Musical Contour Regulation Facilitation (MCRF) to Support Emotion Regulation Development in Preschoolers: A Mixed Methods Feasibility Study

Title from PDF of title page, viewed on July 7, 2015Dissertation advisor: William EverettVitaIncludes bibliographic references (pages 216-236)Thesis (Ph.D.)--Conservatory of Music and Dance and School of Education. University of Missouri--Kansas City, 2015Emotion regulation (ER) is the ability for a person to maintain a comfortable state of arousal by controlling and shifting his or her emotional experiences and expressions. The emergence of maladaptive ER occurs in childhood and is one characteristic often shared by several disorders. Maladaptive ER can significantly affect multiple areas in child development, such as the ability to learn in school, form and maintain healthy relationships with peers and adults, and manage and inhibit behavioral responses. Interventions for children at-risk for developing maladaptive ER skills are limited and need further exploration. Based on limitations noted in existing treatment options, this study provided a preliminary examination of the utility of using a music-based approach. An embedded convergent mixed methods research design was used to explore the feasibility of a Musical Contour Regulation Facilitation (MCRF) intervention. The MCRF intervention was developed to improve ER abilities in children by providing opportunities to practice real-time management of high and low arousal experiences. Typically developing preschool-aged children (n = 8) participated in 11 MCRF sessions over four weeks. Data to assess ER skills and related behaviors was collected pre- and post-MCRF treatment; current regulatory levels were assessed and self-reported at the beginning and end of each MCRF session. In addition, parent and teacher interviews and questionnaires were conducted post-treatment. Grounded theory-based qualitative analysis results suggest that most parents and both teachers noted emotional changes in the children following MCRF treatment. Perhaps more importantly, all interviewees believed in the importance and helpfulness of music on developmental outcomes even if they did not note changes in the children or they recognized that other factors may have contributed to perceived changes. Quantitative data analysis results indicated clinically significant improvements in ER skills in the children following MCRF treatment. Convergent mixed methods analyses results further support the efficacy and acceptability of the MCRF intervention. Together, these findings endorse future normative and clinical study of the MCRF intervention as way to facilitate ER development, especially as this medium is highly desired by parents and teachers and can be easily integrated in a preschool setting.Introduction -- Emotion regulation and musical contour regulation facilitation in theory and practice: an integrated literature review -- The effectiveness of MCRF in facilitating emotion regulation: methodology for a feasibility study -- The effectiveness of MCRF in facilitating emotion regulation: mixed methods results -- The feasibility of MCRF in facilitating emotion regulation development in preschoolers: discussion, implications, and recommendations -- Appendix A. Musical contour regulation facilitation (MCRF) intervention manual -- Appendix B. MCRF intervention pilot assessment -- Appendix C. Recruitment materials -- Appendix D. Informed consent and child assent -- Appendix E. Study measure

Theory-guided Therapeutic Function of Music to facilitate emotion regulation development in preschool-aged children

Emotion regulation (ER) is an umbrella term to describe interactive, goal-dependent explicit, and implicit processes that are intended to help an individual manage and shift an emotional experience. The primary window for appropriate ER development occurs during the infant, toddler, and preschool years. Atypical ER development is considered a risk factor for mental health problems and has been implicated as a primary mechanism underlying childhood pathologies. Current treatments are predominantly verbal- and behavioral-based and lack the opportunity to practice in-the-moment management of emotionally charged situations. There is also an absence of caregiver–child interaction in these treatment strategies. Based on behavioral and neural support for music as a therapeutic mechanism, the incorporation of intentional music experiences, facilitated by a music therapist, may be one way to address these limitations. Musical Contour Regulation Facilitation (MCRF) is an interactive therapist-child music-based intervention for ER development practice in preschoolers. The MCRF intervention uses the deliberate contour and temporal structure of a music therapy session to mirror the changing flow of the caregiver–child interaction through the alternation of high arousal and low arousal music experiences. The purpose of this paper is to describe the Therapeutic Function of Music (TFM), a theory-based description of the structural characteristics for a music-based stimulus to musically facilitate developmentally appropriate high arousal and low arousal in-the-moment ER experiences. The TFM analysis is based on a review of the music theory, music neuroscience, and music development literature and provides a preliminary model of the structural characteristics of the music as a core component of the MCRF intervention

A Systematic Review on the Neural Effects of Music on Emotion Regulation: Implications for Music Therapy Practice

Emotion regulation (ER) is an internal process through which a person maintains a comfortable state of arousal by modulating one or more aspects of emotion. The neural correlates underlying ER suggest an interplay between cognitive control areas and areas involved in emotional reactivity. Although some studies have suggested that music may be a useful tool in ER, few studies have examined the links between music perception/production and the neural mechanisms that underlie ER and resulting implications for clinical music therapy treatment. Objectives of this systematic review were to explore and synthesize what is known about how music and music experiences impact neural structures implicated in ER, and to consider clinical implications of these findings for structuring music stimuli to facilitate ER. A comprehensive electronic database search resulted in 50 studies that met predetermined inclusion and exclusion criteria. Pertinent data related to the objective were extracted and study outcomes were analyzed and compared for trends and common findings. Results indicated there are certain music characteristics and experiences that produce desired and undesired neural activation patterns implicated in ER. Desired activation patterns occurred when listening to preferred and familiar music, when singing, and (in musicians) when improvising; undesired activation patterns arose when introducing complexity, dissonance, and unexpected musical events. Furthermore, the connection between music-influenced changes in attention and its link to ER was explored. Implications for music therapy practice are discussed and preliminary guidelines for how to use music to facilitate ER are shared

A Preliminary Overview of Music Reimbursement Practice in the United States

Music therapy services are currently being reimbursed through state and private insurance funding streams, yet to date, there is no known systematic exploration on music therapy reimbursement practices. Such information would be helpful to include when com- municating with third-party payers and can assist in tracking reim- bursement trends. Thus, we sought to provide baseline information on how music therapy services are currently being reimbursed in the United States, with a focus on approved treatment parameters, re- ferral sources, Current Procedural Terminology (CPT) codes used, and types of music interventions and music therapy experiences imple- mented. Board-certified music therapists in private practice who had successfully obtained reimbursement for music therapy services be- tween 2012 and 2018 completed a 28-item online survey. In total, 7 respondents provided information on 55 unique reimbursement cases from 5 different states, most of which were based on Medicaid waiver programs. We conducted descriptive analyses to summarize music therapy reimbursement practices. Most of the clients were referred by doctors or physician’s assistants. The most common CPT code utilized was 97530 (Therapeutic Activities, one-on-one, each 15 minutes), and most of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes were based on specific diagnoses rather than general clinical needs. In most of the cases, reimbursement of music therapy was ongoing, and services incorporated a variety of music therapy methods, with few specific music interventions identi- fied. Most notably, reimbursement practice varied by state; thus, we recommend the creation and dissemination of state-specific surveys

Feasibility of the Musical Contour Regulation Facilitation (MCRF) Intervention for Preschooler Emotion Regulation Development: A Mixed Methods Study

Abstract Emotion regulation (ER) describes the goal-directed ability to manage and shape the dynamics and timing of one's emotional experiences and expressions, an ability that develops early in life. Though development of maladaptive ER skills can significantly impact developmental outcomes, interventions for at-risk children are limited. The purpose of this mixed methods study was to examine feasibility and preliminary efficacy of the Musical Contour Regulation Facilitation (MCRF) intervention, a multi-session strategy for promoting ER development in preschoolers, with a focus on typically developing preschoolers as a preliminary exploration of a novel intervention. Eight typically developing children (M = 3.88 years) participated in the 11-session MCRF intervention across four weeks. ER-related behaviors were assessed pre- and post-intervention, and teacher interviews were conducted post-intervention. Teachers noted positive change in children's behavior following the intervention in terms of their emotion skills and peer interactions. Furthermore, they believed in the importance of music for developmental outcomes. Large and medium effects sizes in ER-related abilities were noted, and acceptability and integration of the intervention into the regular daycare environment was supported by interview data. Findings support further refinement and examination of the MCRF intervention in children who are at risk

The Effectiveness of Music as a Mnemonic Device on Recognition Memory for People with Multiple Sclerosis

Research shows that people with multiple sclerosis exhibit learning and memory difficulties and that music can be used successfully as a mnemonic device to aid in learning and memory. However, there is currently no research investigating the effectiveness of music mnemonics as a compensatory learning strategy for people with multiple sclerosis. Participants with clinically definitive multiple sclerosis (N = 38) were given a verbal learning and memory test. Results from a recognition memory task were analyzed that compared learning through music (n = 20) versus leaming through speech (n = 18). Preliminary baseline neuropsychological data were collected that measured executive functioning skills, learning and memory abilities, sustained attention, and level of disability. An independent samples t test showed no significant difference between groups on baseline neuropsychological functioning or on recognition task measures. Correlation analyses suggest that music mnemonics may facilitate leaming for people who are less impaired by the disease. Implications for future research are discussed

Feasibility and acceptability of a self-managed exercise to rhythmic music intervention for ICU survivors

Post-ICU rehabilitation is a challenging clinical issue for patients discharged from an Intensive Care Unit (“ICU survivors”). Our exercise to rhythmic music intervention was designed to allow ICU survivors to self-manage their exercise by following a personalized, recorded exercise playlist. Our study reports the feasibility and acceptability of an innovative music intervention among ICU survivors enrolled in a randomized controlled pilot study. ICU survivors, admitted in ICU for at least 5 days and cognitively intact, were randomly assigned to an exercise to rhythmic music group (n = 10) or an active control group (n = 10). Participants in the music group were taught to self-manage exercise by listening to a recorded playlist of instructions and music-facilitated movements tailored to their musical preference and exercise ability. Participants in the control group were provided a brochure with exercise instructions. After 5 days or at hospital discharge, participants completed an 8-item acceptability questionnaire and were interviewed. Content analysis was conducted. 18 Participants were included for final analysis. Participants were 61.8 ± 14.7 years old, predominantly male (66.7%), and Caucasian (55.6%). Results demonstrated feasibility, as the study team was able to meet the enrollment goal of 5–6 participants per month. Three themes related to general, physical, and psychosocial benefits were identified. Based on positive feedback, the exercise to rhythmic music intervention was deemed acceptable. The exercise to rhythmic music intervention was feasible and acceptable, suggesting that clinical trials with larger sample sizes should investigate the effects of the intervention on outcomes among ICU survivors. •ICU survivors experience persistent physical and psychological impairments resulting from their original illness.•ICU survivors can self-manage their exercise by following a personalized, music-enhanced exercise playlist.•Study findings showed that the pilot randomized controlled trial was feasible and acceptable.•Participants in the exercise to rhythmic music group provided extensive positive narrative feedback post intervention.•The exercise to rhythmic music intervention is low-cost, easy to implement, and patient-centered

Randomized Controlled Study of Self-Managed Music-Guided Exercise Intervention Following Intensive Care

Patients who are discharged from ICU (ICU survivors) often experience persistent physical impairment. To explore the effects of a self-managed, music-guided exercise intervention on physical outcomes and adherence rates among ICU survivors. A randomized controlled design was used. Following ICU discharge, participants admitted to the ICU for at least 5 days were randomly assigned to a music group (n = 13) or active control group (n = 13). Activity counts were measured using an Actiwatch, and physical health score was measured using the Patient-Reported Outcomes Measurement Information System global health subscale. Adherence to exercise was documented daily. Independent t-tests were used for data analysis. Data were analyzed for 26 participants. The mean age was 62.8 ± 13.8 years, 53.8% were male, 65.4% were White, and mean Acute Physiology and Chronic Health Evaluation severity of illness score was 59 ± 23.4. Global health physical scores were significantly higher in the music group than in the active control group. Although not significantly different, music group participants tended to be more active and had higher physical activity and adherence rates compared to those in the active control group. A self-managed, music-guided exercise intervention demonstrated positive benefits on physical outcomes. Future clinical trials with a larger sample size should be conducted to examine the effects of this tailored, cost-effective, innovative, self-managed exercise intervention among ICU survivors