Music. A creation of sound, fusing rhythm and melody. It is part of all cultures, all over the globe. We often take music for granted because it is so readily available to us. Elevator music, CDs, radios, headphones, concerts, TV, commercial jingles, music while on "hold" on the telephone-a seemingly endless source of music that engulfs us wherever we go. Do we listen? Really listen? Are we aware that our bodies respond to music even if we are not consciously aware of what we are hearing? More important for our purposes here, do we recognize the nourishing and healing powers of music?

     The shamans believed that music was an essential part of many healing rituals, and often chanted or drummed as they cared for their clients. The ancient Greeks, such as Pythagoras, believed that music had great physical and sacred powers. Music has been regarded as a "bridge" between the sacred and the profane or secular worlds in many traditions. Listening to certain types of music, particularly the music of Mozart, seem to improve short-term abstract reasoning (as shown in the research of Gordon Shaw and others).

     Today, as we approach the year 2000, more and more research is focused on the application of music as a therapeutic tool. Nursing research has demonstrated the value of music, both used alone and in conjunction with imagery, in pain management, symptom management, and relaxation in a variety of health care settings. Music therapy as a professional discipline has demonstrated the psychological and behavioral applications of both listening to and playing music instruments.

Musical Therapy
     A classic example of the healing properties of music, and its role in health maintenance, can be found in the works of 20th century French physician Alfred A. Tomatis. Dr. Tomatis was called in to evaluate the declining health of a group of Benedictine monks. Other specialists were puzzled by the monks' symptoms, which included general malaise and inability to perform their daily duties, and could not be traced to any disease or disorder. Tomatis proved that the monks became ill when they gave up their time-honored practice of chanting for 6-8 hours every day. When the chanting was restored to its schedule, the monks returned to health. Bradford Weeks summarized Tomatis' work as proving that "sacred music... appears to be a form of health maintenance for monks across cultures" [Bradford Weeks, "The Physician, the Ear and Sacred Music," in Music: Physician for Times to Come . Don Campbell, ed. (Wheaton: Quest Books, 1991)].
       
       Some additional comments about the healing properties of music were quoted by Barbara Crowe. Speaking to a group of music therapists about the true nature of music and music therapy, Crowe was able to put together a patchwork of definitions and testimonies about the importance of music in our lives:

music is... "the resurgence of self'

...."a development of the spiritual within us"

...."moisture from the drops of music [which] nurtures and supplies vital nutrients to our physical and emotional well-being. We become healthy. We flourish as a species. We prosper. We grow. We laugh. We cry. We dance. We sing. We love. We live. We become one."

....Music therapy is a personal power made manifest.

"It is a map to the place where strength and well-being and love lie buried deep inside us all."

"It is a force to create change from within, to find the healer in all of us."

[quoted by Barbara Crowe, "Music: The Ultimate Physician," in Music: Physician ]

     The implications of music as a therapeutic tool have been the topic of a variety of books and articles, and extend beyond the scope of this book. (Please look in the bibliography for additional readings on this topic.) For our purposes, it is important to know some of the key effects of music on the mind and body in order to better apply music as a tool for stress management. Drawing from the writings of holistic nursing researcher Cathie Guzzetta, listening to music has been shown to have the following effects on humans:

      1. enhanced creativity
      2. increased awareness of the body and facilitation of the mobilization and release of energy
      3. improved learning
      4. correction of unhealthy unconscious thought patterns
      5. facilitation of reframing and processing past experiences
      6. enhanced ability to evoke imagery for therapeutic purposes
      7. the facilitation of mental suggestion and enhancement of clients' own self-healing capacities, whether to promote relaxation in coronary care units or assisting with pain management in a labor and delivery setting

      [Cathie Guzzetta, "Music Therapy: Nursing the Music of the Soul," in Music: Physician ]

     You may be wondering how music can achieve such profound effects on a person's mind and body. The explanation lies in an understanding of how our bodies work. We are innately rhythmic beings: each time our heart beats it sends out vibrations which reach every cell in our body. We are very literally a walking collection of pulsating, vibrating atoms. Life is rhythm.

      Again paraphrasing Guzzetta, our bodies are transformers, sending and receiving sound waves. We respond to the vibrations of other objects. Music is sound; sound is created by vibrations. The rhythm of the music is its pulse, and will impact on our internal rhythms. Different pitches and melodies will trigger different emotions and moods. It is this connection at the most elemental, cellular level that allows music to be so powerful and to have such a deep effect on us. Music can alter both physiological and psychological processes.

       Enough theory. You can gain a deeper understanding of the relationship between music, mind, and body by completing the Music Self-Assessment Tool. Once again, this assessment tool can be used with clients in the health care setting as well as for you as an individual. Before you attempt to use music as a therapeutic tool, you must know how you or your client would react to it; each person is different.

Music Self-Assessment Tool As with all the exercises in this book, take this as an opportunity to gain a better understanding of yourself, and to learn how different creative arts can become a part of your overall stress management and wellness program 1. when you think of music, what are the first 3 words that come to your mind?  _________________________________________________________ _________________________________________________________ 2. When do you listen to music during the day? Check all the answers that apply to you: while in the car                                                                       ______________ to relax while at work                                                           ______________ at bedtime                                                                              ______________ when you get up in the morning                                       ______________ for entertainment purposes                                               _____________ for excitement                                                                        _____________ for relaxation                                                                          _____________ while sleeping                                                                       _____________ while doing other things                                                     _____________ to assist with meditation or spiritual pursuits               _____________  while exercising                                                                    _____________ other: ____________________________________ 3. What types of music make you feel upbeat and active? _______________________________________________________ _______________________________________________________ _______________________________________________________ 4. What types of music help you relax? _______________________________________________________ _______________________________________________________ _______________________________________________________ 5. Have you ever participated in relaxation or imagery techniques which incorporated music? If so, how did you feel about the experience? _______________________________________________________ _______________________________________________________ _______________________________________________________ 6. Have you ever used music to help with relieving pain or anxiety? If so, how did you feel about the experience? _______________________________________________________ _______________________________________________________ _______________________________________________________

     What did you learn from this tool? Most people find that they hear music a surprising amount of time, even if they are doing other things simultaneously. The therapeutic effects of music are greater if we are being intentional in our listening, or focusing on being present with the music rather than using the music as background noise.

     The next phase of the music self-assessment process is to learn how your body responds to music on a physical level. As we discussed, the rhythm of a piece of music can have a significant effect on a person's internal rhythm. This next exercise will illustrate that principle for you.

Music Self-Assessment Tool, Phase II For this part of the assessment, plan on spending 45-60 minutes listening to music and answering the questions which follow each selection. The equipment needed for this portion of the tool is quite simple:           a cassette recorder or other source for playing recorded music;           a watch or clock with a second hand;           music selections from the following categories:           one "hard rock" or very fast jazz piece with a rapid beat;           one "classical" piece with a slow, regular beat (Baroque pieces tend to work very well here; cue the tape or CD to sections marked 'largo,' 'adagio,' or 'slow);            one of your favorite selections from any type of music. Instructions:           Plan to complete this exercise at a time when your mood is fairly  'neutral,' neither excessively relaxed or anxious. Assemble all  materials            ahead of time so that you can just enjoy the experience. Sit down and make yourself comfortable, and within easy reach of the cassette player. Begin by counting your pulse. Write down your baseline heart rate__________ beats per minute. Now begin to play the fast selection. Let it run for 15-20 minutes. Just listen: don't do any other activities while you are listening. When it is finished, re-count your pulse rate: ___________beats per minute. How would you describe your emotional state after listening to the fast music? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ How does your body feel? Any tension anywhere? ________________________________________________________________ ________________________________________________________________ Now begin to play the slow selection for 15-20 minutes. When it is finished, count your pulse:__________ beats per minute.       How do you feel? _____________________________ Describe your emotional mood:_____________________________________ ____________________________________________________________ ____________________________________________________________ How does your body feel? Any areas that feel different after you listened to the fast selection? ________________________________________________________________ ________________________________________________________________ Now play the third selection, again listening for 15-20 minutes. How do you feel when you listen to it? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Do any images come to mind when you hear it? _____________________________________________________________ ________________________________________________________________ Does it feel fast or slow to you as you listen?___________________________ What is your pulse rate now?________________ beats per minute. Take a few more minutes to write about what you learned from this exercise:    _____________________________________________________________    _____________________________________________________________   _____________________________________________________________   _____________________________________________________________

     As stated before, each person reacts differently to music. You have learned how your mind and body react to a few types of music, and this information can be very valuable for you. By learning what types of music help you to relax, you can incorporate them into your overall stress management program. If you are a health care professional, you can work with your clients to help them harness the healing powers of music for themselves. Many hospitals maintain a library of music cassettes for their patients, with different types of selections available for relaxation, inspiration, comfort, or whatever purposes the patients wish. You can do the same for yourself.

     As you plan how you can use music for stress management, there are several principles which you should keep in mind. First of all, Guzzetta discusses the "iso-principle" [Guzzetta, "Music," in Music: Physician, p. 274]. This refers to the fact that it is helpful to match the music selections to the mood of the person. In other words, if you are feeling happy and upbeat, you will feel most comfortable listening to upbeat music-not a dirge. If you feel very tense and nervous, jumping immediately into a very slow, meditative piece of music will seem like a sonic "jolt." It is more effective to begin with a few minutes of a piece that seems to resonate with your mood, then add selections that move you to a progressively more relaxed state. De-escalate your mood and your physical signs of stress by de-escalating the music.

     A second principle is that of entrainment. This means that if two vibrating objects are placed near each other, the more weakly vibrating of the two will begin to "lock-in" with the rhythm of the stronger one. This is one reason why listening to loud rock music increases the heart rate of many people, or why a loud march tends to incite people to stand up and move. The vibrations and rhythm of our bodies change over time in response to the stronger pattern of the music. If the vibrations are basically similar, it reinforces our internal rhythms.

     At this point, you may be wondering where to start. How to select the music which will give you the optimal therapeutic benefits and relaxation. Although each person has unique tastes in music, there are certain selections which have been very successful with stress management groups I have taught. I suggest these pieces based on this experience. Experiment for yourself and see what works for you at different times of the day, and for different purposes.

Suggested Musical Selections for Stress Management
General Relaxation:
     Gregorian Chant: there are numerous recordings of chant performed by        both male and female choruses. Look in any record store or "New Age" bookstore. This music is very effective in relaxation and promoting a general sense of well-being.

     Baroque music is very popular, pleasant to listen to, and easy to find at most record stores. Some suggestions: Pachelbel's Canon in D is slow and rather tranquil; Albinoni wrote a number of "Adagios" which are very lovely and soothing; Bach's Cantatas may also be soothing because of their spiritual nature. Once again, listen and see what you like. One of my personal favorites for relaxation is the Goldberg Variations by Bach.

     Gabriel Faure's music, including the Requiem, tends to have a calm, ethereal quality which many of my students have enjoyed. The same goes for the piano works of Claude Debussy and Erik Satie (particularly the Three Gymnopedies).

     Almost anything played on the Celtic harp has worked well with my group s and individual clients, particularly as background for guided imagery sessions.

     Most "New Age" music has either no obvious beat, or tends to be slow and melodic. Go to the local New Age bookstore and look at the tape selections, many will have sample tapes for you to listen to before you buy. Get what you like!
     Nature sounds, such as running streams or singing loons are also very popular and easy to find. See what you think.

     These are just a few suggestions. You may already know exactly what pieces of music will work best for you; go with your instincts. As I have said, each of us is different and that is part of the fun. My personal relaxation tapes which I use might be very "nerve-racking" to another person; that's OK. Once you have the music that you like and find relaxing, repeat the Conditioned Relaxation Exercises in Chapter 5 with the music playing in the background. Follow the same basic process, just add the music. After you finish the exercise, write down the answers to the following questions:

Music and Relaxation Exercise: Evaluation 1. How was your experience different with the music as background? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ 2. Did the music help you to relax more quickly? ____________________________________________________________ ____________________________________________________________ 3. Do you prefer to do the Relaxation Exercise with or  without the music? ____________________________________________________________

     Whatever approach you find more helpful is the correct one for you to follow. Likewise, work with your client's preferences if you are working in a health care setting.

     Music also works very well in conjunction with imagery. Music helps to enhance our creativity, and to stimulate all our senses. Music speaks to our brains in its own non-verbal language, touching emotions and feelings which may not be as easily accessible with words. To illustrate how this works, and how music can make guided imagery sessions even more effective for most people, we will be completing a few exercises combining the two processes.

     The first exercise is generally called a Music Bath. What you are going to do is basically letting yourself be immersed in the music rather than water. This is a very easy, very relaxing exercise to teach your clients when they are experiencing stress or discomfort of any kind. Enjoy!

Music Bath Preparation:     Select 25-30 minutes of music which you find soothing and relaxing; it is most convenient if the selections are all on one tape or CD.      Pick a time when you will not be interrupted, turn down the lights, and sit or lie down in a comfortable position. As with all relaxation exercises, begin with a few healing breaths to quiet and I focus your attention. Continue to focus on your breathing as you give yourself permission to release and relax the tensions and stress of the day. Let it all go out with your breath. Let your breath relax and heal you.      Starting at your feet, focus on relaxing each part of your body as you continue to focus on your breathing. Slowly and naturally, just let your muscles soften as you breathe in and out...       When you feel comfortable, turn on the music.       As the sound begins to rise, imagine yourself immersed in the music as if in a soothing, cleansing bath. Let it surround you with its gentle beauty. Listen, release, and relax.      Let the music soothe you as it washes away the tension, washes away the stress. Let your self 'float' in the music. Just relax, listen, and enjoy.      Let the music play on, just listen and let go of your stress.      As the music comes to an end, begin to come back into your physical body, back into this time and place. Begin to gently wiggle your fingers and toes, let yourself move around in your chair or bed. Take in some nice, deep breaths.      As you become more fully aware of the room around you, take a moment to remember how nice it feels to be relaxed, to let go of the tension. Remember that you can return to this feeling any time you wish, just by letting the music soothe and cleanse you. Whenever you are ready, open your eyes. Stretch and move around. You are feeling relaxed and refreshed. Be well.

     Take a few minutes to write about your experience. How did it feel while the music was playing? How do you feel now? (If you are using this exercise as part of a pain management program for your client, you should suggest that they write or talk about how their body feels right now; how is the pain? Less? The same? It is helpful to have them process the experience and see if any changes in the music selections need to be made.)

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     Remember when you went on your "mini-vacation''? Combining music with an imagery experience, whether done alone or with a guide assisting with the script, can increase the effectiveness of the imagery process. The next exercise will provide an opportunity for you to repeat your vacation with the addition of the music.

     As with the relaxation exercises, you may find that some pieces of music are more imagery-provoking for you than others. Once again, experiment and see what works for you. If you do not have any specific selections in mind, I have found a few pieces that work very well as background for this exercise with most people:

Suggested Music for Imagery "Mini-Vacation"
     

Gustav Hoist, The Planets . While the entire suite is very vivid and full of aural images, the most calming sections are 'Venus" and "Neptune." Ralph Vaughan Williams, The Lark Ascending . This piece captures an ethereal, bird-like quality that is highly conducive for relaxing and floating above whatever stresses with which you may be dealing. Erik Satie, any of the Gnossienes . Piano solo works with no perceptible beat or pulse; very exotic and good for imagery work. Claude Debussy: if you can find a tape or CD with Clair de Lune, Reverie , and La Cathedrale engloutie , these three pieces work well together for this imagery exercise. If you like to chant, you will probably enjoy the music of Hildegard of Bingen. Her music is becoming increasingly popular and available in most good music stores.

     Once again, try different selections until you find the type of music which evokes the most relaxing, healing imagery for you or your clients. Another possibility would be nature sounds. If you like the beach, get a tape of the sound of the ocean surf-take a mini-vacation to the seashore!

      Get your music together, and prepare for take-off...

Music-Enhanced Imagery: The "Mini Vacation" Revisited Preparation:      Pick a period of 30-40 minutes when you will not be interrupted. Assemble your cassette or CD player and music selections to last for 30-40 minutes.      Make yourself comfortable in your chair or reclining.      Begin, as you always do, with a healing breath. Breathe in the healing oxygen. Breathe out the tension-release and relax      Let your body breathe itself, slowly and gently. With each breath, feel yourself becoming more and more relaxed and comfortable....feel your muscles softening, from your feet up to the top of your head. Just release and relax.      Continue to focus on your breathing for a few minutes.      Turn on the music.      Close your eyes, and let the music rise around you like a comforting blanket. Let your mind begin to wander wherever the music takes it. Take a journey to a special place. It can be real or imaginary. That doesn't matter, as long as it feels peaceful and restful to you.      As you near this special place, let the music help you to experience as many sights, sounds, and smells as you possibly can along the way. Can you feel the warmth of the sun? Can you smell the trees or flowers? Can you feel the grass or soil beneath your feet? Let all your senses come alive with the joy and beauty of this special place....let the music carry you along.      Spend some time just enjoying the place you have found. Enjoy the feelings of peace and relaxation. Just release, relax, and enjoy.      As the music comes to a close, begin to travel back from where you have been, telling "good bye" to any people or creatures you have met along the way.      Continue to come back, returning to your physical body by wiggling your fingers and toes...start to move around in your chair or bed.       Take in some nice, deep breaths and stretch your arms and legs.      Take a moment to remember how nice this journey has felt, and to remember that this special place will always be there for you. You can travel there any time you wish by using the power of the music and your own mind.      When you are ready, open your eyes. You feel relaxed, refreshed, and content. Be well.

Take a few moments to process your experience by writing or drawing about what you saw on your journey. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

Also take a few moments to evaluate how this imagery exercise compared with the exercise which did not involve music. Which did you find more beneficial? What changes would you like to make? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

     This section of the text explored the role of music in relaxation and stress management. As you can see, the potential applications of music within the health care setting are numerous. It is a highly valuable tool in many aspects of nursing and medical practice, once the practitioner becomes familiar with how to apply it correctly. It must again be emphasized that each client must be assessed prior to using music as a therapeutic tool: you as a health care professional must gain an understanding of how that person reacts to music before you decide to use it therapeutically. Musical tastes are highly varied, and often reflect many facets of a person's background and experience. Work with your client to determine how music, or any other stress management strategy, can serve him best.

     The next technique we will explore is the role of drawing as a stress management and wellness promotion tool. Don't worry if you are not a professional artist. This is not a drawing class. This is a program to teach you how to become a facilitator of your own healing and health improvement, and to learn how to share these ideas with others. Leave your 'inner critic' at the door when you do this work. This is for you! Give yourself permission to be!