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A Single-Case, Mixed Me hods S udy Explo ing he Role o Music Lis ening in
Vib oacous ic T ea men
© The Au ho s, 2019.
Published e sion
Campbell, Elsa; Bu ge , Bi gi a; Ala-Ruona, Esa
Campbell, E., Bu ge , B., & Ala-Ruona, E. (2019). A Single-Case, Mixed Me hods S udy Explo ing
he Role o Music Lis ening in Vib oacous ic T ea men . Voices : A Wo ld Fo um o Music
The apy, 19(2), A icle 27. h ps://doi.o g/10.15845/ oices. 19i2.2556
2019
RESEARCH | PEER REVIEWED
A Single-Case, Mixed Me hods S udy
In es iga ing he Role o Music Lis ening in
Vib oacous ic T ea men
EElslsa Aa A. C. Campbellampbell1122 **,, Bi Bi gi gi a Bu a Bu gge e 1122 ,, EEssa Ala Alaa-Ruona-Ruona11
11 Finnish Cen e o In e disciplina y Music Resea ch, Depa men o Music, A and Cul u e S udies,
Uni e si y o Jy äskylä, Finland
22 VIBRAC Skille-Lehikoinen Cen e o Vib oacous ic The apy and Resea ch, Eino Roiha Founda ion,
Uni e si y o Jy äskylä, Finland
*elsa.campbell@ ib ac. i
Recei ed: 14 Sep embe 2018 Accep ed: 28 Ap il 2019 Published: 1 July 2019
Edi o : A i Gilboa Re iewe s: Amy Clemen s-Co es, Lau ien Hak oo
Abs Abs ac ac
Ch onic pain is a widesp ead issue accompanied commonly by dep ession and anxi-
e y. Ch onic pain has been shown o al e b ain p ocessing wi hin he emo ional and
ewa d ci cui s, poin ing owa ds a possible link be ween pain and como bid mood
diso de s. Pain elie may be achie ed by alle ia ing dep essi e and anxious symp-
oms. Relaxa ion is impo an o pain elie and elici ing elaxa ion h ough music
lis ening is shown o elie e pain, dep ession, anxie y, and discom o among o he s.
In addi ion o audi o y s imuli, ib oacous ic ea men – he ac ile applica ion o
low equency sinusoidal sound ib a ion, plus music lis ening and he apeu ic in e -
ac ion – has been shown o be bene icial o elie ing hese symp oms. Al hough he
combina ion o music lis ening and low equencies has been p e iously explo ed,
he ole o he music lis ening wi hin he ib oacous ic ea men con ex is unknown.
A single case, mixed me hod c osso e s udy was conduc ed wi h a clien su e ing
om ch onic pain and como bid mood diso de s, ou sessions wi h music lis ening,
and ou sessions wi hou . Quan i a i e ou comes showed he clien was mo e e-
laxed, less anxious, and had less pain a e he music sessions. Quali a i e indings
showed ha he clien a i s could no elax wi hou he music lis ening because o
he se e e anxie y, la e lea ned o use music as a dis ac o om he hough s o e-
lax, bu also ha silence was equally impo an o he . These hinged on he making
he choice based on he needs, which had p e iously been di icul o he .
KKeeywo ywo ds:ds:
music lis ening, ib oacous ic ea men , pain, anxie y, dep ession
In In oduc ionoduc ion
One in en adul s epo ch onic widesp ead pain (Mans ield, Sim, Jo dan, & Jo dan,
2016). Fu he mo e, dep ession and anxie y a e p e alen in indi iduals wi h ch onic
pain, wi h hese mood diso de s longi udinally p edic ing ch onic pain and pain- ela -
VOICES: A WORLD FORUM FOR MUSIC THERAPY | VOL 19 | NO 2 | 2019
PPublishe ublishe :: GAMUT - G ieg Academy Music The apy Resea ch Cen e (NORCE & Uni e si y o Be gen)
CCopopy igh y igh :: 2019 The Au ho (s). This is an open-access a icle dis ibu ed unde he e ms o he
h p://c ea i ecommons.o g/licenses/by/4.0/, which pe mi s un es ic ed use, dis ibu ion, and
ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
DOI:DOI: h ps://doi.o g/10.15845/ oices. 19i2.2556
ed disabili y (Le man, Rudich, B ill, Shale , & Shaha , 2015). Ch onic pain pa ien s
may expe ience maladap i e anxie y and ha bou a endency owa ds hype igilance
o ca as ophising hei symp oms, o en being ocused on he nega i e meaning o po-
en ial consequences o hei pain (Sym eng & Fishman, 2004). Ch onic pain has al-
so been shown o al e b ain p ocessing, being obse ed in he emo ional and ewa d
ci cui s, showing a possible link be ween ch onic pain and como bid mood diso de s
(Na a ilo a, Mo imu a, Xie, A che ley, Ossipo , & Po eca, 2016). Indeed, educing
dep ession, anxie y, and pain ca as ophising is ound o elie e pain, and educe pain-
speci ic disabili y days and likelihood o disabili y (Sco , K oenke, Wu, & Yu, 2016).
Due o his in e ela ion be ween pain and anxie y, disce ning he p inciple ac o may
be di icul ; howe e , his o e lap is o ui ous in ea men as app oaches o ea -
ing one can be bene icial in simul aneously managing he o he (Sym eng & Fishman,
2004).
Music in e en ions o elie ing pain and mood
Non-pha macological in e en ions ha ha e been bene icial o managing bo h pain
and anxie y include hose such as paced b ea hing echniques, muscle elaxa ion, o
a en ion di e sion (Sym eng & Fishman, 2004). Indeed, elaxa ion has been shown o
be an impo an elemen in elie ing pain (Ezenwa e al., 2018) and anxie y (Nelson,
Adamek, & Kleibe , 2017) and as musical expe iences (e.g. music making such as
singing o lis ening o p e- eco ded music) elici and e oke emo ional esponses in us,
hey a e o en used o egula e emo ions (Lonsdale & No h, 2011) bu also o he pu -
pose o pain elie (Tamplin & Cla k, 2016).
Music in e en ions ha e been shown o be e icacious a elie ing anxie y, dep es-
sion (Lai, Li, & Lee, 2012), pain, and inducing a s a e o elaxa ion (Liu & Pe ini,
2015). I is p oposed music may ac as a dis ac o om pa ien s’ psychological and
physiological sensa ions as well as educing pa ien s’ expe iences o discom o (Nils-
son, 2008) by se ing as an audioanalgesic, audioanxioly ic, o audio elaxan , as well
as music lis ening ha ing an e ec on hospi al pa ien s’ s ess esponses (Nilsson,
2009). A sys ema ic e iew (B ad , Dileo, & Shim, 2013) ound ha music lis ening
migh be bene icial o educing anxie y in people wi h myoca dial in a c ion, also in-
dica ing ha music lis ening may educe pain. Al hough music as a dis ac o is an
impo an mechanism in anxioly ic esponses (Nilsson, 2008), B ad e al. (2013) a -
gued ha music also a o ds an aes he ic expe ience, able o o e com o , and c e-
a i e engagemen in music may esul in an inc ease in pe cei ed con ol. In a su gical
se ing, Wu, Huang, Lee, Wang, and Shih (2017) epo ed signi ican ly educed anxie y
o pa ien s unde going an awake c anio omy a e lis ening o hei p e e ed music.
Al hough Gillen, Biley, and Allen (2008) ound ha anxie y educ ion om music lis-
ening seems o be mo e s ongly e lec ed in he psychological pa ame e s (e.g. S a e-
T ai Anxie y In en o y) a he han physiological ma ke s o anxie y and s ess (e.g.
hea a e), he a o emen ioned o e lap be ween he physiological and psychological
aspec s o pain and anxie y/dep ession poin s owa ds a cumula i e in e en ion e -
ec . This may be impo an in designing in e en ions o pa ien s su e ing om hese
psychological and physical symp oms. Resul s o s udies p esen ed he e seem o gene -
ally sugges consis en ly posi i e and signi ican educ ion in anxie y and pain due o
music in e en ion, as well as inc eased elaxa ion and dec eased dep ession.
Vib oacous ic ea men o elici ing psychophysiological changes
Music in e en ions can also be deli e ed in a ac ile manne such as wi h pulsed,
sinusoidal, low equencies be ween 20–120 Hz h ough a ecline chai o ma ess
combined wi h music lis ening and he apeu ic in e ac ion. When applied by a ained
p ac i ione , hese combined elemen s (see Figu e 1) a e e e ed o as Vib oacous ic
(VA) ea men (Campbell, Hynynen, & Ala-Ruona, 2017). Low equencies may also
be deli e ed wi hou music lis ening, based on he clien ’s needs and p e e ences, e.g.
music may e oke memo ies o sensa ions which he clien is no ye eady o add ess.
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FFigigu u ee 11
Elemen s o VA ea men
The a ionale o lis ening o music is he e o e based on whe he he music lis ening
may enhance he expe ience o he clien . Fo hose who enjoy music, i may mo e
eadily enable elaxa ion and o e a sou ce o com o .
As is o en he case o music lis ening, elaxa ion is one o he mos commonly e-
po ed ou comes o VA ea men (Ala-Ruona, Punkanen, & Campbell, 2015;Camp-
bell, Hynynen, & Ala-Ruona, 2017). The elaxa ion esponse, a elaxed bu ale s a e
elici ed h ough epea ed and ocused medi a i e p ac ices (Benson, 1975), is posi ed
o be one possible explana ion o he posi i e ou comes associa ed wi h his ea men
modali y (Punkanen & Ala-Ruona, 2012). Recen s udies ocusing only on he pulsed
sinusoidal low equency sound ib a ion, i.e. wi hou music lis ening o he apeu ic
in e ac ion, ha e shown ha low equencies a e bene icial o pain elie and mood
egula ion (B aun Janzen, Panedu o, Pica d, Go don, & Ba el, 2019;Naghdi, Aho-
nen, Maca io, & Ba el, 2015), anxie y educ ion (Rüü el, Ra nik, Tamm, & Zilensk,
2004), spas ici y in hose wi h spinal co d and b ain inju ies (Rüü el, Vinkel, & Eelmäe,
2017), can be bene icial o dec easing bo h pain and s ess, and inc easing emo ion-
al en ichmen , concen a ion, and physical and emo ional elaxa ion (Ahonen, Deek,
& K oeke , 2012) as well as educing anxie y and a o ding elaxa ion in hose wi h
Alzheime ’s disease (Clemen s-Co és, Ahonen, F eedman, & Ba el, 2017). Campbell,
Hynynen, and Ala-Ruona (2017) showed imp o emen s in pain, mood, and elaxa ion
o hose ecei ing he combined ea men o low equencies and music lis ening wi h
he apeu ic in e ac ion. Skille and Wig am (1995) compa ed he e ec s o music plus
ib oacous ic s imula ion (40 and 55 Hz) o music alone o hose wi h mul iple physi-
cal disabili ies, inding ha ib oacous ics was bene icial in educing muscle one and
inc easing ange o mo ion. Wig am (1996) compa ed new age music lis ening, ib oa-
cous ics (40 Hz), and lying in silence wi h non-clinical pa icipan s and ound educed
a ousal in he ib oacous ic g oup compa ed o bo h he music and con ol g oup.
Bo h ib oacous ics and music g oups had educed hea a e compa ed o he silence
g oup. Rüü el (2002) also examined he e ec s o music, ib oacous ics, and silence
on heal hy people, inding ha one o wo sessions o ib oacous ics we e bene icial
o educing a igue o s ess o heal hy people in e e yday li e.
These s udies ha e examined he e ec s o low equencies alone, he combina ion
o all h ee VA ea men elemen s, as well as compa ing he e ec s o low equencies
wi h and wi hou music. Howe e , he ole ha music lis ening plays in he ea men
session wi h he apeu ic in e ac ion has no been explo ed. As discussed, music lis en-
ing has been shown o be e icacious a inducing a elaxed s a e and elie ing pain,
anxie y, and dep ession. Low equency ib a ion has also been shown o do so, as has
he combina ion o music lis ening, low equencies, and he apeu ic in e ac ion. Gi -
en ha bo h music and ib a ion can be bene icial o symp om elie , he aim o his
s udy was o explo e in mo e de ail he ole ha he music lis ening elemen wi hin
a p ac i ione -suppo ed VA ea men se ing may ha e wi h a clien su e ing om
ch onic pain, anxie y, and dep ession. Fu he mo e, his s udy in es iga es whe he he
clien ’s pe cep ion and expe ience o he symp oms - and he in luence VA ea men
has he eon - a e enhanced by music lis ening.
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Me hodMe hod
S udy design
A mixed me hod, n-o -1 c osso e design was used o explo e he ole o music in
VA ea men , in eg a ing quan i a i e and quali a i e da a o iangula e he esul s
and indings o gain a g ea e unde s anding o hese subjec i e physical and psycho-
logical phenomena. Al hough quan i a i e me hods a e help ul when add essing he
ela ionship be ween speci ic a iables, hey a e no sui able o answe ing p ocess-
o ien ed ques ions ha can be add essed using quali a i e app oaches (Leech & On-
wuegbuzie, 2007). T iangula ion o mixed me hods is used o desc ibe an issue (e.g.
pain) om se e al pe spec i es o gain a mo e comple e imp ession o he phenome-
non (O’Ca hain, Mu phy, & Nicholl, 2010). In case s udies, he quan i a i e da a can
shed ligh on a pa ien ’s change (e.g. po en ial imp o emen ) du ing he he apeu ic
p ocess, whils he quali a i e da a may be used o unde s and he sudden luc ua ions
on he symp oms ep esen ed in he quan i a i e scales (Sandahl & Wilbe g, 2006).
Pa icipan
Jane was a 34-yea -old mo he o wo li ing wi h he pa ne who was on disabili y
sick lea e. She i s ook lea e in 2008 due o bu nou and hen due o su ge y o
a he nia ed disc in 2012 a e a b ie e u n o wo k. She had mode a e dep ession,
panic diso de and anxie y, di icul y elaxing and sleeping, s ess, ension headaches,
mig aines, and shoulde pain, al hough he e was no o ganic eason o hese symp-
oms. The lack o disce nible medical explana ion o he collec ion o symp oms may
be g ouped unde he e m Medically Unexplained Symp oms (MUS). This includes
musculoskele al pain and ‘pseudoneu ology’ – i edness, sleeping issues, a igue, and
mood changes (E iksen & U sin, 2004). Al hough unexplained, hese symp oms ha e,
in addi ion o headaches, high blood p essu e, and emo ions such as ange , anxie y,
and panic, been linked o nega i e s ess (Yehuda & Seckl, 2011) such as om shock.
She explained she would like o mo e o wa d wi h he li e bu was eeling s uck. Once
o wice pe mon h, Jane isi ed he local heal hca e cen e and spoke wi h he psy-
chia ic nu se. She did no ake any medica ion, excep o analgesics when mig aines
we e pa icula ly se e e. She had applied o pa icipa e in music he apy as pa o
clinical aining a he Music The apy Clinic o Resea ch and T aining a he Uni e -
si y o Jy äskylä, Finland, and due o he se e i y and collec ion o symp oms, was
app oached by EAC ega ding he willingness o pa icipa e in VA ea men ins ead o
music he apy o managing pain and como bid symp oms. The esea ch was conduc -
ed a he music he apy clinic and he e o e ollowed he gene al p inciples and ules
o he apeu ic wo k a heal hca e uni s. She ga e in o med consen o ha e weekly ses-
sions and o publish he expe iences o he p ocess.
P ocedu e
Vib oacous ic (VA) ea men consis s o h ee elemen s: pulsed sinusoidal low e-
quency sound ib a ion (20-120Hz), (clien p e e ed) music lis ening, and he apeu ic
in e ac ion be ween clien and p ac i ione (Campbell, Hynynen, & Ala-Ruona, 2017;
Ala-Ruona & Punkanen, 2017). The music lis ening and low equency sound ib a ion
a e ecei ed simul aneously. The sound ib a ion is ansmi ed h ough de ices such
as chai s, cushions, o ma esses whils he music lis ening is ypically deli e ed
h ough headphones. In gene al, he p ocedu e is conduc ed in se e al s ages: p epa-
a ion o he session (se ing up he equipmen ), in oducing he clien o he ea -
men modali y, beginning he combined sound ib a ion and music lis ening, moni o -
ing he clien ’s ecep ion, ending he s imulus, and pos -s imulus wo k (e.g. p ocess-
ing) (G ocke & Wig am, 2007). The he apeu ic ela ionship be ween he clien and
p ac i ione may ake he o m o e bal in e ac ion be ween he clien and p ac i ion-
e , usually be o e and a e he low equency sound ib a ion and music lis ening.
Howe e , in some cases, he clien may wish o in e ac wi h he p ac i ione du ing
VOICES: A WORLD FORUM FOR MUSIC THERAPY RESEARCH
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he s imula ion. A clien may all asleep du ing he s imulus and he p ac i ione ’s ole
he ea e is o eassu e and guide he clien back o he p esen momen . Be o e and
a e he s imulus, he p ac i ione plays an impo an ole in expe ien ial p ocessing.
This may ake he o m o o e ing com o and helping he clien o p ocess and e lec
on expe iences and sensa ions.
The VA ea men p ocedu e in his s udy was as ollows: 10 VA ea men sessions
we e planned wi h he clien (he ea e e e ed o as ‘Jane’) o ake place once pe
week in a single case c osso e design o Vib oacous ic sessions wi h (VA-Music) and
wi hou (VA-Silence) music lis ening. Jane wo e headphones in all sessions, bu no
music was played du ing VA-Silence sessions. Be o e he i s session, he p ac i ion-
e asked Jane o send a lis o he p e e ed music lis ening choices. Jane sugges ed
some a is s o which she some imes lis ened and he p ac i ione made a playlis based
on hese sugges ions. The VA sessions ook place in a music he apy clinic equipped
wi h a Nex Wa e Physioacous ic ecline chai (Nex Wa e, n.d.). The clien lay in
a supine posi ion on his chai wi h a blanke du ing all sessions and he ligh s we e
dimmed du ing he low equency s imula ion. The same 20-minu e low equency p o-
g amme ( anging om 29—61 Hz) was used in all sessions; his equency ange has
been bene icial o managing physical and psychological diso de s and inducing elax-
a ion (Campbell, Hynynen, & Ala-Ruona, 2017).
The clien ecei ed eigh sessions in o al; wo sessions we e cancelled due o illness.
Fou sessions (S1, S3, S5, S6) comp ised usual p o ocol o VA ea men : low equen-
cy sound ib a ion, music lis ening, and he apeu ic in e ac ion (VA-Music). Fou ses-
sions (S2, S4, S7, S8) comp ised all o hese elemen s minus music lis ening (VA-Si-
lence). I was planned ha e e y second session would be VA-Silence, howe e his
change in scheduling was made o he apeu ic easons (discussed in sec ions Con ol
h ough choice and Music as a ansla ional mechanism).
Sessions 1 and 2 ocused on p epa ing Jane o he p ocedu e and becoming accus-
omed o he sensa ion o low equencies and discussing he di icul y wi h elaxa ion
in gene al. Sessions 3-5 ocused on how Jane could become mo e awa e o he physical
sensa ions as a way o ancho he in he p esen momen . She was also paying a en-
ion o he e ec s o he ea men and beginning o in eg a e hese changes in o he
daily li e. Sessions 6 and 7 we e abou making choices o he ega ding sel -ca e (e.g.
aking medica ion, ecei ing massage) and no icing o he changes ou side he sessions.
The inal session u he explo ed making choices and how he e ec s o he sessions
may be ansla ed in o daily li e, and exp essing a willingness o con inue o y and
help he .
Ou comes assessmen
The da a o his s udy consis ed o bo h quali a i e and quan i a i e measu es. The
quali a i e da a we e ansc ibed discussions be ween Jane and P ac i ione , whils he
quan i a i e da a comp ised Visual Analogue Scales (VASs). A VAS is a unidimensional
sel -comple e scale composed o a ho izon al 100mm line wi h wo e bal desc ip o s
on ei he end (Hawke e al., 2011). The scales used in he p esen s udy assessed pain
(VAS-P), mood (VAS-M), anxie y (VAS-A), and elaxa ion (VAS-R) and we e comple ed
by Jane be o e and a e each 20-minu e ea men p og amme in each session. The
ancho s o hese scales we e: 0 (wo s pain imaginable) o 100 (no pain); 0 (dep essed) o
100 (happy); 0 ( e y anxious) o 100 (no anxie y); and 0 ( ense) o 100 ( elaxed) espec-
i ely. A all VAS measu emen poin s, Jane was asked o ma k each scale o ep esen
he cu en s a e a ha momen , he eby enabling an assessmen o bo h wi hin- and
be ween-session change. Visual Analogue Scales a e widely implemen ed in di e se
popula ions due o low esponden bu den and ease o adminis a ion (Hawke , Mian,
Kendze ska, & F ench 2011).
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Quan i a i e da a analysis
The p e- and pos - ea men VAS ou comes we e analysed using SPSS (IBM SPSS S a-
is ics, Ve sion 24). Bo h an o e iew o he p ocess as well as a compa ison be ween
each condi ion a e p esen ed. The p e- ea men sco e in Session 1 and he pos - ea -
men sco e in Session 8 o each a iable a e used o gi e an o e iew o he be ween-
session he apeu ic p ocess. Addi ionally, he mean (and s anda d de ia ion) p e- and
pos - ea men pain, mood, anxie y, and elaxa ion sco es o bo h VA-Music and VA-
Silence condi ions a e p esen ed o show wi hin-session change. Guidelines o in e -
p e ing quan i a i e ou comes such as VASs a e bene icial o unde s and pa ien s’ e-
sponses o in e en ions. Jensen and colleagues (2003)1 ecommend cu -o in e p e a-
ion poin s o VAS-P o 0-4mm (se e e pain), 5-44mm (mode a e pain), 45-74mm (mild
pain), and 75-100mm (no pain). Fu he , clinically ele an change is also necessa y in
in e en ion e alua ion; his is e e ed o as he minimal clinically impo an di e -
ence (MCID) and o VAS-P has been de ined as 10-20% as MCID, > 30% as mode a e
imp o emen , > 50% as subs an ial imp o emen (Dwo kin e al., 2008). These in e -
p e a ion guidelines a e employed he e o e alua e all VAS da a.
Quali a i e da a analysis
Pa ien s’ expe iences and he co esponding disabili y o ill-being esul an o ch onic
pain a e impo an in u he delinea ing he e icacy o ch onic pain managemen
ea men me hods. Unde s anding how a clien engages in meaning-making and he
elemen s o a subjec i e expe ience which hey conside impo an gi e insigh in o
he expe ience o su e ing and alle ia ion he eo . To his end, in e p e a i e phenom-
enological analysis (IPA) allows esea che s o gain insigh in o wha is impo an o
pa icipan s, hen explo ing wha his means o hem (Smi h & Osbo n, 2007). Si u-
a ing and unde s anding a pa icipan ’s expe iences and meaning making can help o
in e p e indings om quan i a i e ou comes (La kin & Thompson, 2011). Thus, IPA
was used in his s udy o gain g ea e insigh in o he meaning o music wi hin he VA
ea men p ocess.
The analy ic p ocess was as ollows. The ansc ip s om all sessions we e ead and
e- ead se e al imes o ob ain a sense o he pa icipan ’s expe iences. Se e al coding
me hods we e used. The i s coding ound consis ed o desc ip i e coding, in addi ion
o emo ion coding, p ocess coding, condi ional coding, and e alua ion coding. Desc ip-
i e coding highligh ed Jane’s expe iences h oughou he p ocess, whils p ocess cod-
ing showed wha happened o he pa icipan h oughou his p ocess; emo ion coding
highligh ed all emo ion wo ds used by he pa icipan ; condi ional coding was applied
o s uc u es such as ‘i … hen’, o ind connec ions be ween condi ions and ac ions/
ou comes, and inally e alua ion coding was applied o see how he pa icipan e al-
ua ed each condi ion/in e en ion. These codes we e p ima ily o ganised in o hemes
and hen explo ed o in e ela ionships (Saldaña, 2009), wi h a ocus on Jane’s o e all
esponse o he VA ea men sessions and hen paying a en ion o how she espond-
ed o he VA-Music and VA-Silence sessions sepa a ely. Themes ha clus e ed oge he
we e g ouped as supe o dina e hemes (Osbo n & Smi h, 1998;Smi h & Osbo n, 2007).
The eme gen hemes we e o ganised such ha a consis en and meaning ul ep esen-
a ion o Jane’s expe iences we e p esen ed, ep esen ing he essence o he esponses
o he ea men and he ac o s po en ially in luencing his esponse. The analysis hus
ollowed an induc i e a he han deduc i e app oach, es ablishing hemes om he
da a a he han om p e-de e mined cons uc s.
In eg a ion
A e bo h quali a i e and quan i a i e ou comes we e analysed sepa a ely by EAC, he
esul s and indings o each we e co-explo ed and a e p esen ed na a i ely and isual-
ly, highligh ing he quan i a i e esponses o each ea men modali y and discussing
he quali a i e indings suppo ing hese ou comes. The ole o he VASs was o gain
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insigh in o he po en ial in luence o VA sessions wi h and wi hou music lis ening
on pain, mood, anxie y, and elaxa ion, howe e as hese a e subjec i e phenomena,
he pa icipan ’s subjec i e expe iences o he ea men – as well as he s a e in be-
ween sessions – was impo an in b inging g ea e unde s anding o how he ea -
men p ocess a ec ed he . The e bal p ocessing wi hin he ea men sessions, and
la e in he membe check in e iew, a o ded he he possibili y o explo e and sha e
he own expe iences (B ad e al., 2015).
Membe check
To assess he alidi y o he analysis, a membe check in e iew – o he wise e e ed
o as a alida ion in e iew – was conduc ed wi h Jane o discuss he eme gen hemes
and hei genesis based on he ansc ip s, and o “con i m, subs an ia e, e i y o co -
ec esea che s’ indings” (Buchbinde , 2011), i.e. o discuss whe he he hemes p e-
sen ed accu a ely ep esen ed he discussions and he expe iences du ing he ea men
p ocess. In he in e iew, EA-R p esen ed bo h quan i a i e esul s and he quali a i e
indings o assess i hese we e accu a e ep esen a ions o he expe ience du ing he
p ocess o no , whe he she wished o add some hing o he ou comes which she el
was impo an , o whe he he e we e aspec s she wished o co ec in he esul s and
indings o be e po ay he sessions. (EAC’s ole in his p ocess is discussed in he
subsequen sec ion.) Conduc ing he membe check in e iew – e med as desc ip i e
iangula ion – in which he esea che (s) show he indings o in e p e a ions o he
pa icipan s in o de o assess accu acy, was a means o inc easing us wo hiness o
he quali a i e indings (Leech & Onwuegbuzie, 2007).
Roles o he esea che s / p ac i ione
The au ho s played a ious oles in he he apeu ic p ocess as well as he da a collec-
ion and analysis phases. Du ing he ea men p ocess, EAC illed he oles o bo h
p ac i ione and esea che . She me wi h he clien o discuss he p ocedu e o he
sessions, acqui ed in o med consen om Jane, and collec ed he da a a he begin-
ning and end o each session. In he p ac i ione ole, EAC acili a ed he he apeu-
ic p ocess, deli e ing he music and ac ile in e en ions a each session. A numbe
o clinical esea che s subsc ibe o he idea ha esea ch in i sel , as well as ollow-
up in e iews, has a he apeu ic e ec (Sandahl & Wilbe g, 2006). F om his pe spec-
i e, he in e ac ing and o e lapping oles o a p ac i ione and esea che may in ol e
complemen a y p ocesses.
Bo h EAC and EA-R conduc ed he membe check in e iew. Al hough i was ini ial-
ly planned ha only EA-R would conduc he membe check, Jane eques ed ha EAC
also be p esen in he mee ing. EAC’s ole was passi e in he membe check in e iew
unless cla i ica ion was needed and eques ed om he pa icipan .
RResul sesul s
Quan i a i e esul s
When iewing he o e all p ocess, Jane eco ded clinically ele an pain dec ease and
elaxa ion inc ease we e when only he p e- ea men sco e om Session 1 and he
pos - ea men sco e om Session 1 a e p esen ed (i.e. bo h VA-Music and VA-Silence
sessions). A he end o he p ocess, he pain co esponded o no pain and elaxa ion
co esponded o mild ension when ollowing he in e p e a ion guidelines (Jensen e
al., 2003). Mood and anxie y de e io a ed du ing his ime o a minimal clinically el-
e an deg ee (see Table 1). Bo h mood and anxie y we e mode a e a he end o he
ea men p ocess.
When compa ing he mean VAS ou comes be ween he music and silence sessions,
VAS-M, VAS-A, and VAS-R showed imp o emen ; VAS-P change was nega i ely clin-
ically ele an change in he silence sessions, bu showed imp o emen in he music
sessions, indica ing ha music was a leas somewha bene icial o pain. VAS-M im-
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TTablablee 11
P e- ea men Session 1 and pos - ea men Session 8 sco es o all a iables showing p og ession o e ime, and mean (and s an-
da d de ia ion) o all p e- and pos - ea men sco es o each a iable compa ing VA-Music and VA-Silence sessions.
No e: All Visual Analogue Scales ange om 0-100mm; a highe sco e ep esen s a mo e a ou able ou come; *Indica es he
Mini-
mal Clinically Impo an Di e ence
(MCID); **Indica es mode a e change; ***Indica es subs an ial change
VVAS-PAS-Painain VVAS-MoodAS-Mood VVAS-Anxie AS-Anxie yy VVAS-RAS-Relelaxaxa iona ion
O O e e aall ll eea men p a men p ococesess (0-s (0-100mm; highe sc100mm; highe sco o e indice indica a es be es be e ou e ou ccome)ome)
Whole
p ocess
Session 1 Session 8 Session 1 Session 8 Session 1 Session 8 Session 1 Session 8
69 93* 51 43 64 52 5 71*
CCompompa ing Va ing VAA-Music and V-Music and VAA-Sil-Silencence sese sessions (0-sions (0-100mm; highe sc100mm; highe sco o e indice indica a es be es be e ou e ou ccome)ome)
P e- ea -
men
Pos - ea -
men
P e- ea -
men
Pos - ea -
men
P e- ea -
men
Pos - ea -
men
P e- ea -
men
Pos - ea -
men
VA-Music 60.82(
17.86
) 65.25(
12.19
) 43.39(
7.46
) 52.75(
5.31
)* 34.79(
17.98
) 54.5(
13.28
)*** 21.54(
14.54
) 51(
12.75
)***
VA-Silence 85.75(
5.26
) 73.75(
11.65
) 47.75(
8.13
) 50.5(
13.46
) 35.5(
8.20
) 45.25(
12.70
)* 30.75(
16.16
) 54.75(
13.94
)***
p o emen was clinically ele an in he music sessions, bu VAS-A and VAS-R we e
subs an ially clinically ele an in bo h condi ions acco ding o he MCID (see Table
1). These esul s indica e ha he VA-Music sessions we e mo e bene icial o anxie y
and elaxa ion han o pain o mood.
Pain
VA-Silence p e- ea men sco es we e gene ally be e compa ed o VA-Music, as he
mean p e- ea men sco e o VA-Silence was in he minimal ca ego y and o VA-Mu-
sic was in he mild ca ego y. F om an indi idual session pe spec i e (see Figu e 2),
subs an ial imp o emen was eco ded in Sessions 3 (VA-Music), wi h MCID in Ses-
sion 5 (VA-Music). MCID nega i e change was epo ed in Sessions 1 and 6 (VA-Music)
and Sessions 2, 4, and 7 (VA-Silence). The e was ela i ely high a ia ion be ween he
condi ions; howe e , when he p e- ea men sco e was he wo s (Session 3), he im-
p o emen was also he mos subs an ial.
Mood
Mean mood sco es o p e- ea men VA-Music sessions was in he mode a e ca ego y
and VA-Silence in he mild ca ego y. Again, Session 3 (VA-Music) showed subs an ial
imp o emen (see Figu e 3), whils Sessions 1 and 6 we e also clinically ele an . Fo
VA-Silence sessions, mode a e imp o emen was epo ed in Session 4, clinically el-
e an imp o emen in Session 7 bu nega i e clinically impo an change in Sessions
2 and 8. The e o e, al hough he inal sco e a he end o he p ocess was wo se han
he beginning o he p ocess, he mean change o e ime was ne e heless owa ds im-
p o emen , al hough only clinically ele an o he VA-Music sessions.
Anxie y
P e- ea men sco es in bo h condi ions on a e age we e mode a e and pos - ea men
sco es we e mild o bo h condi ions, sugges ing ha bo h we e bene icial o anxie y
elie . The e was g ea e elie eco ded o he music sessions, howe e . Minimal clin-
ically impo an change was epo ed in Sessions 1 and 7, wi h mode a e imp o emen
in Sessions 4 and 8, and subs an ial imp o emen in Sessions 3 and 6. As seen in Fig-
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FFigigu u ee 77
In e ela ed elemen s o (1) low equency sinusoidal sounds and music lis ening, (2) p ac i ione sup-
po , and (3) choice, oge he c ea ing space o he apeu ic change h ough he elaxa ion esponse
wi hin he VA ea men se ing
o selec i ely lis en and use he music as a dis ac o as needed wi hin music sessions,
and inally o make he choice based on he needs, i.e. choosing o no lis en o music.
This is suppo ed by he quan i a i e ou comes; Jane was unable o elax wi hou
music in Session 2 and he elaxa ion dec eased by 40% (VAS-R), he anxie y inc eased
by 39% (VAS-A), he pain go wo se by 22% (VAS-P), and he mood also de e io a ed
by 18% (VAS-M), all clinically ele an changes. I can also be seen ha he wo sening
in pain du ing VA-Silence sessions ep esen ed clinically ele an change, compa ed o
only minimal and non-clinically ele an wo sening in VA-Music sessions. Elici a ion
o a elaxa ion esponse seems o ha e an impo an ole o play in VA sessions, bu
in e es ingly an inc ease in pain le els appa en ly did no a ec he abili y o elax no
educe he anxie y, sugges ing ha he o e all s a e o su e ing was mo e ela ed o
he anxie y han was a ec ed by he pain. Indeed, se e e anxie y seems o ha e aken
p ecedence o e he physical symp oms.
Suppo om he p ac i ione
Secondly, he in e ac ion wi h and suppo i e ole o he p ac i ione was impo an ,
especially a a ime when she el isola ed in he su e ing. The VA sessions we e a
place whe e Jane could exp ess he sel when seemingly no one else was lis ening. The
hope and expec a ions ha Jane had o he sessions, coupled wi h expe iences o sel -
e icacy om success ul elaxa ion expe iences wi hin he session, ounded on he sup-
po i e ole o he p ac i ione , a e indica i e o some elemen s necessa y o elici he -
apeu ic change.
Choice
Thi dly, inc easing Jane’s empowe men and sel -e icacy was possible h ough a o d-
ing he he con ol and choice o whe he o lis en o music o no du ing he sessions.
She ini ially began his choosing p ocess du ing VA-Music sessions, when she chose o
use music as a dis ac ion om he hough s – wea ing in and ou o ac i e and pas-
si e lis ening, using music as a way o sel - egula e. Music and choice we e he ac o s
which opened he p ocess o needs-based and clien -cen ed decision making; al hough
he choice o whe he o lis en o music was a s uggle, she chose based on he needs
and wan s in ha momen . In Session 6 when Jane made he pe inen decision o lis-
en o music al hough i was in ended o be a VA-Silence session, i was clea om he
quan i a i e ou comes ha she was making his decision om a s a e o acu e anxie y;
she expe ienced he g ea es anxie y elie (184%, subs an ial imp o emen ) in his
session, sugges ing ha he combina ion o con ol om he choice, music lis ening
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wi h he low equency s imulus, and he encou agemen om he p ac i ione we e
all pa o he e ec .
The in e ela ionships be ween he supe o dina e hemes coupled wi h he VAS ou -
comes highligh s he complexi y o hese in e connec ed symp oms and he ways in
which hey in e ac and in luence each o he .
Desc ip i e iangula ion h ough a membe check in e iew
In he membe check in e iew, Jane con i med ha she el less pain and anxie y,
was in a be e mood, and was mo e elaxed a e he VA-Music sessions, and ha VA
ea men was a “good model” o managing he pain and anxie y. She also el ha ,
al hough he e was a lo o a ia ion and dis up ion in he quali y o sleep, he elax-
a ion and “maybe a li le mo e o a i ed eeling” a e VA-music mean she did no
umina e as much be o e bed, a ibu ing his o he be e sleep.
She con i med ha al hough he pain was no se e e du ing he p ocess, i was pe -
sis en and in e connec ed wi h he anxie y and mood and ha he MD had con i med
he e was no de ec able cause o he symp oms. He expe ience o music o no mu-
sic was con adic o y, “some imes i was good, some imes no .” This, she explained,
was dependen on he le el o coping a he ime. Jane no iced she was hype sensi i e
o senso y s imuli. I eeling low o s essed, she could ole a e only so /quie music.
When she did lis en o music, howe e , she ound ha i was di icul o he o ocus
on he sel ; du ing he VA-music sessions became imme sed in he expe ience and el
like “being on op o wa es, and he wa es jus ca ied me” bu ound his was a way
she could also a oid wo king on he issues. She also old she was able o gain di e en
pe spec i es on he issues h ough he discussions wi h he p ac i ione , expe iencing
a cla i y o mind – “basically somehow ligh e .”
She con i med ha he expe ience o he ea men was bo h a physical and men al
one: “when he chai was ib a ing, I could eel i in my body, bu when I was qui-
e and concen a ed on jus ha , again i a ec ed my mind.” She old ha du ing
he p ocess she lea ned o concen a e on he sel and lea ned ha he anxie y would
no o e whelm he ; i she could become quie , she was hen able o enjoy “a so
o …peace ul momen .” Ini ially, he non-music sessions we e di icul o Jane because
she had o “ ole a e mysel .” She was cons an ly awa e o hings happening in he su -
oundings, which was bu densome. She also commen ed i she no iced a new pain, she
immedia ely ca ego ised i as he wo s possible pain – “I’m e y sensi i e o ha .”
Jane acknowledged he hemes om he quali a i e analysis we e ep esen a i e o
he expe ience and ag eed ha con ol is a majo pa o he pe sonali y. She also ex-
plained ha he pain and anxie y we e e y igh ly in e wined and ha hey usually
co-exis ed. She con i med ha she el apped by he anxie y, ha she s uggled o
emain in con ol o all aspec s o he li e, and ha she began o change he way she
hough abou and app oached si ua ions because o he VA ea men s: “I no iced ha
I ha e pain e en i I did no hing and I lea ned o jus li e wi h i a bi be e and hen
i was easie .” She el ha i was “always a kind o holiday eeling o some hing qui e
exci ing [going o he sessions] … I could cope somehow be e … my head was a bi
emp ie ,” bu ini ially he sessions we e igh ening o he because she did no eel
in con ol o he si ua ion. When no in con ol, “I’m e ibly anxious” and she ound
schedule changes e y di icul : “I some hing su p ising happens, I eel ha he whole
mee ing is gone o pieces.”
Jane ag eed wi h he inding o he changing sel - e lec ion du ing his p ocess. She
began o each he sel how o app oach hings di e en ly: “maybe ha kind o mo e
elaxed iew, way o being.” Th ough a ending he sessions, she el ha “my head
go a bi o a b eak;” his cla i y o mind was a con as o he “lump” on he ches ha
she desc ibed as he anxie y. Finally, she old she was encou aged by he ac ha he
indings om he analysis we e ele an o he and ha i was “ eally nice o me ha
hey a e eally my hings and I el I also go some hing om hese esul s [discussed
in he membe check in e iew]”.
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DiscDiscusussionsion
This single case s udy explo ed he in luence o music lis ening wi hin VA ea men
and he iad o i s componen s: low equency sounds, music lis ening, and he apeu ic
in e ac ion. The quan i a i e esul s showed ha Jane le he VA sessions eeling much
mo e elaxed, which was also co obo a ed by he quali a i e indings and he mem-
be check in e iew, and ha he e we e mo e consis en posi i e e ec s in he VA-
Music condi ion. This, in addi ion o imp o emen s in he emaining a iables, may
poin owa ds lowe le els o s ess, as was epo ed by Rüü el (2002). Relaxa ion is
one o he mos commonly epo ed e ec s o VA ea men (Campbell, Hynynen, & &
Ala-Ruona, 2017;Punkanen & Ala-Ruona, 2012) and elici ing he elaxa ion esponse
is bene icial o elie ing s ess (Esch, F icchione, & S e ano, 2003). The elaxa ion
esponse (Benson, 1975) esul s in educed s ess esponse and sympa he ic ne ous
sys em a ousal and may explain he e ec s o VA ea men (Punkanen & Ala-Ruona,
2012), pe haps due o he epe i i e, pulsed na u e o he equency cycles in he ea -
men p og ammes and he sympa he ic esonance be ween he body and he applied
equencies, as well as he anspo ing e ec o lis ening o one’s p e e ed music.
Su e ing and sensi isa ion
The indings showed ha Jane was s uggling o cope wi h he unp edic able symp-
oms as well as unce ain y wi hin he amily s uc u e, which con ibu ed o an o e -
all sense o su e ing. Su e ing is cha ac e ised as a s a e o dis ess ins iga ed by h ea
and loss o wholeness, an indi idualised and subjec i e expe ience ha includes assign-
ing nega i e meaning o an e en o pe cei ed h ea (Cassell, 1998; in Deal, 2011).
A e he su ge y in 2012 she epo ed as unexpec ed, Jane was cons an ly a aid o
a ious pains o sensa ions she el , ea ing hey would esul in mo e medical p o-
cedu es. She was unde con inuing psychological h ea o he subjec i e wellbeing.
Medically unexplained symp oms (E iksen & U sin, 2004) a e highly ep esen a i e o
Jane’s su e ing. The lack o iden i iable cause also may ha e added o hype awa e-
ness o he symp oms. Al hough he lack o disce nible disease sou ce o he physical
pain was con i med by a scan du ing he p ocess, she was su e ing om he psycho-
logical s ess and anxie y associa ed wi h he ea o new pain and wha implica ions
i may ha e. A en ional (hype igilance) biases in in e p e a ion a e s ongly ela ed
o anxie y ( an Dies e al., 2005). The heo y o cogni i e sensi isa ion o medical-
ly unexplained complain s (B osscho , 2002) ou lines ha hose who ha e an ex eme
conce n abou soma ic disease will de elop a cogni i e bias o in o ma ion ela ed
he e o. This bias appea s in an ac i a ed cogni i e ne wo k, meaning ha signals e-
la ed o, o example, pain a e mo e closely obse ed and no iced by us. As a esul ,
one would o e - epo , misa ibu e, o o e -in e p e hese soma ic sensa ions based
on hei own ea s o illness belie s. Jane was highly sensi ised o all sensa ions – bo h
soma ic and psychological – and had de eloped a con inued le el o anxious su e ing
because o his cogni i e sensi isa ion o he medically unexplained symp oms. As she
explained in he membe check in e iew, she was ying o e- ain his esponse.
Fou hemes ela ed o su e ing a e no ed by Reed (2003, in Deal, 2011): isola ion,
hopelessness, ulne abili y, and loss. Essen ial o alle ia ing su e ing is a sense o
hope, wi h a ocus on a ealis ic u u e. Ou pe cei ed eali y becomes clouded when
one loses hope, as i esul s in a lack o desi e o su i e he expe ience (Rolley, Chang,
& Johnson, 2014). Jane’s expe iences can be ca ego ised unde hese hemes o su -
e ing such ha she was alone in he su e ing and ini ially el hopeless and helpless,
s uggling o con ol, leading he o a eeling o ulne abili y. She g ea ly disliked be-
ing ou o con ol in all si ua ions and since he sudden heal h issues, she had los he
li e she had once led and was los in he own sphe e o anxie y, apped in he own
hough s.
Ye , Ha (2018) discussed wo ypes o su e ing: one in which one eels wo ied,
hopeless, mise able, ang y, and wo hless wi h he “s ess ul anxie y o loss and e-
sponsibili y” (p. 142), and he o he in which one glimpses hope, lea ning o see hings
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op imis ically and g a e ully. The ac and expe ience o su e ing is no only a soli a y
s a e bu also one in which one lea ns o see he way o wa d; i is bo h dissonance
and consonance. Music lis ening - and he choice o lis en o no – was a ma ke o
bo h o hese ypes o su e ing o Jane. Fi s , ha ing sessions wi hou music lis ening
we e impossible in his wo ied, hopeless, and mise able s a e, bu la e , in choosing
o no lis en o music in Session 8 - he eby lis ening o he own needs - she was able o
see hings op imis ically, lea ing he sessions wi h a “ ee eeling” and ge ing o e he
ea o silence (“I hink I bea my ea ”). Music is widely used o inc ease one’s sense
o wellbeing and ac as a dis ac o om hough s and eelings, imp o e mood and
educe anxie y, and dec ease pain (Kempe & Danhaue , 2005;Nilsson, 2008), which
was ce ainly he case o Jane. Hanse (2014) desc ibes he ole o music in aming
he expe ience o pain as “an e e -changing phenomenon ha ises and alls as he mu-
sic changes in synch ony. As hese dimensions shi , he pe cep ual pa h o pain ebbs
and lows, and i is possible o pain o dissipa e in he mind o he lis ene ” (pa a. 15).
This was also he case o Jane and he anxie y; as he music played, he pe cep ual
pa h o he anxie y ebbed and lowed so ha i dissipa ed and she was able o elax,
educing he bodily ension and pain.
Lis ening
Due o Jane’s isola ed su e ing, she lamen ed ha ing no one wi h whom o alk and
hus eso ed o supp essing he emo ions, spu ing mo e anxie y. One’s a emp s o
unde s and and endu e one’s su e ing a e eased by he sha ing o his expe ience wi h
o he s, so a lis ene is an impo an aspec o any he apeu ic p ocess (Deal, 2011).
Lis ening o and con eying ha he clien has been hea d and unde s ood a e impo -
an elemen s in building up a suppo i e en i onmen (Pin o e al., 2012). In he case
o VA ea men , he p ac i ione akes on a suppo i e ole o he clien ’s sel -explo-
a ion in a clien -cen ed app oach by p o iding he clien he oppo uni y o make
choices suppo ing hei own heal hca e. Pa ien empowe men and sel -e icacy a e
essen ial o elici ing change and clien s aking con ol o hei own li es and well-
being; u he , he e has been inc eased emphasis on he iden i ica ion o pa ien s’
heal hca e wishes and an inc ease in pa ien au onomy (Laugha ne & P iebe, 2006).
One way in which p ac i ione s can suppo pa ien empowe men is o assume a guid-
ing o coaching ole (Chambe lin, 1997). In Jane’s case, his in ol ed a o ding he he
possibili y o make he choice o lis en o music h ough lis ening o he own needs.
Jane lis ened o and exp essed he own needs, which he p ac i ione hea d and ac-
knowledged. Choice has been shown o ha e posi i e consequences in educa ional,
wo kplace, and heal h con ex s (Pa all, Coope , & Robinson, 2008), leading o a sense
o pe sonal con ol (Taylo , 1989, ci ed in ibid.). When a choice has impo an im-
plica ions (i.e. elici ing elaxa ion o anxie y educ ion), i may be mo e di icul o
make (e.g. choosing whe he o lis en o music o no ), pa icula ly when he op ions
a e equally a ac i e; indi iduals expe ience inc eased mo i a ion, pe se e ance, pe -
o mance, and p oduc ion when hey asse hei au onomy h ough choice-making
(Pa all, Coope , & Robinson, 2008). Choice has also been sugges ed o in luence pa-
ien s’ commi men and mo i a ion o a ending he apy (Rokke, Tomha e, & Jocic,
1999). In he case o p o iding choice o music o which pa ien s could lis en o man-
aging pain, hei p e e ence was impo an as he e was ul ima ely no di e ence in
he pain ou comes be ween pa ien s choosing Taiwanese o Ame ican music (Huang,
Good, & Zauszniewski, 2010). The au ho s w o e ha p e e ence is in eg al when one
employs music lis ening on a long- e m basis o pain managemen . Jane’s choice was
a pi o al momen in he ea men p ocess, as i opened he doo owa ds explo ing
he meaning and use ha she could he sel a ibu e o he music lis ening.
Implica ions o p ac i ione s
The esul s and indings om his s udy sugges VA ea men in gene al may be ben-
e icial o imp o ing pain, mood, anxie y, and elaxa ion o a clien wi h medically
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unexplained symp oms. As such, when compa ing he in luence o music wi hin he
ea men p o ocol, an impo an inding o his esea ch is ha he clien ’s p e e ence
o lis ening o music should supe sede he heo e ical unde s anding o he physiolog-
ical and psychological e ec s music has on us (discussed in he sec ion Music in e en-
ions o elie ing pain and mood).The p ac i ione ’s ole wi hin he ea men sessions
o suppo a clien ’s he apeu ic p ocess and sa ely deli e VA ea men also means
he p ac i ione should help he clien o make an in o med decision on whe he mu-
sic lis ening could be used; his would be based on he needs and goals o he o e all
p ocess as well as a single ea men session. The e o e, his s udy suppo s he use o
goal-di ec ed music lis ening a he han deli e ing music lis ening solely based on e-
sea ch e idence.
Limi a ions o he esea ch
The s udy design employed he e, he single case expe imen al design, was chosen o
e alua e how one clien ecei ing VA ea men sessions would espond o bo h he
p esence and absence o he music lis ening elemen . The e o e, ca yo e o o he pa-
ien s – e en hose wi h a simila con igu a ion o symp oms – is p oblema ic (Cha -
ness, Gneezy, & Kuhn, 2012). In gene al, he disad an ages o exposing one pa icipan
o mul iple ea men s ela e o he con ounding elemen s inhe en in an indi idual’s
expe ience, especially in a mo e na u alis ic se ing (ibid.). As such, he esul s p e-
sen ed he e a e o be in e p e ed wi h cau ion, as he ea men p ocess o e ime –
ega dless o he speci ic condi ion o each session pe se – in luenced he o e all e -
ec s o he music lis ening elemen . AB designs as such can be use ul in explo ing he
easibili y o an in e en ion, bu do no p o ide de ini i e indica ions o he e ec i e-
ness o a ea men (Manolo , Gas , Pe dices, & E ans, 2014). On he o he hand, he
a ied ea men esponses also highligh he di icul y in managing medically unex-
plained symp oms and he many ex e nal ac o s in luencing a he apeu ic p ocess.
Ano he po en ial limi a ion o his s udy is he ac ha EAC illed wo oles, one
as he VA ea men p ac i ione and he o he as a esea che . She collec ed all da a
in he ole o p ac i ione and also conduc ed all da a analysis and in e p e a ion; de-
spi e he quali a i e and quan i a i e da a being analysed sepa a ely in hei en i e y
be o e he in eg a ed analysis, his p ocess could no be comple ely sepa a e as a esul
o his ole o e lap. This ne e heless may also be seen as ad an ageous, as EAC had
a comple e pic u e o he p ocess om a p ac i ione ’s pe spec i e om he sessions o
he membe check in e iew as a esul o he dual oles (as discussed in sec ion Roles
o he esea che s / p ac i ione ).
Finally, Visual Analogue Scales may ha e been oo simplis ic a measu emen ool o
assess Jane’s nuanced expe iences. The e bal p ocessing / quali a i e da a we e he e-
o e ex emely impo an in suppo ing he quan i a i e esul s. The b oade opics o
discussion be ween he clien and p ac i ione du ing he sessions allowed o a mo e
complex examina ion o Jane’s con ex ual he apeu ic expe iences, bu he in eg a ion
o di e se da a sou ces – he quan i a i e as speci ic and quali a i e as mo e gene al
explo a ions – was mo e complica ed as a esul . Al hough i may ha e po en ially been
bene icial o conduc mo e o malised in e iews o he expe iences pe aining di ec ly
o he a iables unde examina ion, his would ha e comp omised he in eg i y o he
he apeu ic con ex . The esea ch p ocess and ou comes o his s udy he e o e suppo
he use o mixed me hods as a means o explo ing how a clien may espond o a he -
apeu ic in e en ion when ha ing di e se symp oms o no disce nible medical sou ce,
despi e he po en ial pi alls o single case esea ch in gene al.
A eas o u he explo a ion
The clien ’s speci ic connec ion o hei p e e ed music may be impo an in sensa ion
pe cep ion. Ha ing a clea e idea o how an indi idual esponds o ce ain music
would be an impo an s ep in u he unde s anding he in e ac ion o he VA ea -
men elemen s. This suppo s he necessi y o he he apeu ic and suppo i e ole o
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he p ac i ione in planning and execu ing he he apy p ocess, wi h he clien sha ing
he esponsibili y in how hei ea men p og esses. Unde s anding mo e closely he
indi idual bene i s and cumula i e e ec s o each a m o he VA ea men iad wo ks
owa ds mo e e ec i e and sa e u ilisa ion o VA. Mo e esea ch is also needed o ex-
plo e how he VA ea men elemen s wo k oge he o a ious a ge g oups such as
pa ien s wi h complex and in e ac ing symp oms.
CConclusiononclusion
Music lis ening wi h low equency sound ib a ion and he apeu ic in e ac ion was
bene icial o educing anxie y, imp o ing mood, and educing pain wi h po en ial im-
plica ions o imp o ing quali y o sleep o a clien wi h medically unexplained symp-
oms. Low equency sinusoidal sound ib a ion and he apeu ic in e ac ion wi h and
wi hou music lis ening was bene icial o elaxa ion. Music ul ima ely became an op-
po uni y o Jane o lea n how o bo h ac i ely and passi ely sel - egula e he anxie y,
and he choice o no lis ening o music was equally impo an as i enabled he o ad-
d ess and engage wi h he own needs. Choosing o lis en o music o no was suppo ed
and ein o ced by he p ac i ione , as he choice was based on Jane’s cu en needs and
se ed o empowe Jane, impo an o he apeu ic change. Al hough mo e esea ch is
needed, music in his case was an impo an pi o al poin o change in he he apeu ic
p ocess, enabling he pa icipan o make posi i e choices o he own wellbeing. The
choice o whe he o lis en o music o no , o indeed he music o which one lis ens,
wi hin VA ea men can play an impo an ole in he e ec music lis ening may ha e
wi hin a p ocess.
Abou he au ho Abou he au ho ss
Elsa A. Campbell, M.A., is a music he apy doc o al candida e a he Finnish Cen e o
In e disciplina y Music Resea ch, Depa men o Music, A and Cul u e S udies, Uni-
e si y o Jy äskylä, Finland. She is also coo dina o o he VIBRAC Skille-Lehikoinen
Cen e o Vib oacous ic The apy and Resea ch, Finland.
Bi gi a Bu ge , Ph.D., is an Academy o Finland pos doc o al esea che a he
Finnish Cen e o In e disciplina y Music Resea ch, Depa men o Music, A and Cul-
u al S udies, Uni e si y o Jy äskylä, Finland.
Esa Ala-Ruona, Ph.D., is a music he apis , psycho he apis , and senio esea che a
he Finnish Cen e o In e disciplina y Music Resea ch, Depa men o Music, A and
Cul u al S udies, Uni e si y o Jy äskylä, Finland.
AcknowlAcknowledgmen sedgmen s
Suppo ed by: The Facul y o Humani ies and Social Sciences, Uni e si y o Jy äskylä,
Finland. The au ho s would like o u he acknowledge he aluable inpu om
Ne dinga Le ulė and Oli ie B aban .
No No eses
1. These alues a e in e ed.
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