Facing the end of life, your own or a loved one’s, commonly brings with it feelings of anxiety.
These feelings may stem from a variety of sources, including emotional, psychological, spiritual or social. Medications, physiological changes in the body due to the progression of illness may also contribute to anxiety in patients on hospice care.
Let’s examine several anxiety scenarios and how music therapy may be applied as a safe, efficacious and cost-effective way to reduce anxiety in patients and their loved ones:
When a hospice patient experiences dyspnea, or shortness of breath, anxiety and panic may exacerbate the condition and create in the patient a cycle of dyspnea-induced anxiety. The more panicked the patient feels, the more breathless he or she gets, which, in turn, leads to more anxiety. This cycle of anxiety can often be interrupted by the use of music-assisted breath control exercises, visualization, or the application of music therapy relaxation techniques. These techniques, all part of the music therapist’s “tool bag” include music and imagery, progressive muscle relaxation with music, music for distraction and the iso principle. Singing together with the patient can also be helpful in inducing a deeper and more regular breathing pattern.
Restlessness or agitation may be present in the final stages of life. Hospice patients experiencing restlessness, which may manifest as moaning, thrashing, non-directed movement of limbs, or facial grimacing, may also feel anxious, as may their loved ones who witness the distress. Music therapy techniques, particularly live singing of the patient’s preferred music, applied in these situations can be beneficial for both the patient and his or her loved ones, or even caregivers.
Not long ago, I visited the bedside of a woman, Jane, with advanced dementia who had experienced a hip fracture which had confined Jane to her bed for some months. The woman’s hands and arms moved seemingly randomly above her body and she repeated syllables such as “ma-ma-ma-ma” and “ba-ba-ba-ba” continuously. Jane’s eye gaze was unfocused and her muscled tone appeared rigid.
I had spent many previous hours with this client, providing music therapy in the Adult Family Home in which she lived, so I knew one of her favorite hymns was “In The Garden.” As I began singing the song, accompanying myself on the guitar, Jane’s affect narrowed, then brightened as she recognized the tune.
Her eyes drifted to meet mine and her arm movements organized themselves into a “conductor’s pattern” as she gently “conducted” me as I sang. Her repetitive syllables stopped and she joined me in singing those famous words,
“And He walks with me and He talks with me,
and He tells me I am His own.
And the joy we share as we tarry there,
no other has ever known.”
Jane smiled broadly when I finished the song and said, very clearly and deliberately,“That was beautiful!” while looking me directly in the eye.
I stayed in Jane’s room a while longer, humming the tune and gently holding her hands. Her muscle tone relaxed, her breathing became deeper and she gradually closed here eyes and fell asleep as I sang.
“How will my death happen?”
“Will there be pain?”
“Where will I go when I die?”
“What will we do without you?”
These fears and anxieties and many other questions crop up commonly when patients and their families try to make sense of the end of life process. Music therapists call upon their counseling training to help clients sort out these fears and anxieties using original song writing, analysis of the lyrics of topical songs, and creating space for the patient and family to discuss their thoughts and concerns.
Last year I was asked to lead music therapy sessions for families with children who had lost a loved one in the past year. I listened to hundreds of pop songs to find just the right one to use in the group sessions. I finally chose a simple, lovely song called “I Miss You” by Miley Cyrus, which tells the story of her grandfather’s death, and how she has coped with her anxiety since losing him.
The chorus of the song goes like this:
“I miss you, I miss your smile
And I still shed a tear
Every once in a while
And even though it’s different now
You’re still here somehow
My heart won’t let you go
And I need you to know I miss you
I miss you.”
I asked the participants in the group to change the words of the song to reflect their own reality in their own bereavement process. One girl, whose mother had died not long before, wrote:
“I miss you, I miss talking to you,
and I still do every once in a while.
And even though you’re not here
You’re still in my thoughts.
My heart longs for you
And I need you to know you are still special.
I miss you.”
The girl joined me at the front of the room as we sang her words to Miley Cyrus’s tune. In that moment, she experienced support, understanding, and emotional release through the music she had created. After she sang, she relaxed, smiled and hugged her dad and sisters, her feelings having been shared and validated, and her anxieties lessened at least for the moment.
Anne Vitort, MT-BC,
Neurological Music Therapist
April 25, 2014 (Published on May 11, 2014)
Music Therapy at the End of Life by Cheryl Dileo, Ph.D., MT-BC and Joanne V. Loewy, D.A., MT-BC