Glimt av glede. Musikkterapi med demensrammede som har symptomer på depresjon og angst
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The dissertation describes an empirical study in which six elderly people suffering from dementia have received short term music therapy. The sessions have been videotaped and standardized instruments have been applied in a Mixed Methods Research Design. Evaluation of change and distinctive features in the processes are focused. The first chapter, the introduction, presents the main subject and the key notions Music therapy, Dementia, and State of mind. This is followed by a theory section where connections between memory, music, and dementia are elucidated from neuropsychological and cognitive psychological perspectives. After this, a literature survey is presented which contains a review and descriptions of research studies published from year 2000 within the areas music, dementia, and depression in addition to anxiety, behavioral and psychological symptoms in dementia (BPSD) and quality of life/wellbeing. The introduction closes off with the main research question: Can music therapy influence the state of mind among people with dementia who have symptoms of depression or depression and anxiety? The subject in chapter two is methodology. The concepts of Mixed methods, Case study, and Single case design are elaborated. In addition to this, the framework for the collection of data is described, as well as qualitative and quantitative procedures. Chapter three and four contain analyses and results. The most important findings in the quantitative investigation are statistically significant positive change in Anxiety and Quality of life after an average of 12 sessions for the group as a whole (p<0,05). The subcategory Anxiety is measured by the Neuropsychiatric lnventory NPI and Quality of life by the Alzheimer Related Quality of Life ADRQL. Within sessions there are statistically significant positive changes in the Dementia Mood Picture Test (DMPT) and between sessions in the subcategory Wandering in the "Døgnvariasjonsskjema" (form for 24 hours varieties in behavior). When the cases are considered individually, the results show that five out of six persons with dementia had a positive change in state of mind, demonstrated by reduced behavioral and psychological symptoms as well as an increase in quality of life after the music therapy period. A follow-up after three months shows an increase in symptoms and reduction in quality of life, but the levels are still better than before intervention for four of the five persons involved. The most important results in the qualitative investigation are that the six cases either show an increase or an unchanged degree of attention, response to the music, expressions of emotions, and relational accessibility, both in the beginning and the end of the music therapy period, as well as in the beginning and end/midst of the sessions. The changes observed in the video analyses are yet not significant. Even though the changes are small, the analysis shows generally high levels of participation. Results from the research methodology are thereby that changes are registered mainly by standardized instruments and not by video analysis. However video analyses are considered important to get information of what goes on in the music therapy sessions. Besides this, both types of methods are considered necessary for mutual corrective purposes and for giving a comprehensive picture of what is happening. The final part of the thesis contains discussions of the results related to previous research in the field and also critique of the method. ln addition to this, transference to dementia care in general and the music therapy profession is considered. The study sticks out from other music and dementia studies by the application of both quantitative and qualitative methods, and that positive changes are registered in both aspects of mood symptoms and quality of life. Moreover, it is the first Ph.D. study in Norway that addresses individual music therapy with persons suffering from dementia. The study utilizes a small sample and thus it cannot be generalized to the population of persons with dementia. However, it can be used for replication. In addition to this there is an argumentation for "analytical or theoretical" generalization. This means that results from a small sample are related to material from similar studies and to a theory which supports the results. In this study, one case event is repeated in five other parallel case events. The results are positive for five of the six cases. In addition, the results for the group as a whole show a reduction of symptoms and improved quality of life. Combined with other research studies yielding positive results in the same areas of investigation, in addition to theory on the field, these give foundations for analytical generalizing. There is also the argument that music therapy yields special qualities concerning communication with people who have limitations in their language and memory abilities and therefore should have more influence in dementia care. For the music therapy profession, standardized instruments are recommended when evaluation of music therapy outcome is considered. Based on the results yielded here, other research studies within the same area, theories in the fields of neuropsychology, and music psychology about connections between memory and music perception, the conclusion is that music therapy can have a strong impact on the state of mind for people suffering from dementia that have symptoms of depression and anxiety.
Avhandling (Ph.D.) - Norges musikkhøgskole, 2013