During my work with patients and survivors of cancer and their caregivers in India, difficulty in finding a way back to usual routine and reintegrating into social life was a common concern. Those in rehabilitation and remission quite effectively managed their physical pain with medication. However, other symptoms like anxiety, stress, and their emotional, psychosocial, and spiritual needs were often unaddressed. This paper explores the therapeutic benefits of music towards holistic healing in cancer care, the target population for music group therapy, and a design proposal for the therapy sessions.
Holistic Musical Healing Music and the Body
Among the various elements of music that include rhythm (time and tempo), timbre (tone color or quality), dynamics (volume), harmony (tonality), melody (pitch), form (structure of music), and texture (overall quality), rhythm of music which resonates with the internal bodily rhythms plays a vital role as an external indicator that the brain easily recognizes (Zatorre et al., 2007). Musical entrainment refers to the synchronization of bodily movements, breathing, pulse, and heart rate with the perceived rhythmic cues in music (Altenmüller & Schlaug, 2013). People suffering from possible after effects of treatment like neurological impairments and problems with motor functions have seen musical miracles with the help of entrainment. Music and the Mind Music is known to affect the mood and arousal in a way that we can adapt to our given circumstances. When choosing music, one can play songs that are synchronous to their mood and energy levels or they may choose to play songs that would bring about a shift in their mood and energy levels (DeNora, 2000). Music has the potential to be either energizing or relaxing; the same song may evoke different emotions at different times and the same song may have a different meaning and evoke a different response for someone else at the same time (North & Hargreaves, 2008).
Musical vibrations impact the entire body starting from the cellular level through to complex organ systems and music can modulate multiple physiological processes (Schneck & Berger, 2006). Music can stimulate neurotransmitters like dopamine and serotonin, better known as happiness hormones, which infuse feelings of pleasure (Rodriguez-Fornells et al., 2012). Music acts as an analgesic by activating the limbic system which in turn releases endorphins that reduce the perception of pain. In addition to benefits of heightened pleasure and pain inhibition, listening to music can suppress cortisol (stress hormone) which reduces anxiety (Bradt & Dileo, 2014).
The Musical Group
Being aware of the benefits that music can provide towards holistic healing of patients with cancer in rehabilitation, I would like to devise a music therapy program for patients with breast cancer who have completed their cancer treatment and are currently recuperating. Music therapy for this group of patients would help in boosting psychosocial factors such as elevating their mood, decreasing anxiety, and enhancing their motivation (Clark & Harding, 2012). The aim of therapy sessions is to reduce stress levels and to enhance their motivation for social interactions which can be achieved through cohesion in a group of patients with breast cancer who have gone through a similar journey of cancer treatment and face similar concerns during rehabilitation.
The Group Design Participants
Patients with breast cancer who have recently completed their treatment protocol and are in rehabilitation would participate in the music group therapy. Venue. The sessions would be held in a hospital setting where the patients have been treated and have been following up with their doctor post-treatment. A soundproof room where 10 participants and a therapist can be seated in a circle would be preferred. Instruments like keyboard, guitar, violin, flute, djembe or handy percussion drums would be available in the room. Number of sessions and Length of sessions. The group would meet every week for 90 minutes on a weekend (Saturday 4 pm to 5.30 pm) for a period of 10 weeks. Activity. The session would begin with group members checking in and expressing their feelings by singing a song of their choice that resonates with their mood and energy levels. After a round of singing, a drumming exercise would be carried out with varying rhythm and energy. Next, members would be encouraged to play an instrument of their choice and to reflect and to express their emotions in the here and now. Each week a member would get an opportunity to select a song that the entire group would sing together towards the end of the session. Research has shown that singing has multiple benefits like relaxation, affect release, reduction in stress levels, sense of joy, and an improved sense of emotional and physical wellbeing (Clift, 2012). And the effects get magnified when people sing along with others in a group (Gridley et al., 2012).
Role of the therapist
The therapist would moderate the group during the check-in activity and facilitate the expression of emotions and feelings while members are playing their individual instruments. The therapist would also model the drumming exercise by changing the rhythm, tempo, beats, and volume for other members to follow. Expectations of participants. Though the motive of therapy is to decrease anxiety and stress levels and to elevate the mood, the activities may uncover some painful memories that may evoke fear, anger, and frustration during the sessions. Exploring both highs and lows during sessions, will only aid the therapeutic process.
Both subjective and physiological markers can be used to evaluate the effectiveness of the therapy sessions. Subjective stress levels. Pre and post-test evaluation can help to determine the change in stress levels before and after the 10-week program. Perceived stress scale, a psychometric test, can be administered during the intake session before the beginning of the first session, midway after the fifth session and after the end of the 10th session. A subjective evaluation of members can be conducted by asking the members to check-in about their mood and feelings of anxiety at the beginning and end of each session. Physiological markers. Studies have shown that music has the potential to reduce physiological markers like heart rate, blood pressure, and cortisol (Chanda & Levitin, 2013; Kreutz et al., 2012). Given the hospital setting, heart rate and blood pressure can be monitored at the beginning and end of every session. Considering the feasibility and the cost factor, cortisol levels can be tested pre and post 10 weeks of the program to evaluate the change in stress levels.
Initially, readiness and willingness of all members to sing and to play instruments in a group may be a challenge. Some may feel embarrassed, some may not be in a position to sing or play instruments due to post-treatment effects, while some may feel they are not good at singing and playing instruments which could be detrimental in achieving their goals. Unlike analytical music therapy that focuses on the roots of the problems that could originate from childhood, this approach is based on addressing the feelings and emotions in the here and now. Use of improvisation to enable members to delve deeper into childhood issues that could be instrumental in producing anxiety and stress in members may not be addressed through this approach. Conclusion
- Clift, S. (2012-02-23). Singing, Wellbeing, and Health. In (Ed.), Music, Health, and Wellbeing: Oxford University Press. Retrieved 25 Feb. 2019, from http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199586974.001.0001/prof-9780199586974-chapter-009.