Transcript Effects of Entrained and Sedative Music on Mechanically

Music Therapy Pain Management
and Entrainment
Cheryl Dileo, PhD, MT-BC
Carnell Professor of Music Therapy
Temple University, Philadelphia
Definition of pain
• An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage (IASP, n.d.)
• Pain is a culturally-defined physiological and
psychological experience. Each culture has
its own language of distress when
experiencing pain. (Calister, 2003)
Types of Pain
• Acute
• Chronic
• Procedural
• Cancer
Pain
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True Biopsychosocial phenomenon
Individual differences
Total pain experience
Pain/Suffering
The Experience of Pain
• Personal, subjective experience of painful
sensations known only to the person with pain
• Includes a mental and emotional component in
addition to awareness of painful physical
sensations
• Cannot be objectively measured, confirmed, or
disconfirmed by another person
IN MUSIC THERAPY
Why levels of pain management?
• Appropriate for Biopsychosocial nature of pain
• Addresses wide range of interventions possible
in MT based on a range of goals/therapeutic
intent
• Describes progression of interventions from
most basic and symptom-focused to most
comprehensive
• Appropriate for Incorporating range of patient
coping preferences and cultural perspectives
Dileo, 2013
Why Levels of Pain Management?
• Subsumes various theoretical perspectives
• Allows various ways for patient to be in relationship
to the pain
• However,
▫ May be overlap in categories
▫ Same interventions may serve multiple purposes
Dileo, 2013
Levels of Music Therapy Pain
Interventions
1.
Distraction/Refocusing
2. Supportive
3. Cathartic/Expressive
4. Existential
5. Transformational
Dileo, 2013
Distraction/Refocusing
• Refocus of attention to another stimulus (strong and/or
engaging).
• Intent is to avoid or ignore pain
• Patient can participate in an active or passive manner
• Examples:
• Various types of Music Listening (structured by patient and/or
therapist)
• Instrument playing
• Musical Journeys (remove from present)
• Music and Imagery experiences (escape situation)
• Music as Focal Point
Supportive
Intent is to palliate specific symptoms of pain- make pain go away or enhance
personal resources for dealing with pain.
• Patient can participate actively or passively (most often passively)
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Examples:
Song-writing
Music-based relaxation
Music and Imagery
Music Iso
Toning
Vibroacoustics
Music-Based Breath Work
Improvised/Precomposed Music to Hold/Soothe
Dileo, 2013
Expressive/Cathartic
• Intent: express experience of pain and or emotions and suffering
associated with having pain
• Patient may participate actively or passively, but most often
actively
• Patient establishes contact with pain and/or emotions associated
with being in pain
Examples:
• Instrumental or Vocal Improvisation
• Drumming
• Song-writing, e.g., blues, rap
• Song Improvisation
Dileo, 2013
Existential
• Focus is on finding meaning in the pain experience within
the patient’s life and/or new ways of thinking
of/conceptualizing pain
• Patient is in touch with the pain experience, the emotions
accompanying it as well as the thoughts and
interpretations of its meaning
• The patient may participate actively or passively
Examples:
• Song-writing
• Song Discussion
• Referential or non-referential Improvisation
• GIM
Dileo, 2013
Transformational
-Intent is to observe carefully, dialogue with and/or
enter into the pain to achieve a relationship with it and
sometimes to travel through it.
-There is an awareness of the body, the pain and the
emotions related to pain. There is also an awareness of
what might heal the pain
Active, passive or combined approaches can be used.
-Examples:
GIM
Music Therapy Entrainment (process)
Dileo, 2013
Personal Assessment
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Own history with pain
Reactions to pain: avoidance, etc.
Reactions to pain in others
Boundaries, rigid, loose
• Dileo, 2013
Music Therapy Entrainment
• Interactive, music-centered therapy process using
improvisation to treat pain
• Both active and passive in nature (client participates in
variety of ways)
• Uses imagery (accepted cross-culturally)
• Can address wide range of coping styles (active, passive,
problem-focused, emotion-focused, etc.)
• Differentiated from other types of MT pain approaches
▫ Involves sensory exploration of pain characteristics
▫ Entrance into pain by therapist and client (Dileo, 2013)
Theoretical foundations
• Relies on theories in physics regarding pull of one
vibrating object on another (tendency to achieve
synchrony) (e.g., Pantalleone, 2002)
• Iso principle- matching phenomenon musically
and then changing music in desired direction
(Altschuler, 1948; Rider, 1997; 1985)
• Biopsychosocial theory-interrelationship of mind,
body, social contexts (Engel, 1977)
• Aesthetic theory (Metzner, 2012)
Evidence for Music Therapy
Entrainment
• Chronic upper limb pain
▫ Schwoebel, Coslett, Bradt, Friedman, Dileo (2002)
• Acute post-operative pain in children (Bradt, 2010)
• Laboratory pain (Metzner, et al., 2012)
• End-of-life pain (Clinical observations, Patrick, 2010)
• Cancer Pain (Dileo, et al., in preparation for
publication, 2013)
• Support from EEG and MEG analysis (Metzner, et
al.,2012; Dileo et al, 2013)
CLINICAL PRACTICE OF
Contraindications
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Psychosis
Borderline personality
Physical/emotional fragility
Dementia
Extreme anxiety
Inability to verbalize
• Dileo, 2013
Stages of Entrainment
• 1. Assessment: Pain Interview
Dileo, 2013
Stages of Entrainment
• 2. Imaging the Pain as Music
• Auditory image of pain
• Match music as closely as possible to the pain
• Dileo, 2013
• Imaging What Can Heal the Pain
▫ Auditory image of what can heal
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Timbre
Pulse
Tempo
Combination of sounds
Sequence of sounds
Duration of sounds
▫ Match music as closely as possible
Stages of Entrainment
• Confronting the Pain and Letting Go
▫ Patient sits quietly and listens
▫ Improvisation created: sounds of onset of pain,
progressing to a peak of pain, and then
diminishing of music and movement into healing
sounds
▫ Resonance with pain by therapist
▫ Dileo, 2013
Stages of Entrainment
• Healing Interview
• Processing of the experience: Feedback on the
pain and healing music
Evaluation
• Did music match pain precisely….if not, what
could be changed
• Degree of resonance
• Delayed responses
• Longevity of responses
• Does entrainment open up layers of feelings,
what has been repressed?
• Dileo, 2013
HEALING ASPECTS OF ENTRAINMENT
• Empathy for pain expressed in various
ways
• Pain is perceived as external to patient
• Pain can be viewed objectively
Dileo, 2013
Contact
• [email protected]
• www.temple.edu/musictherapy
• www.temple.edu/boyer/researchcenter