Effects of vibroacoustic stimulation in music therapy for palliative care patients: a feasibility study

Background: The present study aimed at examining whether methodological strategies from a previously implemented study design could be transferred to the evaluation of the psychological and physiological effects of a music therapy intervention working with vibroacoustic stimulation in palliative care. Method: Nine participants suffering from advanced cancer took part in single-sessions of music therapy, lasting for 30 min. The live music therapy intervention utilized singing chair sounds and vocal improvisation. Visual analogue scales (VAS) were used to assess self-ratings of pain, relaxation, and well-being before and after each session. During the intervention, we continuously recorded heart rate variability (HRV) as a measure of autonomic functioning. Data collection was complemented by a semi-structured interview to explore subjective experiences in more detail. Feasibility was defined as the ability to complete 80 % of the sessions in accordance with the study protocol. Results: In 5 out of 9 sessions (55 %) it was possible to deliver the intervention and obtain all data as intended. VAS assessment was feasible, although graphical and statistical examination revealed only marginal mean changes between pre and post. HRV recordings were subject to artifacts. While HRV parameters differed between individuals, mean changes over time remained relatively constant. Interview data confirmed that the individual perception was very heterogeneous, ranging from “calming” to “overwhelming”. Conclusion: The criterion of feasibility was not met in this study. Physiological data showed high attrition rates, most likely due to movement artifacts and reduced peripheral blood flow in some participants’ extremities. Examination of individual-level trajectories revealed that vibroacoustic stimulation may have an impact on the autonomic response. However, the direction and mechanisms of effects needs to be further explored in future studies. Trial registration: German Clinical Trials Register – DRKS00006137 (July 4th, 2014)

"Song of Life (SOL)" study protocol: a multicenter, randomized trial on the emotional, spiritual, and psychobiological effects of music therapy in palliative care

Background: Although patients in palliative care commonly report high emotional and spiritual needs, effective psychosocial treatments based on high quality studies are rare. First research provides evidence for benefits of psychosocial interventions in advanced cancer care. To specifically address end-of-life care requirements, life review techniques and creative-arts based therapies offer a promising potential. Therefore, the present study protocol presents a randomized controlled trial on the effectiveness of a newly developed music therapy technique that is based on a biographically meaningful song (“Song of Life”; SOL). Methods: In a design with two parallel arms, 104 patients at two palliative care units will be randomly assigned to three sessions of either SOL (experimental group) or relaxation exercises (control group). Improvements in the psychological domain of quality of life will be the primary endpoint, while secondary outcomes encompass spiritual well-being, ego-integrity, overall quality of life, and distress. Additionally, caregivers will be asked to provide feedback about the treatment. Assessment of biopsychological stress markers and qualitative analysis of perceived strengths and weaknesses will complement data collection. Discussion: Based on the results of a previous pilot study, we dedicated considerable efforts to optimizing the intervention and selecting appropriate outcomes for the present trial. We are confident to have designed a methodologically rigorous study that will contribute to the evidence-base and help to develop the potential of psychosocial interventions in palliative care. Trial registration: German Clinical Trials Register (DRKS) – DRKS00015308 (date of registration: September 07th 2018)

Trajectories of Terminally Ill Patients\u27 Cardiovascular Response to Receptive Music Therapy in Palliative Care

Context: Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms. Objectives: The present analysis aimed at examining the psychophysiological pathways of terminally ill patients\u27 cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise. Methods: Eighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants\u27 gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors. Results: Both VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals\u27 trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow. Conclusion: Higher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients\u27 physiological response and need to be taken into account in clinical practice and future theory building. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Chronic Hiccups: An Underestimated Problem

Persistent singultus, hiccupping that lasts for longer than 48 hours, can have a tremendous impact on a patient's quality of life. Although involved neurologic structures have been identified, the function of hiccups remains unclear they have been controversially interpreted as a primitive reflex preventing extent swallowing of amniotic fluid in utero, an archaic gill ventilation pattern, or a fetus' preparation for independent breathing. Persistent singultus often presents as a symptom for various diseases, most commonly illnesses of the central nervous system or gastrointestinal tract; they can also be evoked by a variety of pharmacological agents. It is often impossible to define a singular cause. A wide range of treatment attempts, pharmacological and nonpharmacological, have been concerted to this date; however, chlorpromazine remains the only Food and Drug Administration approved drug in this context. Large-scale studies on efficacy and tolerance of other therapeutic strategies are lacking. Gabapentin, baclofen, and metoclopramide have been reported to accomplish promising results in reports on the therapy of persistent singultus; they may also be effective when given in combination with other drugs, eg, proton pump inhibitors, or as conjoined therapy. As another approach of note, acupuncture treatment was able to abolish hiccups in a number of studies. When managing hiccup patients within the clinical routine, it is of importance to conduct a comprehensive and effective diagnostic workup; a well-functioning interdisciplinary team is needed to address possible causes for the symptom. Persistent singultus is a medical problem not to be underestimated; more research on options for effective treatment would be greatly neede

Evaluating a Treatment Manual for Music Therapy in Adult Outpatient Oncology Care

Music therapy is a prevalent treatment for people with a life-threatening illness, with inpatient oncology care being one of the most common fields of application. A recently published review on this topic shows that studies examining the effects of active music therapy treatments in an outpatient setting are still rare. Based on the Phase Model of Psychotherapy Outcome, a treatment manual has been developed for outpatient music therapy cancer care, consisting of 20 individual sessions. The aim of this study was to evaluate the effectiveness of the procedures of this manual by comparing prescores and postscores of 20 patients’ self-reported general therapy outcome, quality of life, and subjective pain intensity ratings. Results show that the intervention led to a significant improvement on all 3 dependent measures. Effect sizes ranged from medium to large. The authors conclude that it is necessary to further expand outpatient cancer care in Germany and to integrate music therapy as an effective treatment into these areas. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Psychoneuroendocrinological effects of music therapy versus mindfulness in palliative care: results from the ‘Song of Life’ randomized controlled trial

Although research on psychosocial interventions in palliative care provided evidence for their effectiveness regarding patient-reported outcomes, few studies have examined their psychobiological effects yet. Therefore, the purpose of the present work as part of an overarching study was to investigate differential effects of music therapy versus mindfulness on subjective distress and both neuroendocrine and autonomic stress biomarkers.A total of 104 patients from two palliative care units were randomly assigned to three sessions of either music therapy or mindfulness. Before and after the second session (completed by 89 patients), participants rated their momentary distress and provided three saliva samples for cortisol and alpha-amylase analysis. Furthermore, photoplethysmography recordings were continuously assessed to calculate mean heart rate and heart rate variability. Data were analyzed using multilevel modeling of all available data and sensitivity analysis with multiply imputed data. Between 67 and 75% of the maximally available data points were included in the primary analyses of psychobiological outcomes. Results showed a significant time*treatment effect on distress (b = -0.83, p = .02) indicating a greater reduction in the music therapy group. No interaction effects were found in psychobiological outcomes (all p > .05), but multilevel models revealed a significant reduction in cortisol (b = -0.06, p = .01) and mean heart rate (b = -7.89, p = .05) over time following either intervention. Findings suggest a beneficial effect music therapy on distress while no differential psychobiological treatment effects were found. Future studies should continue to investigate optimal stress biomarkers for psychosocial palliative care research

I Need to Hear Some Sounds That Recognize the Pain in Me: An Integrative Review of a Decade of Research in the Development of Active Music Therapy Outpatient Treatment in Patients With Recurrent or Chronic Pain

Music is widely used to reduce pain in a broad variety of clients and settings. Most studies focus on the pain-reducing effect of music-listening interventions on patients with acute pain, whereas studies investigating the effect of active therapy (ie, music making) on pain perception in patients with recurrent or chronic pain are rare. This article reviews the findings of a series of previously published studies by our work group, conducted during the past 10 years, using defined music therapy plans in the treatment of outpatients with conditions of recurrent or chronic pain. This review provides evidence that a specific music therapy concept tailored to the demands of the patient might be able to substantially reduce pain frequency and pain intensity in patients with recurrent or chronic pain. However, further studies need to investigate the nature of those beneficial effects and their specificity. [PUBLICATION ABSTRACT