Music facilitation styles and behaviours across the health-care continuum: explanatory multiple case studies.

BACKGROUND: Understanding how music group facilitators work across the health-care continuum has received sparse research attention. METHODS: An explanatory multiple case study design was used to identify approaches employed by experienced facilitators. Five music facilitators working in contrasting areas of practice were interviewed and video recorded engaging with the same groups at three timepoints. RESULTS: All facilitators demonstrated four common behaviours: applying a consistent structure for each session; creating a positive and relaxing atmosphere for the work; engaging with varying musical repertoire and activities; and offering clear instructions for the participants. Their styles of practice were found to be shaped by their personality, educational background, as well as the size of the group, health conditions, and cultural identities of their music participants. CONCLUSION: These skilled facilitators showed flexibility, always aiming to accommodate participants' needs, and revealing new evidence of a common approach to music facilitation across different types of participant groups.

Learning to use music as a resource: the experiences of people with dementia and their family care partners participating in a home-based skill-sharing music intervention: a HOMESIDE sub-study.

An increasing number of people with dementia receive informal care from family members to help them remain living in the community. Music therapy is particularly beneficial for supporting the wellbeing of people living with dementia. However, little is known about how music therapy might support people with dementia and their family care partners as dyads. This study explored the experiences of six dyads participating in a 12-week home-based skill-sharing music intervention facilitated by a music therapist. We examined their experiences during the intervention period and in the 3-6 months following. This study was conducted within a larger randomised control trial, HOMESIDE. Data was collected through video-recorded music-based interviews, participant diaries, and a semi-structured interview. Data was analysed using an abductive and relational-centred research approach in consideration of the Contextual Connection Model of Health Musicking for People Living with Dementia and Their Family Care Partners. The study found fifteen themes that describe dyads' supported experiences of sharing music in their homes. These were organised into three global themes: (1) experiences were shaped by complex influences; (2) a connected musical ecosystem; and (3) music was a resource for wellbeing. This study highlighted the important role of personalised facilitation and the therapeutic relationship as dyads learned to use music as a resource through a process of trial and error. The implications for skill-sharing, indirect music therapy and direct music therapy practice are discussed.

Corrigendum: What young people think about music, rhythm and trauma: An action research study.

[This corrects the article DOI: 10.3389/fpsyg.2022.905418.].

What Young People Think About Music, Rhythm and Trauma: An Action Research Study.

A number of popular theories about trauma have suggested rhythm has potential as a mechanism for regulating arousal levels. However, there is very little literature examining this proposal from the perspective of the young people who might benefit. This action research project addresses this gap by collaborating with four groups of children in the out-of-home-care system to discover what they wanted from music therapists who brought a strong focus on rhythm-based activities. The four music therapy groups took place over a 12 month period and each cycle of action and reflection led to adjustments in what activities were offered, as well as exploring different levels of structure and ways of building relationships in the groups. The initial group incorporated a strong emphasis on highly structured rhythm-based activities, but young people found the format difficult to engage with. The second cycle included more opportunities for creativity and self-direction within semi-structured activities which children reported enjoying, but too much freedom also became overwhelming at times. The two groups in the third cycle seemed to balance structure and responsiveness successfully but were also influenced by the introduction of individual sessions prior to group commencement, which was designed to contribute to safety and trust building. Final reflections on the role of rhythm in supporting young people who have had adverse experiences were centred around the ideas of co-regulation. This was qualitatively different to our expectations that practicing rhythm-based activities would lead to an expanded window of tolerance that resulted in less time being spent in either hypo-arousal or hyper-arousal. Instead of entraining to an external rhythm, young people felt safe when their rhythms were matched, even if they were irregular, out of time and unpredictable. The small moments of co-regulation resulted in pleasure, comfort, satisfaction and peace and these moments were highly valued by the young people, who described just wanting to be relaxed and happy. Although not as rhythm-specific as the literature might suggest, music making with trusted adults helped the young people in this study feel more content.

Young peoples' lived experiences of multidisciplinary mental health assessment in an intensive day program.

OBJECTIVE: We aimed to explore young peoples' lived experiences of multidisciplinary mental health assessment in an intensive mental health day program. METHOD: Interpretative phenomenological analysis (IPA) was applied to data from semi-structured interviews with six males, aged 13-16 years. Member-checking interviews were conducted to ensure the trustworthiness of findings. RESULTS: Analysis revealed three themes, 'therapy fatigue', '360 supports' and 'experiential assessment'. Participants had either attended many years of psychological therapy without significant change or had failed to engage with therapy. Participants' attitudes changed at the day program with intensive support and their own determination. Participants valued experiential elements of assessment such as music therapy and art therapy which helped them understand the service, get to know others and experience positive emotions. CONCLUSIONS: Unsuccessful psychological treatment can leave young people feeling jaded and reluctant to engage with services. The potential for iatrogenic harm should be monitored and alternative approaches, such as intensive, multidisciplinary treatment including music therapy and art therapy considered to help young people overcome therapy fatigue, regain hope and reengage with mental health services.

Music, Rhythm and Trauma: A Critical Interpretive Synthesis of Research Literature.

Recent theorizing about the connection between the brain and trauma (Perry, 2009; Porges, 2011; van der Kolk, 2015) has led to a burgeoning of interest in the provision of music-based programs with people who have had adverse experiences. Although there has been critique of the lack of scientific basis of these theories and their implications for practice (McLean, 2016), they remain popular with practitioners who are keen to introduce innovative and potentially beneficial approaches to the people with whom they work. Music therapists have a long tradition of working with traumatized clients, however, the brain-based rationales did not seem congruent with the less predictable and more idiosyncratic benefits reported, which seem to occur through more psychodynamic mechanisms of action. In order to unravel what seemed to be a body of literature plagued by the conflation of theories, we undertook a critical interpretive synthesis of literature in the past 10 years to cross-examine the ways that music and trauma have been connected. To do this we extracted data from 36 identified articles to distinguish what music methods were used, what claims were made about benefits, what theoretical justifications were provided and how much research basis there was for the claims being made. Having systematically disentangled the various dimensions, we then constructed a spectrum of approaches that offers a logical categorization of four different ways of using music with people who have had adverse life experiences. These included using music for stabilizing, entrainment, expressive and performative purposes. Specific music-based methods were proposed for those associated with brain-based rationales, and more responsive, multi-method approaches were congruent with recovery and social change models. Future research would benefit from a more clearly articulated connection between theoretical rationale, music-based methods, benefits and research approaches. The resultant spectrum may provide useful guidance for both practice and research design.

Music Use for Mood Regulation: Self-Awareness and Conscious Listening Choices in Young People With Tendencies to Depression.

The current study explored the circumstances in which seven young people with a tendency to depression chose different styles of music to listen to, and their level of awareness of the impact of their music listening habits on mood and wellbeing. A model of various pathways through music use was developed that may explain why music listening intentions in young people do not always align with their wellbeing outcomes. We suggest that the relationship between intentions and outcomes are mediated by differing levels of self-awareness and insight into the mood regulation processes occurring during music listening.

Intentional music use to reduce psychological distress in adolescents accessing primary mental health care.

RATIONALE: Many young people turn to music as a way of exploring and managing their moods and emotions. The literature is replete with studies that correlate music preferences and mental health, as well as a small but increasing interest in uses of music to promote well-being. Recent studies have shown that music use is often unconscious, thus difficult to influence without therapeutic conversations. No study has yet tested whether it is feasible to increase awareness of music use in young people who tend to ruminate with music, and test whether increased awareness can reduce distress. DESIGN: This feasibility study aimed to determine whether involvement in a brief music-based intervention was engaging and acceptable to a small sample of young people, and whether their levels of distress decreased and insight into music uses increased. A mixed methods approach was adopted, merging scores of distress and self-reported experience of the intervention to foster interpretation. RESULTS: Convergent analysis of the different data forms suggests that at least some of the measurable decreases in distress captured for all of the participants were related to participation in the sessions, according to the self-report of a number of the young people in interviews. This is demonstrated through descriptive data compiled under two key themes (Agency and Changed Uses) and illustrated through three case examples that were drawn largely from the words of the young people. CONCLUSION: This feasibility study suggests that young people's relationship with music provides a powerful platform for leveraging engagement in services and improvements in distress, when well timed and carefully scaffolded.

Group Rumination: Social Interactions Around Music in People with Depression.

One of the most important roles that music serves in human society is the promotion of social relationships and group cohesion. In general, emotional experiences tend to be amplified in group settings through processes of social feedback. However, previous research has established that listening to sad music can intensify negative emotions in people with tendencies to rumination and depression. This study therefore investigated the phenomenon of ruminating with music, and the question of whether listening to sad music in group settings provides social benefits for emotionally vulnerable listeners, or whether it further exaggerates depressive tendencies. Participants recruited via online depression groups and mental health websites were surveyed as to music listening habits. Results revealed that people with depression were more likely to engage in "group rumination" using music, and that this behavior could be partially explained by a general tendency to ruminate using music. Both affective states and coping styles were found to be related to the affective outcomes of group interactions around music. These findings go some way toward clarifying the situations in which group interactions around music are able to provide important social benefits for those involved, and situations in which negative emotions can be amplified by the group context.

The Challenges of Using Self-Report Measures with People with Severe Mental Illness: Four Participants' Experiences of the Research Process.

This study aimed to explore four mental health consumers' experiences of completing self-report outcome measures in a research project. Participants were recruited from a community mental health organisation in Melbourne and were interviewed upon completion of a mixed methods research study where they were asked to complete a series of self-report outcome measures. Descriptive phenomenological micro-analysis was used to analyse interview data and is presented along with the researchers' observations during the data collection process. Results revealed that participants found the outcome measures cognitively challenging and the language used in the measures did not support the empowering intentions of mental health recovery. The authors suggest that the value of completing surveys for people with severe mental illness needs to be carefully considered so that the research process does not diminish other benefits of participation.

Group Music Therapy as a Preventive Intervention for Young People at Risk: Cluster-Randomized Trial.

BACKGROUND: Music forms an important part of the lives and identities of adolescents and may have positive or negative mental health implications. Music therapy can be effective for mental disorders such as depression, but its preventive potential is unknown. OBJECTIVE: The aim of this study was to examine whether group music therapy (GMT) is an effective intervention for young people who may be at risk of developing mental health problems, as indicated via unhealthy music use. The main question was whether GMT can reduce unhealthy uses of music and increase potentials for healthy uses of music, compared to self-directed music listening (SDML). We were also interested in effects of GMT on depressive symptoms, psychosocial well-being, rumination, and reflection. METHODS: In an exploratory cluster-randomized trial in Australian schools, 100 students with self-reported unhealthy music use were invited to GMT (weekly sessions over 8 weeks) or SDML. Changes in the Healthy-Unhealthy Music Scale (HUMS) and mental health outcomes were measured over 3 months. RESULTS: Both interventions were well accepted. No effects were found between GMT and SDML (all p > 0.05); both groups tended to show small improvements over time. Younger participants benefited more from GMT, and older ones more from SDML (p = 0.018). CONCLUSIONS: GMT was associated with similar changes as SDML. Further research is needed to improve the processes of selecting participants for targeted interventions; to determine optimal dosage; and to provide more reliable evidence of effects of music-based interventions for adolescents.

Exploring the literature on music participation and social connectedness for young people with intellectual disability: A critical interpretive synthesis.

BACKGROUND: This article explores the literature on social connectedness and music for young people with disability. It then critically examines the level of congruence between the reported literature to date and current rights-based disability studies discourse. METHOD: A critical interpretive synthesis was used to examine 27 articles referencing the use of music for social connectedness. Areas of focus in the review are the nature of connections being fostered in music programs, the use of voice and collaboration. RESULTS: The majority of music programs reported on closed groups. Outdated 'expert' models of working persist. The use of participants' voice in the literature is growing, although there is a lack of collaboration and negative reporting. CONCLUSION: A shift in thinking heralds greater collaboration with participants, although this could be broadened to include decisions on research agendas, planning and evaluation. There is also need for active fostering of broader socio-musical pathways.

Integrating Emotions Into the Critical Interpretive Synthesis.

Critical interpretive synthesis is a particular form of systematic review that critically examines the decisions made by authors while conducting and publishing about their research and practices. It differs from empirical syntheses of qualitative research by emphasizing the interpreted and constructed nature of this form of secondary analysis. In this article, we extend previous literature on critical interpretive syntheses by highlighting the integration of emotional responses when developing critical questions for interrogating the literature and interpreting results. Our extension of the critical interpretive synthesis is illustrated through examples from five studies examining literature in our own field of music therapy, as well as related fields of disability studies, mental health, music psychology, and child welfare. The methodology we have refined uses an iterative and recursive method that promotes increased critical awareness of the assumptions driving the production of research in health contexts.

A critical interpretive synthesis of the most commonly used self-report measures in Australian mental health research.

OBJECTIVE: To critically examine the self-report measures most commonly used in Australian mental health research in the last 10 years. METHOD: A critical interpretive synthesis was conducted using seven outcome measures that were identified as most popular in 43 studies from three mental health journals. RESULTS: Results suggest that the amount and type of language used in outcome measures is important in both increasing the accuracy of the data collected and fostering positive experiences of data collection for participants. CONCLUSIONS: Results indicate that many of the measures most often used in Australian mental health research may not align with the current contemporary philosophy of mental health clinical practice in Australia.

Development and validation of the Healthy-Unhealthy Music Scale.

BACKGROUND: Music is an integral part of life in youth, and although it has been acknowledged that musical behavior reflects broader psychosocial aspects of adolescent behavior, no measurement instruments have been specifically designed for assessing musical engagement as an indicator of adolescent wellbeing and/or symptomatology. This study was conducted in order to develop and validate a scale for assessing musical engagement as an indicator of proneness for depression in youth. METHOD: Items were developed based on the literature and a prior grounded theory analysis and three surveys (N = 54, N = 187, N = 211) were conducted to select, refine, test, and validate the items. Scale structure was investigated through interitem correlations, exploratory and confirmatory factor analyses (EFA, CFA), and concurrent validity was tested with correlations to depression and wellbeing. RESULTS: The final Healthy-Unhealthy Music Scale (HUMS) consists of 13 items that are divided into Healthy and Unhealthy subscales. Cronbach's alpha coefficients were .78 for Healthy and .83 for Unhealthy. The concurrent validity of the HUMS was confirmed through correlations to wellbeing, happiness and school satisfaction on one hand and depression, rumination, and stress on the other. CONCLUSIONS: The HUMS is as a promising instrument for screening musical engagement that is indicative of proneness for depression in youth.

How musical engagement promotes well-being in education contexts: the case of a young man with profound and multiple disabilities.

Students with profound intellectual disabilities disorders (IDDs) have the right to participate in educational opportunities that recognize their unique resources and needs, as do all children. Because of their specific communication challenges, positive relationships with attentive communication partners are critical for success. In fact, the power of positive relationships in schools is recognized to be connected to student well-being more broadly. This article examines the case of one young man with profound IDD and his relationship with his music therapist using a duo-ethnographic informed paradigmatic case study. Video analysis based on multi-voice perspectives is used to generate hermeneutic phenomenological findings to closely examine the relationship between a young man with profound IDD and a music therapist. The voices of four allied health researchers were also gathered to inform the authors' construction of an informed commentary on the phenomenon. The results suggest that the essence lay in a combination of attentive, responsive and creative being with the other person over time. Four principles of musical engagement were identified in the video footage as critical to the meaningful relationships through music: the music therapist listens; the music therapist takes responsibility for structure; spontaneous initiation is sought from the young person; and the relationship is built over time. These concepts are contextualized within a discussion of student well-being that is underpinned by positive relationships and leads to students achieving their full potential within diverse school contexts.

A mixed methods analysis of songs written by bereaved preadolescents in individual music therapy.

BACKGROUND: Providing opportunities for children to process loss and express grief in response to the loss of a loved one has been shown to assist with successful coping (Worden, 1996). Songwriting may be a relevant method that fosters the expression of thoughts and feelings related to the loss. OBJECTIVE: The purpose of this study was to analyse lyrics written by bereaved children during individual music therapy and to determine if they did use the opportunity to address grief through songwriting. METHODS: Participants were 14 bereaved children (13 girls, 1 boy) aged between 7 and 12 years. Children were recruited and participated in individual music therapy in their homes with a credentialed music therapist. Participants wrote a total of 49 songs and their lyrics were analysed using a mixed methods content analysis. An inductive analysis identified categories existing within the lyrics and each lyric was then deductively attributed to one of the categories. RESULTS: Results revealed that the children wrote songs about themselves, their experiences, and their relationships, including, but not limited to the topic of loss. CONCLUSIONS: It became apparent that through songwriting these children expressed their experiences of the world based on their developmental capacities and limitations.

Music therapy in pediatric palliative care: family-centered care to enhance quality of life.

Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative data collected through interviews with parents to interpret results from the PedsQL Family Impact Module of overall parental quality of life. Parents described music therapy as resulting in physical improvements of their child by providing comfort and stimulation. They also valued the positive experiences shared by the family in music therapy sessions that were strength oriented and family centered. This highlighted the physical and communication scales within the PedsQL Family Impact Module, where minimal improvements were achieved in contrast to some strong results suggesting diminished quality of life in cognitive and daily activity domains. Despite the significant challenges faced by parents during this difficult time, parents described many positive experiences in music therapy, and the overall score for half of the parents in the study did not diminish. The value of music therapy as a service that addresses the family-centered agenda of PPC is endorsed by this study.

Music therapy with bereaved teenagers: a mixed methods perspective.

Qualitative investigations have indicated that music therapy groups may be beneficial for bereaved teenagers. The existing relationship between young people and music serves as a platform for connectedness and emotional expression that is utilised within a therapeutic, support group format. This investigation confirms this suggestion through grounded theory analysis of focus group interviews. Changes in self-perception were not found as a result of participation, however practically significant results were found on adolescent coping. These cannot be generalized because of the small sample size. Grief specific tools are recommended for use in future investigations in order to capture the emotional impact of music therapy grief work with adolescents.

Bereaved parents' experiences of music therapy with their terminally ill child.

The purpose of this study was to investigate bereaved parents' experiences of music therapy with their terminally ill child. In-depth interviews were conducted with 7 bereaved parents who were recruited through a community-based palliative care program. The parent participants' experiences varied as their children who received music therapy ranged in ages from 5 months to 12 years old. The interview transcripts were analyzed using phenomenological strategies. Five global themes emerged from the analysis. These included (a) music therapy was valued as a means of altering the child's and family's perception of their situation in the midst of adversity, (b) music therapy was a significant component of remembrance, (c) music therapy was a multifaceted experience for the child and family, (d) music therapy enhanced communication and expression, and (e) parents shared perceptions of and recommendations for improving music therapy services. These emergent themes yield knowledge into the relevance of music therapy within pediatric palliative care.