Live Therapeutic Music

A Newly Recognized and Developing Art Form of Healing 

Live Therapeutic Music (LTM) is an art form based on the science of sound. As a complementary, non-pharmacologic intervention, LTM uses acoustic sound (presented as music) as the agent to impact a patient’s symptoms or condition, utilizing the intrinsic healing elements of acoustic music to create a peaceful environment that is conducive for healing and rest. 

LTM helps mitigate unwanted physiologic and/or psychologic symptoms. Through individual bedside sessions, a CMP’s only goal is to create a healing environment. CMPs focus on the sonic characteristics of music to impact a patient’s autonomic nervous system; selecting and modifying music based on the patient’s immediate needs, current condition, and the patient’s response to the music. Certified Music Practitioners (CMPs) are trained and certified through accredited therapeutic music programs recognized by the National Standards Board for Therapeutic Musicians.

The efficacy of LTM is supported by clinical research. In a 2015 article (based on research conducted by D. Schneider, et al. at the Mayo Clinic) researchers found that LTM improved patients’ symptoms of pain, fatigue, anxiety, and sadness while improving their ability to relax during and after therapeutic music interventions and also improved the patient’s quality of life while hospitalized.

Differece between Live Therapeutic Music and Music Therapy

LTM is not Music Therapy. “Music Therapy is where the experience of the music, including the relationship with the Music Therapist, is the vehicle for needed change. There are numerous approaches

in Music Therapy utilizing many therapeutic models, including psychotherapy, behaviorism, neurological intervention and community performance.”

Music Therapy is a goal-oriented therapy prescribed by a physician to achieve specific outcomes. Music Therapists may conduct sessions with multiple patients, use recorded music, or have patients play, sing, or compose music with the therapist. Music Therapists also help patients regain lost function (due to trauma or illness), or help them process emotions by engaging with them as they play or listen to music they might request.

How Does LTM Work?

Utilizing principles of Frequency, Resonance, Sympathetic Vibration, and Entrainment, LTM helps

mediate changes in a patient’s condition or symptoms. Changes may be observed in a patient’s heart

rate, blood pressure, rate of respiration, and / or O2 saturation percentage. Symptoms of agitation and anxiety are often relieved as patients “entrain” to various tempos and rhythms of the therapeutic music session.

CMPs carefully observe the patient and monitor the patient’s responses during each LTM session. By continuously adjusting various components of the music throughout the session, CMPs strive to create a healing environment where patients often relax, stabilize, and/or fall asleep. CMPs alter tempo, frequency, complexity, and mode to create a musical intervention designed to meet the needs of the patient.

By monitoring physiologic and/or emotional responses of the patient, CMPs modify the music as needed in order to create a healing environment.

Familiar music can help some dementia patients recall lost memories; helping them become more oriented,

lucid, and / or responsive after listening to songs they learned during their formative years. Some patients experience and release emotionally when listening to familiar music, reminding them of loved ones or events they experienced over the years. Releasing emotions often helps patients relax and center when dealing with stressful situations.

The Science Behind LTM

Resonance is the frequency at which an object naturally vibrates. Parts of the human body, varying in size and density, actually resonate when exposed to specific frequencies.

Sympathetic Vibration occurs when a passive vibratory object (a patient’s body) responds to external vibrations from a nearby source (acoustic instrument) with harmonic similarities. 

Sympathetic Resonance is the harmonic (audible) representation of Sympathetic Vibration.

The human body; bones, muscles and soft tissue, can actually resonate to specific frequencies as the body absorbs acoustic sound from instruments or the human voice. As an object begins to vibrate, adjacent objects with similar harmonic properties also begin to vibrate in Sympathetic Vibration. Sympathetic Vibration can even occur in materials of differing composition and density.

Entrainment is defined as the synchronization of two or more rhythmic cycles. When two related rhythmic cycles interact, they entrain. Any two vibrating bodies will entrain if exposed to each other long enough. Entrainment is part of the process that allows LTM to help patients relax, rest more comfortably, stabilize, manage various physiologic or psychologic symptoms, and/or fall asleep.

“Fight or Flight”, The Sympathetic Nervous System in Action

When we struggle in pain, fear or anxiety, we can experience “Fight or Flight”. As adrenaline courses through our body, heart rate, blood pressure, and respirations all increase as we rise up to either fight or flee from a perceived threat. Patients struggling with these symptoms respond in similar ways with stress and worry developing into real pain, physiologic and / or emotional distress.

The “Relaxation Response” and Para-Sympathetic Nervous System

Alternatively, when patients listen to LTM, they begin to relax. Heart rates, blood pressures, and respiratory rates stabilize. Muscles relax while symptoms of pain, agitation and anxiety begin to subside. During a 20-30 minute LTM session, the body releases natural chemicals that actually inhibit the arousal of the sympathetic system and the “Fight or Flight” response. LTM can initiate the “Relaxation Response, which helps patients stabilize, relax, rest, and continue to heal.

Qualifying Conditions for Live Therapeutic Music Referrals

LTM for patients who “might enjoy some music” does not typically qualify for a nurse’s consult order, as entertainment does not meet the clinical goals established for Therapeutic Music Programs. Therapeutic Music Programs are typically more successful where nurses understand the clinical benefits of LTM and can clearly explain those benefits to their patients. Conditions qualifying patients for live therapeutic music consult include: 

Anxiety – LTM is often prescribed to help relieve anxiety. CMPs play music based on the patient’s current

condition, then modify the music to help the patient stabilize, relax, and rest. By continuously monitoring a

patient’s vital signs and responses, then modifying the music as needed; CMPs allow the patient to ‘guide’ them through the LTM session. Patients who feel stress, fear, or anger are often able to relax and rest better during and after a LTM session.

Pain Management – LTM helps relieve perceived symptoms of pain, especially in patients who have reached their medication threshold. When patients are anxious, stressed, and/or tense, pain levels often become amplified.

Agitation – LTM is also effective in reducing symptoms of agitation by initially distracting the patient, then allowing him/her to relax and rest. LTM also relieves symptoms of withdrawal for patients struggling with substance abuse.

Respiratory Distress – Patients often relax more with LTM prior to intubation and tolerate Spontaneous Breathing Trials more easily.

Scheduling therapeutic music sessions 20 minutes prior to extubation typically provides ample time for patients to relax and become more comfortable.

Unstable Vital Signs – LTM can help stabilize vitals for acute patients through sympathetic vibration and entrainment.

Dementia / Cognitive Issues – Familiar music often helps patients remember forgotten memories lost due to trauma, dementia, or other cognitive issues. LTM can be especially effective in providing brief periods of lucidity when a CMP plays music from a patient’s formative years.

End of Life / Palliative Care – LTM often comforts patients who are transitioning. Though these patients are typically unresponsive, the intrinsic healing properties of therapeutic music helps keep them comfortable and provides a peaceful and calming environment for families to say goodbye and help comfort them in their grief.

Additional Considerations for LTM

Unresponsive patients do not need to be conscious in order to benefit from LTM, as therapeutic music is not presented as entertainment. Unresponsive patients respond to the sonic characteristics of the music played by the CMP, not on whether or not the patient might “enjoy” music. CMPs are trained to identify the subtle responses of unresponsive patients.

“I Don’t Feel Like Listening to Music Right Now”– Patients can decline LTM services at any time, but some do so by confusing therapeutic music with entertainment. When a patient (or family member) understands the benefits of LTM, they are generally more receptive to allowing a nurse’s referral for a LTM session to be provided.

This written overview was provided by Strings of Mercy, a 501(c)3 dedicated to promoting the benefits and practice of live therapeutic music.