Thomas K. Hillecke

Scientific perspectives on music therapy

Abstract: What needs to be done on the long road to evidence‐based music therapy? First of all, an adequate research strategy is required. For this purpose the general methodology for therapy research should be adopted. Additionally, music therapy needs a variety of methods of allied fields to contribute scientific findings, including mathematics, natural sciences, behavioral and social sciences, as well as the arts. Pluralism seems necessary as well as inevitable. At least two major research problems can be identified, however, that make the path stony: the problem of specificity and the problem of eclecticism. Neuroscientific research in music is giving rise to new ideas, perspectives, and methods; they seem to be promising prospects for a possible contribution to a theoretical and empirical scientific foundation for music therapy. Despite the huge heterogeneity of theoretical approaches in music therapy, an integrative model of working ingredients in music therapy is useful as a starting point for empirical studies in order to question what specifically works in music therapy. For this purpose, a heuristic model, consisting of five music therapy working factors (attention modulation, emotion modulation, cognition modulation, behavior modulation, and communication modulation) has been developed by the Center for Music Therapy Research (Viktor Dulger Institute) in Heidelberg. Evidence shows the effectiveness of music therapy for treating certain diseases, but the question of what it is in music therapy that works remains largely unanswered. The authors conclude with some questions to neuroscientists, which we hope may help elucidate relevant aspects of a possible link between the two disciplines.

Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study.

Background: Migraine is very common in school‐aged children, but despite a number of pharmacological and non‐pharmacological options for prophylaxis, randomized controlled evidence in children is small. Evidence‐based prophylactic drugs may have considerable side effects.

Heart rate variability and experimentally induced pain in healthy adults: A systematic review

Reactivity of the autonomic nervous system to experimental pain stimuli has been extensively studied using measures of heart rate and blood pressure. Heart rate variability (HRV) attempts to tease out the relative contributions of sympathetic and parasympathetic activity in the autonomic control of the heart and may therefore be more appropriate to investigate autonomic response to short‐term nociceptive stimulation in detail. The current evidence on HRV and experimentally induced pain has not yet been synthesized within a systematic review.

Body mass index is related to autonomic nervous system activity as measured by heart rate variability--a replication using short term measurements.

ObjectivesThe present analysis is a replication of previous findings presenting first evidence of an association between body mass index (BMI) and autonomic nervous system (ANS) activity as measured by heart rate variability (HRV), in healthy non-obese adults.DesignA total of fifty-nine apparently healthy male (M) and female (F) individuals (M/F = 15/44) were included in the trial. HRV data for analysis was derived from 5 minutes of baseline recordings, while the subject was sitting on a comfortable chair. Subjects’ body measures (weight and height) were taken and BMI was obtained according to common calculation (kg/m2).ResultsBMI was inversely related to pNN50 and RMSSD components of HRV. Statistically significant differences between stratified groups (BMI<20, BMI 20–25, BMI >25) only occurred for analysis of pNN50 components. The pNN50 components and RMSSD are strongly associated with cardiac vagal influence, and thus represents parasympathetic activity.ConclusionsThe present data supports previous findings, that sympatho-vagal balance is related to BMI in non-obese, healthy individuals, providing evidence for a prominent role of the vagus nerve in the modulation of the energy expenditure of the human organism. Furthermore, this relation can be observed in short term recordings of HRV of 5 minutes in length.

Outcome research in music therapy : A step on the long road to an evidence-based treatment

Abstract: Music therapy is the therapeutic use of music and musical activities in the treatment of somatic and mental diseases. In the last decades it has developed from a quasi‐professional working field into an increasingly evidence‐based treatment for various diseases. Selected outcome studies that were carried out in order to give music therapy a scientific and empirical base are presented in this article. Results show that music therapy is an effective intervention for patients with chronic pain, children with migraine, and patients suffering from chronic tinnitus. This positive outcome, in combination with the observed moderate to large effect sizes in different metanalyses, provides evidence for the use of music therapy in specific clinical fields. Future research should focus on studies that compare well‐defined music therapy interventions to standard treatment.

Lowered Parasympathetic Activity in Apparently Healthy Subjects with Self-Reported Symptoms of Pain: Preliminary Results from a Pilot Study

The aim was to evaluate differences in the autonomic nervous system (ANS) activity, indexed by heart rate variability (HRV) in apparently healthy subjects with self‐reported symptoms of pain (SRSP) within an exploratory analysis.

Two-Week Test-Retest Stability of the Cold Pressor Task Procedure at two different Temperatures as a Measure of Pain Threshold and Tolerance

The cold pressor task (CPT) was originally developed as a clinically indicative cardiovascular test, and quantifies vascular response and pulse excitability when a subjects hand is immersed into ice water. Since the test procedure results in a gradually increasing cold pain, the CPT has been widely used as a nociceptive stimulus in experimental studies on adults and children.

Music Therapy in Palliative Care.

BACKGROUND Music therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects. METHODS In a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle. RESULTS Analyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p <0.001) and well-being (F = 6.41; p = 0.01). This effect was supported by a significantly greater increase in high-frequency oscillations of the heart rate (F = 8.13; p = 0.01). Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03). CONCLUSION Music therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care.

Two-week test–retest reliability of the Polar® RS800CX™ to record heart rate variability

Recently, research has validated the use of Polar® heart rate monitors as a tool to index heart rate variability (HRV). In the current investigation, we sought to evaluate the test–retest reliability of both time and frequency domain measures of HRV using the Polar® RS800CX™. Continuous HRV data were collected as 60 nominally healthy adults underwent a resting and orthostatic stress test. We evaluated reproducibility by means of the interclass correlation coefficient for absolute agreement and consistency, and the standard error of measurement. We found moderate reliable 2‐week test–retest reliability of HRV using the Polar® RS800CX™, results that are in line with previous studies that have validated the stability of HRV using other methods of measurement (e.g. electrocardiogram). Additionally, when examining different methods of spectral density estimation, we found that using the auto‐regressive transformation method provides the most stable indices of HRV. Taken together, our results suggest that the Polar® RS800CX™ is not only a valid method to record HRV, but also a reliable one, particularly when using the auto‐regressive transformation method.

Methodological challenges for music therapy controlled clinical trials in palliative care

Since the late 1970s, music therapy has been an important part of multidisciplinary palliative care programs. Despite its wide application and high acceptance by patients, caregivers and staff members, recent systematic reviews and reports point to a lack of research, and the need for controlled clinical trials. The present article reviews the methodological quality of controlled clinical trials on the effects of music therapy in palliative care and addresses issues regarding the implementation of such designs. We identified eight studies (both published and unpublished), conducted between 2003 and 2013, through a systematic search of the scientific literature. We present major challenges according to the PICOS taxonomy and provide recommendations for future research using controlled clinical trial designs.