American Music Therapy Association Music Listening Guidelines
The AMTA Music Listening Guidelines are intended to provide guidance to individuals engaging or assisting others in regular music listening to address physiological, psychological, communicative, behavioral, educational, and/or wellness needs. The recommendations below should always be used in consultation with the listener’s health team, including but not limited to physicians, psychologists, psychiatrists, counselors, audiologists and music therapists.
It is important to note the difference between Personalized Music Listening (PML), Background Music Listening (BML), Leisure Music Listening (LML) and Music Listening (ML). For the purposes of this document:
- PML is defined as music selections chosen from an individual listener’s preferences and life experiences. PML is designed to support the individualized needs of the listener.
- BML is defined as music listening intended as an unobtrusive accompaniment to some activity such as eating or to help facilitate a type of atmosphere.
- LML is defined as engaging in music listening as an activity for leisure and/or entertainment.
- ML is defined as any music listening experience and includes PML, BML and LML.
- Auditory Safety
- ML should be delivered at a volume controlled at 65dB or lower.
- When ML is to be delivered via headphones, the style of headphones should be selected based upon the listener’s comfort and safety.
- Bluetooth headphones are recommended for listeners whose safety could be at risk and/or music listening experience could be interrupted by become entangled in headphone wires.
- Listeners with hearing aids and/or hearing impairments should have a consultation with their audiologist prior to beginning a regular music listening program.
- Infection Control Safety
- For cleaning and disinfecting, use EPA-registered, disposable disinfectant wipes, ultraviolet-C disinfection wands, or follow any other sanitary procedures provided by a person’s physician or facility infection control staff.
- Cleaning and disinfecting is recommended:
- when visibly soiled,
- before and after each use if person has an infection and/or is on infection control precautions,
- when equipment is being transferred between individuals for use,
- when a person has been traveling with their equipment, and,
- when it may have come into contact with contagious diseases.
- Music Content Considerations
- Song selections for ML, especially PML, should take into consideration lyric content that may promote or suppress healthy behaviors and information should be obtained on any songs, lyrics, subjects that should be avoided and note any negative reactions to song lyrics should they occur.
- Individuals with a history and/or predisposition for addictions and/or unhealthy behaviors, or who have a history of trauma, should consult with their physicians, counselors, music therapists and other treatment team members and practice caution when selecting ML, and especially PML, songs associated with and/or containing lyrics pertaining to those addictions, behaviors or memories.
- Use of ML songs, especially PML songs, known or likely to cause intense emotional and cognitive responses are not recommended for use outside of a treatment plan with a qualified healthcare professional.
- Health Considerations
- Physiological Considerations
- Individuals with cardio-pulmonary health concerns should consult their physician prior to using a PML program in conjunction with a physical exercise regimen to determine ideal tempos for their heart and respiration.
- Individuals with physical disabilities or injuries should consult their physical therapist, occupational therapist, music therapist and/or physician to determine PML tempos/beats per minute, rhythms and other music elements appropriate for engaging in specific motor repetition for habilitation or rehabilitation.
- Psychological Considerations
- Generally it is recommended that individuals with mental health diagnoses consult with their treatment team and music therapist (when possible) when planning to begin PML.
- An individual experiencing strong and unpleasant thoughts or feelings from certain songs, genres, or artists should cease listening to music that elicits these reactions or responses and/or seek the help of a professional music therapist.
- While selecting music to match an individual’s current mood can be effective, it is important that the music not prohibit the individual from changing moods and experiencing the full spectrum of feelings and emotions.
- Individuals with mental health diagnoses that present with hyperactivity and/or mania should avoid selecting songs or playlists of songs that only express and elicit fast-paced sound and activity, high energy and/or excitement.
- ML, whether individually or in groups, may be accompanied by other experiences (such as art composition, moving, story composition, or lyric discussion) designed to give form to thoughts, impressions, or emotions generated by the music.
- Cognitive, Communicative and Sensory Considerations
- Individuals with cognitive and sensory processing deficits should have PML delivered in consideration of their environmental stimuli, physiological stimuli and their ability to neurologically process the music stimuli within their current state of recovery from injury or disease.
- An individual experiencing severe and/or chronic pain may demonstrate hypersensitivity to music stimuli and therefore may require frequent adaptations in delivery of music stimuli in order to meet their changing ability to process varying amounts and types of stimuli and to benefit from PML.
- Individuals with seizure disorders may find that some music triggers seizures. Individuals with music-induced seizures should consult with a music therapist and/or their healthcare team when planning to engage in ML, especially PML.
- Infants with delayed neurological development, especially those hospitalized in a Neonatal Intensive Care Unit (NICU), who have not fully developed the ability to process intense sound stimuli, should be provided music with the consultation of a music therapist or other qualified professional specializing in infants, neurology, and/or auditory processing, to avoid overstimulation and harm to the infant.
- Individuals with disorders, diseases, and injuries that affect their ability to exhibit focused attention, comprehension, memory recall, and/or reality orientation should receive PML in a setting and with a plan of care that:
- Facilitates monitoring of the individual’s responses to music stimuli to allow for changes or discontinuation of the PML when unbeneficial responses are observed, or;
- Appropriately engages the individual in social, cognitive and communicative tasks that exercise the neurological pathways exhibiting improved functionality from the stimuli of PML when beneficial responses are observed.
- Music Listening Safety Considerations
- It is important to be prepared to recognize and support, or obtain support for, any significant emotions and/or memories that emerge from PML experiences.
- Monitor the person listening. ML, especially PML, may cause an increase or decrease in movement that may need to be monitored, depending on what activity the individual is engaged in, and particularly if the person is considered a fall risk. See Appendix A. Responses to Watch For.
- Respond in the moment to significant changes, emotions and/or memories. See Appendix B. Responding to Observed Reactions to Music.
- Make note of significant changes, emotions, memories and/or observations, including the music playing at the time. This information may affect whether the playlist or listening regimen needs to be modified or whether follow up needs to be made by a qualified psychosocial healthcare provider such as a social worker, counselor, or music therapist (particularly beneficial for non-verbal listeners).
- Music Listening Frequency & Delivery
- Individualized responses and reactions to PML can vary with time of day and from day-to-day. When using or facilitating personalized music listening, it is imperative to watch for responses of pleasure and relaxation, but also signs of increased agitation and discomfort from music to allow you adjust music delivery accordingly as indicated in section 5.
- PML is not recommended to continue beyond 50 minutes for one session, and sessions may occur up to four times a day.
- See Appendix C. Considerations for Planning Music Listening Length, Frequency and Schedule.
- See Appendix D. Considerations for Determining Best Method of Music Listening Delivery.
- See Appendix E. Considerations for Caregivers to Enhance the Social and Relationship Benefits of Music Listening.
- Music Preference & Playlist Recommendations
- Individual music preferences may be based on a wide variety of influences such as familiarity, artist or performer, preferences of friends/relatives, prior musical experience, composer, recommendations of authority figures or acquaintances, accompanying instruments or styles, or concurrent and changing mood. Playlist songs should always be selected with cultural, historical and ethical considerations relevant to the listener.
- Different preferences may often be expressed by the same individual depending on that person’s state of mind at a given moment.
- Research shows that most people prefer the music that they listened to in their teens and 20’s due to the association of that music with the formation of one’s self identity, goals, and development of mechanisms for independence. Music from adulthood can also be preferred, especially music which relates to significant periods of time, experiences and/or achievements in the person’s adult life.
- The needs of the individual should always be considered when building a PML playlist. For example, songs may be placed in an order so as to induce excitement/alertness or relaxation/sleepiness. Playlist may require periodic revisiting to ensure continued relevance to the individual’s needs.
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PML may be provided in a predictable set order of songs or in a mix or shuffle of songs, as indicated by the goal of the music listening and the listener’s responses to the music.
AMTA Music Listening Guidelines Appendix A
Music Listening Safety Considerations
Research and experience shows us that music can elicit a wide range of emotions, memories, and thoughts. Even within a single song, music can elicit smiling and happiness one minute and tears and sadness or anger and agitation in the next. It is important to be prepared to recognize and support, or obtain support for, any significant emotions and/or memories that emerge from PML experiences. Find below recommendations for safely and effectively supporting PML:
- Monitor the person listening. Ensure the music listener is within your sight and be present. It is impossible to know how the listener is responding without maintaining focus on them. Listeners may display significant emotions or recall of memories that need to be noted or addressed. Listeners may also become increasingly alert and stimulated, and therefore, increase movement. This may be problematic for individuals who are fall risks. Good monitoring helps ensure the benefits of a positive and safe music listening experience. If you are unable to monitor the person yourself, arrange an appropriately trained person who can also successfully monitor the listener. Responses to watch for include:
- Affect – Positive or Negative?
- Tears - Positive or Negative?
- Alertness - More awake/responsive or Sleepier/less responsive?
- Physical responses - Tapping toes or hand, or swaying body to the beat?
- Movement - shifting in bed or chair, standing or attempting to stand, walking or attempting to walk, dancing?
- Verbal expression - More/Less, particular subject or words used in expression?
- Orientation to correct time, place, person, situation - Better/Worse?
- Eye contact - More/Less?
- Change in agitation - Increased/Decreased?
- Listener self-reports of memories, changes in mood, etc.
- Changes in breathing or muscle tone (relaxed tone, easy breaths or tense/flexed tone, rapid or short breaths)
AMTA Music Listening Guidelines Appendix B
Responding to Listener’s Reactions
It is important for listeners to have support nearby to respond in the moment to significant changes, emotions and/or memories.
- If you observe a listener having a significant emotional response to the personalised music listening, verbally acknowledge what you are observing and check in with the listener and attempt to have the listener confirm or deny the accuracy of your observation(s) and elaborate on what they are thinking and/or feeling.
- If the listener verbally expresses their response, listen intently and acknowledge what they are telling you until they are done talking. Then ask if they would like to continue listening or stop and talk.
- If the listener is non-verbal, acknowledge what you are observing and let them know you are there with them. Sit next to them and consider appropriate comforting measures for the situation, perhaps placing a hand on the person’s arm or hand. If the person can non-verbally communicate yes or no, ask if they would like to continue listening or stop and talk. If the person is unable to verbalize and is displaying what appears to be a negative response, it may be best to stop the music until a professional can determine what is happening with that listener.
- If the listener is having a concerning physical response to music, such as attempting to shift, get up or walk when the person is unsafe to do so independently, respond with assistance if you are trained, or seek assistance from someone who is trained to support the listener safely.
AMTA Music Listening Guidelines Appendix C
Music Listening Frequency & Delivery
The following are considerations for planning frequency and length of music listening:
- Music listening may be beneficial to individuals suffering from insomnia who demonstrate responses of relaxation to a variety of music stimuli or to specific music stimuli. Individuals may also benefit from PML during patterns of agitation, such as sun-downing periods, to promote soothing and reduction of unpleasant feelings.
- PML prior to activities may allow an individual to demonstrate increased participation and benefit from the activities such as meals, outings, receiving visitors, and therapies.
- Facilities may consider providing PML or BML during shift changes, meals, or other busy times when larger amounts of people are on a unit and background noises increase. Music at this time allows a more pleasant environment for facility patients or residents.
- Listening to self-selected, preferred music as desired has been shown to result in significant improvement in state-mood and cognitive performance scores, as well as increased motivation and productivity, therefore individuals should be able to receive (upon request) music listening devices that will deliver preselected, preferred music with loudness and song selection controlled by the listener.
- Length of listening should be dependent on the length of time the listener is able to process and benefit from music stimuli. Many individuals will need periods of time with less or different stimuli between music listening periods. PML length and periods of time between music listening should be determined based upon the individual’s needs and observed responses.
- Population/Need specific listening frequency & duration research indications:
- Stress - Labbé, E., Schmidt, N., Babin, J., & Pharr, M. (2007)
- Pain - Martin-Saavedra, JS. et al. (2018) & Ames, N., et al (2017)
- Pre-operative Anxiety - Jeppesen, E., et al. (2019)
- Operative Anxiety - Vachiramon, V., Sobanko, J., Rattanaumpawan, P., & Miller, C.J. (2013)
- Stroke Recovery - Särkämö, T., et al, (2008) & Särkämö, T., et al, (2014)
AMTA Music Listening Guidelines Appendix D
Music Listening Delivery
Recorded PML may be delivered through headphones or speakers. The following factors should be considered when determining the best method of music delivery:
- Any hearing impairments;
- Any hearing assistive devices;
- The pitch range, timbre, and decibel level an individual is able to auditorily process;
- Sensitivity to the sensation of various styles of headphones touching their head and/or ears;
- Any behaviors the individual may exhibit that may limit the listener’s ability to listen to the music, such as changing the volume too high or too low, hitting buttons that may unintentionally start, stop, or change the music playlist, becoming unintentionally wrapped up in cords and/or the equipment, becoming intentionally wrapped in equipment cords if the individual may be suicidal;
- Other sound stimuli in the environment where music listening is to take place;
- In environments where there are other individuals in the music listening area who do not or may not wish to listen to music or a specific type of music that may be played, headphones are recommended if the listener can tolerate them. If headphones cannot be tolerated it is recommended that the listener be placed in a location away from others who may respond negatively to the listener’s preferred music but where the listener may still be monitored for safe listening as appropriate.
AMTA Music Listening Guidelines Appendix E
Music Listening as a Social Experience
While the recipient of PML can benefit from engaging in this activity individually, music is also a social experience. The following are considerations for caregivers to assist in enhancing relaxation, quality caregiver relationship, reciprocity and caregiver role satisfaction.
- Caregivers can use PML as a method of engagement with those they care for by using a headphone splitter or speakers to share the music listening experience. When listening together, the caregiver can tap their lap in time to the beat, hum, or sing main choruses of familiar songs to demonstrate their own enjoyment of the music. The individual may watch what is being modeled for them and begin to respond to the music as adjustment to the medium occurs.
- Caregivers may also initiate conversation with listeners who are able to effectively communicate based upon the music’s lyrics and musical elements, as well as the thoughts, emotions and memories facilitated from the music listening.
- Caregivers can utilize touch and movement to increase listener engagement, e.g. holding the listeners hands and bouncing or swaying to the song. Gently tapping a pulse on the listeners’ leg or arm can increase attention and interaction.
- The addition of relevant pictures or photo viewing while listening can also enhance the social experience. Be mindful of sensory overload, and adjust according to the listener’s responses.
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