The Harmony - Vol 4 Iss 4 Dec 2015

Taking Forward Music Therapy : Shaping The Future

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December 2015

the HARMoNY Volume : IV

Issue : 4

Dec 2015

EDITOR’S DESK Hello Readers, Here is what we have in store for this quarter's bulletin. The theme of the current year's cover pages of “The Harmony” is Ragamala Paintings. Ragamala paintings of medieval Indian period depict expression of different ragas through imagery. They are visual representations of different musical modes capable of evoking pleasant feelings, mood or emotions on the performer and the listener of the raga. Guided and unguided Imagery techniques of music therapy are popular in the western countries and are used in medical settings to relax the patients and alleviate their anxiety and depressive symptoms. More studies are needed to test the efficacy of using Ragamala visual illustrations as tools in guided imagery techniques in Indian context. In this issue, as usual, there is a featured article on the topic “Effect of relaxing music on blood pressure and heart rate in hospitalized pre-hypertensive women in 3rd trimester of pregnancy: A randomized control study.” There is also an article on application of SOLO Taxonomy in evaluating the students' learning outcome. There is also a flash news on the Master's degree program in Medical Music Therapy being launched by CMTER in a pioneering effort.

This is already a productive year for CMTER with many significant advances made and please have a look at this bulletin and do not hesitate to email to musictherapy@mgmcri.ac.in to know more about us especially about the exciting program “ DRUMMING FOR WELLNESS” planned for all faculty and students of SBV. Happy reading.

Inside this issue Editorial Featured article Solo Taxonomy in Music Therapy Flash News

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EFFECT OF RELAXING MUSIC ON BLOOD PRESSURE AND HEART RATE IN HOSPITALIZED PRE-HYPERTENSIVE WOMEN IN 3RD TRIMESTER OF PREGNANCY: A RANDOMIZED CONTROL STUDY SUMATHY SUNDAR, BHUVANESWARI RAMESH AND ANANDARAJ R blood pressure between 80 to 89 mm Hg; based

Abstract :

upon the average of two or more properly

Objective : To observe effect of relaxing music on

measured readings at each of two or more visits

systolic blood pressure, diastolic blood pressure

after an initial screen [1]. Prehypertension is more

and heart rates in hospitalized pre-hypertensive

prevalent than hypertension. Prevalence of

pregnant women in 3rd trimester of pregnancy

prehypertension in Indian adults is estimated to be between 40 to 60% [2, 3].

Methods : 60 hospitalized pre-hypertensive pregnant women in 3rd trimester of pregnancy

Pathophysiologically, prehypertensive adults share

were included in the study. They were divided in to

many risk factors with hypertensive patients.

experiment (n=30) and control (n=30) groups by

Prehypertensive adults are also significantly more

randomization. Experiment group received 3 15-

likely to develop hypertension as compared to

minute-sessions of receptive music therapy in form

normotensive adults; with higher rates of target

of non-rhythmic instrumental music. Control group

organ damage and cardiovascular complications.

did not receive music therapy intervention. Blood

Hence prehypertension is considered an

pressure and heart rates were measured before

intermediate step during progression from “normal

and after each session.

blood pressure” to “hypertension” by many

Results : Experiment group showed significant

authorities. Management of prehypertensive is

reduction in systolic blood pressure, diastolic blood

usually life style modifications, including sodium-

pressure and heart rate after each session of

restricted diet, DASH (Dietary Approaches to Stop

receptive music therapy. In comparison between

Hypertension) diet, weight reduction, physical

two groups, systolic blood pressure showed

activity, alcohol moderation, tobacco abstinance,

significant reduction. No subject experienced any

stress reduction, etc.

adverse effect.

Music therapy is known to be effective for

Conclusion : Listening to relaxing music can

hypertensive and prehypertensive adults [4,5].

reduce blood pressure and heart rates in

Music therapy is also known to be beneficial to

hospitalized pre-hypertensive pregnant women

pregnant women during pregnancy as well as

during 3rd trimester. The blood pressure lowering

during labor [6]. However, little is known about

effect of relaxing music listening is more significant

effects of music therapy on cardiovascular vitals

for systolic blood pressure. Receptive music

(blood pressure and pulse rates) in prehypertensive

therapy seems to be safe in pregnant women.

pregnant women. We decided to study effects of receptive music therapy on blood pressure and

Introduction :

pulse rate in hospitalized prehypertensive women in 3rd trimester of pregnancy.

Prehypertension is defined as systolic blood pressure between 120 to 129 mm Hg or diastolic

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Methods :

Results :

The study was conducted in antenatal ward of

Out of total 60 subjects, 5 from experiment group

Mahatma Gandhi Medical College & Research

and 3 from control group had withdrawn

Institute (MGMCRI), Pondicherry, India. The study

themselves from the study. Hence 25 subjects in

design was that of a randomized controlled trial

experiment group and 27 subjects from control

without blinding. 60 hospitalized women in 3rd

groups were included for analysis.

trimester of pregnancy with prehypertension were

Means, standard errors and confidence intervals of

included in the study. They were divided into

pre-session and post-session systolic blood

experiment and control group; each consisting of

pressures, diastolic blood pressures and heart rates

30 subjects. Randomization was done by using

of subjects in experiment groups are shown in Table

sequential method; so that subjects with alternate

1. Analysis of pre-session and post-session

registration numbers formed each group. Women

observations in experiment group indicates

with history of hypertension before or during

significant improvement in all three parameters (F=

pregnancy, taking antihypertensive medications or

47.894; P<0.00; = 0.750); systolic blood pressure

any other medications affecting blood pressure,

(mean sq = 1984.602; F = 85.26; p<0.01; =

having other medical conditions or pregnancy

0.630), diastolic blood pressure (mean sq = 812.500;

related complications, with hearing problems were

F = 24.086; p<0.01; = 0.325), and heart rate (mean

excluded. Informed written consent was obtained

sq = 679.892; F = 53.451; p<0.01; = 0. 515).

from all the subjects and the study was approved by institutional ethical committee of the MGMCRI.

Means and standard deviations of pre-session and post-session observations for each of the three

The experimental group received 3 sessions of

sessions for both groups are shown in Table 2.

receptive music therapy with relaxing music; the 1st session at 8:30 am on the 1st day of music

As may be noted in the graph and descriptive data,

therapy, the 2nd session at 3:00 pm on the same

post treatment measures of Systolic and Diastolic

day and the last (3rd) session at 8:30 am on the

pressure are lower than pre-treatment measures

next day. Duration of each session was 15 minutes.

for both the experiment group as well as control

The relaxing music that we used for our study

group. However, Systolic measure is much lower in

consisted of 4 sound tracks of instrumental music

the post-treatment for experiment group compared

played over piano, guitar and flute. The music was

to the control group where no music treatment was

without lyrics and non-rhythmic. Blood pressure

given. This is further analyzed in the sections

and heart rates were measured both before and

below. While Systolic pressure in the Pre-treatment

after each session and recorded by the investigator.

condition seems to be marginally lower for the

The control group did not receive music therapy.

control group, the reduction of systolic pressure in

Their pre-session blood pressure and heart rate

the post-treatment condition is steeper in the

were measured at 8:30 am on the 1st day , 4:00 pm

experiment group. Diastolic pressure on the other

on the same day and and at 8:30 am on the next

hand is higher for the control group both pre-

day. They were asked to lie down quietly for 15

treatment as well as post-treatment. The reduction

minutes and then their post-session blood pressure

in diastolic pressure seems higher in the 1st music

and heart rates were measured.

session than in the others.

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The interaction effect of pre-session and post-

such as stress-induced increased blood pressure in

session observations with the between subject

health adults, intraoperative patients, post-

factor of the two study groups is also significant

operative patients, etc [8,9,10].

(F=3.512; P= 0.022 with an effect size =0.180).

The main mechanism for blood pressure lowering

This indicates that the pre-treatment and post-

effect of music has been postulated to be stress-

treatment measure differences also vary across the

reducing effect of music [11]. However, the

experimental and control groups. In this condition

physiology of chronic stress-response is very

only systolic measure was significant (mean sq =

complex; involving multiple interactions between

239.768; F = 10.301; p<0.002; = 0.171);

psychology, neurology and hormonal system.

The main effects of the within subjects factor -

Hence blood pressure lowering effect of music

music sessions - was also significant indicating that

seems to be multifactorial.

there was variation on measures across the three

Our study shows that listening to relaxing music

sessions (F= 2.464; p=0.038; = 0.247). The main

can reduce blood pressure and heart rate in

effects was again significant only for the systolic

prehypertensive pregnant women during 3rd

pressure (mean sq = 395.946; F = 9.24; p<0.01; =

trimester of pregnancy. Most of the studies in male

0.156).

and female adults have shown that blood pressure

Estimated marginal means of systolic blood

lowering effect of music listening is more on systolic

pressure, diastolic blood pressure and heart rate in

blood pressure as compared to diastolic blood

both experiment group and control groups are

pressure. Our study in pregnant women also has

shown in Figure 1. Reduction in all three

reflected similar findings. This could be due to the

parameters was seen in experiment group as

fact that systolic blood pressure is more affected by

compared to control group, however, significant

stress response and sympathetic nervous system

reduction was seen in systolic blood pressure only.

arousal, while factors affecting diastolic blood pressure are multiple.

None of the subjects reported any adverse effect

Limitations of our study were inclusion of only

during the study.

hospitalized pregnant women during 3rd trimester,

Discussion :

use of digital sphygmomanometer, and non-

Receptive music therapy is becoming more popular

blinding. The study also did not record long term

as a non-pharmacological management of

effect of music therapy on blood pressure and heart

hypertension. Various studies have shown that

rates.

listening to music reduces blood pressure. Some

Conclusion :

studies have shown that particular type of music (e.g., Mozart's classical music) is more effective for

Listening to relaxing music can reduce blood

reducing blood pressure, while some types of music

pressure and heart rates in hospitalized pre-

(e.g., rock music) can elevate blood pressure [7].

hypertensive pregnant women during 3rd

The same study by Crippa G, et al. [7], has also

trimester. The blood pressure lowering effect of

shown that listening to classical music reduces

relaxing music listening is more significant for

heart rate significantly. Listening to music has also

systolic blood pressure. Receptive music therapy

shown to reduce blood pressure in various settings

seems to be safe in pregnant women.

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Table 1 : Pre Post Treatment Measure

Systolic

Diastolic

Heart Rate

Pre Post Treatment

95% Confidence Interval Mean

Std. Error

Lower Bound

Upper Bound

Pre - Treatment

123.895

.762

122.364

125.425

Post - Treatment

118.847

.743

117.355

120.339

Pre - Treatment

86.564

2.307

81.930

91.198

Post - Treatment

83.334

2.345

78.624

88.043

Pre - Treatment

93.090

.793

91.496

94.683

Post - Treatment

90.135

.856

88.415

91.855

Table 2 : Mean Values of Systolic And Diastolic Pressure Across Treatment Conditions and Study Groups Systolic Pressure

S1Presys

S1Postsys

S2Presys

S2Postsys

S3Presys

S3Postsys

Diastolic Pressure

Study Group

Mean

Std. Deviation

N

Study Group

Mean

Std. Deviation

N

Experiment

127.52

5.53569

27

Experiment

85.0741

14.80365

27

Control

124.68

4.46953

25

Control

88.0000

21.36976

25

Total

126.1538

5.20326

52

Total

86.4808

18.13294

52

Experiment

118.1111

7.69282

27

Experiment

79.8519

15.31139

27

Control

121.5200

6.90483

25

Control

86.4400

22.82557

25

Total

119.7500

7.45411

52

Total

83.0192

19.38414

52

Experiment

124.4074

8.26140

27

Experiment

84.7778

12.21391

27

Control

123.4000

7.61577

25

Control

90.5200

20.21575

25

Total

123.9231

7.89601

52

Total

87.5385

16.63620

52

Experiment

119.3704

6.69183

27

Experiment

82.7037

14.02145

27

Control

120.6800

6.28305

25

Control

85.9600

20.29261

25

Total

120.0000

6.46863

52

Total

84.2692

17.22528

52

Experiment

121.4815

6.44724

27

Experiment

84.3704

13.53954

27

Control

121.8800

7.25328

25

Control

86.6400

20.42645

25

Total

121.6731

6.78152

52

Total

85.4615

17.06213

52

Experiment

115.5185

7.32945

27

Experiment

81.4074

13.22951

27

Control

117.8800

7.80128

25

Control

83.6400

20.64558

25

Total

116.6538

7.57934

52

Total

82.4808

17.06101

52

S1Presys

S1Postsys

S2Presys

S2Postsys

S3Presys

S3Postsys

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fig 1: Combined marginal mean for Pre and post treatment systolic and diastolic measures in the two study groups

We can see from the figure that Systolic for the experiment group falls more steeply than for the control group. This indicates an interaction effect between the study-groups and treatment levels. This means that there is a significant effect of the treatment on the measures in the two groups.

We can see from the figure that the experimental group is lower in the pretreatment and post-treatment diastolic. measures

The mean values of the heart rate for the experimental group is also lower than that of the control group. The heart rate indicates a reduction in the post-treatment measurement in both groups

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Application of SOLO (Structure of the Observed Learning Outcome) Taxonomy in Music Therapy Sumathy Sundar, Parin Parmar, Sethuraman KR Although “true understanding” is always expected

Abstract

from students in any subject, this becomes of

Written examinations and verbal viva-voces are

paramount importance in music therapy education;

time tested methods used by educators to evaluate

because

whether the learning outcome objectives are met

of

its

multidisciplinary

and

multidimensional nature. In academic exams,

adequately. It is important that the educators use

evaluation of memorizable facts is usually easier as

structured and objective methods to evaluate

compared

learning outcomes. Use of unstructured methods in

to

evaluation

of

knowledge,

understanding and skills.

examinations may result in biased evaluations which do not reveal the exact learning outcome and

Sethuraman KR1 observed that a hierarchical

also can de-motivate the students who may end up

Structure of Observed Learning Outcome – SOLO –

getting frustrated. Learning music therapy is

Taxonomy described by Biggs and Collis in 19822

complex to the students as the training exposes

helps an educator to be more critical and accurate

them to many interdisciplinary concepts which they

in assessment of learning outcome of the students

have to integrate to understand the applications.

in cognitive domain in medical education and

This article attempts to discuss application of SOLO

described the five levels of SOLO with worked out

taxonomy as an evaluating method in music

sample answers to make the abstract concrete for

therapy education. SOLO taxonomy seems to have

medical education. This article attempts to describe

a very good potential to evaluate the extent to

similarly through worked out sample answers in

which the students have understood the concepts

music therapy that could be categorised into five

and also their ability to transfer their knowledge

levels of SOLO to the question "Explain what kind of

into applications.

musical experiences can you plan to relax a patient/client?".

Introduction

The answers could be categorised into five levels of

Music therapy is a unique combination of art and

SOLO as follows:

science; a discipline that touches multiple

Level 1: Pre-structural

disciplines – music, psychology, clinical medicine, anthropology, acoustics of sound, neurology of

The answers are simple, tautological, transductive

music, ... – the list can be still extended. The

and bound to specifics. In simple terms, the

students who enrol into professional courses in

question is merely reworded to resemble an

music therapy are also from different academic

intelligent answer!

backgrounds. Hence a neutral yet comprehensive evaluation of music therapy students could be one

Since music is known to have relaxing properties,

of the most desirable aspects of music therapy

musical experiences using relaxing music can be

education.

planned as researches have proved that these experiences relaxes the patient/client.

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suitably prepared and the patient also should be

Level 2 : Uni-structural

instructed to adopt a relaxed and comfortable body

The answers contain "generalisations" in terms of

posture. Based on research so far, minimum

just one aspect.

duration of receptive music therapy to achieve

All instrumental musical pieces especially with slow

optimum relaxation in the patient/client is 10 to 20

tempo, soft timbre, predictable rhythm and with

minutes daily for 4 weeks.

ragas with long frequency notes can be used for

Level 5: Extended Abstract

relaxing a patient as these properties have been studied and known for their relaxation properties.

These answers are characterised by deduction and

Musical pieces having these properties or

induction.

composing music by controlling these elements of

generalisations beyond what is strictly required by

music like timbre, tempo, melody and rhythm to the

the question.

desired effect could be planned and administered to

The answers cover situations and

There is no one particular music that can always

relax a patient/client.

cause relaxation to all at all times and so it is important to make an assessment of the musical

Level 3: Multi-structural

profile of the client which includes assessing

The answers reveal generalisations in terms of a

musical training aspects, musicality levels, family

few limited and independent aspects.

traditions, musical preferences and listening

Instrumental musical pieces especially with slow

pattern before choosing the music with the

tempo, soft timbre, ragas with long frequency notes

properties of relaxation.

and predictable rhythm can be used for relaxing a

A relaxing music stimulus can act as an external

patient. Music therapy should be delivered in

pacemaker that entrains the biological rhythms of

peaceful environment. The patient/client should be

the human body. Hence instrumental musical

made to listen to the music for 10 to 20 minutes

pieces, especially with slow tempo, soft timbre,

daily for 4 weeks.

ragas with long frequency notes and predictable rhythm can be used for relaxing a patient. The

Level 4 : Relational

environment also can affect the mental status of

The answers are characterised by induction and

the patient, hence music therapy should be

generalisations within a given context using related

delivered in a peaceful atmosphere.

aspects.

The

environment must be suitably prepared and the

A relaxing music stimulus acts as an external

patient should also be instructed to adopt a relaxed

pacemaker that entrains the biological rhythms of

and comfortable body posture. Based on research

the human body. Hence instrumental musical

so far, minimum duration of receptive music

pieces, especially with slow tempo, soft timbre,

therapy to achieve optimum relaxation in the

ragas with long frequency notes and predictable

patient is 10 to 20 minutes daily for 4 weeks.

rhythm can be used for relaxing a patient. The

However, the music should be selected according to

environment do affect the mental status of the

patient's preference because music with all

patient, hence music therapy should be delivered in

desirable relaxing qualities could be ineffective if it

a peaceful atmosphere. The environment must be

is inappropriate to the patient's cultural or social 9

the HARMoNY Volume : IV

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deep or strategic learning outcome.

background, musical profile or traditions. Also, a thorough evaluation of the patient from

The extended abstract uses inductive and

psychological point-of-view should be done before

deductive logic in the answer. Deduction is to

planning music therapy. Ensuring suggestion for

mention the facts and deduce the principle behind

appropriate medical care is also important as the

those. The sample answer clearly goes beyond the

patient's/client's condition requires.

simple question “what kind of musical experiences can you plan for relaxing a patient”. The answer

Discussion

deserves 80 to 100% of total marks. Such answers

Pre-structural level answers are simple and indicate superficial learning or memorised facts.

Dec 2015

indicate a deep understanding and a higher

The

conceptualization of the topic by the student, and

sample answer says that as music has relaxing

uses link words like 'notwithstanding', 'moreover'

properties, music therapy can be planned for

and 'however'.

relaxation. This is a simple tautological answer which deserves 0 to 20 % of total marks. Such

Usually, pre-structural, uni-structural and multi-

answers indicate that the student has not really

structural answers can be assessed quantitatively;

understood the topic.

relational and extended abstract answers require qualitative assessment.

Uni-structural answers discuss one aspect of the question and reveal some understanding of an

Evaluation by SOLO Taxonomy could lose its

aspect of the topic. The sample answer shows that

effectiveness if “higher level” answers are already

the student has understanding of one aspect –

“given” by the educator during classes. Some

“qualities of music” – and has not discussed other

“factual” questions are inappropriate for evaluation

aspects for relaxation. The answer deserves 20 to

by SOLO taxonomy like – “Give names of scientists

40 % of total marks.

who developed technique of guided imagery”, etc.

The answers to such questions are usually at pre-

Multi-structural answers reveal understanding of

structural level.

more than one aspects of the topic but they are

Conclusion

described independently. In the sample answer, more than one aspects are touched upon – quality

It is apparent that SOLO taxonomy is of great use in

of music, surroundings, and duration – but in an

classifying the learning outcome in the cognitive

unconnected manner. The answer deserves 40 to

domain for use by music therapy educators too.

60 % of total marks. Such answers indicate piece-

The 5 levels of SOLO lends itself well to a 5-point

meal learning of superficial or strategic type.

graded assessment as recommended by

Relational answers are logical but only use the

educationists. Since music therapy training

inductive type of logic, i.e., from the main

program is introduced from the health sciences

principles, the related points are derived in the

university and the evaluation methods also are

answer. In the sample answer, more than one

similar to those in health care education; SOLO

aspects are described in a more connected and

assessment can be utilised by all of us for accurate

logical manner, using link words like 'hence',

and a more objective assessment of individual

'therefore', and 'because'. The answer deserves 60

answers, especially for descriptive and viva

to 80 % of total marks. Such answers indicate a

answers in music therapy education.

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References 1.

Prakash ES, Narayan KA, Sethuraman KR. Student perceptions regarding the usefulness of explicit discussion of â&#x20AC;&#x153;Structure of the Observed Learning Outcomeâ&#x20AC;? taxonomy. Advances in Physiology Education Published 1 September 2010 Vol. 34 no. 3, 145-149 DOI: 10.1152/advan.00026.2010 (accessed on 21-09-2015).

2.

Biggs JB and Collis KF. Evaluating the Quality of Learning. New York & Sydney: Academic Press, 1982.

3.

Marton F, Housnell D and Entwhistle N. The Experience of Learning. Edinburgh: Scottish Academic Press, 1984.

Taking Forward Music Therapy : Shaping The Future

CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH offers The First Post Graduate Degree In Music Therapy In The Country Degree : M.Sc. in Medical Music Therapy Time frame : 2 years Nature of the course : Part-time /weekly 5 days/ 4 hours a day from Mondays through Fridays Delivery : Mahatma Gandhi Medical College and Research Institute Campus Eligibility Criteria : Any Bachelors degree preferably in science or any health care/ allied health care profession with demonstrable strong skills in music.

Lateral entry permitted for 2nd year of the Masters degree on completion of 1 year equivalent PGDMT program from CMTER/elsewhere.

Student Learning Outcome : Students become skilled music therapists and this is the primary learning outcome.

Students are trained in advanced-level of clinical practice by honing their clinical and music therapy skills integrating current research in the field Enhance their personality in physical, psychological and spiritual dimensions.

Become reflective, and become sensitive to the aesthetic and therapeutic qualities of music. In addition, they develop a commitment to the subject of music and its therapeutic use.

To develop professionalism in the areas of Music Therapy Standard of Practice and professional competencies and code of ethics.

Choose and research two specialized clinical areas To become informed about music therapy research and ethics Integrate and engage in quantitative and qualitative research in their clinical music therapy work For more details contact at : musictherapy@mgmcri.ac.in 11

Taking Forward Music Therapy : Shaping The Future

CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH

Editorial Board

Patrons Shri. M.K. Rajagopalan, Chairman Prof. Dr. Rajaram Pagadala, Chancellor Editor-in-Chief : Dr. Sumathy Sundar Advisory Board

Executive Editors

Prof. Dr. K.R. Sethuraman

Prof. Dr. A.R. Srinivasan

Prof. Dr. N. Ananthakrishnan

Prof. Dr. B. Sivaprakash

Prof. Dr. S. Krishnan

Ms. A.N. Uma

Members Dr. S. Srirangaraj

Dr. V.R. Hemanth Kumar Dr. Sobana Jaiganesh Mrs. Asha Suresh Babu Ms. Vijay Chitra

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