Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses

A Research Paper Presented to the Faculty of College of Nursing Arellano University Jose Abad Santos Campus, Pasay City

In Partial Fulfillment of the Requirements for the Degree of Bachelor of Science in Nursing

Tulawie, Yushra

Dr. Gina Pardilla Research Adviser

October 2011

APPROVAL SHEET

The research entitled Impact of Music Therapy on the Depression Mood of College Students prepared and submitted by Yushra Tulawie has been examined and hereby recommended for acceptance and approval in partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing.

Dr. Gina Pardilla, MD, MPH Research Adviser Panel Examiner

Gina F. Pardilla, MD, MPH Member

August I. Manzon RN, MAN Member

Jennifer H. Mesde RN, MAN Chaiman

Accepted in partial fulfillment of the requirements for the Degree of Bachelor of Science in Nursing.

Dr. Arlene Blaise T. Cortez RN, MAN Dean, College of Nursing

ACKNOWLEDGEMENT

This dissertation would not have been possible without the guidance and the help of several individuals, who in one way or another have contributed and extended their valuable assistance in the preparation and completion of this study, and my utmost gratitude for them will forever be in my heart:

To Dr. Arlene Blaise T. Cortez, whose consideration, sincerity and encouragement I will never forget.

To Dr. Gina Pardilla, for her guidance, patience, and moral support. For being an inspiration as I hurdle all the obstacles in the completion of this research work.

To Mr. August Manzon, Ms. Jennifer Mesde, and Mr. Ernie A. Gale for their assistance and valuable insights to better my research.

To the student respondents, for their selfless cooperation and participation all through out the study.

To my family for their never-ending guidance and support.

And mostly, all praise is due to Allah, whose will must be done, and peace and blessings be upon our Prophet Muhammad and upon his family and his Companions.

TABLE OF CONTENTS

Preliminaries

Page

Title Page Approval Sheet Acknowledgement Table of Contents List of Tables List of Figures Abstract

i ii iii iv vii ix x

Chapter 1 The Problem and Its Setting A. Introduction 1

B. Statement of the Problem C. Hypothesis D. Conceptual Framework E. Scope and Delimitations of the Study Limitations of the Study F. Definition of Terms

3 3 4 9 10 11

G. Significance of the Study

12

Chapter 2 Review of Related Literature and Studies

13

Chapter 3 Research Method and Procedures A. Setting B. Research Design C. Respondents of the Study D. Sampling Design E. Research Instrument F. Data Gathering Procedure 20 20 21 21 22 23

G. Data Processing

24

H. Statistical Treatment

24

Chapter 4 Presentation, Analysis and Interpretation of Data

26

Chapter 5 Summary of Findings, Conclusions and Recommendations Summary of Findings Conclusions Recommendations 43 45 46

Bibliography

xiv

Appendices A. Letter to the Dean xxi

B. Letter to the Respondents C. Instrument Used D. Scoring of Depression Tests E. Results of the Collected Data Before the Experiment F. Computations G. Approval and Interviews H. Researchers Profile

xxii xxiv xxvii xxx

xxxii xxxviii xlii

LIST OF TABLES

Table 1 Profile of Respondents According to Age

27

Table 2 Level of Depression Scale Before Music Therapy According to Zung Self-Rated Anxiety Scale 30

Table 3 Level of Depression Before Music Therapy According to Goldbergs Depression Scale 32

Table 4 Level of Depression of Experimental Group According to Zungs Self-Rated Anxiety Scale, Before and After Music Therapy 34

Table 5 Level of Depression of Experimental Group

According to Goldbergs Depression Scale Before and After Music Therapy 35

Table 6 Level of Depression of Controlled Group According to Zungs Self-Rated Anxiety Scale Before and After Music Therapy 36

Table 7 Level of Depression of Controlled Group According to Goldbergs Depression Scale Before and After Music Therapy 38

Table 8 Zungs Self-Rated Scale Tool

xxiv

Table 9 Goldbergs Depression Scale Tool

xxv

Table 10 Scoring for Zungs SAS Tool

xxvii

Table 11 Scores on Zungs SAS Before the Experiment

xxx

Table 12 Scores on Goldbergs Depression Scale Before the Experiment xxxi

Table 13 Correlation on Experimental Group (Zungs SAS)

xxxii

Table 14 Correlation on Experimental Group (Goldbergs DS)

xxxiii

Table 15 Correlation on Controlled Group (Zungs SAS)

xxxv

Table 16 Correlation on Controlled Group (Goldbergs DS)

xxxvi

LIST OF FIGURES

Figure 1 EEG Pattern

Figure 2 Therapeutic Relationship Model

Figure 3 Profile of Respondents According to Gender

26

Figure 4 Profile of Respondents According to Age

28

Figure 5 Number of Respondents With and Without Depression During the 1st Stage of the Experiment 29

Figure 6 Level of Depression Before Music Therapy According to Zungs Self-Rated Anxiety Scale 31

Figure 7 Level of Depression Before Music Therapy According to Goldbergs Depression Scale 33

Figure 8 Difference Between Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale of Controlled Group and Experimental Group 39

Figure 9 Correlation Between Music Therapy and the Students Depression Scale According to Zungs Self-Rated Anxiety Scale of Experimental Group Vs Controlled Group 40

Figure 10 Correlation Between Music Therapy and the Students Depression Scale According to Goldbergs Depression Scale of Experimental Group and Controlled Group 41

Abstract

Name of Institution: Arellano University, Jose Abad Santos Campus Address: 3058 Taft Avenue, Pasay City, Metro Manila, Philippines Title: Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses Author: Yushra S. Tulawie

Date Started: July 30, 2011 Date Finished: October 17, 2011 General Objectives: To measure the depression mood of 3rd year student nurses as an indicator on the impact of music therapy on their mental function. Specific Objectives: To measure the depression scale between male and female, and their age. To measure the depression scale of the respondents who took the tests. To compare the depression scale of the experimental group against controlled group. To compare the results showed in Zungs Self-Rated Anxiety Scale versus Goldbergs Depression Scale. To measure the correlation between music therapy and depression scale of the respondents included in the experiment. Scope and Limitations: This study evaluated the depression scale of 3rd year student nurses of Arellano University, Jose Abad Santos Campos using Zungs Depression Test and Goldbergs Depression Test in correlation to music therapy that will be applied. The age and gender of respondents were determined in the survey. The research used tools to assess the depression mood of the respondents included to be a basis of the criteria required. The tools were the Zungs Self-Rated Anxiety Scale (SAS), which have 20-item questions with a scale of less likely to most likely, and the Goldbergs Depression Scale (DS) with a. 18-item questions with a scale of 0-5. The tools were not a determinant to diagnose a persons mental function but just an assessment and results were just a basis of the possible mental function. However, results are still valid during the

context of the study when taken.

Methodology:

The research is quantitative study on the impact of music

therapy on the depression mood of 3rd year student nurses. It is a true experimental using a control group and an experimental group. Through the use of two-staged samplings which are the non-probability, convenience sampling, and the non-probability, purposive sampling, respondents were chosen according to a set of criteria. For the first stage non-probability, convenience sampling was used to look for third year nursing students who were readily available to be included in the study. The students were administered the Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale tests. For the 2nd stage non-probability, purposive sampling was used. All those who met the following criteria: 1. are screened from without use of medication related to depression; and 2. who had depression score on both depression tests administered by the researcher were included in the second stage. The researcher had 30 respondents in total included in the 2 nd stage from which 15 were in the controlled group and the other 15 were in the experimental group. The controlled group was asked to continue their usual daily routine or whatever schoolwork they were doing. Then the experimental group was also asked to do their usual daily routine or whatever schoolwork they were doing, while the researcher played a variety of music from classical, to pop to rock according to the subjects preference. After an hour, both groups were asked to answer the depression tests one more time.

Findings: The study came up with the average depression scale of 39.96 according Zungs SAS and 30.7 according to Goldbergs DL. Students who are part of the experimental group and have received music therapy showed an improvement on their depression scale from 42.2 to 38.6

according to Zungs SAS, and from 34.6 to 30.13 according to Goldbergs Depression Scale. While students who are part of the controlled group who had not received music therapy had a slight difference of depression scale from 37.72 to 38.26 according to Zungs SAS, and from 28.53 to 28.47 according to Goldbergs DS. Both the tools that were used showed a little difference in the results of data in every group. The overall correlation between music therapy and depression had a result of r=0.90393 according to Zungs Self-Rated Anxiety Scale, and r=0.94725 according to Goldbergs Depression Scale for the experimental group. While controlled group had a result of r=0.99124 according to Zungs Self-Rated Anxiety Scale, and r=0.98699 according to Goldbergs Depression Scale.

Conclusions: Of the respondents who took the exam during the 1st stage of the experiment to see who are depressed there were only 2 students who are not depressed aside from the 30 students target of this study. The students who were part of the experimental group and had received music therapy had showed an improvement in the depression scale compared to the students who were part of the controlled group and had not received any music therapy. Music therapy generally can help improve a students mental function, where the researcher has proven the hypothesis that it has a therapeutic effect.

Recommendations: Awareness of the level of depression should be increased among students and school administrators. Music therapy as an intervention, which has a therapeutic effect on an individual, is encouraged to help student be mentally healthy. Further studies can also be taken to show the impact of music therapy and the cause of depression on college students.

CHAPTER 1

The Problem and Its Setting

Introduction Mental health problems, which are featured by the disturbance and disorder of mental and psychological activities, refer to the undesirable psychological factors or psychological states that affect the normal behavior and activity efficacy of individuals. According to study done by Wen, H., Li, X. and Ge, J.J entitled Research on Students Psychology and Mental Health Condition, a special group that undertakes the high expectation from the society and parents, college students are obviously under more psychological pressure than other peer groups. A review on previous investigations about college students mental problems showed that college students suffer from different types of psychological problems, especially depression, anxiety, somatization, and interpersonal sensitivity. Depression ranks the top among these mental problems that disturb college students in the order of seriousness. Therefore, this study chose depression as the target of intervention of music therapy. (Wang, J., Wang, H. and Zhang D., 2011). According to previous research on college students depressive

symptoms, depression may be closely relate to various life events and individuals ways of coping with these psychological stimuli. For instance, social competition, academic pressure, interpersonal communication pressure, quarrelling with others, serious defeat, being not smooth or being disappointed in love, and disordered close family relationship can contribute to the depressive symptoms of college students. Among these reasons, negative coping method, health adaptation factor, active coping methods, punishment and study pressure have most impact on depressive symptoms. Research also showed that individual variables are important to depression, such as high sensitivity to loss and being overlooked, low self-esteem, difficulty in admitting and mobilizing the emotions, intrapsychic conflict caused by dependence, frequent bouts of tension,

and long exposure to depression-induction environment (Chinese Journal of Clinical Psychology). At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 lives every year. Depression is the leading cause of disability as measured by YLDs (Years Lived with Disability) and the 4th leading contributor to the global burden of disease (DALYs) in 2000. By the year 2020, depression is projected to reach 2nd place of the ranking of DALYs (Disability Adjusted Life Years) calculated for all ages, both sexes. Today, depression is already the 2nd cause of DALYs in the age category 15-44 years for both sexes combined (WHO, 2011). Instead of using drugs to relieve mental problems, there are already other options without side effects like meditation, and therapies. Music therapy is a well-established health care profession that uses music to help meet the physical, emotional, cognitive, and social needs of individuals of all ages. The American Music Therapy Association (2004) has a mission to advance public awareness of the benefits of music therapy and increase access to quality music therapy services in a rapidly changing world. The researcher has chosen this topic from her love of music to looking ways on how music can affect an individual, on how music can be just more than a song you can listen to a radio but a song that will explain how it can create a space for healing. As a college student, the researcher has had her share of having sleepless night studying, finishing school work and trying to handle personal problems at the same time has put her in a state of depression due to stress. Without her knowledge of her situation, knowing she was mentally healthy before taking the depression test, now the researcher questions if all students are the same as her. The question of how students really have knowledge of depression and if they are already in a state of it has been now a curiosity to the researcher.

Statement of the Problem

To measure the depression level of 3rd year student nurses as an indicator of the impact of music therapy on their mental health. 1. What is the profile of the student respondents according to: 1.1 Gender 1.2 Age

2. What is the number of respondents that had a depression result against to those who did not had depression result on the Depression Test that was taken? 3. What is the level of depression of student nurses before the music therapy?

4. What is the level of depression of college students after an hour of usual routine and activity with music therapy?

5. What is the level of depression of college students after an hour of usual routine and activity without music therapy?

6. What is the difference in result of the respondents between the Zung SelfRated Anxiety Scale and the Goldbergs Depression Scale?

7. Is there a correlation between the students depression scale and the music therapy?

Hypothesis Music therapy may promote the overall mental health of college students by alleviating the depressive symptoms.

Conceptual Framework

EEG Pattern

Left Frontal Asymmetry

Right Frontal Asymmetry

Depression

High Level Cortisol

Music Therapy

Stimulant

Decreased Cortisol Level

Relaxant

Improve: Emotional, Physiological, and Psychological of an Individual Improve and Develop: Communication and Relationhip-Building Skills of an Individual

Figure 1. EEG Pattern in Correlation Between Depression and Music Therapy Paradigm Figure 1 shows the EEG or the Electroencephalogram Pattern relating to depression. EEG is a test that shows and records the measure of electrical activity in the brain. Cortisol is a hormone that is secreted by the adrenal gland, in which it is also known as the stress hormone because it is secreted in higher levels during the bodys fight or flight response to stress; and small increase of this hormone may have some positive effects like sudden burst of energy, heightened memory function, lower sensitivity to pain, and so forth. And it is always present when the right frontal asymmetry (part of the brain) is having a negative experience and when this hormone continues to increase it causes depression. So when music therapy is applied the effect of its vibrating waves trigger the electrical activity in the brain, specifically the left asymmetry that activates the positive experiences which lessens the cortisol that the right brain is producing, thus the overall results improves an individuals emotional and mental function. Music therapy can be considered as a complimentary or alternative means of treatment for the benefit of depressed patients in view of high prevalence of depression. Music therapy is innovative, artistic, scientific and evidenced based method of restoring, maintaining and improving emotional, physiological and psychological well-being of individuals of all ages and abilities through the power of music (Aigen, 1998). Music therapy had been effective in alleviating various symptoms of depression and improved overall behavior and

mental state of the patients. It aims at exerting a possible beneficial effect on social, emotional, and cognitive skills and helps in reducing the behavioral problems of patient s with depression (Aldridge, et al. 2001). A definition of evidence-based clinical practice, in which the patient, in addition to the health care professional, plays an active role in clinical decisionmaking: Evidence-based clinical practice is an approach to decision-making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best like its preference of music when music therapy is applied. (Abrams, 2010) According to Darrow and Cohen music therapy has been found to be effective and beneficial. There is much documented material on the efficacy of music therapy intervention to improve and develop communication and relationship-building with individuals with depression. Behavioral approaches in music therapy have frequently developed the use of music as a stimulant, a relaxant, or a reward. In addition, the structure and properties of music have been applied and manipulated to achieve development, growth and improvement in depressed patient. In this sense, therapeutic process does not involve a dynamic and responsive interaction with the patient, but the music is structured in order to help the patient overcome emotional, physical, or psychological problems from which they are suffering. Field, et al have discussed how music reduces stress and anxiety levels, and even enhances performances on abstract/ spatial reasoning tests. Music has improved mood according to self-report, and heart rate and systolic blood pressure have also been shown to improve. According to some researchers these effects can be attributed to musics ability to alter mood states of individuals. In addition, music therapy has altered behavior in depressed individuals. The question for this study was whether music could alter electrophysiological and biochemical measures of depression, namely right frontal EEG activation and stress hormone (cortisol) levels.

In continuation, recent studies suggest that affective states are associated with EEG patterns in the frontal region of the brain. Specifically, left frontal asymmetry has been associated with positive affect or decreased negative affect, whereas right frontal asymmetry has been associated with negative affect or decreased positive affect. In addition, chronically depressed adults are noted to have right frontal activation even during remission of depressed behavior symptoms. Elevated cortisol has also been associated with depression, and relaxation interventions have been noted to decrease cortisol levels in depressed adolescents. He found that relaxing and listening to about 20 minutes of music changed their brainwave state and their stress hormones (Field, 1998) Recent studies examined the effectiveness of music therapy in short-term group psychotherapy with chronic mental illness (depressed phase). Results show that group music therapy for adults with mental illness may help to reduce psychiatric symptoms related to anxiety (Wigram, 2002). That the therapeutic effect of music is through the response of an individuals brain processing information just like when a person tries to memorize a sentence from reading it aloud. Also, patients perceive music therapy as helpful and improve attitudes toward help seeking and openness about ones problem. Music is widely used to enhance well-being, reduce stress, and distract individuals from unpleasant symptoms. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through autonomic nervous system. It also has indirect effects by modifying behavior. Music effectively reduces anxiety and improves mood for adolescents. Other clinical trials have revealed a reduction in heart rate, blood pressure, breathing rate, insomnia, depression, and anxiety with music therapy. No one knows all the ways music can benefit the body, but studies have shown that music can affect brain waves, brain circulation, and stress hormones. These effects are usually seen during and shortly after the music therapy.

Figure 2. Therapeutic Relationship Model

Therapeutic Relationship that is shown in figure 2 explains the concept of the music therapy itself. It is balance by the therapist who will be a mediator between a client and the music that is preferred or is according to the clients needs. The figure also explains that every case of the client is different, and it emphasizes that music therapy like nursing practice is client-based; each individual is unique and so as the application of the therapy. Overall the process of using musical experiences to reach non-musical goals is at the core of Music Therapy. The practice is goal-driven, customized for the client, and based on observable and measurable outcomes. The musical experiences, coupled with the relationship with the therapist, are the vehicles that helps motivate and transform the client. When the client, the therapist, and the music are all working together, Music Therapy is taking place. Other examples of music therapy at work include: Inviting a group of adults in addiction recovery listen to and discuss the lyrics of specific songs. (The Therapist chooses songs because of their potential to open up discussions on various topics related to the therapeutic goals.), helping a client in physical rehabilitation learns and participates in a traditional dance. (The therapist chooses the dance based on the inclusion of specific types of movements.), and showing a group of young

mothers how to sing to and move with their infants. (The therapist writes songs that help the mothers bond with their babies and provides the infants with an important developmental foundation that will increase their chances to do well in school later on). Music Therapy applies to almost any setting where a client is working towards a goal. General areas include physical (developmental, rehabilitation, habilitation, maintaining functioning, etc.), cognitive (educational, insight, psychiatric, remembrance, environmental, etc.), emotional (stress-reduction, coping skills, elevation of mood, adjusting to transitions, etc.) (Kalani, 2011).

Scope and Delimitations of the Study

This study evaluated the depression scale of 3rd year student nurses of Arellano University, Jose Abad Santos Campus using Zungs Self-Rated Anxiety Scale Test Goldbergs Depression Scale in correlation to music therapy that were applied. The age and gender of respondents were determined in the survey. The subjects of the study were students who were readily available to participate, both male and female, and were qualified during the 1st stage of the experiment where the researcher used a non-probability, convenience sampling. Then on the 2nd stage, students who got a depressed score on both the depression tests they took in the beginning, and also those who were not taking any medication for depression or affecting it were included in the study to avoid other interventions aside from the music therapy that the researcher had applied. Expectedly, results and conclusions are limited to this group of samples. The

study was also delimited to the following demographic characteristics: 18-26 years old, full-time student nurses who were enrolled in a 22-25 unit with at least 1 major subject, and is currently enrolled in the 1st semester of Level III-BSN course of school year 2011. Through the use of a two-staged non-probability sampling, the researcher selected the respondents who met the criteria of the study which was explained above, then a total of 30 students were included in 2 nd stage of the study. Then by random distribution, 15 respondents were asked to just continue their normal routine, schedule and activity as a student while the other 15 respondents were also asked to do the same but the researcher had applied music therapy. After an hour while being observed by the researcher, all 30 students were asked to take the Depression Tests one more time to compare from the 1st result they had. The survey was conducted at Arellano University, Jose Abad Santos Campus at 3058 Taft Avenue Extension, Pasay City. And the music therapy, where the researcher observed their activity for an hour of the week of October 10-14, 2011 for both the control and experimental group was also held at the same school stated above. Limitations of the Study

The Depression Tests that was used, both Zungs Self-Rating Anxiety Scale and Goldbergs Depression Test, are a screening tool to assess the individuals general gauge of anxiety and depression but in no way should be used as a substitute for the clinical expertise or health providers diagnosis. It is just a basis of a possibility of the individuals state of mental function. The music that was used is according to related research that have shown improvement on an individuals response but results still vary because of the different preferences on music on each respondents. Music was chosen according to the respondent reaction by first playing a classical, to rock, to pop,

to rnb in 5 minutes that was observed by the researcher and then it was continued to play for a whole hour according to their preference, and this was suggested by one of the music therapist, named Jennifer Buchanan, BMT, MTA, that was interviewed by the researcher and the interview was attached in Appendix G. The technique used in the research is simply by listening to a preferred music of the respondents that is already recorded in the mp3. Since there are many other ways of how music therapy works, like using music that is recorded or is live may also differ in result. Or playing the instrument, memorizing the lyrics to a song, songwriting, and so forth are other ways music therapy also works, which is not included in this study. The researcher alone, who is not a certified music therapist, had only imitated the process done from the previous research, executed the experiment, and had followed some process that was advised by the 5 music therapists that were interviewed by the researcher, which is also attached in Appendix G. And a major limitation of this study is the small sample size, which may affect the power to detect statistically significant differences between groups.

Definitions of Terms

The following terminologies are defined in a lexical manner:

Depression - is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or

appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. (WHO, 2011)

Music Therapy - is a technique of complementary medicine that uses music prescribed in a skilled manner by trained therapist. Programs are designed to help patients overcome physical, emotional, intellectual, and social challenges. Applications range from improving the well being of geriatric patients in nursing homes to lowering the stress level and pain of women in labor. Music therapy is used in many settings, including schools, rehabilitation centers, hospitals, hospice, nursing homes, community centers, and sometimes even in the home.

Zung Self-Rating Anxiety Scale (SAS) - was designed by William W. K. Zung, a psychiatrist from Duke University, to quantify a patient's level of anxiety.

Goldbergs Depression Scale - is a depression test developed by the American psychiatrist Ivan K. Goldberg. The test is an 18 question scaled multiple-choice test where a score above 15 indicates the possible need for a psychiatric evaluation.

Regular college students students enrolled in a college or university.

Significance of the Study

This study is significant to the following target populations:

To college students, who is willing to learn more on how to cope with depressions while handling school and personal responsibilities.

To the school administrators, to give importance on the mental health of their students and practice such exercises on how to help their students balance the activities and schedules.

To the parents, to help their children be mentally healthy by applying such intervention like music therapy to avoid severe depression.

To the future researchers, who will be able to further research on this study.

CHAPTER 2 Review of Related Literature and Studies

Depression is described as 'a broad and heterogeneous diagnostic grouping, central to which is depressed mood or loss of pleasure in most activities'. The International Classification of Diseases (ICD) uses an agreed list of ten depressive symptoms and provides a guide for assessing the severity of an episode based on the number of symptoms present. The common form of major depressive episode is divided into four groups: mild depression, moderate depression, severe depression and severe depression with psychotic symptoms. Depression is the most common mental disorder in community settings and is a major cause of disability across the world. It is projected to become the second leading contributor to the global burden of disease by 2020. The condition affects approximately 121 million people worldwide and is associated with the loss of 850,000 lives per year. Apart from the subjective suffering experienced by people who are depressed, the impact on social and occupational functioning, physical health and mortality is substantial (Pilkington, et al, 2006).

An inspection on literature showed that some effective means of intervention into depressive symptoms of college students are applied from the perspectives of cognition, will, behavior, and society, which involve change of cognition, tempering of will, enhancement of behavior, and adaptation to society. Zhang (2008) also pointed out that current mental health education inclines to "highlighting behavior training while overlooking the internalization of experiences" during specific practice. Therefore, the important role of internalization of emotion and experiences shall be emphasized properly. According to the analysis on the literature, depressive symptoms are a type of sad emotion experienced by the individual, with subjective negative emotional experience as its core element. Therefore, the key to reducing depressive symptoms is to transfer the negative emotional experience into positive emotional one, and this is where music comes in. Studies from the University of Jyvskyl in Finland reveal that by combining counselling sessions with classes that teach music skills - such as learning to play the drums - people with anxiety disorders and depression make greater progress and respond better to treatment than they would with counselling alone. "Music therapy has specific qualities that allow people to express themselves and interact in a non-verbal way," lead researcher professor Christian Gold explained upon the release of the findings. "Even in situations when the subjects cannot find words to describe their inner experiences, the music sessions help them to open up." The Finnish study, carried out on 79 people engaged in ongoing treatment for the symptoms of depression, isn't the first of its type to examine therapy that involves playing music. In 2008, a review of existing studies into the treatment of depression - which is thought to affect as many as 121 million people worldwide - highlighted four out of five separate studies, which found reduced depression symptoms in people who took part in music therapy. Prof Christian Gold said: "Our trial has shown that music therapy, when added to standard care including medication, psychotherapy and counselling, helps people to improve their levels of depression and anxiety (The National Newspaper, 2011).

In addition to the advantage of music therapy, Richard et als study have concluded that music therapy can become a universal practice due to its low cost, ease of administration, minimal-to-no risk of harmful side effects, and potential to improve the hospital experience for patients. He did his experiment by applying music therapy and letting post-operative patients listen to a different variety of upbeat music. Findings did suggest that patients were more satisfied with their care when music therapy was utilized. The literature implies potential for enhanced patient satisfaction in areas such as the emergency department when music is used to decrease stress levels. A study entitled Anti-Depressant Potential of Music Therapy by Arya & Parle have concluded and provided clinical evidence for the application of devotional music in managing patients suffering from depression. The patients involved in their study had positive influence on the cognitive parameters and patients showed stable mind, better perception, improved expression, good intellect, fine decision making ability and sharp memory after five days of receiving music therapy. The study have concluded that music has the unique capability of bringing back the charm and making the life worth living for depressed patients. And this therapy is now being recognized globally. This study was overall anchored from Impact of Group Music Therapy on the Depression Mood of College Students by Wang, et al (2011) that was done in China to show how music can be a tool to alleviate college students mental function such as depression. The study examined the depression scores between the experimental group and control group before and after the application of music therapy. And the final conclusion on this research found that music therapy could improve mental health. Participants feedback to the study was generally good and they were satisfied with the experiment as a whole. Aside from the improvement of mental health of the students involve, academic and extra curricular activity was later on had an impact to the overall response. The students were more active and the average grade from before the experiment showed improvement as well.

Related Studies

According

to

Hirokawa

et

al

(2003),

music

therapy

stimulates

neurohormonal and neurotransmitter systems resulting in the levels of serum melatonin, plasma norepinephrine, and epinephrine. Effects of music listening on neuroendocrine responses were reported in several studies. Previous studies reported a significant decrease in the epinephrine level after listening to the meditative type of music and a significant decrease in the norepinephrine level of hypertensive subjects after listening to modern classical music. Results of other studies included a significant decrease in norepinephrine levels in college students after listening to both joyful and peaceful music, and a significant increase in norepinephrine level in healthy young subjects after listening to techno-music. Although the types of music used in these studies are different, it is clear that music has influences on these neuroendocrine levels. In continuation, Hirakawa et al have examined the different effect of two different types of music on college students after a stressful task. High-uplifting music may have positive effects on psychological states, as indicated in decreased depression and increased liveliness. Results suggest that this type of music appears to be effective in improving one's mood by gradually increasing the uplifting qualities of the musical selections. Low- uplifting music may also have a positive effect on the psychological states in college students. Music that has soothing qualities is known to suppress excitement of the autonomic nervous system and enhance relaxation responses. In this study, low-uplifting music, which had soothing qualities, increased the sense of wellbeing. Low-uplifting music did not necessarily affect the subjects' emotional state negatively. Instead, it enhanced a calm and soothing mood in subjects. This type of music, therefore, has potential to enhance a sense of wellbeing.

Research in music's effect on the human psychological system has demonstrated that slow, quiet, patient-preferred music is an effective means to promote relaxation and reduce state anxiety (Robb, 2000). State anxiety is the amount of anxiety that one is experiencing in the moment; it is not a personality trait. Thus, the level of state anxiety fluctuates based on the amount of stress an individual is currently experiencing. Consequently, much research has been conducted to explore the effects of music listening to reduce state anxiety due to depression in medical settings. Music listening is a variable of interest in many relaxation studies. Labb, Schmidt, Babin, and Pharr (2007) reported that listening to either classical music or music selected by the individual reduced state anxiety scores and increased relaxation ratings after a stressor more than listening to heavy m etal music or sitting in silence. Researchers have begun to examine the effect of live music therapy sessions to reduce patient anxiety in hospitals. Even from Gadberrys study titled Steady Beat and State Anxiety published last fall of 2011, have discussed how music with steady beat can be more effective in decreasing anxiety which can be cause of depression than an individual relaxing in silence. Experimental anxiety was induced in healthy subjects who then either sat in silence or listened to a steady beat per their treatment group. Though no statistical differences existed between the groups prior to the treatment phase, posttest results indicated that listening to a steady beat was significantly more effective in reducing anxiety than was silence. The implications of steady beat decreasing state anxiety include a cost-effective and accessible means to self-regulation for the many persons who suffer from anxiety. It follows that the amygdala is an important brain center for regulating anxiety and music is shown to affect the amygdala and other part of the brain like the frontal asymmetry through the use of EEG. Mei-Hsien and Mei-Feng (2006) studied the relation between level of depression and quality of sleep in middle-aged women. Their results showed a significant correlation between quality of sleep and depression, so that as level of

depression rose, quality of sleep decreased and vice versa. They proposed two explanations for the positive impact of music on depression: first, Musical stimuli activate particular brain areas, including the insular and cingulated cortex, the hypothalamus, the hypocampus, the amygdale and the prefrontal cortex, which are all linked to emotional behavior. Second, endorphins and dopamine are released while a person listens to music, thus improving mood and creating a pleasant feeling. As mentioned, the current research revealed that music reduces depression. Taking notes on how music affects the brain waves of an individual, another study were worth taking into consideration related on the frontal asymmetry that causes the positive and negative experience of a person or how emotional is co-existent with mental function, and that is DiGiacomo & Kirbys study entitled The Effect of Musical Mode on Emotional State. The results of their study show that there are consistent effects of musical mode on emotional state. The major musical mode results in high accounts of vigor, indicating a positive and energizing effect. As hypothesized, the major musical mode is associated with a positive emotional response. The minor musical mode results in high accounts of anger, depression, and tension. As hypothesized, the minor musical mode is associated with a negative emotional response. The mixed musical mode results in moderate accounts of anger, depression, and tension. However, the mixed musical mode also results in low accounts of confusion and fatigue, which are considered positive emotional responses. As hypothesized, the mixed musical mode is associated with a range of moderate emotional responses. The instrumental noise results in highly elevated scores of anger and tension, and a moderate score for depression. However, the noise also results in low accounts of fatigue, which is considered to be a positive emotional response. The results indicate that the noise is linked with extreme emotional states. As hypothesized, the noise is associated with a range of extreme emotional responses. Overall this study shows that there is different effect on the human brain with regards to the different of mode or beats of music used.

One study that is significant on this research is done by Block et al entitled The Effects of Music Relaxation on Sleep Quality and Emotional Measures in People Living with Schizophrenia. The subjects may differ but this specific study had explained how music therapy is done and applied during the sleeping time of the patients. That even when a person is sleeping, the music used was still working in the human brain that activates and releases such hormones like epinephrine and norepineprhine. And found significant results on decreased anxiety level and improved sleep efficiency. With the curiosity of what more if the person is awake, how would music work in the human brain, would it be the same as when it is sleeping or faster in neuron-to-neuron activity since the individual is awake. A study done by Martinez, J. have been about the anxiety and depression of patients receiving hemodialysis. By changing the environment of the clinic where the experiment was done, Martinez chose patients with challenging issues such as anxiety, depressions and anger. And by the end of the experiment, 100% of the patient have reported that music therapy have relieved all or most of their anxiety, 80% stated that music made treatment easier and more relaxing, estimated of 80% decrease in aggression, anger and depression were reported by the staff nurse, and all new patients were encourage to try the music therapy session where some adjusted quickly while others requested for more music therapy. Effects of a Single-Session Assertiveness Music Therapy Role Playing Protocol for Psychiatric Inpatients by Silverman, M. have studied the effectiveness of a single-session assertiveness music therapy on his subjects. He divided his subjects into four groups with different variance according to the time admitted, number of patients per group, their age and the preference of music. With just a single-session of music therapy, Silverman have concluded that even a slightest change in a human behavior it still exists. He even saw enjoyment as an effective intervention for developing assertive behaviors in psychiatric patients.

CHAPTER 3

Research Method and Procedures

This chapter explains how the researcher chose the overall plan or the blueprint, like the research and sampling design. The criteria and process of choosing the respondents were also included, the instruments used in the entire experiment, the data procedure as well as how it was processed, and the statistics that was used to calculate the data that was gathered was also stated in this chapter. All this was important to answer the questions stated in Chapter 1 and to validate if the hypothesis is the same as the outcome that will be discussed in later chapter.

Setting

The test was carried out in a natural setting to the respondents. They were carried in Arellano University, Jose Abad Santos Campus-College of Nursing during their free time in their perspective classroom located in MB building. While the application of music therapy was also a natural setting for the respondents since it was played while they were doing their normal routine, activity as a student in the same location.

Research Design

The research is a quantitative study because it investigates a phenomenon that lend themselves to a precise measurements and

quantification, often involving a rigorous and controlled design in correlation with this study is on the impact of music therapy on the depression mood of 3rd year student nurses (Polit & Beck, 2008). It is a true experimental since it focuses the study in the future or what will be when variables are carefully controlled or manipulated (Paler-Calmorin & Calmorin-Piedad, 2008). And it uses a Beforeand-After Experimental Technique that compares the results of the beginning and end data of the Two-group design, which are the control group that represents subjects under study on which no experiment is conducted, and an experimental group, that represents the subjects in which one variable is altered (Salustiano, 2009).

Respondents of the Study

Respondents was 3rd year student nurses of Arellano University, ages ranges from 18-26 years old was included in the 1st stage of the experiment, and they were chosen through the use of non-probability, convenience sampling since they were readily available to participate. While later on the 2nd stage, nonprobability, purposive sampling was used by the researcher to filter the students on the criteria required which are a full-time 3rd year student nurses, free of use of any medication related to depression, and have a score of depressed on both the depression tests that have given. The researcher had a total of 30 respondents from which 15 students were randomly assigned in the controlled group, and the other 15 students were also randomly assigned in the experimental group. The controlled group was asked to continue their usual daily routine or whatever schoolwork they were doing. Then the experimental group was also asked to do their usual daily routine or whatever schoolwork they were doing, while the researcher played a variety of classical and modern music according to

the subjects preference. After an hour, both groups were asked to answer the depression tests one more time to compare the difference of score from the 1st time they took it.

Sampling Design

The researcher used a two-stage Non-Probability design to 1 st initially measure depression on 3rd year student nurses where a Convenience sampling was used because those who were readily available and convenient to participate in the study was included. Then on the 2nd stage, a Purposive or Judgmental sampling is used in selecting the respondents who are to participate in the study because the researcher selects and studies a specific number of a special group that represents the target population with regards to certain characteristics such as age, sex, and economic status or in relation to this research are the depression scales (Venzon, 2004). They are chosen according to a set of criteria mentioned above. And from then on the researcher randomly assigned the total of 30 respondents in which 15 students were in the controlled group and the other 15 students were in the experimental group.

Research Instrument

The respondents were asked to answer the demographic profile such as the age and gender. A structured 3-item question was also included in the survey to screen if the respondent is free from medication related to depression, and if they are a full time student at Arellano University. Depression tests are also asked of respondents to answer to screen who qualify in a depression scale. These depression tests were: Zung Self-Rated Anxiety Scale that evaluates a persons mental function with a 20 question, and a scale of less-likely to most-likely. Score 20 and above reflects that a person is depressed, 50-70 score is the usual range of depression, and 70-80 score reflects severe depression. And Goldbergs Depression Scale is a tool used to quantify a persons mental function with an 18 question, and a scale of 0-5 (0 as never and 5 as the most). Both test have also been asked permission to use by the researcher for this study and is attached in Appendix G, while the copy of both the tools used was attached in Appendix C. To maintain confidentiality and privacy, the questionnaires were numbered so that respondents can opt to not state their name. The number on the questionnaires corresponds to the number on the data collection sheet where it was used as their identity all throughout the study. The experimental group who received music therapy had a music played for a whole hour while they were doing their schoolwork. The mp3-recorder is contained of different types of classical, pop, rock, rnb and western music from high-uplifting music to low-uplifting to satisfy the different preferences, and effect of music to each individual. The strategy used by the researcher to find the preference of each respondent was by observing the respondents reaction in the music played; if they showed positive behavior like singing along, dancing, or sudden change of facial reaction like smiling in 5 minutes the researcher then continues the type of music to play for an hour. But if the respondent showed a negative behavior like nothing changed in their reaction, or a sudden change in facial reaction like smirking, then the researcher changes the type of music till the respondents showed a positive reaction.

For the last part, all 30 respondents took the depression tests one more time to check any changes from the 1st scores they had. And respondents used their corresponding number they had from the beginning of the study to be able to compare the data.

Data Gathering Procedure

Students who participated were given a brief summary of the process of the study; the explanation of the depression tests, and written consent was obtained from all participants. The 3-item questionnaire plus the depression tests was then collected from each participant and then they were screened who were part of the 2nd stage of the study that involved music therapy. There were 30 students who were randomly assigned to experimental and control group to continue the study. 15 students were part of the experimental group; the researcher applied music therapy for an hour while they were doing their schoolwork. The researcher played different classical and modern music according to the subjects preference by observing their mood for 5 minutes. While the other 15 students who were part of the controlled group, were asked to continue their schoolwork while the researcher plainly observed them for an hour. Both groups were asked to take the depression test after an hour. They used the number they had from the beginning of the test as their identity to maintain confidentiality. Then both the tests they had from the beginning and the end have been then compared by calculating and tabulating the changes of scores they had.

Data Processing

The tabulated data of the first and last depression scale grade of the respondents was inputted against demographic data of both the groups using Microsoft Excel-SPSS. The score each respondent had was based on the scoring of each tool, which is attached in Appendix D. SPSS (Statistical Package for the Social Science) sheets were created to compare sets of data and create corresponding line graphs or circle graphs to answer questions outlined in the statement of the problem.

Statistical Treatment

The profile of the respondents according to gender and age were measured in ratio, and both circle and bar graph was used to illustrate the percentage distribution of each variable in reference to the whole sample. The formula for computing percentage was used:

% = ( Amount) x100 Total

The level of depression scale grade of respondents was computed by getting the central tendency or the weighted mean of distribution using the following Mean formula:

M = X1 + X2 + X3 + X4 + X5 5 or the sum of all scores divided by the number of scores.

Interval measurement was used in treating data on the respondents first depression scale grade and the last depression scale grade. Both the first and last depression scale grade of the respondents will be to determined casual relationship between the two variables. The relationships of data collected are then illustrated in a table and line graph. Final depression scale grade of experimental group and the controlled group were processed by first plotting the final depression grade of experimental group on the x-axis and the other being considered on the y-axis. The relationship between the x and y variables are then illustrated using both bar and line graphs. The correlation between music therapy and the depression scale of the respondents will be computed using the formula: r = NXY - (X)(Y) / Sqrt([NX2 - (X)2][NY2 - (Y)2]) Charting with the use of a bar and line graph was used to illustrate the result from this formula wherein the numbers will be inputted in the x-axis and the tool used and the event will be considered in the y-axis.

CHAPTER 4 Presentation, Analysis and Interpretation of Data

On this chapter, all the tabulated data collected from the experiments were recorded in Microsoft Excel-SPSS to show and compare the difference if there is improvement or not. This was shown in a table and graphs to simply and better understand its measurement, comparisons, difference and correlations.

Figure 3. Profile of Respondents According to Gender

As seen in the figure above, the student respondents were mostly female with 21 students or 70% of the sample, while males consisted only of 9 students or 30% of the total respondents. From Dixon, et als study they stated that men and women differed in their perceptions of perceived college stress and level of depression. These findings

lend support to the report by the American Psychiatric Association (2000) as well as previous research that has indicated that women experience, or at least report, more depression than do men and typically experience more stress than do men. In a recent study comparing anxiety scores of college students from various countries, American females had the highest mean anxiety score among males and females in Germany, Spain, the United Kingdom, and the United States (Abdel-Khalek & Maltby, 2009).

Table 1. Profile of Respondents According to Age

Age 18-20 year-olds 21-23 year-olds 24-26 year olds

Frequency 10 13 7

Percentage 33% 44% 23%

Table 1 shows the age profile of the respondents according to age in manner that it is clustered in a group. Ages 18-20 year-olds have 10 respondents or 33%, while majority of the respondents were from 21-23 year olds who have 13 respondents, or 44%, and 7 were 24-26 year-olds or 23%.

Figure 4. Profile of Respondents According to Age

The age of the student respondents ranges from 18-26 years old, with 21 year-olds making the majority of the respondents with 24%. There were 4 respondents on each age group of 18, 20 and 24 year-olds, making up 13% and 3 respondents on each age group of 22 and 23 year-olds or 10%. 7% of the respondents were 19 and 25 year-olds followed by 3% of a 26 year-old student. Fatigue in older people is related to anxiety, low physical activity, and

high levels of nutritional risks (Martin, Bishop, Poon, & Johnson, 2006). The

older the person reached, the deterioration in mental function is most likely, and the denial of acquiring this is a battle.

Figure 5. Number of Respondents With and Without Depression During the 1st Stage of the Experiment

The graph shows that from a convenient sampling, aside from the 30 students target as part of the 2nd stage of the experiment that had a purposive sampling, only 2 students were not included for the reason of the result that they did not met the criteria required. As explained in the procedure, right after the respondent takes the test it was immediately checked if they qualify in the test as having a score of being depressed, and two respondents had scores of being not depressed. As explained, Wang ets study have expressed how college students were most prone in have a deficit in mental function due to stress in school, personal life, financial and social life. This is also the stage where an individual starts to adjust on being independent while coping with demanding schedules and tasks.

Table 2. Level of Depression Scale Before Music Therapy According to Zung Self-Rated Anxiety Scale

Score/s 20-30 31-40 41-50 51-60 61-70

Frequency 3 11 14 2 0

Percentage 10% 37% 47% 6% -

71-80

Table 2 shows the level of depression before the experiment of the 30 respondents included. According to Zungs Self-Rated Anxiety Scale, 3 students have scored between 20-30 or 10%, scores 31-40 have 11 students or 37%, the majority scale was 47% or the 14 students who scored around 41-50, and 2 remaining students, or 6% have scored around 51-60.

Figure 6. Level of Depression Before Music Therapy According to Zungs Self-Rated Anxiety Scale

39.96

Figure 6 shows the level of depression of the 30 respondents from the scores they had according to Zungs Self-Rated Anxiety Scale. The longer the line stays on the x-axis meant the bigger of the respondents had received the scored indicated on y-axis. From the results collected the average or weighted mean is 39.96. From Naomi et al study they explained that the shortened version of the Zung depression questionnaire, which includes 20 questions, was used in the study. Participants are asked to rate on a 4-point scale the frequency (ranging from less likely to most likely) of various symptoms of depression, such as sadness, fatigue, feelings of emptiness, and so forth. And added, The questionnaire was found to be highly correlated with the Depression scale of the MMPI (r = .7), and distinguishes between depression and anxiety (Zung & Durham, 1965).

Table 3. Level of Depression Before Music Therapy

According to Goldbergs Depression Scale

Score 18-21
(Bordeline Depressed)

Frequency 5

Percentage 17%

22-35
(Mild to Moderate)

15

50%

36-53
(Moderate to Severe)

10

33%

54+
(Severely Depressed)

Table 3 shows the level of depression before the experiment of the 30 respondents included. According to Goldbergs Depression Scale, 5 students have scored between 18-21 (Borderline Depressed) or 17%, the majority scale was 50% or the 15 students who scored around 21-35 (Mild to Moderate Depressed), and 10 remaining students, or 33% have scored around 36-53 (Moderate to Severe Depressed).

Figure 7. Level of Depression Before Music Therapy According to Goldbergs Depression Scale

30.7

Figure 7 shows the level of depression of the 30 respondents from the scores they had according to Goldbergs Depression Scale. The longer the line stays on the x-axis meant the bigger of the respondents had received the scored indicated on y-axis. From the results collected the average or weighted mean is 30.7. From Wang et als study, the result in the beginning of the also showed no difference between the control and experimental group because the intervention was not yet applied.

Table 4. Level of Depression of Experimental Group According to Zungs Self-Rated Anxiety Scale, Before and After Music Therapy

Before Music Therapy 45 42 49 48 40 50 55 42 32 37 45 40 40

After Music Therapy 39 34 45 46 29 42 52 39 31 33 44 36 39

35 33 42.2

32 30 38.06

Table 4 shows a significant difference obtained from the data before the experiment which is 42.2, and the data after the application of music therapy which is 38.06 of the 15 respondents of experimental group using the Zungs Self-Rated Anxiety Scale. This shows how music therapy that was applied as an intervention decreased the depression scale of the respondents part on this group.

Table 5. Level of Depression of Experimental Group According to Goldbergs Depression Scale, Before and After Music Therapy

Before Music Therapy 50 27 26 41 39

After Music Therapy

Interpretation

45 19 19 35 27

Mild-moderate to Mild-moderate Mild-moderate to Borderline Depressed Mild-moderate to Borderline Depressed Mild-severe to Mild-moderate Mild-severe to Mild-moderate

34 38 19 52 23 52 39 30 24 25 34.6

27 36 17 50 21 49 34 28 22 23 30.13

Mild-moderate to Mild-moderate Mild-severe to Mild-severe Borderline Depressed to Possible Mild Depression Mild-severe to Mild-severe Mild-moderate to Borderline Depressed Mild-severe to Mild-severe Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate

Table 5 shows a significant difference obtained from the data before the experiment which is 34.6, and the data after the application of music therapy which is 30.13 of the 15 respondents of experimental group using the Goldbergs Depression Scale. Using this tool also shows the impact of music therapy on the respondents included on this group because there is a decrease in the depression scale, which also shows the effectiveness of the intervention used.

Table 6. Level of Depression of Controlled Group According to Zungs Self-Rated Anxiety Scale, Before and After Music Therapy

Before Music Therapy 38 35 43 37 42 28 27 34 41 27 31 42 53 46 42 37.73

After Music Therapy 36 36 43 41 40 30 27 34 43 27 31 44 53 47 42 38.26

Table 6 shows a slight difference obtained from the data before the experiment which is 37.73, compared from the data after the one hour of experiment which is 38.26 of the 15 respondents of controlled group using the Zungs Self-Rated Anxiety Scale. With this slight difference, the researcher concludes that respondents who were part of the controlled group had small improvement of depression.

Table 7. Level of Depression of Controlled Group According to Goldbergs Depression Scale, Before and After Music Therapy

Before Music Therapy 34 27 26 29 21 20 21 25 28 21 30 36 40 33 37

After Music Therapy

Interpretation

34 25 26 27 23 20 21 25 28 20 31 36 41 33 37

Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate Mild-severe to Mild-moderate Borderline Depressed to Mildmoderate Borderline Depressed to Borderline Depressed Borderline Depressed to Borderline Depressed Mild-moderate to Mild-moderate Mild-moderate to Mild-moderate Borderline Depressed to Borderline Depressed Mild-moderate to Mild-moderate Mild-severe to Mild-severe Mild-severe to Mild-severe Mild-moderate to Mild-moderate Mild-severe to Mild-severe

28.53

28.47

Table 7 shows a slight difference obtained from the data before the experiment which is 28.53, compared from the data after the one hour of experiment which is 28.47 of the 15 respondents of controlled group using the Goldbergs Depression Scale. Without music therapy, the respondents belonged in this group have not shown any improvement of decreased in depression versus the experimental group.

Figure 8. Difference Between Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale of Controlled Group and Experimental Group

According to the data collected from both the tools Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale, figure 8 shows a bar graph of

the before and after the experiment. The blue bar indicates the before of the experiment from both tools which have a difference of 0.04, wherein from 0.90393 (Zungs SAS) and 0.94725 (Goldbergs DS), while the red bar indicates the results after the experiment which shows a slight difference of 0.01 from 0.99124 (Zungs SAS) and 0.98699 (Goldbergs DS). This shows that both tool have been in used, is effective in data collection and is significant because only small amount of difference had shown. Both the tool had been used on different experiments. Wang et al have used the Zungs Self-Rated Depression Scale in his study and have also shown a result that correlates from the observed behavior. And Dixon et al have used the Goldbergs Depression Scale as a tool to filter the college students they need in their experiment. Both studies that have been mentioned had used these tools on students as their respondents and have a positive conclusion according from the data itself.

Figure 9. Correlation Between Music Therapy and the Students Depression Scale According to Zungs Self-Rated Anxiety Scale of Experimental Group Vs Controlled Group

Table 9 interprets the correlation of music therapy to depression according to Zungs Self-Rated Anxiety Scale. The blue line represents the experimental who have received music therapy, r=0.90393 while the controlled group who have not received any therapy represents the red line, r=0.99124. Meaning that the experimental group have decreased in depression since the music therapy was applied while the controlled group who did not receive any intervention have a slight change in the depression scale.

Figure 10. Correlation Between Music Therapy and the Students Depression Scale According to Goldbergs Depression Scale of Experimental Group Vs Controlled Group

Table 10 interprets the correlation of music therapy to depression according to Goldbergs Depression Scale. The blue line represents the experimental who have received music therapy, r=0.94725, while the controlled group who have not received any therapy represents the red line, r=0.98699. Similar to the result in Zungs SAS, the experimental group have shown an improvement in their depression scale when music therapy was applied compared to the controlled group who have a slight change in the depression scale. Similar to Wang et al study, the overall result was similar showing that music therapy shows result of improvement in the students depression mood. Hence, the application is short-term the outcome is equal to the hypothesis stated earlier.

CHAPTER 5 Summary of Findings, Conclusions and Recommendations

Summary of Findings

1. Profile of Respondents 1.1 According to Gender Majority of the respondents are female with 70% or 21 respondents, and males completing the number 30% or 9 of the total 30 respondents. 1.2 According to Age Age of respondents varied from 18-26 years old, showing a

heterogeneous sampling population. 21 year-olds have the majority of respondents, which have 7 out of 30 or 24%.

2. Number of Respondents With or Without Depression According to Both Zungs SAS and Goldbergs Depression Scale Respondents who got depression on both the Depression Scale were 30 students, and which was included in the proper experiment. While 2 students showed no depression on both the Depression Tests taken.

3. Level of Depression of 30 Respondents Before the Experiment

Thirty (30) students who got the depression test had a computed average of 39.96 on Zungs SAS with a maximum of 80 as a score, and a computed average of 30.7 on Goldbergs Depression Scale with a maximum of 90 as a score.

4. Level of Depression Scale of Students Receiving Music Therapy Students showed a remarkably improvement with consideration of a single-session music therapy with an average of depression scale from 42.2 to 38.06 using a Zungs Self-Rated Anxiety Scale, and from 34.6 to 30.13 using the Goldbergs Depression Scale.

5. Level of Depression Scale of Students Who Did Not Receive Music Therapy Students showed a slight difference of result because of the absence of the intervention, which is the music therapy. The controlled group have an average of depression scale from 37.73 to 38.26 using a Zungs SAS, and from 28.53 to 28.47 using the Goldbergs Depression Scale.

6. Difference Between Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale Comparisons of the results of the data from the beginning to the end was only a small difference in numbers between Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale, which also shows that both tools have given a conclusion that is required by this study.

7. Correlation Between Music Therapy and Depression Scale of Students

Students who received music therapy showed a decrease of depression showing its correlation of r=0.90393 using the Zungs Self-Rated Anxiety Scale and r=0.94725 using the Goldbergs Depression Scale. While the students who did not receive any music therapy or any intervention showed a high result with comparisons of a correlation of r=0.99124 using the Zungs Self-Rated Anxiety Scale and r=0.98699 using the Goldbergs Depression Scale.

Conclusions

Based on the findings of the study, the following conclusions were arrived at:

1. Over 93% of students (30 out of 32) may be depressed. 2. The tools Zungs Self-Rated Anxiety Scale and Goldbergs Depression Scale showed a slight difference in results. 3. Music therapy has a therapeutic effect on students when depression mood rises.

The study found that there was no significant difference in the mental health scores between the experimental group and control group before the intervention. However, after the intervention, a significant difference between the pre-test and post-test was obtained for the experimental group, while no related and little significant difference between the pre-test and post-test was obtained for the controlled group. This indicates that, music therapy, through amelioration of the depressive symptoms of the participants in the experimental group, improves the overall mental health of the participants in the experimental group and realizes another purpose of the experiment. The researchers finding is in consistent with previous research showing that music therapy can improve mental health.

Recommendations

In light of significant findings and conclusions of the study, the following recommendations are hereby offered:

1. An information campaign targeting students must be launched to stress the importance of being not at risk of depression, like a seminar relating depression or counseling to every student. 2. An event showing the therapeutic effect of music aside from being recreational, like a musical or a free session like voice lesson, guitar lesson, and so forth. 3. A practice of such therapy, by encouraging students with different activities related to music, like when doing a seatwork or review time, encourage and allow students to listen to a music even for 5 minutes just to relax them mentally. 4. Encourage parents to practice such therapy, like playing music in the morning to stimulate their childrens mood, or even spending time with their children and doing fun stuff like karaoke time or dancing time. 5. Further studies can be undertaken on the subject to show the casual relationship between depression mood and music therapy, like knowing the main reasons of the depression, or the time the experiment had done, the depression scale of per level of student nurses, the depression scale of student in different courses, and so forth.

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Therapy. International Journal of Pharmaceutical Sciences and Drug Retrieved October 19, 2011, from ProQuest Health and Medical Complete. (Document ID: 2387127071).

Bloch, B., Reshef, A., Vadas, L., Haliba, Y., Ziv, N., Kremer, I., & Haimov, I. (2010) The Effects of Music Relaxation on Sleep Quality and Emotional Measures in People Living with Schiziphrenia. Journal of Music Therapy, Retrieved September 8, 2011, from https://libris.mtsac.edu/login? url=http://proquest.umi.com/pqdweb? did=2033998641&Fmt=4&clientId=13211&RQT=309&VName=PQD

DiGiacomo, A., & Kirby, B. (2006). The Effect of Musical Mode on Emotional State. Canadian Journal of Music Therapy, 12(1), 68-90. ID: 1254203021). Retrieved October 19, 2011, from ProQuest Psychology Journals. (Document

Dixon, S., & Robinson-Kurpius, S. (Oct. 2008) Depression and College Stress Among University Undergraduates: Do Mattering and Self-Esteem Make a Difference?. September Journal 3, of College Student Development, Retrieved 2011, from https://libris.mtsac.edu/login?

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Gadberry, A. (2011) Steady Beat and State Anxiety. Journal of Music Therapy. Retrieved October 10, 2011, from https://libris.mtsac.edu/login? url=http://proquest.umi.com/pqdweb?did=2439609381&sid=2&Fmt=3&clientId=132&RQT=309&VName=PQD

Gleadhill, L. & Ferris, K. (2010) A Theoretical Music Therapy Framework for Working with People with Dissociative Identity Disorder [online]. Australian Journal of Music Therapy, Vol. 21, 2010: 42-55, Retrieved September 30, 2011, es=IELHEA> ISSN: 1036-9457. from http://search.informit.com.au/documentSummary;dn=150406325610211;r

Hughes, P. (2004) What happens in music therapy: An Ecological Approach and a Theoretical Model. Music Therapy Today (online) Vol. V (3) May 2004, Retrieved September 11, 2011, from http://musictherapyworld.net

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Laurier, W. (n.d.). Music Therapy for Stress and Anxiety, Retrieved September

30, 2011, from http://www.mtabc.com/examples/stress.htm

Martin, P., Bishop, A., Poon, L., Johnson, M.A. (2006). Influence of personality and health behaviors on fatigue in late and very late life. Journals of Gerontology, B Psychological Sciences and Social Sciences, Retrieved October 10, 2011, from http://www.fcs.uga.edu/fdn/faculty.php?id=424.

Martinez, J.. (2009). Is Music Therapy?, Nephrology Nursing Journal, 36(3), 32930. Retrieved October 19, 2011, from Health Module. (Document ID: 1757456841).

Naomi Z., Tomer, R., Zahi, A., & Iris, H. (2208) The Effect of Music Relaxation versus Progressive Muscular Relaxation on Insomnia in Older People and Their Relationship to Personality Traits. Journal of Music Therapy, Retrieved September 3, 2011, from https://libris.mtsac.edu/login? url=http://proquest.umi.com/pqdweb? did=1601929391&Fmt=4&clientId=13211&RQT=309&VName=PQD

Pilkington, K., Rampes, H., & Richardson, J.. (2006). Complementary medicine for depression. Expert Review of Neurotherapeutics, 6(11), 1741-51. Retrieved October 10, 2011, from ProQuest Health and Medical Complete. (Document ID: 2453242141).

Richards, T., Johnson, J., Sparks, A., & Emerson, H. (2007) The Effect of Music Therapy on Patients Perception and Manifestation of Pain, Anxiety, and Patient Satisfaction. Medsurg Nursing, Retrieved September 27, 2011,

from

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Silverman, M. (2011) Effects of a Singe-Session Assertiveness Music Therapy Role Playing Protocol for Psychiatric Inpatients. Journal of Music Therapy, Retrieved October 2, 2011, from https://libris.mtsac.edu/login? url=http://proquest.umi.com/pqdweb? did=2439609401&Fmt=3&clientId=13211&RQT=309&VName=PQD

Tony

Wigram,

Inge

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Ole

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(2002).

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Werner, P., Swope, A., & Heidi, F. (2009) Ethnicity, Music Experience, and Depression. Journal of Music Therapy, Retrieved September 26, 2011, from https://libris.mtsac.edu/login?url=http://proquest.umi.com/pqdweb? did=2109801811&Fmt=3&clientId=13211&RQT=309&VName=PQD

D. Newspaper

More science suggests music can boost mind and body. (2011, August 28). The National. Retrieved October 19, 2011, from ProQuest Newsstand. (Document ID: 2437934951).

APPENDICES

Appendix A

Appendix B

Informed Consent to Participate in a Research Study Arellano University Jose Abad Santos Campus 3058 Taft Avenue, Pasay City Title of Research: Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses Name of Researcher: Yushra Tulawie Phone Number of Researcher: 0927-5143215; 0933-2599697 A. PURPOSE AND BACKGROUND Under the supervision of Dr. Gina Pardilla, Professor of Introduction to Research at Arellano University, Yushra Tulawie, a student in nursing research is conducting research on the impact of music therapy on mental function. The purpose of this interview and survey is to help the researcher gather data on college students depression mood. B. PROCEDURES If I agree to participate in this research study, the following will occur: 1. I will be asked to answer a questionnaire regarding my mental condition. 2. I will also be asked if I am talking any medication related to depression. C. RISKS 1. Risks: I will be asked questions of a personal nature and I might feel uncomfortable talking about some things. I am free to decline to answer any questions that I do not wish to answer, or I may stop my participation in the discussion at any time without penalty. 2. Confidentiality The records from this study will be kept as confidential as possible. No individual identities will be used in any reports or publications resulting from the study. All transcripts and summaries will be given codes and stored separately from any names or other direct identification of participants. Research information will be kept in locked files at all times. Only the researcher who will have access to the files and only those with an essential need to see names will have access to that particular file. After the study is completed and all data has been transcribed from the questionnaires, the questionnaires and results sheet will be held for one year and then destroyed. D. DIRECT BENEFITS There will be no direct benefit to me from participating in this research study except knowing my depression scale results.

E. ALTERNATIVES I am free to choose not to participate in this research study and to withdraw from the study at any time. F. COSTS There will be no costs to me as a result of taking part in this research study. G. QUESTIONS I have spoken with Yushra Tulawie about this study and have had my questions answered. If I have any further questions about the study, I can contact her by calling 0927-5143215 or 0933-2599697. H. CONSENT I have been given a copy of this consent form to keep. PARTICIPATION IN RESEARCH STUDY IS VOLUNTARY. I am free to decline to participate in this research study, or I may withdraw my participation at any point without penalty. Participants Name (optional) & Signature:_______________________________ Date: ________________ No: ____________

Interviewers Signature: ____________________________________ Date: _____________

Appendix C Instruments Used

Name (optional): ___________________________ Participant No: _______ Age: ______ Gender: ( ) Male ( ) Female > Are you a full-time college student? ( ) YES ( ) NO > Do you think you are suffering from depression? ( ) YES ( ) NO > Are you taking any medication related to depression (with serotonin or norepinephrine)? ( ) YES ( ) NO >Zung Self-Rated Anxiety Scale (SAS) Put a check mark on the column you think best relates to you for this past month.
Place check mark in correct column. A little of the time Some of the time Good part of the time Most of the time

1 I feel downhearted and blue.

2 Morning is when I feel the best. 3 I have crying spells or feel like it. 4 I have trouble sleeping at night. 5 I eat as much as I used to. 6 I still enjoy sex. 7 I notice that I am losing weight.

8 I have trouble with constipation. 9 My heart beats faster than usual. 10 I get tired for no reason.

11 My mind is as clear as it used to be. 12 I find it easy to do the things I used to.

13 I am restless and cant keep still. 14 I feel hopeful about the future. 15 I am more irritable than usual. 16 I find it easy to make decisions. 17 I feel that I am useful and needed. 18 My life is pretty full.

19 I feel that others would be better off if I were dead. 20 I still enjoy the things I used to do.

Table 8. Zungs Self-Rated Scale Tool > Goldbergs Depression Scale Encircle: 0 = Not at all; 1 = Just a little; 2 = Somewhat; 3 = Moderately; 4 = Quite a lot; 5 = Very much
1 I do things slowly. 2 My future seems hopeless. 0 0 1 1 2 2 3 3 4 4 5 5

3 It is hard for me to concentrate on reading. 4 The pleasure and joy has gone out of my life. 5 I have difficulty making decisions. 6 I have lost interest in aspects of life that used to be important to me. 7 I feel sad, blue, and unhappy. 8 I am agitated and keep moving around. 9 I feel fatigued. 10 It takes great effort for me to do simple things. 11 I feel that I am a guilty person who deserves to be punished. 12 I feel like a failure.

0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5

13I feel lifeless - - - more dead than alive. 14 My sleep has been disturbed too little, too much, or broken sleep. 15 I spend time thinking about HOW I might kill myself. 16 I feel trapped or caught. 17 I feel depressed even when good things happen to me. 18 Without trying to diet, I have lost, or gained, weight.

0 0 0 0 0 0

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

Table 9. Goldbergs Depression Scale

Appendix D Scoring of Depression Tests

Scoring for Zung Depression Scale Scoring Directions: 1) For each statement, look up for response and corresponding score (1-4). 2) Fill in the score for each statement under the last column labeled Score. 3) Calculate the Total Score by adding up all 20 scores. 4) Scoring: 50-69 is the common range for people with depression. 70 or

higher indicates severe depression (range 20-80).

Place check mark in correct column.

A little of the time

Some of the time

Good part of the time

Most of the time

Score

1 I feel downhearted and blue.

2 Morning is when I feel the best.

3 I have crying spells or feel like it.

4 I have trouble sleeping at night.

5 I eat as much as I used to.

6 I still enjoy sex.

7 I notice that I am losing weight.

8 I have trouble with constipation.

9 My heart beats faster than usual.

10 I get tired for no reason.

11 My mind is as clear as it used to be.

12 I find it easy to do the things I used to.

13 I am restless and cant keep still.

14 I feel hopeful about the future.

15 I am more irritable than usual.

16 I find it easy to make decisions.

17 I feel that I am useful and needed.

18 My life is pretty full.

19 I feel that others would be better off if I were dead.

20 I still enjoy the things I used to do.

Table 10. Scoring for Zungs SAS Tool

Scoring for Golbergs Depression Scale 1) Calculate the Total Score by adding up all 18 scores. 2) Equivalent are the following: 54+ = Severely Depressed 36-53 = Moderate to Severe 22-35 = Mild to Moderate

18-21 = Borderline Depressed 10-17 = Possible Mild Depression 0-9 = Likely Not Depressed

Appendix E
Collected Scores on each Tool Before the Experiment A. According to Zungs Self-Rated Anxiety Scale 0-19 Score/s 16 19 20-30 Scores 28 27 27 31-40 Scores 32 37 40 40 35 41-50 Scores 45 42 49 48 40 51-60 Scores 55 53 61-70 Scores 71-80 Sores

33 38 35 37 34 31

50 42 45 43 42 41 42 46 42

17.5

27.3

35.6

44

54

Table 11. Scores on Zungs SAS Before Music Therapy B. According to Goldbergs Depression Scale 0-9
(Likely Not Depressed)

10-17
(Possible Mild Depression)

18-21
(Borderline Depressed)

22-35
(Mild to Moderate)

36-53
(Moderate to Severe)

54+
(Severely Depressed)

17 16

19 21 20 21 21

27 26 34 23 30 24 25 34 27 26 29

50 41 39 38 52 52 39 36 40 37

25 28 30 33 0 16.5 20.4 28.07 42.4 0

Table 12. Scores on Goldbergs Depression Scale Before Music Therapy

Appendix F
Correlation Between Music Therapy and Depression Scale A. According to Zung Self-Rated Anxiety Scale (Experimental group) Zung Anxiety Scale Before Music Therapy (X)
45 42 49 48 40 50 55 42 32 37 45 40 40 35 33

Zung Anxiety Scale After Music Therapy (Y)

39 34 45 46 29 42 52 39 31 33 44 36 39 32 30

Table 13. Correlation on Experimental Group (Zungs SAS) r = NXY - (X)(Y) / Sqrt([NX2 - (X)2][NY2 - (Y)2]) r= (15)(24657)-(633)(571)/ Sqrt([(15)(27315)-(633)2][(15)(22375)-(571)2]) r= 369855-361443/ Sqrt([409725-400689][335625-326041]) r= 8412/ Sqrt([(9036)(9584)]) r= 8412/ Sqrt(86601024) r= 8412/ 9305.9671 r= 0.9039361

Table 13 shows the correlation of the before and after data of correlation between music therapy and the students depression scale (who recived music therapy) using Zungs SAS, which is r=0,9039361.

B. According to Goldbergs Depression Scale (Experimental group) Goldberg's Depression scale Before Music Therapy (X)
50 27 26 41 39 34

Goldberg's Depression scale After Music Therapy (Y)

45 19 19 35 27 27

38 19 52 23 52 39 30 34 25

36 17 50 21 49 34 28 22 23

Table 14. Correlation on Experimental Group (Goldbergs DS)

r = NXY - (X)(Y) / Sqrt([NX2 - (X)2][NY2 - (Y)2]) r= (15)(17474)-(529)(452)/ Sqrt([(15)(20207)-(529)2][(15)(15310)-(454)2]) r= 262110-239108/ Sqrt([303105-279841][229650-204304]) r= 23002/ Sqrt([(23264)(25346)]) r= 23002/ Sqrt(589649344) r= 23002/ 24282.69639 r= 0.9472589

Table 14 shows the correlation of the before and after data of correlation between music therapy and the students depression scale (who received music therapy) using the Goldbergs Depression Scale, which is r=0,9472589.

C. According to Zungs Self-Rated Anxiety Scale (Controlled group) Zung Anxiety Scale w/o Music Therapy (X)
38 35 43 37 42 28 27 34 41 27 31 42 53 46

(Y)
36 36 43 41 40 30 27 34 43 27 31 44 53 47

42

42

Table 15. Correlation on Controlled Group (Zungs SAS)

r = NXY - (X)(Y) / Sqrt([NX2 - (X)2][NY2 - (Y)2]) r= (15)(22435)-(566)(574)/ Sqrt([(15)(22144)-(566)2][(15)(22744)-(574)2]) r= 336525-324884/ Sqrt([332160-320356][341160-329476]) r= 11641/ Sqrt([(11804)(11684)]) r= 11641/ Sqrt(137917936) r= 11641/ 11743.8467 r= 0.9912425

Table 15 shows the correlation of the before and after data of correlation between music therapy and the students depression scale (who did not received music therapy) using the Zungs SAS, which is r=0.9912425.

D. According to Goldbergs Depression Scale (Controlled group)

Goldberg's Depression Scale w/o Music Therapy (X)

34

(Y)
34

27 26 29 21 20 21 25 28 21 30 35 40 33 37

25 26 27 23 20 21 25 28 20 31 36 41 33 37

Table 16. Correlation on Controlled Group (Goldbergs DS)

r = NXY - (X)(Y) / Sqrt([NX2 - (X)2][NY2 - (Y)2]) r= (15)(12731)-(427)(427)/ Sqrt([(15)(12717)-(427)2][(15)(12761)-(427)2]) r= 190965-182329/ Sqrt([190755-182329][191415-182329]) r= 8636/ Sqrt([(8426)(9086)]) r= 8636/ Sqrt(76558636) r= 8636/ 8749.77919 r= 0.98699

Table 16 shows the correlation of the before and after data of correlation between music therapy and the students depression scale (who did not received music therapy) using the Goldbergs Depression Scale, which is r=0.98699.

Appendix G Approval to use the tool

1. Zung Self-Rated Anxiety Scale It have a banket permission on using the tool as long as you do not own the tool and should credit the author, and there should in no other way that the title or the test itself should be changed. 2. Goldbergs Depression Scale

Hi . . . You are welcome to reproduce the Goldberg Depression Scale so long as you also reproduce my copyright notice on each copy. Best regards . . . Ivan K. Goldberg, M.D.

Interview with Music Therapist

Good day Sir/Ma'am, Hi my name is Yushra Tulawie and I'm a third year nursing student. I'm doing a research about "Impact of Music Therapy on the Depression Mood of College Students" since you are a music therapist i was wondering if there is any genre of music that you would greatly recommend for me to use on my research. Thank You for your kind consideration. Yushra Tulawie 1. Jennifer Buchanan, BMT, MTA Date: Monday, September 26, 2011, 7:01 PM Hi Yushra, Thank you so much for your email. Congratulations on being a 3rd year in Nursing. I have written a few short articles on music and stress that can be found here: http://www.jbmusictherapy.com/?s=stress It comes down to preferences - and ensuring that music is used with intention (not doing other things - but focusing on the music). If you have more questions after reading these articles please do not hesitate to send them to me. Jennifer Date: Sunday, October 2, 2011, 3:58 PM

Hi Yushra. This is difficult as it still depends on preferences. Perhaps give people the choice of listening to a Beethoven, Bach, Vivaldi or Rachmoninov piece and see what they feel is the most relaxing. try to get them to at least 5 minutes of listening. Goodluck,
Jennifer Buchanan, BMT, MTA President and Professional Speaker t: 403.240.3877 f: 403.290.2394 www.jenniferbuchanan.ca

www.jbmusictherapy.com 2. Susan Hadley, PhD, MT-BC Date: Wednesday, October 12, 2011 3:59 AM Dear Tulawie: Thank you for your message. It is interesting that you are doing a paper on music therapy for your nursing program. I cannot answer your question as that is not how we do music therapy. We use music which is preferred by an individual and which meets the needs of the patient. So, what I might use to relax a person would be different from what I might use to help in pain reduction. It also would be different from what I would use to help a patient who needs physical rehabilitation or who might need to work on emotional or personal issues. Also, as music therapists we advocate the use of live music rather than recorded music. So, it may be best to consult nursing journals for this. Nurses tend to use music differently with patients than music therapists. I hope this is helpful. Best, Dr. Hadley Professor Susan Hadley, PhD, MT-BC Music Therapy Program Slippery Rock University 222 Swope Music Slippery Rock, PA 16057 724.738.2446 (w) 724.738.4469 (f) 3. Julie M. Guy, M.M., NMT-F, MT-BC Date: Friday, September 30, 2011, 3:18 PM Music therapy implies that a trained music therapist is involved administering music in your study so Id recommend changing your wording to Impact of music for decreasing depression... or just the impact of music. I recommend that you look up similar studies involving music and replicate the music that they used. In general research shows that there isnt one kind of music that helps with this, that its patient preferred. So this could be anything

from rock, to relaxation to classical to country. Best to you in your research. Julie Julie M. Guy, M.M., NMT-F, MT-BC Board Certified Neurologic Music Therapist Vice-President | The Music Therapy Center of California M| 7840 Mission Center Court Suite 205 | San Diego, CA | 92108 W| www.themusictherapycenter.com T| 619.299.1411 F| 619-299-1412 4. Anne Vitort, MT-BC Date: Wedenesday, October 12, 2011, 6:37 AM Hello Yushra, What kind of research are you doing? What are your treatment goals and objectives? And who is the client? These factors are important in choosing a piece of music. Research consistently shows client-preferred music is the most effective at achieving desired results. If your clients don't like classical, your interventions aren't likely to succeed. I don't tend to use classical as much as jazz, big band, and country/western because those are the genres my clients prefer. I have used Vivaldi's Four Seasons, however, for movement activities targeted at gross motor skills and flexibility. Hope that helps. Anne Anne Vitort, MT-BC upbeat Music Therapy Services LLC 16200 SE 18th Way Vancouver, WA 98683 360-607-8187 www.upbeatmusictherapist.com 5. Kimberly Sena Moore, MM, MT-BC Date: Wednesday, October 12, 2011, 12:34 PM Hello Yushra, As a general rule, we try to use patient-preferred music in our work, which may or may not be classical. Additionally, the music we use also depends heavily on our treatment goal (e.g. pain management, anxiety reduction, spiritual support, procedural support, etc.). For these two reasons, it's difficult to suggest a particular piece I'd recommend.

This Cochrane Review may help point you in the direction of some studies that may help: http://www2.cochrane.org/reviews/en/ab006911.html Good luck! Kimberly Kimberly Sena Moore, MM, MT-BCMusic Therapist: Neurosong Music Therapy N Blogger: Music Therapy MavenPT Blog: Your Musical SelfPodcast: Music Y Therapy Round Table Music Therapy Pro kimberly@neurosong.com

Appendix H

Researchers Profile

Name: Yushra Tulawie

Address: Block 7 Lot 3 Maguindanao St. Maharlika Village, Taguig City, Philippines 1633

Learning Feedback: Taking this subject, Introduction to Research, had taught me lessons more than this course have offered. First, was how to make a proper nursing research, the step-by-step process, the different designs, and why it is important. Even simple things, like making a graph and the different uses of it, and the techniques used to search data in the internet so I can find the things I needed was unexpectedly rewarding for me that I can use in the future. During data collection, I was able to communicate well with the respondents and learn more from them. The research alone, which is about music therapy and depression, that I have done was also a lesson that I can apply for myself, and I can share with other people. And the most important things that I had learned were patience and dedication. This research needed a lot of these things for me to be able to make it, not to give up and just move forward. All these lessons were not just to pass the subject, but it is also something that I have acquired and achieve in which I can use in my daily life for the rest of my life.