Music Therapy Pain Management and Entrainment Cheryl Dileo, PhD, MT-BC Carnell Professor of Music Therapy Temple University, Philadelphia

Definition of pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP, n.d.) Pain is a culturally-defined physiological and psychological experience. Each culture has its own language of distress when experiencing pain. (Calister, 2003)

Types of Pain Acute Chronic Procedural Cancer

Pain True Biopsychosocial phenomenon Individual differences Total pain experience Pain/Suffering

The Experience of Pain Personal, subjective experience of painful sensations known only to the person with pain Includes a mental and emotional component in addition to awareness of painful physical sensations Cannot be objectively measured, confirmed, or disconfirmed by another person

LEVELS OF PAIN MANAGEMENT IN MUSIC THERAPY

Why levels of pain management? Appropriate for Biopsychosocial nature of pain Addresses wide range of interventions possible in MT based on a range of goals/therapeutic intent Describes progression of interventions from most basic and symptom-focused to most comprehensive Appropriate for Incorporating range of patient coping preferences and cultural perspectives Dileo, 2013

Why Levels of Pain Management? Subsumes various theoretical perspectives Allows various ways for patient to be in relationship to the pain However, May be overlap in categories Same interventions may serve multiple purposes Dileo, 2013

Levels of Music Therapy Pain Interventions 1. Distraction/Refocusing 2. Supportive 3. Cathartic/Expressive 4. Existential Transformational Dileo, 2013

Distraction/Refocusing Refocus of attention to another stimulus (strong and/or engaging). Intent is to avoid or ignore pain Patient can participate in an active or passive manner Examples: Various types of Music Listening (structured by patient and/or therapist) Instrument playing Musical Journeys (remove from present) Music and Imagery experiences (escape situation) Music as Focal Point

Supportive Intent is to palliate specific symptoms of pain- make pain go away or enhance personal resources for dealing with pain. Patient can participate actively or passively (most often passively) Examples: Song-writing Music-based relaxation Music and Imagery Music Iso Toning Vibroacoustics Music-Based Breath Work Improvised/Precomposed Music to Hold/Soothe Dileo, 2013

Expressive/Cathartic Intent: express experience of pain and or emotions and suffering associated with having pain Patient may participate actively or passively, but most often actively Patient establishes contact with pain and/or emotions associated with being in pain Examples: Instrumental or Vocal Improvisation Drumming Song-writing, e.g., blues, rap Song Improvisation Dileo, 2013

Existential Focus is on finding meaning in the pain experience within the patient’s life and/or new ways of thinking of/conceptualizing pain Patient is in touch with the pain experience, the emotions accompanying it as well as the thoughts and interpretations of its meaning The patient may participate actively or passively Examples: Song-writing Song Discussion Referential or non-referential Improvisation GIM Dileo, 2013

Transformational -Intent is to observe carefully, dialogue with and/or enter into the pain to achieve a relationship with it and sometimes to travel through it. -There is an awareness of the body, the pain and the emotions related to pain. There is also an awareness of what might heal the pain Active, passive or combined approaches can be used. -Examples: GIM Music Therapy Entrainment (process) Dileo, 2013

Personal Assessment Own history with pain Reactions to pain: avoidance, etc. Reactions to pain in others Boundaries, rigid, loose Dileo, 2013

MUSIC THERAPY ENTRAINMENT

Music Therapy Entrainment Interactive, music-centered therapy process using improvisation to treat pain Both active and passive in nature (client participates in variety of ways) Uses imagery (accepted cross-culturally) Can address wide range of coping styles (active, passive, problem-focused, emotion-focused, etc.) Differentiated from other types of MT pain approaches Involves sensory exploration of pain characteristics Entrance into pain by therapist and client (Dileo, 2013)

Theoretical foundations Relies on theories in physics regarding pull of one vibrating object on another (tendency to achieve synchrony) (e.g., Pantalleone, 2002) Iso principle- matching phenomenon musically and then changing music in desired direction (Altschuler, 1948; Rider, 1997; 1985) Biopsychosocial theory-interrelationship of mind, body, social contexts (Engel, 1977) Aesthetic theory (Metzner, 2012)

Evidence for Music Therapy Entrainment Chronic upper limb pain Schwoebel, Coslett, Bradt, Friedman, Dileo (2002) Acute post-operative pain in children (Bradt, 2010) Laboratory pain (Metzner, et al., 2012) End-of-life pain (Clinical observations, Patrick, 2010) Cancer Pain (Dileo, et al., in preparation for publication, 2013) Support from EEG and MEG analysis (Metzner, et al.,2012; Dileo et al, 2013)

MT ENTRAINMENT CLINICAL PRACTICE OF

Contraindications Psychosis Borderline personality Physical/emotional fragility Dementia Extreme anxiety Inability to verbalize Dileo, 2013

Stages of Entrainment 1. Assessment: Pain Interview Dileo, 2013

Stages of Entrainment 2. Imaging the Pain as Music Auditory image of pain Match music as closely as possible to the pain Dileo, 2013

Imaging What Can Heal the Pain Auditory image of what can heal Timbre Pulse Tempo Combination of sounds Sequence of sounds Duration of sounds Match music as closely as possible

Stages of Entrainment Confronting the Pain and Letting Go Patient sits quietly and listens Improvisation created: sounds of onset of pain, progressing to a peak of pain, and then diminishing of music and movement into healing sounds Resonance with pain by therapist Dileo, 2013

Stages of Entrainment Healing Interview Processing of the experience: Feedback on the pain and healing music

Evaluation Did music match pain precisely….if not, what could be changed Degree of resonance Delayed responses Longevity of responses Does entrainment open up layers of feelings, what has been repressed? Dileo, 2013

HEALING ASPECTS OF ENTRAINMENT Empathy for pain expressed in various ways Pain is perceived as external to patient Pain can be viewed objectively Dileo, 2013

Contact cdileo@temple.edu www.temple.edu/musictherapy www.temple.edu/boyer/researchcenter