Amanda Wilde (Host): Music can influence your mental state and your physical well-being. And because of that, music is a powerful tool in the world of health. Today, we are diving into the transformative realm of music therapy. In this episode, we unravel the power of melodies, rhythms, and harmonies in enhancing our well-being. Join us as we explore music therapy and its practical uses in healthcare with therapists, Janelle Mitchell and Becca Kelly.

This is Flourish, a podcast brought to you by Prisma Health. I'm Amanda Wilde. Janelle, Becca, thank you so much for being here to talk about the relationship between music and health. And Janelle, I'm going to start with you and music therapy itself. How does that differ music as therapy from simply listening to music for pleasure?

Janelle Mitchell: Music therapy is the therapeutic use of music to address non-music goals. We are a therapist first, and then we use music as the medium to address a variety of goals. Becca and I both work at children's hospitals, so those goals could look like supporting procedures through pain management and distraction, promoting rehabilitative goals, normalizing the hospital experience, teaching coping skills using music, self-expression, and we do address neurodevelopment specifically in the NICU.

A lot of times I'll hear someone say, "Oh, listening to music is my therapy," or "Talking to my friend is my therapy." And just knowing that unless it's facilitated by a credentialed therapist, counselor, psychologist, or music therapist, it's not technically considered music therapy. And just knowing that we have a specific training and education to complete in order to hold the title.

Host: Can you talk a little more about that, Janelle, the training and education you need to be a music therapist?

Janelle Mitchell: Yeah. So, we have to have a degree, at least a bachelor's or master's equivalency from approved programs. You have to complete a six-month internship, and we have to sit for a board certification exam to hold the credential MTBC. We have to be proficient in guitar, piano, voice, and percussive instruments, because we have a lot of adaptive instruments and equipment that we utilize here at the hospital. And we have a basis of training in psychology, behavior, how music in the brain works, how music can affect the brain, and then overall development.

Host: So ,you have to be a musician, a health care worker, and a psychologist.

Janelle Mitchell: Well, I mean, we do counseling-based interventions, yeah, to help our patients process, you know, especially if they're a new diagnosis, what they're going through. And so, we have some of that foundational knowledge, yes.

Host: I think it's so interesting that you have to be proficient in several instruments, and then you have a specialty, right? What is yours, Janelle?

Janelle Mitchell: Well, I started on clarinet, and I went to Florida State, and that's how I auditioned just to be in the studio. But I only had to do that for two years, because you have to be able to sing, because we do patient-preferred music, so if a patient likes Taylor Swift or they like Broadway. You know, I love rapping with patients too.

Host: Oh, wow.

Janelle Mitchell: Yeah. We have to really be able to learn it all, and guitar is such an easy instrument and versatile, so we can kind of, you know, take that song and try to replicate it on guitar for patients, but we manipulate the music. But everything we do is live, for the most part, live music that we use.

Host: That's pretty amazing. And Becca, you came in training on voice, right?

Becca Kelly: I sure did. And honestly, I've got to give a shout out to Janelle on the rapping. That is not a skill a lot of music therapists have, but she is amazing at it. I mean, maybe lots of music therapists have it, but Janelle is extra awesome.

Host: Well, Becca, turning to you, can you shed some light on the origins of music therapy, how it evolved, and how it became a recognized therapeutic practice?

Becca Kelly: Yes. I think everyone knows that music is very powerful. And so throughout history, even back in biblical times, you think of David and Saul, and David being able to calm Saul's anger through his music and through his harp. And that of course is, you know, not necessarily music therapy, but knowing that music is so powerful.

And so, really how music therapy developed as a career, as a profession, is that after World War II, the soldiers came home and a lot of them were experiencing what we now call PTSD. And they realized that music was helpful in their therapies with these soldiers. So, music therapy was kind of born from that experience. But since the war, post-war, it's grown so much. Now, it's not just music with veterans. Of course, we've got music in all sorts of areas, you know, in schools, in rehab units, in psych units, and of course, children's hospitals, our favorite, and nursing homes, hospice. And there's specific training now for NICU music therapists, hospice and neurological music therapists, just to name a few.

Host: It's a language everyone speaks. It unites all of us.

Becca Kelly: It really does.

Host: Janelle, before we get into how it actually works, do you run into any common misconceptions when you encounter people experiencing or starting to think about music therapy for the first time.

Janelle Mitchell: We definitely do get a lot of different reactions, I'd say, because our Children's Hospital is connected to our main hospital, and so if I walk through with my guitar in my back, I do get sometimes comments, but a lot of people at children's hospital understand. Becca's been here over 20 years, so they understand when they see us come and they know us. But yes, music can be used as a medium in multiple ways, which can be confusing. We go to concerts, we hear it on the radio, there's music education in the schools and just how to learn how to read music. But we are not teachers. We're not entertainment. We're not performers, even though sometimes we do get called that, because people just don't understand what we're doing. And then, you know, they associate music with all these different mediums.

And relating to other therapies, physical therapy, they address physical goals. Speech and language, SLPs, address speech and language goals. And music therapy, we don't address music goals. We address all of these different goals that I mentioned, some of them I mentioned previously, but we do it through music, through a medium. And so, that can look very differently depending on what we're working on. And so that, again, when someone sees us with a guitar, that's probably what they think of, but we're not.

We do a lot of education here, especially with new staff. We have to do a lot of in-service and just kind of explain how we're different and why it's therapy and not all the other things you can think of when you hear music.

Host: Yeah, I like the way you put it. Your goals are not music goals, they're therapeutic goals using music. So, can you get a little deeper into kind of the roles and activities you engage in as therapists to assist individuals in their therapeutic journey?

Janelle Mitchell: Yeah. So first, when we meet a patient, we complete an assessment. That can be we might be seeing them for a procedure, so that's a quick assessment, or it might be someone we're seeing for multiple sessions. So, here at the hospital, you kind of have to be flexible and adapt a lot of times. So, we address a lot of variety of goals, so there might be multiple goals on the plate we could address, and so we have to prioritize them.

So, for example, if a patient is experiencing pain, we may address that goal first because pain may impede engagement and other goals or therapies. So, music can be a non-pharmacological intervention. We can decrease the amount of medication needed because maybe we can help in between those doses, different things like that, so a patient wouldn't need a bolus necessarily. And I mentioned we do patient-preferred music and we do age appropriate interventions, so, you know, we're going to respond better, you know, by music we like and be more motivated.

So back to pain management, we have different interventions and protocols we utilize. And one of them is iso principle that a lot of music therapists use in different ways. But here at the hospital, during a procedure, if a patient's experiencing pain, we match them with the music behaviorally if they're hooked up to the monitor, which all our patients on the ICUs are. We try to match their heart rate with the intensity of the music. And then from there, since everything we do is live, we manipulate it to take the patient where we want them to go. So, we might slow it down. We might make it not as loud and kind of slowly dissipate into nothing in order to increase relaxation, decrease agitation. So, just taking stimuli at a higher level and then kind of slowly making it very minimal. And oftentimes with patients, they fall asleep. So, you have a patient that's having pain and awake. But then, we're able to get them to soundly fall asleep a lot of times. So, we use that principle with a lot of different interventions to help, but that's specifically what we use for pain.

That's just naming one thing. You know, I could go on a lot for what we could do and how. But we can use songwriting for self-expression. So, we have patients, if they're a new cancer diagnoses, they're trying to process everything they're going through, we can do that through songwriting. We also have a music room here in our office. So, the patient can actually come to the music room and record it. The music room acts kind of like a recording studio. We have a drum pad set, we have an electric guitar, we have pianos, we have the whole gamut and a whole system, mix board for them to record that project. And then, there's others too that I've listed. I don't know how long, how many goals I can talk about, but those are some of the ones we can work on.

Host: I think Becca had said earlier that it was patient-driven, and you've just described a bit about how music therapy is specifically tailored to aid patients as individuals in their own healing process. Janelle, what specific health benefits have you seen documented through the application of music therapy?

Janelle Mitchell: In order to do music therapy in the NICU specifically, you have to be NICU-certified, which I am, and that's a lot of where my passion is as well. I had a patient who was post-surgery, and they were having a lot of pain, mom was there. And during the music therapy session, you know, afterwards, she commented on how much calmer her baby was post-surgery than she has been without music. So, it was really touching to know that I had that impact. But then also just, you know, I had a patient once who was having dressing changes every other day or they were having them fairly frequently, and I provided support for one of the times they were having that dressing change. And I remember nurses saying that is the best it's ever gone with the presence of music therapy, because that was the only difference, so just being able to see those little moments, you know, just overall. We had a patient that was intubated and sedated on our ICU and they were agitated and they could tell based on their elevated heart rate. And when I went in there, the heart rate decreased, so we were able to see it. And then, that's some of the things we chart and document on in our charting system. So, being able to see that for other staff to know that, you know, "If this happens again, you know, call us, and we can be there for that as well.

Host: And that's an instance where you can really see the changes. Becca, from your experience, what do you see in terms of positive changes or benefits that patients experience through the music therapy sessions?

Becca Kelly: So many. All the ones that Janelle mentioned. And then also, and I know Janelle and our whole music therapy team here has experienced this, when you go into a room and you're interacting with a child and you know you're having a great session. And at the end, a parent says, "That's the first time they've smiled all week. That's the first time they've smiled since they've been here," just the good feelings you even give to the parents that they know that their child's mood has been elevated, that they know their child is engaged.

Other things I love about the music therapy and the healing and all those things with it is, just when we have groups, music groups, a hospital can be very isolating to children. They are taken out of their school, their normal setting. And when we have these groups and connect other kids their age, if it's a drum circle or just a group in the playroom, socializations and friendships can be made at a place that can be isolating. So, that always warms my heart.

And I think it's, in general, just seeing the positive impacts it has, not just on the patient, but their family and even on the staff, that everyone feels the patients were given a choice and were part of something proactive to do in their procedure or in getting themselves better. So, I think just the empowerment of patients is one of my favorite things.

Host: Is there going to be more scientific research or is there a whole body that supports the efficacy of music therapy?

Janelle Mitchell: Yeah. So, we have our two journals, Music Therapy Perspectives and Journal of Music Therapy, which we get it quarterly, I believe. We have research and nursing journals, pediatric journals. We are kind of published all over. And there's also neurologists that do use music and how it impacts the brain from their training. And so, we're able to take that and then kind of implement it, because we're feet-on-the-ground implementing the intervention so we can take a lot of their research and utilize it. So, we have lots of results. And again, with our journals we can work in the NICU to end-of-life, so really the whole span of life. And so, specifically to children's hospital in the NICU, research shows infants can get discharged sooner and gain weight. We decrease pain perception, increase patient satisfaction scores. So, I have a whole list of all of the benefits, but that research has stated specifically to children's hospital and the NICU. But yeah, there's lots of benefits that we've documented and have to kind of reference to justify what we do too.

Host: And Becca, for families interested in incorporating music therapy principles at home, are there some practical tips or activities you can recommend?

Becca Kelly: Sure. Janelle was talking about, you know, using music to help children relax and even sometimes them falling asleep. I think that relaxation piece, sometimes you have children who have a lot of pain, they have a sickle cell crisis. You know, what do you do with that at home when you're not in the hospital? Can you make a music list? You can make one in the hospital with the music therapist and take it home with you. You can use it there. You can use music principles as part of your bedtime routine to wind down at night. Janelle was talking about the iso principle, but in a very small way, to maybe start with more energy, faster music, and slow it down, slow it down so that you are maybe at the end just concentrating on the breath and that helps a child to fall asleep.

So, some of those things are very easily put to practice at home. Using music to help you calm down, to channel emotions, all those things are such a good way to use music.

Host: Are there any specific resources that you would point people to for families who want to utilize music as a therapeutic tool as part of the household routine?

Becca Kelly: As part of the household routine, honestly, I mean, things like Headspace, some of those Calm apps are very helpful. But just personally, if I was going to tell you, just listen to the music you love. Just sing, even if you think you can't carry a tune in the bucket. Dance, people may be watching you, but it really does make you feel good. Try composing music. Why not? Just make music a part of your everyday life, because we as humans are just really meant to live and feel deeply all these emotions, and music is such a great way to do that.

Host: Music therapists, Janelle Mitchell and Becca Kelly, thank you so much for explaining your work and for the work that you do.

Becca Kelly: Thank you.

Janelle Mitchell: Thank you for having us.

Host: For more information and to listen to additional episodes of Flourish, visit prismahealth.org/flourish. This is Flourish, a podcast brought to you by Prisma Health.