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Mindfulness Meditation (MM) and Relaxation Music (RM) in the UK and South Korea: a Qualitative Case Study Approach

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Mindfulness Meditation (MM) and Relaxation Music (RM) in the UK and South Korea: a Qualitative Case Study Approach Health Practitioners’ Understanding and Use of Relaxation Techniques (RTs), Mindfulness Meditation (MM) and Relaxation Music (RM) in the UK and South Korea: a Qualitative Case Study Approach Mi hyang Hwang A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of Doctor of Philosophy Faculty of Health and Social Sciences University of the West of England, Bristol November 2017 Abstract Background: The information exchange between healthcare practitioners in South Korea and the UK has so far been limited and cross-cultural comparisons of Relaxation techniques (RTs) and Mindfulness meditation (MM) and Relaxation music (RM) within the healthcare context of Korea and the UK have previously been unexplored. This has been the inspiration for this qualitative case study focussing on understanding and use of RTs, MM and RM within the respective healthcare contexts. Methods: Data were collected through qualitative semi-structured interviews with six Korean and six UK healthcare practitioners in three professional areas: medical practice, meditation, and music therapy. Approval from the Ethics Committee was granted (Application number: HLS/13/05/68). The interviews were transcribed and a thematic analysis was undertaken. The topics explored include: a) the value and use of RTs, MM and RM; b) approaches and methods; c) practitioners’ concerns; d) responses of interventions; e) cultural similarities and differences; and f) the integration of RTs, MM and RM within healthcare. Underlying cultural factors have been considered, including education systems and approaches, practitioner-client relationships and religious influences alongside the background of cultural change and changing perspectives within healthcare in the UK and Korea. Findings: A great variety of approaches to RTs, MM and RM were discussed among the sample group. Across a wide client spectrum common therapeutic purposes included stress reduction, emotional support and regulation, rehabilitation, personal transformation and spiritual development. The participants were both discerning and creative in terms of mind-body interventions they use. Practitioners’ training, personal experience and insights gained through practice inform their professional work and they were keen to share knowledge among colleagues. Health Practitioners’ Understanding and Use of RTs, MM and RM in the UK and South Korea i : a qualitative case study approach Nevertheless, practitioners’ level of competency and abilities with respect to the use of RTs, MM and RM were a common concern; training opportunities exist to varying degrees in both countries, however, and growth in the use of mind-body-spirit interventions is a significant trend. Nation-specific and cultural factors can affect the use of interventions, settings and client group. Similarities (focus on individual and subjective factors, client acceptance and practical concerns) and differences (related to historical background, educational culture, prevailing religious outlooks and the respective health services) were found between Korea and the UK. Conclusion: The value of cross-cultural and multidisciplinary research and integrated health is increasingly recognised and the use of RTs, MM and RM as mind-body-spirit interventions considered to be useful integrated treatment within healthcare context. This study shows the difference in range of RTs, MM and RM resources and the approaches in integrating practice and these may lead to cross-fertilisation within therapeutic practice. The value of knowledge sharing and integrated medicine is increasingly recognised across the globe and this study opens up a number of themes that might be taken up again and built on by future researchers. More generally, the study contributes to cross- cultural qualitative research between Korea and UK and integrating theory and practice with respect to RTs, MM and RM. Key words: Relaxation techniques (RTs), Mindfulness meditation (MM), Relaxation music (RM), Meditation, Music therapy, Healthcare, Healthcare practitioners, South Korea, UK Health Practitioners’ Understanding and Use of RTs, MM and RM in the UK and South Korea ii : a qualitative case study approach Table of Contents Abstract ………………………………………………………………………………………………....................i Table of Contents ….…………………………………………………………..........iii Statement of Original Authorship …………………………………………………..ix Acknowledgements ……………………………………………………………………………………………..x Preface ……………………………………………………………………………………………………..............xii Chapter 1: Introduction …………………………………………………………....1 1.1 Relaxation Techniques (RTs), Mindfulness Meditation (MM) and Relaxation Music (RM) in Healthcare ……………………………………….1 1.2 Cross-Cultural Communication regarding Music Therapy and Meditational Practices ……………………………………………………...........................3 1.3 Research Aims and Research Questions ……………………………........6 1.4 Structure of the Thesis………………………………………………….....9 Chapter 2: Literature Review ………………………………………………….…11 2.1 Introduction ……………………………………………………………..11 2.2 Literature Review Process.……………………………………………....13 2.3 RTs, MM and RM as Mind-Body Interventions………………………...15 2.4 Detailed Contents of the Literature Review……………………………..17 2.5 RTs, MM and RM for Health and Well-being ………………………….18 2.6 Music in Health …………………………………………………………26 2.6.1 Music in Medicine………………………………………….....27 2.6.2 Music Therapy in Health……………………………………...30 2.7 Collaborative and Multidisciplinary Approaches ……………….……....38 2.7.1 Music Therapy: Collaborating…………………………….......39 2.7.2 Combining RTs and RM in Music Therapy.…………...……..40 Health Practitioners’ Understanding and Use of RTs, MM and RM in the UK and South Korea iii : a qualitative case study approach 2.8 Characteristics of RM ……………………………………………….….42 2.9 Types of RM ………………………………………………………..…..46 2.10 RTs and Meditational Practices in Health …………………….............52 2.11 Stress Management and Mind-Body Interventions ………...................56 2.12 Mindfulness-Based Practice in Health …………………………..……60 2.13 Creativity and Spirituality …………………………………………….64 Chapter 3: Methodology …………………………………………………...…..…72 3.1 Introduction to Research Design ………………………………..…...…72 3.2 Reflection on Case Study Qualitative Methodology…………….......….73 3.2.1 Case Studies…………………………………………………...73 3.2.2 Qualitative Research…………………………………………..77 3.2.3 Philosophical Assumptions……………………………………78 3.3 Research Procedures ……………………………………………………79 3.3.1 Fieldwork and Interview ………….…………………………..79 3.3.2 Sampling and Size of Groups ……….…………………………79 3.3.3 Information about the 12 Interviewees ………………………..81 3.4 Data Collection and Data Analysis ……………………………………...81 3.4.1 Interview Data Collection………………………………….......81 3.4.2 Data Analysis ………………………………………………….82 3.5 Ethical Considerations and Application………………………………....84 3.6 Engagement with the Research Process through Reflection ………….....85 3.7 Reflections on Quality Criteria ………………………………………….85 3.8 Reflection of Cross-Cultural Interviewing………………………………90 Health Practitioners’ Understanding and Use of RTs, MM and RM in the UK and South Korea iv : a qualitative case study approach Chapter 4: Finding Chapters: Music and Health ……………………………….94 4.1 Introduction to Finding Chapters……………… ……………………….94 4.2 Music and Music Therapy Approaches ………………………………...94 4.2.1 Use of Music ……………………………………………….…95 4.2.2 Criteria for Choice of Music ………………………………...102 4.2.3 Music Genre …………………………………………………107 4.2.4 Musical and Sound Instruments ……………………………..109 4.2.5 Receptive and Active Approaches ……………………….….112 4.3 Music, Health and Well-being …………………………………….…..114 4.3.1 Personal Motivations in Using Music in Health ……….……114 4.3.2 Use of Music in Health Contexts ……………………………121 4.4 Qualities and Abilities of the Practitioners …………………………....128 4.4.1 Personal Qualities and Abilities of the Practitioners …………128 4.4.2 Level of Competency and Abilities of the Practitioners …….134 4.4.3 Qualifications and Interventions Training …………………..138 Chapter 5: Finding Chapters: RTs and MM and Health…………………...….144 5.1 RTs and MM Approaches ……………………………………………..144 5.1.1 Purposes of RTs and MM..…………………………………...145 5.1.2 Practitioners’ Personal Motivations in Using RTs and MM…148 5.1.3 Types of RTs and MM ………………………………….…...150 5.1.4 Adaptations of RTs and MM …………………………………153 5.2 RTs and MM as Healthcare Interventions ……………………………..160 5.2.1 Understanding of RTs and MM for Health and Well-being….161 Health Practitioners’ Understanding and Use of RTs, MM and RM in the UK and South Korea v : a qualitative case study approach 5.3 Use of RTs and Meditation in Health Contexts……………………….163 5.3.1 Breathing Techniques………………………………………..163 5.3.2 Progressive Relaxation Technique (PRT) ………………......169 5.3.3 Body Scan ……………………………………………..…….172 5.3.4 Imagery and Visualisation ………………………………..…174 5.3.5 Autogenic Therapy (AT) …………………………………....176 5.3.6 Walking Meditation ……………………………………....…177 5.3.7 Loving-Kindness and Compassionate Meditation …………...180 5.3.8 Mandalas …………………………………………………….182 5.3.9 Mindfulness Meditation (MM) …………………………...….184 Chapter 6: Finding Chapters: RTs, MM and RM Applications and Responses …………………………………………………………………………………..…188 6.1 RTs, MM and RM, Creativity and Spirituality ...……………….……..188 6.2 RTs, MM and RM as Stress Management ...…………………………..192 6.2.1 Use of RTs, MM and RM for Stress Management with Patients and Clients ……………………………………………………........193 6.2.2 Healthcare Practitioners’ and Trainees’ Use of RTs, MM and RM for Stress Management ……………………………….……………194 6.2.3
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