PPLM & Mood Vectoring.docx

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Objectives: What are the neural, musical, and therapeutic mechanisms involved with mood modulation? What are possible impacts on rehabilitation? What are some roles of patient-preferred live music in medical and rehabilitative settings? How would you use the Iso principle for mood elevation? What w...

Objectives: What are the neural, musical, and therapeutic mechanisms involved with mood modulation? What are possible impacts on rehabilitation? What are some roles of patient-preferred live music in medical and rehabilitative settings? How would you use the Iso principle for mood elevation? What would you take into consideration, and how would you structure it? “Music can modulate activity in all major limbic and paralimbic brain structures, that is, structures critically involved in the initiation, generation, maintenance, termination and modulation of emotions” (Koelsch, 2009, p. 375) How is modulation different than regulation? What is the role of cognition? What MT techniques might be involved in mood regulation? - Image: (Pujol & Irving, 2016) "She made me use my affected arm; it was good" Pt initially hesitant to engage. - Emotion modulation is considered one of five key ingredients in developing a scientific perspective on music therapy (Hillecke et al., 2005; Koelsch, 2009). Music therapists have maximized on these theories and findings by strategically pairing music-based experiences with non-music activities to drive rehabilitation outcomes and impact neuroplasticity (Stegemoller, 2014; Thaut, 2014). This is achieved by pairing music-based strategies, such as music-evoked reward and pleasure, with functional activities (Stegemoller, 2017). For example moving to the beat, vocalizing, singing, and playing music. In other words, the processing of, and interaction with, music can immediately impact cognition, behavior, and emotion. (From Rushing, 2019) From the APA dictionary Arousal: 1. a state of physiological activation or cortical responsiveness, associated with sensory stimulation and activation of fibers from the reticular activation system.  2. a state of excitement or energy expenditure linked to an emotion. Usually, arousal is closely related to a person’s appraisal of the significations for an event or to the physical intensity of a stimulus.  Arousal can either facilitate or debilitate performance. p. 75 Salience hypothesis: a theory of perception according to which motivationally significant stimuli (objects, people, meanings, etc.) are perceived more readily than are stimuli with little motivational importance. It has relevance in social perception, advertising, and linguistics. p 931 Valence: 1. in the field theory of Kurt Lewin, the subjective value of an event, object, person, or other entity in the life space of the individual. An entity that attracts the individual has positive valence, whereas one that repels has negative valence. 2. in certain theories of motivation, the anticipated satisfaction of attaining a particular goal or outcome. How do we observe that someone is in an optimal state of arousal? How do we know that what is happening is salient? Affect: any experience of feeling or emotion ranging from suffering to elation, from the simplest to the most complex sensations of feelings and from the most normal to the most pathological emotional reactions. Often described in terms of positive affect or negative affect, both mood and emotion are considered affective states. Along with cognition and conation [volition], affect is one of the three traditionally identified components of the mind. p. 26-27 Volition: 1. the faculty by which an individual decides upon and commits to a particular course of action, especially when this occurs without direct external influence.  …active rather than passive response to events. p 1147 https://sway.cloud.microsoft/sPAhKWD87Twit1Af#content=JXSV3PqGD4zFV8 - Building rapport with PPLM Background: 80-year-old female with history of hypertension brought in as a stroke alert with right upper extremity weakness. Last known normal was 1830. Patient received TPA from outside hospital prior to arrival. Finger stick blood glucose on arrival was 94. Patient reports improvement in symptoms since TPA given. MT Note: Pt confirmed fatigue from PT as RN stated.  When asked about music involvement pt perked up sharing personal involvement in music.  Pt played keyboard, dulcimer, and sings.  Pt assisted MT-BC in selecting folk songs and sang each with MT-BC.  Pt sang a few songs on her own as MT-BC accompanied.  Pt states, "they want me to go to rehab" and that pt would work on use of left UE.  MT-BC shared strategies to use keyboard for movement purposes.  At the conclusion pt expressed thanks for the visit and welcomed continued services. https://sway.cloud.microsoft/sPAhKWD87Twit1Af#content=MELU8y5m0c2nP6 - PPLM in active music-making treatment - "As medical patients may initially prefer receptive interventions, PPLM may be an ideal method to develop rapport and therapeutic alliance before introducing and integrating more active interventions" (p. 1) PPLM is defined as a receptive music therapy experience involving music selected and preferred by the patient that is performed live by a qualified music therapist" (p. 2). Theoretically, PPLM allows for the development of rapport and a motivating therapeutic alliance through patient autonomy in decision-making within a supportive context (Robb - Contextual Model of Support). Outcomes can include: affective state change, pain, nausea, and physiological changes What is a difference between MT-BC facilitated PPLM & music medicine applications? https://sway.cloud.microsoft/sPAhKWD87Twit1Af#content=yi5ZOfOv0MTSok - PPLM for intervention assessment - Live music done by a music therapist has shown to be more effective than music medicine with no significant differences in effects between patient-selected and therapist-selected music (Dileo, 2006; Standley 2000). Consider the therapeutic relationship in combination with music driving neural processes. In other words the integration of humanistic approaches with neuroscience-informed approaches. The combination of human elements preference and personal goals for health and wellness with the neuroscience of music on activation of reward can have impacts on arousal, affect regulation, learning, and experience-driven plasticity. (Sena- Moore & LaGasse 2018; Sihvonen et al., 2017) - Mechanisms involved in the overlap of emotion regulation and music: Decreased activation of the amygdala Increased activation of cognitive control and monitoring areas: ACC, OFC, and lateral PFC Musical characteristics for desired activation patterns? Listening to familiar and preferred music Singing Improvising Musical characteristics for undesired activation patterns? Unfamiliar music dissonance unexpected musical events - What if I don't know their music? Vignettes: lonely island boys vet; Arirang; Always look on the bright side of life - ER Ann Humor; Learn it; recorded; music based discussion; approximate; make choice based on function https://sway.cloud.microsoft/sPAhKWD87Twit1Af#content=lOyQsOYWKRUTI5 - PPLM in termination - provide meaningful closure Objectives: What are the neural, musical, and therapeutic mechanisms involved with mood modulation? What are possible impacts on rehabilitation? What is the role of patient preferred live music in treatment? How would you use the Iso-principle for mood elevation? What would you take into consideration and how would you structure it? What neural structures and networks are involved in music and mood modulation? Mesolimbic dopamine system: VTA, NAc Limbic, paralimbic, frontal cortex ORC, ACC, PFC Amydala processing emotion, motivation, cognitive control, goal setting Reticular activation network arousal, sleep wake Not to forget auditory & memory networks What are three music-based experiences that increase desired activation patterns for emotion regulation? Listening to familiar and preferred music Singing Improvising What are three music-based experiences that increase UNdesired activation patterns for emotion regulation? Unfamiliar music dissonance unexpected musical events What are potential benefits of music-based mood modulation? Increased engagement, motivation, learning, and mood Activation of processes involved in experience-driven neuroplasticity What are theoretical considerations for improved outcomes? What approaches to music therapy have been discussed? Review content and try speaking an answer out loud. Name at least three ways you can use PPLM in practice. Rapport building - development of the therapeutic relationship and working alliance Assessment - monitoring and influencing salience, arousal, affect, and engagement Treatment - as a bridge from receptive to active engagement Affective state, pain, nausea, and physiological changes Termination

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