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Somatron Vibroacoustic Products
IEE Engineering In Medicine and Biology March/April 1999
The Effects of Vibroacoustic
Music on Symptom Reduction Inducing The Relaxation Response Through Good Vibrations
“Good,
good, good, good vibrations.”
Proclaimed the Beach Boys in both words and vibrant harmony. As with most of their music, the simple
lyrics are outweighed by harmonic message. Still, their teenaged composer
and lyricist, Brian Wilson, was inspired by why dogs barked at specific
people and why certain girls emanated exciting vibrations (“excitations”). Music and vibration would appear to be
far from the concerns of human adaptation, but surprise has always
been a driver of scientific investigation.
The need for hospitalized patients to experience the relaxation
response as an antidote to the stress of treatment and adjustment
to the possibility of chronic or life-threatening conditions is clear. The systematic application of music to
promote positive changes in behavior has been used successfully in
a variety of hospital settings.
The effectiveness of music interventions in stress management
has been measured physiologically and behaviorally.
This present study extends previous research by describing
the outcome of a recreation therapy program of Vibroacoustic music
(VAM) offered to hospitalized patients.
In order to provide patients with assistance in achieving the
relaxation response, recreation therapists at a major federal research
hospital created several relaxation opportunities for patients and
family members. Included in these opportunities were classes
in: In addition, the recreation
therapists created a relaxation room, equipped with four Somatrons,
which is commercially available Vibroacoustic Music Recliner delivering
ear-level stereo sound and tactile vibrations that allow the body
to feel the music that is normally only heard.
Patients
can access an initial session in the relaxation room using anxiolytically
designed (relaxing) music titled “Balance.” Subsequent uses of the relaxation room
have employed either “Balance” or music from “The Musical Body” (Therasound).
In all cases, the relaxation room is a recreation therapist-guided
session with a 10-minute introduction, 25 minutes of music/vibration,
and about 10 minutes of debriefing (a total of 45 minutes per session).
The researcher and colleagues were surprised at patients reporting
that they received unintended (and unadvertised) symptomatic relief
as a result of VAM. These
unsolicited testimonials led the program evaluation to include a measure
of patient symptoms in both pre and post VAM sessions. Method (Sampling Procedure) A program evaluation yielded data from the use of these VAM recliners with anxiolytic music gathered from 272 adult patients in a major research hospital. This was a convenience sample of those who came to the relaxation room. Patients were recruited by several methods; physician referral, patient response to recreation therapist recommendation, or patient response to information about the relaxation room (printed materials and word of mouth from other patients). These patients had varying diagnoses; cancer (97); heart, lung, and blood disorders (55); infectious disease (54); mood disorders (32); and miscellaneous conditions (34). Their ages ranged from 21 to 67, with an average age of 43.7 years. Females made up 53% of the sample. Again, this study reports a program evaluation. As such, no effort was made to develop a meaningful control group. Measurements and Variables
Data were gathered from two patient self-report instruments,
completed immediately before and after the VAM session. State of relaxation was measured by selecting
one of seven statements from the “Self-Report Rating Scale for Tension
and Relaxation” asking “Which of the following best describes the
way you feel right now?”
Because this study attempted to track whatever symptoms patients
were experiencing at the moment before the VAM session, the open-ended
questions asked of them were:
“What symptom(s) are you experiencing now?” and “At what level
of intensity?”. Up to three symptoms were requested from
our patients, and they were asked to place a hash mark on a visual
analog scale (VAS) to rate the intensity of each particular symptom. The line was anchored at its ends by the
printed phases “not at all” and “very much.” Some chose no symptoms.
The pre-post data set afforded a between-groups analysis among
the dependent variables. To
analyze the results, we employed a paired t-test to determine
the probability of the changes in pre versus post differences. Results (Descriptive Findings)
To measure the state of relaxation, the seven point Self-Report
Rating Scale for Tension and Relaxation was used.
With N=272, the pre rating was 5.12 (5 is “Feeling Some Tension
in Some Parts of My Body”) while
the post rating was 2.77 (3 is “Feeling More Relaxed Than Usual”),
a statistically significant difference.
Although this scale is ordinal, anchored with descriptive language
(categorically ordered), the Bartlett’s test of fit allowed for an
estimation of effective improvement of 33.4% in state of relaxation.
Aggregation of the symptom data showed an average participant
pre (VAS) rating of 67.20 (of 100) and a post rating of 31.55, a 53% reduction in cumulated symptoms.
Only the first (of up to three) symptoms was analyzed in this
program evaluation to simplify the data displayed here.
The most frequently identified symptoms were tension-anxiety,
pain fatigue, nausea, headache, and depression, which comprised 92%
of the symptoms mentioned. The post rating was done at the end of
the VAM session in order to determine the perceived effect in order
to determine the perceived effect of the session on the symptom and
to reduce the influence of other variables.
Each of these symptoms showed reduction in intensity based
on pre-post mean scores. The intensity of symptoms was reduced
from pre to post by the following percentages; nausea 61%; headache,
58%; tension-anxiety, 54%; pain, 53%; depressed mood, 49% and fatigue,
47%. A one-sample t-test (pre-post) was performed
and all the results were statistically significant at P<.0001.
Discussion
Date were not analyzed by diagnostic group for purposes of
this study. An inspection
of the patient-reported symptoms showed that such symptoms frequently
were not associated with the disease, only occasionally associated
with the treatment (i.e. nausea from chemotherapy), and were clustered
under what could be called psychosocial stress (a result of disease,
hospitalization, and experimental treatment) secondary to primary
diagnosis. Since both
the room and program name were titled “relaxation,” the author felt
that changes in self-reported symptom intensity would be far from
“leading” (not telling us what they thought we wanted to hear). Still, patients seemed to find a way to
give us answers we wanted to receive.
That kind of willingness, plus the nonrandom selection and
lack of control group, should give rise to suspicion as to our results.
This program evaluation data yielded descriptive information
showing symptom reduction over the period of a single 45-minute VAM
session. Having conceived this program evaluation
as an initial exploration, the researcher offered no initial hypotheses. The robustness of these salutary results,
however, affords the opportunity to at least speculate on what might
be going on during VAM.
The power of the relaxation response may yet to be fully documented. Hypnotic trance states have been used
to help patients successfully through difficult medical procedures,
such as surgery, with considerable less post-surgical complications
and reduced recovery time. The
whole area of mind-body medicine struggles with hypothesis development
that requires an expanded view of reciprocal causation in the sympathetic
and parasympathetic systems.
Another speculation offered is the role of the placebo effect
and positive expectations. Our
focus on the relaxation response (name of the room, program name,
and asking for relaxation ratings) was helpful in minimizing any expectation
for symptom reduction. Still
many patients are given to please their caretakers and we might well
have measured a response bias.
The placebo effect has been measured as strong as 30 – 60%.
It is clearly a real effect and ought to be optimized rather
than ruled out. Even double-blind, random selection studies
are unable to factor out the placebo effect; therefore, we acknowledge
and embrace this limitation.
The focus of this study touches on the role of music/vibration
in human adaptation. In
some way, music/vibration of certain frequencies, intensities, rhythms,
etc., might be implicated in the body’s regulatory mechanisms. In general, most hospitalized patients
could benefit from some form of down-regulation of “sympathetic tone”
(an interesting phrase in this discussion).
The researcher entertains the notion that multiple mechanisms
of the body may use music/vibration to regain a healthy homeostasis. Indeed, Chesky has suggested that pacinian
corpuscles, excited by vibrations of certain frequencies, may
mediate pain and other noxious stimuli.
Disease can be seen as the inability of the human organism
to cope with or handle disturbances insulting to its homeostatic systems. The science of medicine is being reshaped
by the role of molecular messengers that communicate to regulatory
mechanisms in ways that are well beyond our understanding of the “hard-wired”
nervous system. The blood-brain
barrier has become about as relevant as the Berlin wall. If the super-high-frequency vibrations
of light effect our mood states and biological time clocks, how far
afield is it to suspect that music and vibration (at much lower frequencies)
have effects on psycho-neurophysiology?
In the future, when this program evaluation develops into a
more carefully conceived research study, with attention to patient
selection and assignment, an attempt at a control condition, and a
range of calibrated dosage levels, our research team will be in a
better position to make stronger claims generalizability.
Nonetheless, sufficient data were generated to indicate that
many patients using VAM experienced a deep relaxation
response and reduced their symptom burden. Clinical impressions by the group of five
recreation therapists were commensurate with the statistical significance
reported. Having some
personal control of their symptom burden pleased most patients. This positive outcome was used to point
out that patients could clearly benefit by regular practice of an
effective relaxation technique.
Patients were given additional training in the “Art of Relaxation;
class, through individual instruction, or by readings. Conclusions
The present results suggest the value of using VAM to induce
the relaxation response in order to reduce the symptom burden of hospitalized patients. These findings point to an avenue of future research using careful selection
assignment, controls, variable dosage, and longer follow-up periods
to test the durability of VAM interventions.
Perhaps Brian Wilson was more right than he knew when he recommended that we would do well
to “Keep good vibrations a happenin’ to me.” Acknowledgment
The author wishes to acknowledge assistance in data collection
and clinical expertise of the following recreation therapists who,
with him, run the relaxation room: Sharon Ballard, Jane Ganz, Cindy
White, Linda Scimeca, and Jim Ebel.
Mark Mattiko helped with data analysis.
George Patrick serves
as chief of recreation therapy in the Rehabilitation Medicine Department,
Clinical Center, of the National Institutes of Health.
He earned his Ph.D. at the University of Illinois. His professional career as a recreation
therapist spans five states and a wide variety of clients. Dr. Patrick plays golf, rides a sport
motorcycle, serves food to the homeless in Washington, DC, and is
enjoying grand fatherhood. With
his wife, Jane, he enjoys music of the National Symphony and sings
in a church choir.
Address for Correspondence:
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