A Pilot Study on Effectiveness of Music Therapy in Hospice in Japan
Nakayama, Hisako, Kikuta, Fumio, Takeda, Hidekatsu, Journal of Music Therapy
This study aims at determining the effectiveness of music therapy in a hospice setting. We employed the salivary Cortisol level, which is widely used to measure stress level, as an objective and physical indicator and the Mood Inventory, which measures mood change, as the subjective and psychological indicators. Though many preceding studies have demonstrated that listening to music lowers cortisol levels and reduces stress, no study seems to have included hospice patients. This study measured, with the consent of 10 hospice inpatients, their salivary Cortisol levels. Individual interviews, according to the Mood Inventory, were conducted before and after a small-group session. Since all the participants had terminal cancer, the 40-minute live session of songs of seasons and the participants' requests was given in a mostly passive manner considering their physical strength. Results showed significant lowering of salivary cortisol levels after the therapy session. As for the parameters of mood, refreshment was significantly increased. Though fatigue remained unchanged, anxiety and depression decreased while the score for excitement tended to increase. Thus, it was indicated that music therapy in a hospice setting reduces the stress level of patients and thereby plays a positive role in improving patients' quality of lite.
Full-fledged music therapy was introduced in Japan in 1967 by Juliette Alvin (Hinohara, Shinoda, Sc Kato, 1998). Since the Japanese Music Therapy Association was established by the merging of a medical-related organization and a clinical expert association that had been working separately in 2001, music therapy has been rapidly introduced in various institutions. A majority of such institutions, however, are for elderly people, followed by those for children/persons with disabilities. Very few hospice/palliative care facilities have adopted music therapy. The first hospice established in Japan is the Seirei Hospice in Seirei Mikatahara General Hospital in 1981 (Hospice Palliative Care White Paper Editorial Committee, 2006). Though hospice/palliative care started to attract attention after this, there are not yet many facilities, much less music therapists in hospice settings (Tsunetou, Shima, & Morita, 2001). Naturally, literature on music therapy in hospice in Japan is very limited. Under Japanese law, recipients of hospice admission are persons with cancer or AIDS who are diagnosed to be within 6 months or less of death (Ministry of Health, Labour, and Welfare Notification No. 93).
As hospice/palliative care is multidisciplinary, clarification of the effectiveness of music therapy in the care is sought. While group sessions are said to be difficult in Europe and the United States due to complexity in ethnic, social, and intellectual backgrounds (Munro, 1999), the great majority of music therapy in Japan are group sessions. One-on-one sessions in a private room in hospice are unpopular due to nervousness and personal reservation.
The Japanese Music Therapy Association defines music therapy as "to use music purposefully with plans to recover from mental and physical disability, to maintain our functions, to raise our quality of life (QoL), and to make changes in actions by physiological psychological social aspects in music" (Hinohara, 2001, p. 3). Since music has an immediate impact on the psychological state, such as changing mood and evoking emotional reactions that are associated with past experience, by diverting attention from a certain stressor to music, or being a positive stimulus (White, 2000), there are a number of clinical studies that have employed music to alleviate anxiety, pain, and stress (Biley, 2000; Watanabe et al., 2002; Yoshiko, Kimiko, Mizue, Takahide, & Ban, 2005). Music is also suggested to have physiological impact such as lowering blood pressure and heart rate (Knight & Rickard, 2001) and increasing the immunoglobulin A (IgA) level (Burns, Harbuz, Hucklebridge, & Bunt, 2001). …