The Role of Music Therapy in Addressing Anxiety in Palliative Care – Part One
A blog post written by Andrea Bryk, Registered Music Therapist, Peninsula Home Hospice
As a registered music therapist working in palliative care, [1-2] one of the most common referrals is to address client anxiety. Anxiety can present itself in many forms; loss of sleep, foggy thinking, or inability to focus. Anxiety amplifies many physiological symptoms such as shortness of breath, dizziness, and pain. Often, patients who need oxygen or have Chronic Obstructive Pulmonary Disease (COPD) have a perceived risk of death that naturally increases anxiety.
Psychologically, a client can be caught in a spiral of thinking about what lies in the future (reinforced by a schedule of medical appointments, treatment, scans, outcomes, follow-ups) and pondering questions that cannot be answered with any degree of certainty. So much focus is placed on the person's physical response to medical interventions while there is an unbalanced proportion of attention to the health of the mind. In addition, these clients can be living in an overstimulating environment or have a history of limited resilience building.
In my experience, the indications of anxiety are usually obvious and present to other members of the interdisciplinary team and lead to a referral to music therapy. The Edmonton Symptom Assessment Scale (ESAS) provides healthcare workers a measure of symptoms such as anxiety. Generally, interventions are suggested for clients whose anxiety is above 3/10 on the scale.
Whilst there seems to be numerous barriers to overcoming anxiety, these clients, predictably, often have a vivid imagination and astute focus. The paradox is that some of the traits that can cause suffering can be used very productively on the other end of the spectrum to create a great sense of calm and well-being. Changing the focus from imagining what the future holds to noticing comfort in the present moment and redirecting attention to a space of safety and comfort is usually the key to decreasing anxiety. [2] Music therapy interventions, specifically the use of music based relaxation programs, can provide an anxious person the opportunity to experience peace in the moment. [3] Imagery, including a simple visualisation helps the brain to become focused. The music can provide a comfortable and supportive grounding. [4-5] Music Therapy has been shown to have a significant effect on decreasing anxiety in palliative care settings.
The typical care plan goals for an anxious client include:
- decreasing or managing anxiety symptoms
- providing a sense of comfort and grounding
- identifying psychological support
- educating on the use of coping mechanisms
- the importance of balance in body and mind.
It is essential to develop trust with the client. I often use the power of suggestion to motivate a shift in thinking, and agree on the aims of the program together. For example, after a music relaxation intervention, I might suggest they will sleep better or notice a change in how they go about daily activities.
The following points are identified in the assessment phase:
- history of relaxation/meditation/mindfulness practice
- previous coping mechanisms
- the person's response and connection to music.
It is important to ascertain the need to:
- validate the use of music therapeutically
- provide education regarding healthy/unhealthy uses of music
- offer guidance when self-discipline is a challenge
- recommend additional psychological support in tandem with music therapy.
Due to the nature of community home visits and long periods between sessions, I can provide resources for private use outside therapy sessions such as the use of recorded music CDs and the use of tailored, guided relaxation with music in digital format.
PART TWO of this blog will discuss the use of music based relaxation programs which can provide an anxious person the opportunity to experience peace in the moment.
References
- Aldridge, D. Music Therapy in Palliative Care. Philadelphia, PA: Jessica Kingsley Pub; 1999.
- Tolle, E. The Power of Now: A guide to Spiritual Enlightenment. Sydney, NSW: Hodder; 1999.
- Groke, D & Wigram, T. Receptive Methods in Music Therapy. Philadelphia, PA: Jessica Kingsley Pub; 2007.
- Warth, M. et al. Music therapy in palliative care. Dtsch Arztebl Int 2015; 112: 788-94.
- Clements-Cortes, A. & Varvas Klinck, S. Voices of the Dying and Bereaved: Music Therapy Narratives. Dallas, TX: Barcelona Pub; 2016.
Please see attachment (489KB pdf) to access the full blog.
Andrea Bryk (RMT, MMus) is a music therapist at Peninsula Home Hospice providing community palliative care services for the Mornington Peninsula area of Victoria