Music Therapy Research Proposal


The Effects of Music Therapy on Emotional

Dysregulation in Children Suffering From Child Abuse


Jewelz A. Lopez

Caldwell University

28 November 2018

Abstract

Child abuse is a prevalent issue in the United States. According to the National Children’s Alliance (2015), as of 2015 Child Protective Services protects over 3 million children, an estimated 683,000 children suffered either child abuse of neglect, and 1,670 of those children died from this abuse or neglect. The aim of this research study is to see the effects of music therapy on emotional dysregulation in abused children. One hundred and fifty child participants ages 7-18 years old will be selected from the New Jersey Department of Child Protection and Permanency and randomly assigned to one of three groups : one on one therapy, “Rock” music therapy, “New Age” music therapy. Therapy sessions will last one hour, twice a week for 8 weeks. Participants will take a pre Difficulties in Emotion Regulation Scale test for baseline measurements, a midpoint follow up test, and a post test after all sessions. Prior research has investigated the use of music therapy with other populations, as well as the effect of music therapy on anxiety, but there is not much literature on the relationship with child abuse. It is hypothesised that children in the music therapy sessions will have lower DERS scores at the end of the intervention.

Keywords: #music, #musictherapy, #emotionaldysregulation, #children, #childabuse, #neglect, #abuse



Children who have been abused have generally displayed emotional dysregulation, especially in the cases of psychological abuse (Espeleta, Palasciano-Barton, Messman-Moore, 2017). Traumatic experiences such as child sexual, physical, and psychological abuse have lasting effects including PTSD, depression and anxiety. The more emotional dysregulation present, the easier it is to predict that personal relationships will also be affected by attachment anxiety and avoidance (Espeleta et. al., 2017).

The presence of anxiety can be measured by the autonomic responses in the body such as heart rate, heart rate variability, blood pressure. Music has an influence on these autonomic responses; in ancient times Romans and Greeks had music playing in their healing spas (Bernatzky, Presch, Anderson, Panksepp, 2011). Increased anxiety can be an indicator of emotional dysregulation, therefore measuring a decrease in anxiety could be due to better ability to regulate emotion. A study on ICU patients looked at the levels of preoperational anxiety before and after 30 minutes of listening to relaxing music and utilizing aromatherapy. After 60 minutes the group who listened to music showed lower self-reported anxiety, heart rate, and lower systolic blood pressure; aromatherapy showed lower heart rate, and slower breathing rate (Chiu-Hsiang et. al, 2017). This shows that even an hour after intervention, music therapy has lasting effects on the autonomic processes linked to emotional states. “Relaxing” music and rock music have shown different effects on these autonomic responses. A style of relaxing music called “new age” has similar characteristics to natural processes such as the autonomic pattern of sinus rhythm; deep breathing also helps regulate heartbeat and evoke a relaxed emotional state ( P Rez-Lloret, Diez, Dome, 2014). Listening to the mechanical sounds in rock music promoted alertness and unpleasant feeling in healthy women (Roque, Valenti, Guida, Campos, Knap, Vanderlei, et al., 2013).

When looking at heart rate variability, low frequency power (below 0.04-0.15Hz ms2) is related to baroreflex (maintaining blood pressure levels), and high frequency power (0.15-0.4 Hz ms2) is related to respiratory sinus arrhythmia (when heart rate variability is synchronized with respiration) (Rez-Lloret et al., 2014). A study on heart rate variability with repetitive exposure to music showed an increase in low frequency power when participants were exposed to either “sedative” or “stimulating” music; the high frequency component was only increased when participants listened to “sedative” music (Iwanaga, Kobayashi, Kawasaki, 2005; as cited by Rez-Lloret et al., 2014). Bernaldi, Porta, and Sleight (2006) found that fast tempo music increased ventilation, blood pressure, and heart rates in participants while decreasing baroreflex. Slower and more meditative music proved to have a relaxing effect on these physiological measures.

The purpose of this study is to see if music therapy does better at regulating emotion than one on one therapy sessions in children who have been abused. This is an important population to target because they are more likely to develop insecure anxious attachment styles in the future as a result of the abuse (Espeleta et. al, 2017). Rock music, “new age” music, and one on one therapy will be given to the abused children to test their effect on emotion regulation. It is predicted that the group listening to the “new age” music will show more significant effects than the group that has one on one therapy. The rock music group is predicted to show less of a decrease in emotional dysregulation. If these hypotheses are correct it will highlight the importance of relaxing music in reducing emotional dysregulation in children who have been physically, sexually, and psychologically abused.

Method

Participants

Participants between the ages of 7 years old and 18 years old will be recruited from the Department of Child Protection and Permanency in New Jersey. New Jersey has a culturally and socioeconomically diverse population that will be easier to generalize results for the American population. These children will have been evaluated and identified as being victims of child abuse whether it be sexually, physically, emotionally, or through neglect. The children will be randomly assigned to either the control group, or the group receiving one of the two musical intervention; 50 children will be in each group. As a reward for their participation the children will receive a cookie after each therapy session.

Music therapy

Music therapy is the evidence-based usage of music in a therapeutic manner to address the physical, emotional, social, and cognitive needs of the client. This can be done by creating, listening to, singing, or moving to music. According to Koelsch et al. (2005), music contributes to healing by powerfully regulating socioemotional processes, cognitive status, and mood. Notably, Romans and ancient Greeks played music in their healing spas (Bernatzky et al., 2011; as cited by Rez-Lloret et al., 2014). The autonomic nervous system may be one avenue for therapeutic effects of music as it’s tempo, accentuation, and rhythm are responsible for inducing changes in physiological responses (Rez-Lloret et al., 2014). The children in either group of music therapy will receive the therapy session for 1 hour twice every week for 8 weeks. One group will listen to music in the genre of “Rock”, and the other group will listen to “New age” music. There will be a playlist of 10 songs in each genre, to help counteract boredom in the children.

Music affects the brain as well as the heart. The amygdala is influenced by the kind of music played; unpleasant music elicits negative emotions, whereas positive music and music improvisation decrease negative emotions. The hippocampus, anterior congulate cortex, nucleus accumbens, and obitofrontal cortex are also functions of emotion processing that are affected by music and music-evoked emotions (Hou, Song, Chen, Sun, Zhou, Zhu, Beauchaine., 2017). According to the evidence provided by Moore (2013), music stimulates the same regions of the brain that are implemented in effective emotion regulation. This is not the same as emotion regulation however, because evoking emotions is passive whereas emotion regulation involves emotion generation and executive control to maintain appropriate emotional responses (Hou et al., 2017).

Measures

Emotional dysregulation. This will be assessed through the 36-item comprehensive self-report measure Difficulties in Emotion Regulation Scale (DERS; Espeleta et al., 2016). The total score is comprised of six subscales: clarity, awareness, nonacceptance, ability to engage in goal-directed behavior when experiencing negative emotions, impulsivity when experiencing negative emotions, and flexible use of emotion regulation strategies. Each item is rated on a 5-point Likert scale , 1 being “Almost never” to 5 being “Almost always”. The possible total scores range from 36 to 180, however some questions have to be reverse scored. The DERS total score has construct validity and high internal consistency; it correlates with other measures of emotional dysregulation and has been utilized in other studies that took a look at emotional dysregulation (Espeleta et al., 2016).

Procedure

150 children from the Department of Child Protection and Permanency will be randomly selected and assigned to one of three groups (1) a control group that receives one on one verbal therapy , (2) a music therapy group that listens to “new age” music (3) a music therapy group that listens to “rock” music. Participants will take a baseline DERS test to determine their level of emotional dysregulation prior to their series of therapy session. Each group will have individual hour long therapy sessions two times a week for eight weeks. The control group will speak with a psychologist. The music therapy groups will listen to a playlist of 10 songs from either the genre of “rock” or “new age” music through headphones in the same room the other children had one on one sessions in.. The children will take a DERS test after 4 weeks of therapy, and a post DERS test after the therapy sessions are complete.

Expected Results

A one way ANOVA will be ran comparing the average DERS scores from the control group, “rock” music therapy group, and “new age” music therapy group. At the four week mark, both music therapy groups will prove to be effective. The control group is expected to score lower on the DERS after 4 weeks than either music therapy group. However, music therapy groups are expected to be more effective than one on one sessions after the intervention is complete - with “new age” music as the most effective.

Discussion

This study aims to raise awareness about the lasting effects of child abuse and neglect on children. In the United States there were 3.4 million children under the protection of Child Protective Service. Of these 3.4 million children, children in their first year of life experience child abuse at a rate of 24.2 per 1,000 children in the national population of the same age. Most often parents are the perpetrator; 78.1% of substantiated cases in 2015 showed the parent as the abuser (“National Statistics On Child Abuse”, 2015). Because of the importance of the child’s attachment style with their parents, child abuse can often lead to a disruption in attachment to other people and significant others later in life, as well as development of psychopathology (Espeleta et al., 2017).

Past studies have looked at the short term and long term effects of early experiences of child abuse. Common psychopathology associated are Post traumatic stress disorder, depression, general psychological distress, anger, aggressive behavior, and anxiety (Espeleta et al., 2017). These children are more likely to develop an insecure anxious attachment style or an avoidant attachment style, which results in increased marital dissatisfaction, marital divorce, and decreased relationship quality (Espeleta et al., 2017). This experiment may be able to provide an answer to help cope with the effects of emotional dysregulation, through music therapy. It is expected that the music therapy groups over the course of two months will have lower DERS scores than the group who had one on one therapy. Because of the effect the “new age” music has on breathing and heart rate, it is expected to be more effective at regulating emotion than “rock” music.

Strengths and Limitations

This study looks to build on past studies in the research of music therapies effect on emotional dysregulation. Music has been shown to evoke strong physiological responses in the brain, as well as the heart that are consistent with the ability to regulate emotions (Hou, Song, Chen, Sun, Zhou, Zhu, Beauchaine, 2017). Studies have looked at the relationship between anxiety and the exposure to various types of music through physiological arousal ( Rez-Lloret et al, 2014; Chiu-Hsiang et al., 2017). This study uses the evidence-based relaxing music choice of “new age” music to soothe the patients during their music therapy session, as well as testing the ability of “rock” music to aid in emotion regulation. “New age” music has been known to lower heart rate and blood pressure up to 30 minutes after intervention (Chiu-Hsiang et al., 2017). “Rock music” has been suggested to produce unpleasant and alert feelings. The study also uses the diverse population of New Jersey to sample children from, in order to have a higher rate of generalizability.

This study is however limited by the lack of use in measurement of physiological responses to the music therapy. Instead this study uses only the Difficulties in Emotional Regulation Scale test to measure the remedy of emotional dysregulation. This is done because measuring the physiological responses show anxiety more accurately than emotional dysregulation. However DERS is self-report measure which can prove to be less accurate; this opens the for future studies to pair another measurement with DERS to get a more complete idea of the effect of music therapy. Another limitation may be inability of the younger participants to correctly grasp what the questions on the DERS are asking, thus skewing the results.

Practice Applications

The greatest benefit of this study would be to psychologists and counselors working with abused children, but also when talking to patients who are suffering psychopathology such as PTSD, anxiety, and depression. The key in child abuse victims is the relationship attachment styles they develop as a result because this is how they develop their idea of self-worth and relationship expectations (Espeleta et al., 2017). Through understanding the lasting harmful effects of child abuse, there may be more protective services put in place, or use of public health education to prevent the cycle of child abuse from continuing. Almost a quarter of child abuse perpetrators are children under 18 themselves (“National Statistics on Child Abuse”, 2015). Music therapy may prove to be a beneficial alternative to medicinal intervention.

Future Research

This study did not make use of physiological responses to music therapy, which can provide a great deal of insight on the concrete effects of music therapy. Future research should build on the physiological aspect of the neural activity as a result music therapy. This can be instrumental in making a case of music therapy over the use of medication when dealing with victims of child abuse. In most cases, the child is of a young age where medication may not be the first option kindly considered. Because child abuse occurs most commonly before the age of 2 years old, it may prove beneficial to investigate the effects of music therapy on children of various ages. This can help determine how well children respond to the introduction of therapy after having met with Child Protective Services, as well as how long it will take before the reversal or remedy of the effects of emotional dysregulation.




Work Cited

  1. Chiu-Hsiang, L., Chiung-Ling, L., Yi-Hui, S., Mei, L. Y., Chung-Ying, L., Long-Yau, L. (2017). Comparing effects between music intervention and aromatherapy on anxiety of patients undergoing mechanical ventilation in the intensive care unit: a randomized controlled trial. Qual Life Res, (26) 1819-1829. http://doi.org/10.1007/s11136-017-1525-5

  2. Hannah C. Espeleta & Sarah Palasciano-Barton & Terri L. Messman-Moore. (2017) The Impact of Child Abuse Severity on Adult Attachment Anxiety and Avoidance in College Women: The Role of Emotion Dysregulation J Fam Viol (2017) 32:399–407 http://doi.org/10.1007/s10896-016-9816-0

  3. Jiancheng Hou,1,2 Bei Song,1,3 Andrew C. N. Chen,4 Changan Sun,5Jiaxian Zhou,1,* Haidong Zhu,6 and Theodore P. Beauchaine7 (2017). Review on Neural Correlates of Emotion Regulation and Music: Implications for Emotion Dysregulation. Frontiers in psychology, 8, 501. DOI http://doi.org/10.3389/fpsyg.2017.00501

  4. (N.A) (N.D) National Statistics on Child Abuse. National Children’s Alliance. http://www.nationalchildrensalliance.org/media-room/nca-digital-media-kit/national-statistics-on-child-abuse/

  5. P Rez-Lloret, S., Diez, J., Domé, M. N., Delvenne, A. A., Braidot, N., Cardinali, D. P., & Vigo, D. E. (2014). Effects of different “relaxing” music styles on the autonomic nervous system. Noise & Health, 16(72), 279–284. https://doi-org.caldwell.idm.oclc.org/10.4103/1463-1741.140507

  6. Shu-Ming Peng, M., Malcolm, Koo., Zer-Ran, Yu. (2009). Effects of music and essential oil inhalation on cardiac autonomic balance in healthy individuals. The Journal of Alternative and Complementary Medicine. 15(1) 53-57 http://doi.org.10.1089/acm.2008.0243