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Music and Mood Disorders
Mood disorders affect adolescent’s everyday. According to the Mayo Health Clinic[], out of every 100,000 adolescents, two to three thousand will have mood disorders, out of which 8-10 will commit suicide. Two prevalent mood disorders in the adolescent population are clinical depression and bipolar disorder.

On average American adolescents listens to approximately 4.5 hours of music per day and are responsible for 70% of pop music sales. Now with the invention of new technologies, such as the ipod and digital downloads, access to music has become as easy. As children make the transition into adolescence they become less likely to sit and watch TV, an activity associated family, and spend more of their leisure time listening to music, an activity associated with friends.

Adolescents have identified many benefits of listening to music, including emotional, social, and daily life benefits, along with the formation on one’s own identity. Music can provide a sense of independence and individuality, which in turn contributes to one’s own self discovery and sense of identity. Music also offers adolescents with relatable messages that allow him/her to take comfort in knowing that others feel the same way they do. It can also serve as a creative outlet to release or control emotions and find ways of coping with difficult situations. Music education programs provide adolescents with a safe place to express themselves and learn life skills such as self-discipline, diligence, and patience. These school programs also promote confidence and self esteem. Ethnomusicologist Alan Merriam (1964) once stated that music is a “universal behavior;” it is something that everyone can identify with. Among adolescent, music is a unifying force, bringing people of different backgrounds, age groups, and social groups together.

Referrals and Assessments
Adolescents may listen to music for its therapeutic qualities, but that does not mean every adolescent needs music therapy. Many adolescents may go through a period of teenage angst, characterized by intense feelings of strife, caused by the development of their brains and bodies. Some adolescents can also develop more serious mood disorders such as major clinical depression and bipolar disorder. Adolescents diagnosed with a mood disorder maybe referred to a music therapist based on observations by the diagnosing physician, therapist, or school counselor/teacher. When a music therapist gets a referral it is important to first assess the patient and create goals and objectives for him/her before beginning the actual music therapy. According to the American Music Therapy Association Standards of Clinical Practice assessments should include the “general categories of psychological, cognitive, communicative, social, and physiological functioning focusing on the client’s needs and strengths…and will also determine the client’s response to music, music skills, and musical preferences” The result of the assessment is used to create an individualized music therapy intervention plan.

AThere are many different music therapy assessment tools, but one that is particularly suited to adolescents is the “Music Therapy Assessment for Emotionally Disturbed Children.”,. The term “emotionally disturbed children” refers to a diverse group of diagnoses including behavioral disorders, schizophrenia, affective/mood disorders, autism, anxiety disorders, and attachment disorders. This assessment concentrates not only on the facts of developmental skills but on the quality, content, and development of these affective behaviors. This music therapy assessment tool consists of seven main areas. The assessment starts with an interview with the patient regarding his/her, and their family’s, previous background in music. Next, the music therapist is to assess developmental appropriateness of the patient’s social and emotional functioning while in the music therapy setting, and then assess the patient’s ability to organize his/her musical experience. An important part of the assessment is to follow the changes in musical behaviors exhibited by the patient over the course of the session, and find any possible meanings in these variations. While interpreting the patient’s musical behavior, the music therapist must consider family history, current behavioral problems, affective developmental levels, and the patient’s current diagnosis. Last, the music therapist must investigate musical responses characteristic of the patient’s particular pathology.

Another assessment tool for adolescents is the Beech Brook Music Therapy Assessment. This assessment measures the patient’s behavioral and social functioning, emotional responsiveness, language and communication skills, and musical skills. Beech Brook, a child oriented treatment facility in Cleveland, Ohio, designed this assessment to help evaluate children beginning music therapy and then throughout the music therapy process, and focuses more on the reasons for referral than the previously mentioned assessment. This assessment uses a quantitative numbered scoring system in which the total score indicates an overall trend of behavior exhibited by a client. Both of these assessment tools help the music therapist plan the client’s treatment process and also establish credibility though accountability.

Treatment Techniques
There are many different music therapy techniques used with adolescents. The music therapy model is based on various theoretical backgrounds such as psychodynamic, behavioral, and humanistic approaches. Techniques can be classified as active vs. receptive and improvisational vs. structured. The most common techniques in use with adolescents are musical improvisation, the use of precomposed songs or music, receptive listening to music, verbal discussion about the music, and the use of creative media outlets incorporated into the music therapy. Research also showed that improvisation and the use of other media were the two techniques most often used by the music therapists. The overall research showed that adolescents in music therapy “change more when discipline-specific music therapy techniques, such as improvisation and verbal reflection of the music, are used.” The results of this study showed that music therapists should put careful thought and deliberation into their choice of technique with each individual client. In the end, those choices can effect the positive or negative outcomes of music therapy treatment.

To those unfamiliar with music therapy the idea may seem a little strange, but music therapy has been found to be as effective as traditional forms of therapy. In a meta-analysis of the effects of music therapy for children and adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at 10 previous studies conducted between 1970 and 1998 to examine the overall efficacy of music therapy on children and adolescents with psychopathology, which can be broken down into three distinct categories: behavioral disorders, emotional disorders, and developmental disorders. The results of the meta-analysis found that “music therapy with these clients has a highly significant, medium to large effect on clinically relevant outcomes.” More specifically, music therapy was most effective on subjects with mixed diagnoses. Another important result was that “the effects of music therapy are more enduring when more sessions are provided.”

Music therapists work with these adolescents on increasing emotional and cognitive stability, identifying contributing factors of current distress, and initiating changes to alleviate that distress. Music therapy may also focus on improving quality of life and building self-esteem, a sense self-worth, and confidence. Improvements in these areas can be measured by a number of tests, including qualitative questionnaires like Beck’s Depression Inventory, State and Trait Anxiety Inventory, and Relationship Change Scale. Effects of music therapy can also be observed in the patient’s demeanor, body language, and changes in awareness of mood and emotion.

Group meetings and one-one sessions are two main methods for music therapy. Group music therapy can include group discussions concerning moods and emotions in/to music, songwriting, and musical improvisation. Groups emphasizing mood recognition and awareness, group cohesion, and improvement in self-esteem can be effective in working with adolescents. Group therapy, however, is not always the best choice for the client. Ongoing one-on-one music therapy has also been shown to be effective. One-on-one music therapy provides a non-invasive, non-judgmental environment, encouraging clients to show capacities that may be hidden in group situations.

Though more research needs to be done of the effect of music therapy on adolescents with mood disorders, most research has been finding positive effects.

Campbell, P.S., Connell, C., Beegle, A. (2007). Adolescents’ expressed meanings of music in and out of school. Journal of Research in Music Education, 55(3), 220-236.