A more fluid way of presenting music experiences also allowed the therapists to act authentically and with loyalty to treatment facility values and their own client-centered leanings. Typically, core experiences were completed within the session time frame. Occasionally, if warranted, a core experience was repeated or continued in the following session. A complete listing of core experiences appears in Appendix C. Closure of the session was verbal or musical with a verbal component, depending on the nature and outcome of the core experience.
At this point, the women were invited to complete the post-session question and all surveys were collected by one of the therapists and placed in a designated envelope before the participants went to lunch. This assistant was blinded to the purpose of the study. A sign test was conducted by the secondary author, a professional statistician who had no connection to the treatment facility and no contact with the women.
Because the objective was to investigate whether women would report a decrease in anxiety, pre-session scores of 1 and, thus, with no potential for a decrease were eliminated prior to this analysis. A total of 53 women participated in at least one group music therapy session, yielding 53 data pairs.
Of these, 29 women Fourteen of the 53 women Incidentally, none of these 14 women reported an increase in anxiety after the session. There were 39 women Of these women, 33 Two women 5. Four women Table 1 shows the various degrees of change for all three categories. A sign test was carried out using scores from the 39 women who reported pre-session anxiety to determine whether the anxiety level had decreased overall for these women.
Table 1: Number and percentage for 39 surveys indicating various degrees of change. The purpose of this study was to gather information about the self-perceived anxiety levels of women with addictions who participated in group music therapy as a foundation for further research on the topic and effective clinical practice with this clientele. Our predictions that a majority of women surveyed would report some level of pre-session anxiety and that most of these women would indicate a post-session decrease were supported.
Scores indicate that nearly three quarters of the respondents entered their first session with anxiety. The vast majority of these individuals registered a decrease post-session, with the magnitude of change ranging from 1 to 4 points on the 7-point survey scale. There are many plausible explanations for this desirable outcome. One optimistic interpretation is that the perceived change resulted from a factor integral to the therapy itself, such as the musical and verbal interventions that were employed in the sessions.
Had it been possible within the facility to employ a comparison group and control for confounding variables, one might more confidently conjecture a causal relationship. Unsolicited verbalizations by the participants at the close of sessions and written statements on their surveys, however, do offer some support for the supposition that the music therapy experiences themselves promoted a positive change in affect.
In particular, instrumental re-creation e. This feedback is consistent with published research about drumming in addictions treatment Mikenas, ; Winkelman, Vocal re-creation e. Another conceivable explanation for the reported decrease in anxiety relates to the power of suggestion. As noted above, experienced members of the group sometimes spoke at the start of the session about the benefits of music therapy. More often than not, these veterans relayed that music therapy had improved their mood, helped them to relax, boosted their self-esteem, and contributed to a general sense of wellbeing.
Unfortunately, we did not track in which particular sessions the returning members shared their positive perceptions. This explanation may apply particularly if initial anxiety scores reflected reactions to interpersonal incidents or situations in the group, which the women did, in fact, mention from time to time. Even so, the case could be made that the music interventions, which were designed to promote group cohesion, served as a catalyst for the resultant decrease. Two women, each in a separate session, registered a 1-point increase in anxiety.
It could be that they simply were more prone to anxiety than their peers and thus more resistant to influence in a positive direction. Another explanation is that they were experiencing withdrawal symptoms or had been diagnosed with a Substance-Induced Anxiety Disorder DSM-IV-TR, , in which symptoms of anxiety develop during or within a month after severe intoxication or withdrawal. It could also be that these particular women experienced interpersonal anxiety i. They may have been experiencing difficulty with their anti-anxiety medications, a situation frequently referenced by study participants.
Or, if they were smokers who did not have a cigarette break immediately prior to meeting, which did occur occasionally, their anxiety may have mounted during the course of the session. Of course, the possibility that anxiety increased for these two women as a result of a particular intervention must not be dismissed. Music can elicit profound and idiosyncratic emotional responses, neither giving us warning nor seeking our permission to do so.
For a woman with addictions, particularly in the beginning stages of the recovery process, this emotional vulnerability may pose a threat that "kicks off" or exacerbates situational anxiety. Negative affects may arise from both endogenous sources e. In the absence of a repertoire of healthy coping strategies, such compensatory use of substances to regulate affect—whether consciously or unconsciously applied—has implications not only for the development of an addiction but also for lapse and relapse after a period of abstinence Ficken, ; Khantzian, Kassel and Veilleux assert that.
It ought to be stated here that the goal of therapy including music therapy may not always be the reduction of anxiety—or for that matter, the amelioration of any distressing affect.
In the present study, the amelioration of anxiety was, in fact, a desired outcome as part of a more comprehensive aim to help the women explore and develop strategies to cope with their addictions. Treatment was short-term, and the facility philosophy was considered supportive Wheeler, rather than confrontational or analytical. The pre-test post-test design afforded some rigor, but the lack of a comparison group prevents suppositions of causality and generalizability.
Neither blinding of clients nor researchers was possible, and testing and social threats may have influenced the findings. Additionally, in our interpretation, we must account for situational variables over which we had no control e. Accordingly, we would be well served by further inquiry to garner meaningful information about the anxiolytic properties of the four music therapy methods and their variations Bruscia, Carefully designed studies within both quantitative and qualitative paradigms are needed to answer salient questions and improve clinical practice with women who have addictions.
Randomized controlled trials will help us to build a base of empirical evidence of cause-effect relationships between specific interventions and anxiety levels of people with addictions. Comparisons between the methods, as well as between music and other modalities, individual and group therapy, single and multiple sessions, sub-clinical and clinically diagnosed anxiety, and men and women would be of particular value. Ultimately, this will enable us to design and facilitate meaningful interventions aimed at empowering women to tap into existing personal resources for recovery and discover new ones.
And, with the ever-increasing awareness of the profound and enduring somatic and psychological correlates of traumatization among women, we strongly encourage further investigation of the role and benefits of music therapy within trauma-informed models of addiction treatment. In spite of identified limitations, the results of this inquiry present a compelling case for the use of music therapy with women who experience situational or chronic anxiety as a feature or outcome of their addictive disorders.
According to criteria in the Substance Use and Addictive Disorders category, a person may use or abuse a substance without demonstrating dependence on that substance. With dependence comes tolerance i. Furthermore, the words chemical and substance tell us that the individual is using alcohol and other drugs, whereas the terms addiction or addictive disorder connote not only substance dependence, but other compulsive behaviors, such as gambling.
In this report, for the sake of consistency and to reflect the fact that many of the study participants were not only dependent on substances but also revealed other compulsions, we have used the term addiction unless specific literature with different terminology is being cited. Apart from definitions in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR , perhaps the most commonly accepted nomenclature comes from Spielberger and colleagues, who distinguished between two types of anxiety in the development of a broadly used anxiety inventory Spielberger et al.
Trait anxiety , on the other hand, is chronic and intense distress. In both types, psychological angst and discernable physiological changes frequently go hand in hand. Albornoz, Y. The effects of group improvisational music therapy on depression in adolescents and adults with substance abuse: A randomized controlled trial.
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