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埔里基督教醫院
李蕙如
MTA, MT-BC, MHA
2016.10.22
Music Therapy-Symphony in Science
音樂治療
大綱
音樂治療的迷思
音樂治療是什麼?
臺灣音樂治療發展
文獻探討
臨床流程
治療目標
臨床案例
其他
從搖籃到墳墓
搖籃曲
兒歌
流行歌曲
國歌、軍歌
地方歌曲 (i.e. 客家、原住民歌 )
校園民歌
爵士樂
古典音樂
其他 (i.e. 宗教音樂 )
慰歌
迷思
一、音樂治療就是聽聽音樂
-聽音樂是音樂治療的一種方法
二、音樂治療有固定的「音樂處方籤」
-音樂處方籤因人而異 , 不因病而異
三、病人一定要會音樂才能接受音樂治療
- 病人不一定要會音樂
音樂治療師服務對象
5
Table2. 台灣醫療院所音樂治療服務族群分布
服務對象 醫院數 百分比
早療兒童 8 38.1%
精神病患 2 9.5%
復健成人 2 9.5%
腦部退化性病患 3 14.3%
其他 6 28.6%
總計 100%
註 : 其他,包含了骨科病人、癌症兒童、成 患者、療養院、青少年病患等癮
國內外音樂治療服務對象
6 (AMTA,2013)
史背景歷
第一位音樂治療師 : 大衛 v.s 掃羅
創傷壓力症候群 (PTSD)WWII
堪薩斯大學 (Kansas University) 於第二次世
界大戰後 1946 年成立全世界第一個音樂治
療系。
全美有 85 所大學設有音樂治療系,提供學士
學位、碩士學位及博士學位,並設有國家考
試。亞洲則包括日本、韓國、新加坡、香港
和中國目前有執業的音樂治療師。
定義
世界音樂治療聯盟 (WFMT): “ 音樂治療是有執
照的專業臨床實證地運用音樂在治療關係中達
成個人目標 , 有計劃、有組織地使用音樂、或
音樂活動、音樂經驗 , 以期幫助個案達到生理
、 心 理 、 社 交 、 認 知 等 方 面 治 療 的 效
果。” (1974)
1974 年第一次世界音樂治療師會議 ; 每三
年舉辦一次 , 至今共 13 次。 32 個國家目前有
音 樂 治 療 師 執 業 。 ( 世 界 音 樂 治 療 聯 盟 ,
WFMT)
文獻探討 (1/3)
最早發表音樂治療的文章為 1789 年在美國發行的
哥倫比亞雜誌,標題為 “ Music Physically
Considered”
Duke 大學針對病患的音樂,不僅僅用於手術房和
恢復室,也已經涵蓋在病房中的兒童和成人
(Taylor, 1981)
不論在手術房或是輔助睡眠上, 95% 的病人表示
音樂確實有治療成效 ( Burdick,1915)
文獻探討 (1/2)
Journal of Music Therapy
Nordic Journal of Music Therapy
Music Therapy Perspective
Music Therapy Association of Taiwan
(MTAT)
一、音樂治療研究會 (1993)
二、音樂治療推廣小組 (1993)
三、中華民國應用音樂推廣協會 (1996)
1950 1958 1960 1970 1971 1974 1980 1989 1993 1994 1995 1996 2000
全
美
音
樂
治
療
協
會
13
NAMT
英
國
音
樂
治
療
協
會
BMTA
相
繼
成
立
相
關
組
織
美
國
音
樂
治
療
協
會
AAMT
加
拿
大
音
樂
治
療
協
會
CAMT
澳
大
利
亞
音
樂
治
療
協
會
AMTA
音鑑
樂定
治理
療事
會
其
它
歐
洲
國
家
及
南
非
相
繼
成
立
中
國
音
樂
治
療
協
會
台
灣
音
樂
治
療
研
究
會
韓
國
音
樂
治
療
協
會
中華
民國
應用
音樂
推廣
協會
紐
西
蘭
音
樂
治
療
協
會
MTNZKMTA
CBMT
荷
蘭
等
十
個
歐
洲
國
家
巴
西
、
阿
根
廷
、
哥
倫
比
亞
、
烏
拉
圭
、
和
MTAT
日
本
音
樂
治
療
聯
盟
1997 1998 2000 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012
14
高
雄
長
庚
紀
念
醫
院
黎
明
教
養
院
林
口
長
庚
紀
念
醫
院
國
立
台
灣
大
學
附
設
醫
院
( 註一 )
財
團
法
人
安
息
日
台
安
醫
院
( 註
二 )
高
雄
市
立
凱
旋
醫
院
財
團
法
人
天
主
教
聖
馬
爾
定
醫
院
高
雄
榮
民
總
醫
院
台
北
榮
民
總
醫
院
台
中
維
新
醫
院
中
國
醫
藥
大
學
附
設
醫
院
衛
生
福
利
部
桃
園
療
養
院
臺
北
醫
學
大
學
附
設
醫
院
社
團
法
人
阮
綜
合
醫
院
社
團
法
人
童
綜
合
醫
院
台
東
基
督
教
醫
院
天
主
教
聖
若
瑟
醫
院
註一 : 2002~2003 (經費不足 )註二 : 2003~2014 ( 內部因素 )
( 註
三 )
註三 : 2012 ( 純粹宣導
中
華
民
國
應
用
音
樂
推
廣
協
會
M
T
A
T
臺灣成立音樂治療醫療院所
台灣成立音樂治療醫療院所
15
Lee, 2014
台灣成立音樂治療醫療院所
16
國內施行音樂治療學程院所
國立台北教育大學音樂教育系、國立台北
教育大學特殊教育系、國立台南藝術大學
應用音樂系、國立台灣藝術大學中國音樂
學系、台北醫學大學醫學研究所人文組、
輔仁大學藝術學院音樂學系、輔仁大學醫
學院臨床心理系、輔仁大學醫學院職能治
療學系、育達商業技術學院幼保系、高雄
醫學大學及中山大學音樂系等。
• 國外大專院校音樂治療學士一般為四年 、
碩士為兩年,並設有博士學位
癌症領域
期刊 年份 方法 結論
Cochrane 2011 Review 小幅幫助心跳、呼吸和血壓 , 以及
改善病人生活品質。
Support Care
Cancer
2012 Meta-
analysi
s
焦慮、憂鬱、疼痛、生活品質
Intergrative
Cancer
Therapies
2013 Meta-
analysi
s
可改善焦慮(四篇 RCT)
Cochrane 2003 Review 可改善癌症患童的 心、與家人溝噁
通,表示音樂具有放鬆之作用
Front
Neurology
2014 Review improving executive functions,
emotional adjustment and
decreasing depression and
其他領域
一 . 音樂幫助人們集中精神
Copyright restrictions may apply.
Molnar-Szakacs, I. et al. Soc Cogn Affect Neurosci 2006 1:235-241
Model of the possible involvement of the human mirror neuron system in
representing meaning and affective responses to music
二 . 音樂幫助人們抒發情緒
Let’s Try Some Music!
Concerto K.216 Peer J (2015)
四 . 音樂提供一個美好的意象
美國心理學會 (APA) 自 2007 至 2014 調 ,在包括查 : 散
步、看書、打電話、飲酒、烹調等廿四種緩解身心疲憊的
方式中,把音樂做為首選方式的人群比例約達到一半。
(American Psychology Association, APA)
Stress
US 30000 adults, 8 yrs longitudinal
43% death by belief
more than skin cancer, AIDS, homicide
Keller, Litzelman, Wisk, et al. (2012) University of Wisconsin, School of
Medicine and Public Health
Social Stress Test, Jamieson, Nock, & Mendes
(2012). Harvard University Department of Psychology
Let’s Try Some Music!
文獻探討
國外期刊
0
50
100
150
200
250
300
1946
1949
1952
1955
1958
1961
1964
1967
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
2006
2009
2012
Pubmed
count
心理領域
期刊 年份 方法 結論
Plos One 2013 Systematic
Review
4 or more music therapy
sessions proved effect
Journal of Music
Therapy
2013 Systematic
Review
music has positive and
negative effect on
emotionBrain Topogram 2013 RCT EEG alpha changed
continuously, but theta
changed most
significantly after 3
months. Music therapy
is helpful for reducing
anxiety and depression.
Cochrane Review 2011 Review Improve global state,
mental state (including
negative symptoms) and
老人領域
期刊 年份 方法 結論
Cochrane 2012 Review 生活品質、認知、 照護人
員的溝通和社交互動
Parkinsonmism
Related
Disorder
2012 Meta-
analysis
平衡表現,行動時間,和步
長方面有顯著改善結果
Journal of
Clinical Nursing
2013 Meta-
analysis
失智症的情緒、行為、認知
和生理有所改善
Ageing Research
Reviews
2013 Meta-
analysis
失智的焦慮和行為有改善
International
Journal
Geriatric
Psychiatry
2013 Narrative
Systematic
Review
各項結果於短期情緒改善和
行為改變的結論一致
32
小兒領域
期刊 年份 方法 結論
BMC Pediatrics 2012 3-armed GEE 研究音樂治療於自閉症的
社交溝通改善。並嘗試瞭
解治療次數多寡的顯著差
異。
Cochrane 2012 Review 音樂治療可改善口頭閱讀
技巧,改善閱讀理解,改
善閱讀流暢,改善語音意
識和拼寫。
Journal of
Music Therapy
2011 Systematic
Review
即興音樂治療為主要
Cochrane 2005 Review 發現音樂治療語言於溝通
的部份優於控制組
Mozart Effect
音樂的功能
增強 Reinforcement
環境 Environment
訊息 Mediator
社交 Social
臨床技巧
Singing assists articulation, rhythm, and breath control.
Playing instruments can improve gross and fine motor
Rhythmic gait consistency and coordination
Improvising offers creative, nonverbal means of expressing
Composing / Songwriting utilizes to facilitate sharing of
feelings, ideas and experiences.
Imagery such as (GIM), provide opportunities to reflect,
process, and interact with unconscious or conscious material
that may be reflected in an individual's life.
Listening helps to develop cognitive skills such as attention
and memory
臨床流程
Assessment
Treatment Plan
Implementation
Evaluation
音樂治療目標
Communication- 語言溝通與表達能力
Academic/cognition- 認知感官經驗學習
Motor- 肢體功能復健
Emotion- 情緒表達能力
Social- 社會互動行為學習
評估工具
IMTAP
As a treatment plan for music therapy
As a tool to develop goals and objective
As a means to address and assess targeted skill sets
As an indicator of overall functioning
As a baseline for treatment
As a research method
As a communication tool for parents and healthcare profession
音樂與語言
音樂與認知
音樂與肢體
音樂與情緒
安寧病房
音樂與社交
台灣執行音樂治療困難因素
51
效益研究
期刊 年份 方法 結論
Journal of
Pediatric
Nursing
200
5
Cost-benefit 平均節省的花費為 $74.24 美
元
Nursing
Economics
200
7
Retrospectiv
e
參與音樂治療的病患由於不適
切行為的減少,照護的需求相
對減少,比例為 0.83
Powers Device
Technologies
Case Study
200
9
Cost-benefit 音樂治療能為醫院每位嬰兒每
天節省 $2,000 美元
音樂治療經費來源
(AMTA,2013)

生命就像是一首詩歌,而愛是最美的樂章

結論和建議
57
( 一 ) 、 政策面
一成立學會公會
建議政府規劃培育音樂治療人才之計畫
、 ( 二 ) 、經濟面
擴大補助層面
提供空間和治療樂器
三、法律面
制定同一規範全國音樂治療師執業資
格認證標準和考核體系,用以規範從
業人員範圍以及職業道德標準
Music Therapy Research
Reduce pain
Decrease anxiety, withdrawal, depression
Improve speech/language rehabilitation
Improve physical and motor rehabilitation
Increase respiratory capability
Facilitate expression of feelings, fears, hope
Increase socialization, acceptance of disability, mood
elevation
Cheerful Heart Is Good Medicine
行公義,好憐憫,與你的神同行
音樂治療派別
發展性音樂治療 (Developmental Music Therapy)
神經音樂治療 (Neurological Music Therapy)
引導想像音樂治療 (Guided Imagery of Music)
音樂治療 (Nordoff-Robbins Music Therapy)
分析式音樂治療 (Analytic Music Therapy)
(2016)Copyright

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埔基

Editor's Notes

  1. 參與程度非演奏
  2. 全美有85所大學設有音樂治療系,設有學士學位、碩士學位及博士學位。並設有國家考試,亞洲地區則包括日本、韓國、新加坡、香港和中國目前有執業的音樂治療師。服務對象包括:早產兒、身心障礙療育、問題青少年、中風復健病患、精神病患、退化性疾患, 及安寧病房。
  3. 最早發表音樂治療的研究是在1789年在美國發行的哥倫比亞雜誌,標題為“Music Physically Considered”,該文章主要介紹音樂治療使用的基本原則,並提供了音樂治療在歐洲執行佐證資料,其理論主要是利用笛卡兒(Descartes) 認為音樂和人的心靈健康有關的想法。在19世紀,音樂治療相關研究的文章陸續出現在音樂期刊、醫學期刊、精神病期刊和醫療論文。這一時期最早的研究為Atlee及Mathews。Atlee及Mathews利用文學、醫學和學術資源共同討論音樂在疾病的治療效果之影響性。主要訴求之目的乃以用音樂強大的影響力對於人類心靈產生影響。首先Atlee及Mathews先定義一些音樂治療專有名詞,並提出音樂可喚起並影響多種情緒,包括喜悅和悲傷的能力,並在最後部份討論音樂是有利於影響各種精神和身體疾病。並舉例三種個案中,成功地治療患者的音樂。其中一種樂器產生的樂符是以長笛為例子,也因此鼓勵可繼續吹長笛以產生療效。Mathews概述了音樂的好處在治療身心疾病,並引述聖經。例如,為了緩解憂鬱症,他建議使用符合病人的情緒的音樂,可能將曲調音律提高,產生更多活潑性及自然性。1915年,Burdick博士在American Yearbook of Anesthesia and Analgesia的研究報告指出,不論是在手術房或是輔助睡眠上,95%的病人表示音樂確實有治療成效(Burdick, 1915)。1929年,Duke大學針對病患的音樂,不僅僅用於手術房和恢復室,也已經涵蓋在病房中的兒童和成人(Taylor, 1981)。因此,有關於音樂治療的國際期刊創立於1977年,至今最主要的音樂治療期刊領域包含了音樂治療,音樂治療觀點,與北歐音樂治療雜誌。
  4. 最早發表音樂治療的研究是在1789年在美國發行的哥倫比亞雜誌,標題為“Music Physically Considered”,該文章主要介紹音樂治療使用的基本原則,並提供了音樂治療在歐洲執行佐證資料,其理論主要是利用笛卡兒(Descartes) 認為音樂和人的心靈健康有關的想法。在19世紀,音樂治療相關研究的文章陸續出現在音樂期刊、醫學期刊、精神病期刊和醫療論文。這一時期最早的研究為Atlee及Mathews。Atlee及Mathews利用文學、醫學和學術資源共同討論音樂在疾病的治療效果之影響性。主要訴求之目的乃以用音樂強大的影響力對於人類心靈產生影響。首先Atlee及Mathews先定義一些音樂治療專有名詞,並提出音樂可喚起並影響多種情緒,包括喜悅和悲傷的能力,並在最後部份討論音樂是有利於影響各種精神和身體疾病。並舉例三種個案中,成功地治療患者的音樂。其中一種樂器產生的樂符是以長笛為例子,也因此鼓勵可繼續吹長笛以產生療效。Mathews概述了音樂的好處在治療身心疾病,並引述聖經。例如,為了緩解憂鬱症,他建議使用符合病人的情緒的音樂,可能將曲調音律提高,產生更多活潑性及自然性。1915年,Burdick博士在American Yearbook of Anesthesia and Analgesia的研究報告指出,不論是在手術房或是輔助睡眠上,95%的病人表示音樂確實有治療成效(Burdick, 1915)。1929年,Duke大學針對病患的音樂,不僅僅用於手術房和恢復室,也已經涵蓋在病房中的兒童和成人(Taylor, 1981)。因此,有關於音樂治療的國際期刊創立於1977年,至今最主要的音樂治療期刊領域包含了音樂治療,音樂治療觀點,與北歐音樂治療雜誌。
  5. 專業:
  6. 台灣音樂治療起步較晚,至今約廿年。1989年,第一位具有音樂治療師證照張初穗女士返台,任職心愛兒童發展中心(2001年遷徙並改名為大同兒童發展中心)。張初穗女士不但積極從事臨床服務,並於1991年在輔仁大學開設臺灣第一個音樂治療選修課程(蕭斐璘,2000 ; 黃創華,2006)。1993年,由張初穗女士發起,成立第一個音樂治療相關組織「音樂治療研究會」,每兩三個月舉辦一次研討會,由音樂治療師報告工作心得,並彙集寄給有興趣的人(張乃文,2005)。 1993年,國際特殊才藝協會中華民國總會增設「音樂治療推廣小組」,舉辦國際音樂治療研習營,邀請國外之音樂治療師來台,進行一系列的演講(蕭斐璘,2000)。 在資深音樂治療師張初穗女士的推動下,1996年6月8日於國際會議中心三樓的國際藝術中心成立「中華民國應用音樂推廣協會」(蕭斐璘,1996),由一群有志於推廣台灣音樂治療工作的音樂治療師、特殊教育界、醫療人員及諮商輔導界的熱心人士組成此協會(蔡安悌,2003)。   中華民國應用音樂推廣協會的第一屆理事長為欒珊瑚女士,於成立協會十,欒珊瑚女士其不惜捐助私人財力與人脈,贊助與支持中華民國應用音樂推廣協會(蔡安悌,2003)。然而,中華民國應用音樂推廣協會的名稱似乎無法與音樂治療劃為等號,乃是因為當初送件申請時,衛生署(現任衛福部)未能認可「音樂治療」之合法性(張乃文,2005)。 二、中華民國應用音樂推廣協會刊物 為了更積極地推廣音樂治療,中華民國應用音樂推廣協會於1996年12月1日開創音樂治療季刊《悅音》,一年四刊,並由李前總統之妻曾文惠女士題名。內容包括音樂治療研習活動訊息、醫療機構簡介、音樂治療系所簡介及音樂治療應用於醫療、身心障礙者、復健老年人等相關研究。 適合一般社會大眾閱讀之刊物。 中華民國應用音樂推廣協會亦不定期地舉辦音樂治療之相關研習活動,目的為推廣音樂治療之應用及提供醫療臨床人員、特殊教育教師或有興趣者人員進修。
  7. 1946~2014pubmed4033篇; 國內文獻1990~2014共224篇 以國外對於音樂治療研究時期,自1946年起,當年之音樂治療發表之期刊大約為10篇,由於這段時間逐漸被證實音樂治療具有療效,產生了不同研究者開始重視此塊研究領域,更多的研究投入以探討應用於不同病科之音樂療效,因此在2010年發表之音樂治療之期刊達250份之多,如圖2-1。台灣也自1990年開始研究音樂治療,至2010年也呈現了大幅成長之趨勢,如圖2-2所示。
  8. https://www.youtube.com/watch?v=ELUSgqdNooc Wiley Interdisciplinary Reviews: Cognitive Science
  9. https://www.youtube.com/watch?v=p5WzmNMGMEg
  10. Singing in a group setting can improve social skills and foster a greater awareness of others. For those with dementia, singing can encourage reminiscence and discussions of the past, while reducing anxiety and fear. For individuals with compromised breathing, singing can improve oxygen saturation rates.  For individuals who have difficulty speaking following a stroke, music may stimulate the language centres in the brain promoting the ability to sing. coordination in individuals with motor impairments or neurological trauma related to a stroke, head injury or a disease process. Instrumental ensembles can enhance cooperation, attention, and can provide opportunities for practicing various leadership-participant roles.  Playing instruments may assist those with prior musical experience to revisit previously learned skills, thereby allowing the individual to experience a renewed sense of pleasure and enjoyment. It can also develop increased well-being and self-esteem in those who are learning to play an instrument for the first time. Rhythm and beat are important in "priming" the motor areas of the brain, in regulating autonomic processes such as breathing and heart rate, and maintaining motivation or activity level following the removal of a musical stimulus. The use of rhythmic patterns can likewise assist those with receptive and expressive processing difficulties (i.e. aphasia, tinnitus) to improve their ability to tolerate and successfully process sensory information. thoughts and feelings. Improvisation is non-judgmental, easily approached, and requires no previous musical training. As such, it helps the therapist to establish a three-way relationship between the client, themselves and the music. Where words fail or emotions are too hard to express, music can fill the void. Where trust and interaction with others has been comprised due to abuse or neglect, improvisation provides a safe opportunity for restoration of meaningful interpersonal contact. Where learning ability is limited, the opportunity to try different instruments, musical sounds, timbres and mediums may provide an opportunity for mastery of a new skill and increase life satisfaction. For example, with hospitalized children, writing songs is a means of expressing and understanding fears. For people with a terminal illness, songwriting is a vehicle for examining feelings about the meaning in life and death. It may also provide an opportunity for creating a legacy or a shared experience with a caregiver, child or loved one, prior to death. Finally, lyric discussion and songwriting can help adolescents deal with painful memories, trauma, abuse, and express feelings and thoughts that are normally socially unacceptable, while fostering a sense of identification with a particular group or institution. . For example, for those facing surgical procedures, it allows the individual an opportunity to exert a sense of control over their often unpredictable environment. During pregnancy, music listening can provide a connection between the uterine environment and the external environment following delivery. During childbirth music listening can facilitate and support the different stages by promoting relaxation and providing distraction for the labouring mother. In situations where cognitive perceptions are comprised, such as in early to mid stage dementia, listening can provide a sense of the familiar, and increase orientation to reality. For those with mental illnesses such as Schizophrenia or Bipolar Disorder, music listening can facilitate increased openness to discussion and provide motivation for engaging in social activity.
  11. 三、成立音樂治療的比率及病患別音樂治療 本研究實地調查中發現,音樂治療師在每個醫療院所編制都以一位為主,而針對不同病患可施以不同音樂療程,包含了兒童、青少年、成人、老人及精神病患、安寧病人及腦傷等人,可與歐陽淑卿(2004)及蔡孟玶(2008)提出利用音樂之歌唱、演奏樂器、聆聽音樂、討論歌曲、即興創作等方式,對個案的大腦與神經系統產生作用,涵蓋各年齡層相互呼應。 四、執行經費及人力資源上不足 本研究實地調查中發現,音樂治療健保並未給付,費用完全為自費方式,也因為如此,在各醫療院所中並未特別增設音樂治療師名額,均以一位為主,這也導致了音樂治療療程推廣上的困難度。
  12. https://www.youtube.com/watch?v=a1xiG29UMOA&list=FL_8QcOh_tdOVwFBhj4pG7jg https://www.youtube.com/watch?v=Pc843WHxEWo
  13. http://www.xibao.tw/ted-mcdermott/?ref=fb endorphin弱勢
  14. 一、政策面 成立學會公會 建立學校統一規範音樂治療培訓大綱 三、法律面 制定同一規範全國音樂治療師執業資 格認證標準和考核體系,用以規範從