The effects of music therapy on stress management in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation: A Feasibility Study

Jennifer D Townsend, Antonio Milland-Santiago. George Carrum, Christof Karmonik, Zhaoyue Shi, Brennan Parmelee-Streck

Center for Performing Arts Medicine/ Cell and Gene Therapy. MRI Core, Houston Methodist. Houston TX 77030

Abstract

Study Intervention

Method

Hematopoietic stem cell transplantation (HSCT) literature suggests strong links between transplant-related stress and late psychological issues/transplant success. Music Therapy is an allied health profession shown to be effective in stress management through influencing physiological and psychological processes. This small-scale pilot tests a study protocol designed to measure stress response in HSCT patients receiving music therapy. The primary aim is to establish the feasibility of measuring patient perception and neuro-connectivity by self-reported scales and fMRI, respectively. Given a sample size of N=3, no statistical analyses will be performed although we will examine the data for preliminary patterns.

Compelling research suggests that Music Therapy interventions can reduce stress. The literature posits that: • Use non-dominant hemispheric activity to increase efficiency of relaxation through

•  Distraction •  Cognitive engagement •  Entrainment of physiologic function

• Educate patients on bodily responses to stress. By bridging the gap between the conscious and normally unconscious activities of the body, individuals can develop a new understanding and increasing sense of control over their internal states. • Help patients recognize feelings and behaviors associated with stress in order to develop appropriate and alternative ways of coping. A brief evaluation of the patient was done at the start of each session and the following decision tree was utilized to determine treatment methods for the day.

Preliminary Findings

Preliminary Findings

Of the two subjects that have participated in this study, it appears that before/after changes in neuro-connectivity are consistent. fMRI findings demonstrate decreased intrinsic functional connectivity of the default mode and salience networks, as well as increased sensorimotor network from the baseline visit to the post-treatment visit. In the baseline images, we see highly correlated brain regions that could indicate high anxiety levels, such as anterior insula and dorsal anterior cingulate cortex, while the post-treatment scans show reduced correlations within stress-related networks.

References Boyde, C., Linden, U., Boehm, K., & Ostermann, T. (2012) The use of music therapy during the treatment of cancer patients: A collection of evidence. Global Advances in Health and Medicine, 1(5), 22-27. Brown, C.J., Chen A., Dworkin, S. (1989). Music in the control of human pain, Music Therapy, 8(1), January 1989, Pages 47–60, https://doi.org/10.1093/mt/8.1.47 Cohen, S. (1994). Perceived Stress Scale [Mind Garden, Inc. is a leading international publisher of psychological assessments, focusing on providing ease, access, speed, and flexibility. This piece is a PDF found on the internet with detailed information on the Perceived Stress Scale.]. Soares, J. M., Sampaio, A., Marques, P., Ferreira, L. M., Santos, N. C., Marques, F., . . . Sousa, N. (2013). Plasticity of resting state brain networks in recovery from stress. Frontiers in Human Neuroscience,7. doi:10.3389/fnhum.2013.00919

Perceived Stress

fMRI Feasibility Successes: 1. Recruitment with no attrition. 2. Completion of two fMRI scans by each participant. 3. Completion of all self-report instruments by each participant. 4. Absolutely no sentinel events. 5. Maintenance of security, confidentiality, and anonymity without breach. Challenges: 1. Timeliness of transportation services 2. Inconsistent administration of daily stress thermometer Future Considerations: 1. Mitigate consent fatigue due to consenting at the same time as consent for procedure 2. Increase recruitment opportunities to capture more patients

Pop

ulat

ion Multiple Myeloma

patient First time transplant English speaking No mental illness/mental disorder/developmental delay/intellectual disability

MT

Inte

rven

tion

Tim

elin

e Procedural music therapy during transplant 7 follow up sessions during inpatient stay

Out

com

e M

easu

res Perceived Stress

Scale (pre and post) Distress Thermometer (daily) fMRI (pre and post)