Music therapy in clinical practice

In their practice, physicians involved in treating patients, face not only vertebrogenic, myogenic pain or pain of other nature, but also varying degrees of severe emotional and affective states developing on its background. The following leads to visceral-motor symptoms and mental experience of pain. Besides, the mental factor, under certain circumstances, may cause a variety of physical disorders. It is known that a ban on the emotion tends to eliminate them from the consciousness. Price for it is impossibility of its psychological processing and growth of the physiological component of pain and discomfort of various localization. The perception of pain is a complex psycho physiological process. Pain is always colored by emotional experiences, which gives it a unique character. The most important factors are the emotional and personal characteristics of the subject, accentuation of character, the level of neuroticism, the asthenic, anxious-phobic, depressive, hypochondriacal, senestopathetic manifestations. It is very important that the antinociceptive system and mental state are closely interacting with each other due to anatomical and functional neurochemical connections. In close cooperation, they determine the levels of pain susceptibility and in particular painful experience. We must emphasize the special importance of so-called chronic pain. The syndrome that lasts more than three months with a variety of visceromotor pain, emotional - affective symptoms and mental experiences, against which there are neural, vertebral, muscular and neurovascular disorders, leading to the patient's disability, is considered as chronic pain. Developing chronic pain often loses the signal value. Breakdown of adaptive mechanisms comes. In this case, the patient does not perceive pain adequately. It manifests in the form of hypochondria, depression, chronic fatigue, senestopathia. Sometimes the syndrome is referred to as "depression-pain". For patients with fibromyalgia depression that correlates with the duration of pain is typical. There is evidence that chronic vertebral, abdominal pain changes associative thinking and structure of verbal expression. Chronic vertebral pain syndromes may be a manifestation of lingering somatized and masked depression.

In patients with discogenic lumbar radiculopathy in 70% of cases sustainable changes in psycho - emotional sphere were identified, which manifested asthenic - depressive syndrome and emotional - affective states. Chronic pain syndrome is a pathological multilevel system, formation and the clinical expression of which is the result of pathological integration of somatic and mental component. It includes genetically determined mechanisms of emotion, thinking, cognitive processes in general, behavior and their transformation under the influence of pathogenic factors. A special importance has the constant identification of psychological factors, emotional and mental unbalance of patient with chronic discogenic pain. As noticeable attendant psychic phenomena confirms the presence of vertebral disorders. These patients with good reason regarded as neurotic, but without any foundation they receive treatment as neurotics. There are two features that distinguish the mental pain from the pain of organic origin, the first, "pure" psychogenic pain is not common, the second, the pain that the patient can describe and locate always be regarded as organic. Pain syndrome, as psycho physiological one, form not only as a sensible image, but also includes, based on the integration of different nociceptive systems and brain emotional feelings and mental distress. Chronic pain of the locomotorium system is a major, well-established cause of neurotic depression and other psychosomatic manifestations. Depression, in turn, can reduce the pain threshold.

There are two points of view: one points out intercommunication between the increased level of neuroticism and chronic pain. Other believes that the level of neuroticism depends on the patient's premorbid features and can not refer to the specific feedback of chronic pain. According to current research, in the genesis of degenerative diseases of the spine prominent place is given to inadequate lingering reactions of vascular, osteomuscular and endocrine systems to stress. Along with the biological stress caused by environmental factors and somatogenes, emotional stress occupies an important place. Thus, this pathology is multifactor, affecting both structural and biochemical and mental components of the human body. There is a vicious circle. We can handle pain and violation of the locomotorium system, physical illness, but we can’t remove the emotional memory. Therefore, it is necessary to conduct the restoration not only of the somatic, but also of the part of the psyche. Music therapy should take one of the main directions in order to remove the emotional damage and normalize psycho-emotional and physical status in the treatment of patients.

If we consider the human being as a cybernetic system, system limitation of the external environment puts a limit to the capacity of the internal evolution of the organism maintaining its identity as a separate system. In general, this phenomenon is known as the second law of thermodynamics, indicating inevitable accumulation of chaos in time bounded by any environmental system. Living systems, from this point of view, actively reduce their thermodynamic entropy, and therefore are not closed. This provision can be interpreted as follows: living systems need to interact with the external environment - the concept of the unity of organism-environment. Music is the information channel that is not available for the control of consciousness, penetrating into the psyche a lot better than the word. Even when a person is in coma, the only link between man and the world around him, and able to bring out of this state is the music. Even A. Meneghetti said that the child when learning to speak, first of all, does not teach the words and sound shapes. So it means that music is the primary language. It seems that it is possible to extend the wording and say that music is the original language of mankind. Depending on the pitch, tempo, rhythm, an infinite number of combinations create, which bring us all the information much faster and more than the word. The prospects of the vibration way of transmission information are pointed out by the classic-cybernetics Wiener. Consequently, due to violation of the vibration receiving and processing the received information, there is a failure of adaptation mechanisms of the body. This is where I would like to note that music influences everyone the same way, and the variety of perceptions of different people and as a consequence of different emotional reactions to them are due to the presence of multi-dimensional combinations of functional blocks. From the standpoint of James-Lange theory, the act of origin emotions as follows: stimulus - the emergence of physiological changes - signals about these changes in the brain - emotion (emotional experience). It is possible to propose the following diagram, which shows how and at what stage imbalances between any areas within this scheme gives us all the variety of psycho-somatic disorders.

Music influences the person in two directions:
1. as a vibration on integrated system - human.
2. as semantic information.
Under vibration you can understand the physical effects of sound on the body. Here, of course, it is important to sound reproducing apparatus to be as small as possible with a wide range playback.
And in terms of revenue semantic information, music can be divided into two categories:
1. The music bearing only semantic information. This is all meditative music (Indian ragas, shaman tambourines, etc.).
2. The music bearing semantic information sent to a specific emotional response. This could include the whole of classical music, songs, world music.

For the normalization of psycho-physical status, removing the emotional damage meditative music is not enough i.e. it enters the patient at the same ego state, he lives it and output happens in him, and nothing has changed qualitatively. This often leads to an even deeper intrapersonal conflict, driving deeper into the unconscious "core of aggrieved affect." In addition, we must remember that this music has always performed at a particular time in a particular place and to a particular person or group specific person. Therefore, transferring it to other conditions and other times not only can not give the desired effect, but also lead to negative consequences. A program compiled from classical and ethnic works is impossible to accurately dock with each other, and even more if the product is taken from a passage. It should also be borne in mind that, as a rule, these products are not recorded by the author and the performer or orchestra - and this is a copy. And like any copy depends on the person who performs it, and, unfortunately, often very far from the original, and can also do more harm than good. If we add to this that each person will have different from each other associations to the same work, we can understand that in these conditions it is impossible to make universal any of the gathered programs. And also get a guaranteed result at the output. It is important to use a complete musical works, with the input and output that can cause emotional damage to a patient and bring him to a qualitatively new level of psycho-emotional and physical state.

Following from all the above, Dedinskaya E.P. wrote a program. It consists of four levels of exposure (4 discs audio series). Patent №2150301 "Method of improvement of health through a constructive way out of stress." 1st level audio series "Echo of Silence", 2nd level audio series "Path of Light", third level audio series "My life - my love", 4th level audio series "Dr. Dream for children and adults."

Together four discs can achieve system stability. In this program not only each disk has its own input and output, but also the end of each disc is an input to another one. In addition, within disk each product has its own entrance and exit to the next product. Three discs - "Echoes of Silence", "The Way of the World", "Dr. Dream for children and adults" are only semantic information. Disc "My life is my love" bears semantic information sent to specific emotional responses. It was found that the program as monotherapy and also with other methods significantly improves the efficiency of the treatment itself.

It is necessary to raise another problem of medicine that applies not only to the patient but also to the doctor. This problem is known as the phenomenon of burnout. Being in the intensive and close contact with the patient, the doctor provides professional assistance in an emotionally-saturated atmosphere. He supports the patient emotionally, cares about him, so that the doctor has a feeling of emptiness, emotional blunting. Medicine is an area of activity, dominated by negative emotional states, hence the decline in empathy doctor. Using this program, not only in the session with the patient, but also after reception, doctor restores empathy and his emotional health.

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4. Grishkin N.V.; Efanov O.I.; Stefanova A.N.; Dedinskaya E.P. Music therapy as a method to ensure systemic stability of the person // VII International symposium. Information, technological and medical protection of population and environment in emergency situations. Moscow, 2000.
5. Dedinskaya E.P. Patent №2150301 "Way of improving the body through a constructive way out of stress."
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Moscow, Russia 2015