PSYCHOLOGICAL FACTORS IN THE USE OF MUSIC THERAPY WITH INDIVIDUALS EXPERIENCING PAIN: A SURVEY OF CURRENT PRACTICE A Thesis by HANNAH HOPE LINGAFELT, MT-BC Submitted to the Graduate School at Appalachian State University in partial fulfillment of the requirements for the degree of MASTER OF MUSIC THERAPY August 2017 Hayes School of Music PSYCHOLOGICAL FACTORS IN THE USE OF MUSIC THERAPY WITH INDIVIDUALS EXPERIENCING PAIN: A SURVEY OF CURRENT PRACTICE A Thesis by HANNAH HOPE LINGAFELT August 2017 APPROVED BY: Christine P. Leist, Ph.D. Chairperson, Thesis Committee Cathy H. McKinney, Ph.D. Member, Thesis Committee Melia Snyder, Ph.D. Member, Thesis Committee William L. Pelto, Ph.D. Dean, Hayes School of Music Max C. Poole, Ph.D. Dean, Cratis D. Williams School of Graduate Studies Copyright by Hannah Hope Lingafelt 2017 All Rights Reserved Abstract PSYCHOLOGICAL FACTORS IN THE USE OF MUSIC THERAPY WITH INDIVIDUALS EXPERIENCING PAIN: A SURVEY OF CURRENT PRACTICE Hannah Lingafelt B.M., Appalachian State University M.M.T., Appalachian State University M.A., Appalachian State University Chairperson: Christine P. Leist This study examined how music therapists consider psychological factors when working with individuals experiencing acute pain and individuals experiencing chronic pain. It is estimated that hundreds of millions of Americans experience pain (Gaskin & Richard, 2012). Since psychological factors such as anxiety and depression can increase the perception of acute pain, integrative therapies, such as music therapy, that address these factors are increasingly needed. This study utilized a mixed methods design to examine how music therapists address psychological factors when working with individuals experiencing acute and chronic pain. The researcher constructed and distributed a survey to 489 music therapists who were board-certified and working in settings likely to include individuals experiencing pain. Sixty-eight music therapists responded to the questionnaire. From those participants, three music therapists volunteered to participate in a semi-structured interview with the researcher to share their thoughts and expertise about the topic. Results of the study suggested that music therapists address psychological factors iv such as trait anxiety and depression prior to an acute pain event or during chronic pain; results further suggested that music therapists tended to prioritize trait anxiety when working with individuals experiencing acute pain. The results of the study demonstrated a need for music therapists to continue to address depression and trait anxiety at all stages of the pain process. v Acknowledgments I would like to thank my committee chair, Dr. Christine Leist, for her support and encouragement throughout this process. Through the daunting tasks and sometimes frenzied states accompanying this process, Dr. Leist was constantly calm and supportive, helping me problem-solve, pushing me, and tirelessly cheering me on. This work would not have been possible without her, and I am so grateful for her. Additionally, I would like to thank the members of my thesis committee, Dr. Cathy McKinney and Dr. Melia Snyder. Dr. McKinney’s expertise in the field of music therapy and mental health and Dr. Snyder’s expertise in the field of counseling, expressive arts, and integrative health proved invaluable to my learning and crafting of this work. Furthermore, their encouragement helped me feel that completion of this process was, indeed, attainable. Further, I would like to thank Lisa Gallagher, Kathy Jo Gutgsell, and Noelle Pedersen for sharing their expertise on the use of music therapy with individuals experiencing pain. Their time and their consideration is greatly appreciated, and the field of music therapy is richer for their work. Finally, I would be remiss if I did not thank my parents, Patti and Steven; my brother, Charles; my dear friend, Cindy; and my dear friend and personal proofreader, Brandi. In the midst of my own self-doubt, you all constantly provided stability, encouragement, and an imperturbable belief that I could do this. I will be ever grateful for your encouraging words, your hugs, your laughter, your love, your proofreading, and your help folding my clothes. vi Table of Contents Abstract .............................................................................................................................. iv Acknowledgments.............................................................................................................. vi List of Tables ..................................................................................................................... ix Chapter 1: Introduction ........................................................................................................1 Definition of Terms..................................................................................................4 Chapter 2: Literature Review ...............................................................................................9 Overview of Pain ...................................................................................................10 Treatment of Pain ...................................................................................................16 Music and Pain .......................................................................................................22 Music Therapy and Pain ........................................................................................24 Statement of Purpose .............................................................................................37 Research Questions ................................................................................................38 Chapter 3: Method .............................................................................................................40 Participant Characteristics .....................................................................................40 Measures ................................................................................................................44 Research Design.....................................................................................................46 Procedure ...............................................................................................................47 Data Analysis .........................................................................................................47 Chapter 4: Survey Results ..................................................................................................49 vii Section 1: Music Therapy and Acute Pain .............................................................49 Section 2: Music Therapy and Chronic Pain .........................................................62 Section 3: Open-ended Questions ..........................................................................68 Chapter 5: Interview Results ..............................................................................................75 Chapter 6: Discussion ........................................................................................................92 Recommendations for Clinical Practice...............................................................106 Limitations ...........................................................................................................109 Implications for Future Research .........................................................................111 Conclusion ...........................................................................................................113 References ........................................................................................................................115 Appendices .......................................................................................................................136 Appendix A: Pain, Music Therapy, and Psychological Factors Questionnaire ...............137 Appendix B: Oral Interview Questions............................................................................142 Appendix C: Email/Survey Consent Form ......................................................................143 Appendix D: Oral Interview Consent Form.....................................................................144 Appendix E: Email of IRB Approval/Exemption ............................................................145 Vita ...................................................................................................................................147 viii List of Tables Table 1. Ages of Participants .............................................................................................41 Table 2. Highest Education Level Obtained in Music Therapy.........................................41 Table 3. Setting in Which Participants are Currently Practicing .......................................43 Table 4. Types of Pain Treated by Participants .................................................................44 Table 5. Types of Music Therapy Sessions Facilitated with Clients in Acute Pain ..........50 Table 6. Assessment at the Beginning of Treatment for Acute Pain .................................51 Table 7. Need Areas Addressed in Music Therapy Before Experiencing Acute Pain.......52 Table 8. Music Therapy Treatment Goals Before Experiencing Acute Pain ....................53 Table 9. Music Therapy Interventions Before Experiencing Acute Pain ..........................54 Table 10. Music Therapy Treatment Goals While