This article documents important music therapy research regarding the impact of music on the health of people living with coronary heart disease.
by Susan E. Mandel, Ph.D., MT-BC
Susan E. Mandel, a board-certified music therapist, introduced a pilot music therapy for stress management program in cardiac rehabilitation at Lake Hospital System in 1991. Mandel tested a variety of music therapy techniques for efficacy and refined the clinical protocol during several years of clinical practice. In 1997, Mandel began working with Suzanne B. Hanser, Ed.D., an experienced music therapy researcher and chair of the music therapy department at Berklee College of Music, to develop a research investigation.
During their initial consultation, Mandel described a challenge. One important component of the music therapy protocol involved Music-Assisted Relaxation and Imagery (MARI). As developed by Mandel, MARI is the systematic application of music, verbal cues and guided imagery, suggested by the music therapist to elicit the patient's relaxation response. The live MARI experience was to be individually taped for each patient's personal use. It was essential to the research study that copyright permission was obtained for use of the music in recording the MARI tapes.
When Hanser asked Mandel whose music was most often preferred to facilitate MARI, Mandel immediately responded "Daniel Kobialka's music". Hanser smiled and said that she personally knew Kobialka and was aware of his interest in offering his music for purposes of research about music and healing. That moment was the prelude to the trio: Kobialka, Mandel, and Hanser.
*NEWSFLASH!!!* "Harmony of Mind & Body: A MARI Experience" is now available to the general public as a 2-CD set.
Although patient preference is a primary criteria in selection of music for relaxation, music selection for the research investigation was determined by knowledge of musical qualities known to be conducive to relaxation (sedative music), along with Mandel's extensive clinical and personal experience. With Kobialka's generous consent, his music was used as a part of the music therapy protocol that was tested through a randomized, controlled trial "Effects of Music Therapy for Stress Management on Health-Related Outcomes in Cardiac Rehabilitation", which was funded and supported by the Kulas Foundation and Lake Hospital System Inc.
The groundbreaking study was reported in The Journal of Music Therapy. As stated in the abstract (Mandel, Hanser, Secic, & Davis, 2007, p.176):
"This study tested effectiveness of music therapy in improving health-related outcomes of cardiac rehabilitation patients. Using a randomized, controlled trial with follow-up, the study was conducted in an outpatient cardiac rehabilitation program in Ohio. Sixty-eight of 103 recruited patients, 30 to 80 years of age, completed the protocol through post-treatment. Physiological and psychological outcomes were measured. Cardiac rehabilitation patients were randomly assigned to cardiac rehabilitation only or to music therapy plus cardiac rehabilitation. Music therapy included musical experiences, counseling, and Music-Assisted Relaxation and Imagery.
The null hypothesis of no differences in health-related outcomes between cardiac rehabilitation patients who experienced cardiac rehabilitation with and without music therapy was rejected due to changes in systolic blood pressure prior to post treatment. Interpretation of changes at 4 months post treatment in anxiety, general health, and social functioning are limited, due to small sample sizes at follow-up. Prior to post music therapy session improvements were also reported. Findings suggest that some health-related outcomes may be affected positively by participation in music therapy in addition to cardiac rehabilitation. Attrition contributed to limitations in statistical power."
REPRISE
In 2005 Kobialka and Mandel produced a compact disc recording of the MARI experience, "Harmony of Mind & Body: A MARI Experience". The recording blends Mandel's spoken voice with selected tracks arranged and recorded by Daniel Kobialka, including "Going Home Medley", "Mystique", and "Air on a G-String". The music selections are extended versions of familiar themes, which incorporate properties of sedative music conducive to relaxation.
Mandel, a professional vocalist, intentionally modulated and paced her spoken voice to complement the volume, tempo, and rhythm of the music. Following a track of verbal instructions, the duration of the CD is about 30 minutes.
The recording was used in a follow-up research study that was conducted by Mandel. Utilization of the CD enabled patients enrolled in the follow-up study to experience the same voice and music experienced by patients in the prior randomized controlled trial to closely replicate administration of MARI.
The results of the follow-up MARI study were published in Mandel's doctoral dissertation, "Effects of Music-Assisted Relaxation and Imagery (MARI) on Health-Related Outcomes in Cardiac Rehabilitation: Follow-up Study". The abstract (Mandel, 2007, p. iii) states:
"The author studied the relationship between listening to a Music-Assisted Relaxation and Imagery (MARI) compact disc recording and health-related outcomes of patients with coronary heart disease (CHD), who were enrolled in an outpatient cardiac rehabilitation program. High worldwide mortality related to CHD substantiated need for the research. An extensive search of the literature revealed a lack of published systematic investigations of the topic. The purpose of the non-randomized study was to identify implications for continued music therapy research of treatment for patients who have CHD. The study examined research questions that were identified by the author from analysis of her prior exploratory, feasibility study. Physiological and psychological outcomes were measured, including: blood pressure, anxiety, stress, depression, and health-related quality of life. Patients' recorded narratives about their MARI experiences were analyzed.
The non-randomized investigation involved intensive analysis and comparison of data from eight patients, who remained in the study through at least 4 months after recruitment Findings suggest a functional relationship between MARI and all measured outcomes. Individual patients' experiences varied, and need for consideration of patients' preferences for music and imagery was evident. The findings of the study were limited by lack of randomization, small sample size, and attrition. A future longitudinal, randomized controlled trial of music therapy in cardiac rehabilitation, with sample size to be determined by statistical power analysis, is suggested."
CODA As a result of Kobialka's generosity, important music therapy research has been conducted and reported about the impact of music on the health of people living with coronary heart disease. Hanser, Mandel, and Kobialka look forward to future research collaboration to continue this important effort.
REFERENCESMandel, Susan E. (2007) Effects of music-assisted relaxation and imagery (MARI) on health-related outcomes in cardiac rehabilitation: Follow-up study. (Doctoral dissertation, Union Institute and University, 2007). Dissertation Abstracts International (UMI No. 3280283).
Mandel, S. E., Hanser, S. B., Secic, M., & Davis, B. A. (2007). Effects of music therapy on health-related outcomes in cardiac rehabilitation: A randomized controlled trial. Journal of Music Therapy, 44(3), 176-197.
About Suzi Mandel: Susan E. Mandel, Ph.D., MT-BC, is a board-certified music therapist who specializes in mind-body and music therapy research. Suzi works as a consultant/researcher at Lake Hospital System, Inc. In addition to her research, Suzi has developed music therapy programs in cardiac rehabilitation and hospice. Suzi is a vocalist, poet, published author, educator, and speaker. Suzi is married to Marty and they are loving parents and grandparents.
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