. The authors outline the history of feminist thought in music therapy and how this framework applies to the discipline and profession of music therapy. Basic tenets of feminism are described including the importance placed on valuing women’s perspectives, egalitarianism, examining social constructs, examining discursive practices, and empowerment. Additionally, systems of oppression are considered with reference to inequalities that exist within the field of music therapy. The chapter ends with an examination of ways in which a feminist framework can inform assessment, clinical practice, research, ethics, and pedagogy in music therapy.

There is a need for research that explores the effects of music lesson on intellectual, behavioral, and emotional functioning of at-risk students who attend regular public school. Some students might benefit more from a direct approach utilizing therapeutic goals and interventions in music therapy while others may be more profoundly impacted by an indirect approach such as piano instruction. It is worthwhile to compare the effects of music lessons and music therapy incorporating music instruction on non-musical behaviors of at-risk students. The purpose of this study is to compare the effects of piano instruction and music therapy incorporating piano instruction on academic achievement, classroom behaviors, and self-esteem in at-risk students. Participants were 32 at-risk elementary school students (2nd, 3 rd, and 4th graders). They were randomly assigned to one of 10 weeks of 30 minute, one-to-one training conditions: music therapy incorporated piano instruction (n=11), piano instruction (n=11), and no-training (n=10). Participants’ language and math scores, Teacher’s Ratings of Classroom Behaviors (TRCB), and Coopersmith Self-Esteem Inventory were measured. There was no statistically significant difference between the training conditions. The present study investigated the effect of two different forms of music instruction; music therapy and piano instruction for at-risk students. With the breadth of variables to be considered and the conclusions drawn by some studies that music may indeed have a significant impact on this particular population, further research is warranted.

Background:Music therapy (MT) has been shown to improve outcomes for patients with sickle cell disease (SCD) and patients with hematologic and/or oncologic conditions excluding SCD (HemOnc) in prior randomized trials. While few studies have described the clinical delivery (ie, volume, clinical settings, patient characteristics, referrals, and session characteristics) of MT and examined its real-world effectiveness, no studies have compared responses between hematology/oncology populations. The purpose of this study was to examine the clinical delivery and effectiveness of MT at a freestanding academic cancer center and compare the effectiveness of MT on pain, anxiety, and fatigue between adult patients in the HemOnc and SCD groups.Methods:A retrospective review was conducted of all MT sessions provided at a freestanding academic cancer center between January 2017 and July 2020. The unadjusted single-session effects of MT on pain, anxiety, and fatigue were assessed among patients reporting symptoms ≥1 out of 10 on a 0 to 10 scale. Adjustments were made for multiple sessions on the same patient using a mixed model to compare pre-session and change scores between the HemOnc and SCD groups. Patients’ comments were analyzed using conventional qualitative content analysis.Results:Music therapists provided 4002 sessions to 1152 patients including 1012 in the HemOnc group and 140 in the SCD group. In the combined sample, statistically significant reductions in pain (1.48 units), anxiety (2.58 units), and fatigue (0.84 units) were observed, with changes in pain and anxiety exceeding clinically significant thresholds. After adjustment, the SCD group reported significantly greater pre-session pain (7.22 vs 5.81) and anxiety (6.11 vs 5.17) as well as greater anxiety reduction (2.89 vs 2.23) than the HemOnc group. Patients’ comments contained themes including enjoyment, gratitude, and improvements in mood, pain, and anxiety.Conclusions:This study supports the delivery and clinical effectiveness of MT for addressing the needs of patients throughout their course of treatment at an academic cancer center and justifies the inclusion of individuals with SCD within integrative oncology services.

Music therapy (MT) has been used in geriatric nursing hospitals, but there has been no extensive research into whether it actually has beneficial effects on elderly patients with cerebrovascular disease (CVD) and dementia. We investigated the effects of MT on the autonomic nervous system and plasma cytokine and catecholamine levels in elderly patients with CVD and dementia, since these are related to aging and chronic geriatric disease. We also investigated the effects of MT on congestive heart failure (CHF) events.Eighty-seven patients with pre-existing CVD were enrolled in the study. We assigned patients into an MT group (n = 55) and non-MT group (n = 32). The MT group received MT at least once per week for 45 minutes over 10 times. Cardiac autonomic activity was assessed by heart rate variability (HRV). We measured plasma cytokine and catecholamine levels in both the MT group and non-MT group. We compared the incidence of CHF events between these two groups. In the MT group, rMSSD, pNN50, and HF were significantly increased by MT, whereas LF/HF was slightly decreased. In the non-MT group, there were no significant changes in any HRV parameters. Among cytokines, plasma interleukin-6 (IL-6) in the MT group was significantly lower than those in the non-MT group. Plasma adrenaline and noradrenaline levels were significantly lower in the MT group than in the non-MT group. CHF events were less frequent in the MT group than in the non-MT group (P < 0.05). These findings suggest that MT enhanced parasympathetic activities and decreased CHF by reducing plasma cytokine and catecholamine levels.

To determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy. Cancer and its treatment provoke a series of changes in the emotional sphere of the patient's anxiety. Music therapy and verbal relaxation had reported the anxiety reduction effect on patients with cancer receiving chemotherapy. Few studies have been undertaken comparing music therapy and verbal relaxation in differentiating high-normal state anxiety subsample. A randomised controlled trial and permuted block design were used. Outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. Ninety-eight patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30 minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three biobehavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. Music therapy had a greater positive effect on postchemotherapy anxiety than verbal relaxation and control groups and a significantly increase in skin temperature. Patients with high state anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did the normal state anxiety subsample. Both music and verbal relaxation therapy are effective in reducing chemotherapy-induced anxiety. Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation. Prior to chemotherapy, patients with high state anxiety must be sorted from all patients as they are more responsive to interventions. Oncology nurses can offer music and verbal relaxation as adjuvant interventions to reduce chemotherapy-induced anxiety and enhance the quality of care.

Background Social anxiety is a common psychological problem among teenagers, manifested as excessive fear and self-awareness in social situations. Social anxiety hinders the development of teenagers' social skills, thereby causing serious negative impacts on interpersonal relationships and future development. Music therapy is an alternative treatment method that provides a non-threatening environment for emotional exploration and social interaction. Involving teenagers in music activities through music therapy can alleviate their anxiety and enhance their potential for emotional expression. Therefore, by studying and analyzing the therapeutic effect of music therapy on social anxiety and its impact on the improvement of social skills, it is expected to provide a certain theoretical basis for mental health guidance in colleges and universities. Methods Randomly select 100 teenagers diagnosed with social anxiety from a certain university. Participants were randomly assigned to the music therapy group, totaling 50 people, and the traditional therapy group, totaling 50 people. The music therapy group received an 8-week music therapy intervention, while the traditional treatment group received no intervention at all. Before and after the intervention, the social anxiety levels and social skills of the participants were evaluated using the Social Anxiety Scale and the Social Skills Scoring System. Results The improvement of social anxiety and social skills in each group is shown in Table 1. As can be seen from Table 1, the music therapy group showed significant improvements in both social anxiety and social skills (p&amp;lt;.01), and the social anxiety score decreased from 62.4 ± 6.1 before the intervention to 45.8 ± 5.3, while the social skills score increased from 28.7 ± 4.2 to 38.9 ± 4.6. Although the traditional treatment group had an improvement effect on teenagers' social anxiety and social skills, the improvement effect was poorer compared to the music therapy group. This result indicates that music therapy has a positive effect on alleviating social anxiety and enhancing social skills. Music therapy effectively improves social anxiety and social skills by providing a safe and supportive environment, enabling teenagers to express their emotions through music, enhance their self-awareness and social interaction skills. Discussion Research results show that music therapy can significantly improve the social skills of teenagers with social anxiety. The effect of music therapy stems from its unique emotional expression and social interaction mechanism, providing teenagers with a non-verbal communication method, which helps to reduce social anxiety and enhance social skills. Future research can further explore the long-term effects of music therapy and how to combine it with other treatment methods to provide more comprehensive mental health support. Furthermore, exploring the specific mechanisms by which music therapy affects social skills can provide valuable insights for the development of targeted intervention measures.

The investigation described in this paper transpired from discussions between the two authors as we struggled to introduce a referral process for young people moving regularly between a special school and a children's hospice in Melbourne, Australia. It became apparent that each of the authors was conducting music therapy sessions with a number of the same young people in the two different settings in which they worked, sometimes within the same week. Parents organized hospice visits independently of the school system, often for respite rather than illness, and it was not feasible to expect families to communicate current music therapy information between the settings for each visit. After the failure of administrative strategies to foster communication, we began to look for more creative, rather than bureaucratic, ways of improving the consistency of service for the young people in both settings. In considering alternatives, we discussed individual young people, and a pattern began to emerge of similar practices despite the diverse settings. Clientcentered practice that incorporated abundant opportunities for choice and control was consistent across both settings, and we hypothesized that the content of sessions would be similar as a result. We chose to explore the similarities and differences in practice and how these impacted the music therapy experiences for the young people involved. Our intention was to better inform one another of relevant strategies for working with young people with profound and multiple disabilities in order to enhance service provision. In addition, we felt that hospice administrators may be interested in knowing if the skill-set for effective music therapy practice in a children's hospice mirrored that of special school clinicians as this knowledge may inform future employment opportunities.The Music Therapy Treatment Process in Two ContextsChildren's HospiceSetting and assessment. A children's hospice is structurally similar to a pediatric hospital, with nurses acting as the gatekeepers who effectively determine what services will and will not be received by young people in their care (Schwarting, 2005). The support team is modeled on adult palliative care services, incorporating consulting doctors, social workers, and counselors, as well as complementary therapists such as play therapists and music therapists (Pavlicevic, 2005). Although the perception of pediatric palliative care is usually oriented to children with cancer, it is young people with neurodegenerative, genetic, and metabolic disorders who dominate children's hospice services (Hynson & Sawyer, 2001). Many present with profound developmental delay, facing significant physical impairments and intellectual damage as well as long trajectories of illness. Instead of the end-of-life model typical of adult services, children's hospices provide respite services as a priority (Martinson, 1996). The team offers safe and stimulating care so that families may choose to utilize the opportunity for a brief period of separation in which they recuperate or spend quality time with siblings of the young person with a life-threatening illness (Sutherland, Hearn, & Eisten, 1993). In this context, the music therapist is often referred to all of the children in the hospice program on a given day, which typically ranges from five to ten. Service is determined by an emerging and intuitive process (Eaves, 2005).Treatment plan. Children's hospices are similar to pediatric oncology units in that families access services over many years and therapeutic relationships are built up over a number of visits (Dun, 2007). Quality of life is central to treatment in pediatric palliative care, and rather than focusing primarily on pain-control, this is enacted through the provision of choices to the young person and their family (Farrell & Sutherland, 1 998). These choices are broadly related to the nature of care accessed and where the care is provided, and specifically within music therapy, choices promote a sense of feeling understood and heard (Levetown, 1996; Davis, 2005). …

Introduction: Music and massage therapy are among the approaches of complementary medicine. Patients with cancer have been hugely encouraged in recent years to use complementary medicine to relieve chemotherapy-induced nausea and vomiting. The present study was conducted to determine the effect of music and periorbital massage therapy on chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancers.Methods: The present single-blind clinical trial study was conducted on 60 patients with gastrointestinal cancer undergoing chemotherapy who were randomly assigned to control and music plus massage therapy groups. Two interventions were concurrently carried out on patients in music plus massage therapy group while receiving chemotherapy medication, but the control group received no intervention. Rhodes questionnaire was used to assess nausea and vomiting before and 24 hours after chemotherapy. Data were analyzed using descriptive and analytical statistical tests (Chi-square and t-tests).Results: Music plus periorbital massage therapy significantly reduced nausea and vomiting in patients undergoing chemotherapy compared to the control group.Conclusion: According to the results, using music plus periorbital massage improves nausea and vomiting in patients undergoing chemotherapy, and can be considered as a complementary medicine method in conjunction with other medicinal therapies to relieve symptoms of patients with cancer.

Introduction Social media has transformed how music therapists work, with numerous practitioners utilizing the affordances of social media in music therapy practice. So far, music therapy research has been significantly limited regarding the ethical implications of social media use. A better understanding of the ethics of social media use is needed to inform the continuous evaluation of professional ethical guidelines. Methods We conducted a systematic text condensation of transcripts from one conversational focus group consisting of five participants with diverse connections to music therapy and social media. Results The results highlight the many ways social media can facilitate both substantial value as well as serious risk in music therapy practice. Through the analysis, it has also become clear that music therapists must make complex considerations in working with social media to maintain a level of responsible practice. Discussion This study provides (a) insights and experiences from practice gathered in a conversational focus group, (b) discussions exploring the possible value and risks of social media use in music therapy, and (c) implications for practice including a summary of some ethical reflections.