the rational-scientific mediating model (r-smm)

The Rational-Scientific Mediating Model (R-SMM)

Provides a link between basic and applied research

Provides a scientific foundation for clinical interventions

Reasons for the Model

To understand the connection between:

Musical Behavior

Non-Musical Behavior

Therapeutic Applications of Music

Level One: Musical Response Models

Neurological, Physiological, and Psychological Foundations of Musical Behavior

Explains how people perceive, produce or respond to music

Basic Research

Level Two: Non-Musical Parallel Models

Processes in Non-Musical Brain and Behavior Function

Identifies parallel processes between musical and non-musical models of perception and behavior

Basic Research

Level Three: Mediating Models

Influence of Music on Non-Musical Brain and Behavior Function

Explains how music mediates to elicit the non-musical behavior

Basic Research

Level Four: Clinical Research Models

Therapeutic Effects of Music

Tests a therapeutic strategy based on prior scientific evidence

Emphasizes lasting functional behavior change and carry-over after treatment

Applied Research

Application of the Model

Potential Research Question:

What is the effect of a therapeutic singing program on the speech intelligibility of children with Down Syndrome?

Level One Research

Musical Response Model

How do children learn to sing?

Basic Research

Level Two Research

Non-Musical Parallel Model

How do children learn to speak?

Basic Research

Level Three Research

Mediating Model

Does singing influence speaking in young children?

Basic Research

Level Four Research

Clinical Model

What is the effect of a therapeutic singing program on the speech intelligibility of children with Down Syndrome?

Applied Research

The Transformational Design Model (TDM)

Translates information from the R-SMM into functional therapeutic music experiences.

Also developed to help clinicians (and students) avoid, perhaps two potential pitfalls:

Potential Weaknesses

An activity-based approach

The application of therapeutic music experiences that address goal areas and functional outcomes indirectly or on a very broad basis.

Five Steps of the TDMStep 1

Steps 1,2,3, & 5 are common to all disciplines. 1.Diagnostic and functional assessment of patient

Provides the diagnostic profile for a patient as well as subsequent deficits in functioning.

Step 2

Development of therapeutic goals and objectives

Goals and objectives are synthesized directly from patient’s areas of deficit or difficulty.

Objectives are measurable so that attainment can be tracked over the course of treatment.

Step 3

Design of functional non-musical therapeutic exercises and stimuli.

Appropriate for exercises to be similar to or based on standardized techniques utilized in other disciplines.

Step 3 cont’d

Thaut asserts that:

“This approach also ensures patient-centered rather than discipline-centered therapy programs”.

Avoids PT goals, OT goals, ST goals, MT goals. Maintains focus on the patient’s goals.

Step 4

Enter - Music Therapist

Translation of Step 3 into functional therapeutic music experiences.

Isomorphic translation of therapeutic nonmusical exercises and stimuli into functional therapeutic music experiences.

Three Determinant Principles of Step 4

Validity of the translation of functional behavior into music therapy techniques. Translation process must be checked against knowledge

obtained through the R-SMM, especially level 4.

If translation occurs without considering the basic and clinical research regarding music perception and nonmusical parallels, it is unlikely that subsequent interventions will be functionally effective.


The musical stimuli used in a therapeutic experience should conform to principles of “good” musical forms.

The perceptual influence of music is determined to a great extent by its conformity to optimal musical structure and patterns.


The functional logic of the transformation process.

TME’s need to be similar in structure and application to nonmusical therapeutic experiences.

MT needs to create good musical analogues for nonmusical behavior and stimuli.

Step 5

Transfer of therapeutic learning to real world applications.

Application of the TDMStep 1

Diagnostic and functional assessment of children with Down Syndrome

Epicanthal folds of skin on the inner corners of the eyes and upwards slant of the eyes.

Fissured and thick tongues. Hypotonic musculature Oral-facial? Hyperflexibility - unusual flexibility of the joints IQ ranges typically from moderate to profound retardation Language and speech are delayed and relatively weak -

receptive typically stronger than expressive.

Application of the TDMStep 1 cont’d

Factors that can contribute to low speech intelligibility Difficulty with the strength, timing and coordination of

muscle movements for speech.

Articulation problems with specific sounds, low oral-facial muscle tone, difficulty with sensory integration and oral tactile feedback, use of phonological processes (e.g. leaving off final sounds in words) and difficulties in motor planning for speech


Design of functional therapeutic goals and objectives

Objective for Speech - Pt. DS will increase clarity of speech as rated by two

independent raters to 80% intelligibility by …


Design of functional non-musical therapeutic exercises or interventions

Speech Stimulation

Speech Cuing


The translation of Step 3 into functional therapeutic music experiences

Musical Speech Stimulation (MSS)

Rhythmic Speech Cuing


Transfer of therapeutic “learning” to real world situations

Short Break

The R-SMM and Affective ProcessingLevel One

Berlyne Gestalt theorist and aesthetic biologist Humans have a biological need to pursue pleasant levels

of arousal through the perception of “good Gestalts” or patterns

At any given moment, a person possesses a particular level of arousal and therefore particular arousal needs.

Extreme levels of arousal are uncomfortable. A moderate change in direction toward homeostasis is

often experienced as quite pleasurable.


Berlyne Hedonic value refers to the intrinsic reward, motivation,

and positive feedback one experiences when perceiving a given stimulus.

The stronger the hedonic value/reward experience of a stimulus, the more motivated the human organism is to pursue it, and the greater influence it has over that human’s behavior.

Music is a sensory-related stimulus generally highly arranged in structures, patterns, or Gestalts


Meyer - Expectation Theory Contends that emotion rises from the perception of

musical structures/patterns Affect is aroused when an expectation, activated by the

music stimulus is temporarily inhibited or blocked. Argues that it is the interruption of expectation followed

by a period of suspension and finally resolution that facilitates arousal and evokes an affective response in the listener.

Based on Dewey’s Conflict Theory of Emotions


Expectation Theory in Outline Form Expectation set up through repetition and learning

Inhibition of expectation through novelty

Suspension of inhibition

Resolution


Meyer cont’d Requires that the listener be familiar with or understands

the “rules” of the musical patterns so that expectations can be created.

Meaning - anything acquires meaning if it is connected to or indicates something beyond itself, so that its full nature is revealed in that connection.

One musical event has meaning when it points to , and makes us expect, a subsequent musical event.


Kraut Like Meyer believes that someone “understands” music

when they have a correct qualitative response to it.

Musical understanding is best thought of as a set of experiences that are connected with the music, e.g. experiences of stability and tension, of metrical groupings, tonal centers, variations on harmonic, rhythmic, or melodic structure and similar musical events.


Raffman An experienced listener can no more fail to understand

his native music than his native tongue. Perception of musical grammar is unconscious, but the

results of those perceptions are experienced consciously. Because you feel a sequence moving from instability to

stability it is analyzed as a cadence. Because you feel a chord to be the most stable chord in a

key, it is analyzed as tonic.


Jackendoff Also like Meyer, believes that expectations fulfilled

bring satisfaction and positive affect while unfulfilled expectations in music bring disappointment and negative affect (in general).


Peretz Research points to activation of the amygdala, changes

in musculo-facial expression, frontal lobe activity, limbic system, and Galvonic Skin Response (GSR) under a variety of listening conditions.

Current work involves amusics, in order to establish complex neuro-systems involved with affective processing of music.

The R-SMM and Affective ProcessingLevel Two

LeDoux Conditioned rats to associate hand clapping with water. Conditioned response was equally as strong for

cortically intact rats as those who had their neocortex removed.

Auditory pathways into the limbic system allowed for the conditioning to take place.

LeDoux’s current work further substantiates the sensory perceptual/limbic system connectivity at a pre-cognitive or subconscious level.


Izard Affect & Cognition are seen as two separate systems that

consistently interact with each other. Emotional feeling states (non-cognitive phenomenon),

are the motivation for our actions and through development they become linked to images, symbols, and thoughts (cognitions).

Cognitive processes are used to control intensity and duration of innate expressions of genuine emotion. This process is culturally regulated.


Izard Affective/Cognitive structures (the interaction of

biological and sociocultural influences) become more and more predominant with age.

Most important thing to remember from Izard is that emotions generally occur pre and sub consciouisly and that they prime our nervous systems for action or behavior.

Associative Network Theory

Emotion

Cognition

Bower’s AssociativeNetwork Theory

Emotions enter into memoryunits with coincident events.Memories, and thoughts in

general, are most easilybrought into awareness whensomeone is in a mood state

congruent with the emotionalquality of the cognition

Influence of MusicMusic can influence cognition(memories, perception of self

and others, self-talk, etc.)Because of its strong

influence on affect and mood.

•I’m a failure•Life is hopeless•No one will ever love me.

•I’m O.K.!•I’ve had some fun times

•I have some really good friends


Teasdale Discusses the relationship between cognition and

depressed mood states. Indicates that findings from various studies indicate

negative cognitions can initiate and maintain a state of depression.

Findings also suggest that mood affects the accessibility of positive and negative cognition.

There is a reciprocating relationship between depression and negative cognitions.

The R-SMM and Affective ProcessingLevel Three

Clark Compared 2 mood induction techniqes (Velten Card &

Music) to see which technique induced a mood that was more representative of a naturally occurring mood.

Velten Card - 50%-75% actually felt the moods implied b the card statements and met the mood change criterion.

Music - 87% reported a change in mood and met the mood change criterion in the musical MIP.

MMIP showed stronger effects such as “loss of incentive, psychomotor retardation, etc.”


Sutherland Hypothesized that unwanted/intrusive thoughts are difficult to remove

during depressed mood states. First experiment verified this.

2nd experiement - Subjects were musically induced into either a “happy” or “sad” mood.

MMIP were shown to induce moods effectively in both directions.

Negative thoughts are difficult to remove because the material necessary for forming a pleasant alternative thought is less accessible when depressed.

Music creates greater accessibility to positive cognitions due to its strong effect on mood.


Thaut & d el’Etoile Compared the effects of music as a mood induction

procedure to music as a background stimulus on recall. Found that MMIP produced best recall performance

when used prior to encoding in learning tasks. Music was played as a background stimulus while

subjects were asked to create a list of antonyms to a series of adjectives.

Music was used as a mood induction procedure - then subjects were asked to perform adjective/antonym task.


Thaut & d el’Etoile Results indicated that subjects who were induced into a

similar mood during encoding and retrieval yielded the highest performance results on the recall of antonyms.

Study supports the principle that music can promote retrieval processes in cognitive memory tasks.

Authors state that investigation is necessary to determine if “…therapeutic music experiences may be used systematically as a tool for affect modification to access positive memories about oneself and one’s life, and thus support cognitive interventions in the tx of depression.

The R-SMM and Affective ProcessingLevel Four

Eiffert Used music to modify mood in a classical conditioning

methodology with phobics who were afraid of specific animals (Australian - lizards, etc.)

Used background music to see whether perceptions and associations could be shifted as mood is altered through exposure to music.

Phobic group that had music showed a significant decrease in negative attitudes toward the feared animal, a decreased heart rate, and a positive change in their ratings of the feared animals.

The R-SMM and Affective ProcessingLevel Four

There are a great deal of Level IV studies.

Many are narrative in nature.

Strong foundation for use of music in affective disorders (could use much more neuro research at Level III)

Good, structurally sound Level IV research an area of need.

Thank You !

…just in case

the rational-scientific mediating model (r-smm)

Documents

therapeutic strategy

therapeutic singing

functional outcomes

nonmusical brain

patients goals

music therapy techniqu

pt goals

ot goals