The efficacy of music The efficacy of music as an aid to smoking as an aid to smoking

cessationcessation

TR 310 Field Study 2007TR 310 Field Study 2007Shaun CavanaghShaun Cavanagh

Southern Institute of TechnologySouthern Institute of TechnologyBachelor of Health Science Bachelor of Health Science

(Therapeutic Recreation)(Therapeutic Recreation)

IntroductionIntroduction

Welcome!Welcome!

Thanks for the opportunity to rely on agency Thanks for the opportunity to rely on agency resources to complete requirements of the resources to complete requirements of the paper.paper.

Disclosure..Disclosure..

Purpose of presentation:Purpose of presentation:

Year 3 SIT Recreation Therapy (or ‘TR’) Year 3 SIT Recreation Therapy (or ‘TR’) students on placement are required to students on placement are required to summarise details of research conducted as summarise details of research conducted as part of the TR 310 Field Study paper…part of the TR 310 Field Study paper…

Presentation PreviewPresentation Preview IntroductionIntroduction

Acknowledge people presentAcknowledge people present ““Hi there”Hi there” Purpose of presentation/PreviewPurpose of presentation/Preview

ContentContent (We are here)(We are here) Purpose of research/hypothesisPurpose of research/hypothesis Rationale for studyRationale for study Goals/objectivesGoals/objectives MethodsMethods Benefits to Public Health South/Cessation providersBenefits to Public Health South/Cessation providers LimitationsLimitations Recommendations/Future Directions/Now what?Recommendations/Future Directions/Now what? Other relevant informationOther relevant information

Conclusion Conclusion (Review; Questions)(Review; Questions) (Excerpt: British (Excerpt: British

Invasion)Invasion)

Purpose ofPurpose of research/hypothesisresearch/hypothesis

• What role can music ‘play’ in assisting heavily What role can music ‘play’ in assisting heavily addicted smokers to quit, or move through the addicted smokers to quit, or move through the stages of readiness to quit?stages of readiness to quit?

• The efficacy may extend to preventing relapse, The efficacy may extend to preventing relapse, and enhancing compliance following a quit and enhancing compliance following a quit attempt.attempt.

• If music caused no internal response perceived as beneficial, If music caused no internal response perceived as beneficial, people wouldn’t listen to it. As for tobacco, without a perceived people wouldn’t listen to it. As for tobacco, without a perceived benefit, there would be no consumption. If the perceived benefit, there would be no consumption. If the perceived benefits of music transcend tobacco, then over time, people may benefits of music transcend tobacco, then over time, people may come to depend on what is healthy rather than what is harmful come to depend on what is healthy rather than what is harmful (Reflection, 8/3/07)(Reflection, 8/3/07)

StudyStudy rationalerationale Music and substances – postulated similarities Music and substances – postulated similarities

(‘Substance’ and ‘Substantial’)(‘Substance’ and ‘Substantial’)

- originate outside the ‘consumer’- originate outside the ‘consumer’

- produce an internal response- produce an internal response

- effects ‘collected’ over time- effects ‘collected’ over time

- comparison with exercise physiology “FITT”- comparison with exercise physiology “FITT”

- stimulate cognition- stimulate cognition

- provide feelings of pleasure/security- provide feelings of pleasure/security

- sense experience/role of nervous system- sense experience/role of nervous system

- preference relates to stage of development..- preference relates to stage of development..

Re: StudyRe: Study rationalerationaleLev Vygotsky, Developmentalist (1896-1934)Lev Vygotsky, Developmentalist (1896-1934)

Like tool systems, sign systems (language, writing, number systems) are created by societies over the course of human history and change with the form of society and the level of it’s cultural development…the internalisation of culturally produced sign systems brings about behavioural transformations and forms the bridge between early and later forms of human development

(Cole and Scribner, (Cole and Scribner, Mind in SocietyMind in Society,, 1978, p. 6) 1978, p. 6)

• Music cannot be neutral in its effects.Music cannot be neutral in its effects.

Goals/ObjectivesGoals/Objectives

• To discover the efficacy of music in smoking To discover the efficacy of music in smoking cessationcessation

• To discover a potentially healthier alternative to To discover a potentially healthier alternative to smokingsmoking

• To follow ethical procedures To follow ethical procedures • To respect applicable Treaty principlesTo respect applicable Treaty principles• To serve as a basis for further studyTo serve as a basis for further study• To introduce student to conducting basic To introduce student to conducting basic

researchresearch• To yield potentially useful information for To yield potentially useful information for

agenciesagencies

MethodsMethods Application through NEAC – SDHB patientsApplication through NEAC – SDHB patients Consent formConsent form Participants de-identified: pseudonymsParticipants de-identified: pseudonyms The British Invasion The British Invasion (Radio NZ)(Radio NZ) – sets the scene – sets the scene 1 week, 3 days1 week, 3 days 3x Half hour on 3 days (1.5 hrs total)3x Half hour on 3 days (1.5 hrs total) Recording sheets: tunes/artists Recording sheets: tunes/artists 14 item questionnaire 14 item questionnaire Participant kit, including tips for music listening Participant kit, including tips for music listening

(www.soundfeelings.com)(www.soundfeelings.com) Search of CINAHL database: ‘Music therapy’ 1100+ articlesSearch of CINAHL database: ‘Music therapy’ 1100+ articles Selection Selection waswas to be according to Fagerstrom assessment: to be according to Fagerstrom assessment:

(31+ per day/Lighting up within 5 mins of waking(31+ per day/Lighting up within 5 mins of waking))

Eventually regular smokers, up to this amount.Eventually regular smokers, up to this amount.

Results/OutcomesResults/Outcomes Research approved by Regional Ethics Committee and Smokefree Support Research approved by Regional Ethics Committee and Smokefree Support

(June)(June) Positive feedback from people in discussion about research topicPositive feedback from people in discussion about research topic Anticipated: Participants would find a potentially healthier alternative to Anticipated: Participants would find a potentially healthier alternative to

smoking, and the research would discover something about the effects of smoking, and the research would discover something about the effects of music on music on ‘quitability’‘quitability’

6 Participants found (1 other unable to take part)6 Participants found (1 other unable to take part) Participants indicated a broad range of music preferencesParticipants indicated a broad range of music preferences Combination of stimulating and relaxing effects. Relief of either boredom or Combination of stimulating and relaxing effects. Relief of either boredom or

anxiety; Habit; To think, concentrate or remain calmanxiety; Habit; To think, concentrate or remain calm

Music tended not to be given as a factor in smoking commencement…Music tended not to be given as a factor in smoking commencement………nor was lack of music considered to contribute to ongoing smokingnor was lack of music considered to contribute to ongoing smoking

Participants tended to place greater emphasis on personal responsibility for Participants tended to place greater emphasis on personal responsibility for smoking-related illnesssmoking-related illness

Despite 5/6 regarding nicotine as more addictive than either heroin or Despite 5/6 regarding nicotine as more addictive than either heroin or cocaine, 4/6 indicated that to quit smoking was simply a matter of personal cocaine, 4/6 indicated that to quit smoking was simply a matter of personal choice.choice.

Benefits to agenciesBenefits to agencies Music potentially provides substitute resources (such as Music potentially provides substitute resources (such as

awareness, enjoyment) to perform the function that clients awareness, enjoyment) to perform the function that clients have traditionally ‘depended’ on substances (cigarettes) to have traditionally ‘depended’ on substances (cigarettes) to meet.meet.

Public Health South: May be applicable to other populations Public Health South: May be applicable to other populations beyond cigarettes that are examples of ‘dependency’ (for beyond cigarettes that are examples of ‘dependency’ (for example: alcohol, gambling, other drugs)example: alcohol, gambling, other drugs)

Cessation Support providers (with/without NRT) : Cessation Support providers (with/without NRT) :

Potential ability to enhance quit rates/stages progression.Potential ability to enhance quit rates/stages progression.

Further exposure to the concept of Recreation therapy, and Further exposure to the concept of Recreation therapy, and it’s role in educating for productive leisure:it’s role in educating for productive leisure:

To be able to fill leisure intelligently is the last product of To be able to fill leisure intelligently is the last product of civilisationcivilisation

- Arnold Toynbee - Arnold Toynbee (Datillo, 2000)(Datillo, 2000)

LimitationsLimitations ““Aspects of the study that cannot be controlled, that Aspects of the study that cannot be controlled, that

represent weaknesses to the study, and that may negatively represent weaknesses to the study, and that may negatively affect the results” affect the results” (Baumgartner/Hensley, 2006, p. 30)(Baumgartner/Hensley, 2006, p. 30)

If efficacy is being measured, validity could be influenced by If efficacy is being measured, validity could be influenced by the frequency and duration of research (design consideration)the frequency and duration of research (design consideration)

Variations in amounts smoked for people on/not on NRTVariations in amounts smoked for people on/not on NRT Time constraints influence decisions on study designTime constraints influence decisions on study design NEAC: waiting for response (approval received 20NEAC: waiting for response (approval received 20thth June) June) Novice research: influence on questionnaire design.Novice research: influence on questionnaire design. Not included in the literature review are examples of tunes Not included in the literature review are examples of tunes

(words put to music)(words put to music)

The extent to which participants have followed instructions:The extent to which participants have followed instructions: Whole half hour?Whole half hour? Complete questionnaire correctly? Complete questionnaire correctly? All available for interview?All available for interview?

Recommendations…Recommendations…Future research into efficacy of music as a smoking cessation aid could Future research into efficacy of music as a smoking cessation aid could

look at:look at:

The nature of the research design (also in line with ‘FITT’)The nature of the research design (also in line with ‘FITT’)

Music as a cessation aid due to particular tunes lasting longer than the time it Music as a cessation aid due to particular tunes lasting longer than the time it takes to smoke a cigarette?takes to smoke a cigarette?

What is the impact of different types of music and artists performing (different What is the impact of different types of music and artists performing (different vocal styles, instrumentation) vocal styles, instrumentation)

Music as a Music as a universal languageuniversal language: does the enduring quality of tunes indicate : does the enduring quality of tunes indicate common preferences (despite individual differences), and does this relate to common preferences (despite individual differences), and does this relate to the enduring ‘quality’ of various types of tobacco? (eg. ‘Hey Jude’ by the the enduring ‘quality’ of various types of tobacco? (eg. ‘Hey Jude’ by the Beatles cf ‘Marlboro’ by PM)Beatles cf ‘Marlboro’ by PM) “SENSE EXPERIENCE”“SENSE EXPERIENCE”

The role of the Nervous system: in-depth consideration (ANS: The role of the Nervous system: in-depth consideration (ANS: sympathetic/parasympathetic)sympathetic/parasympathetic)

Efficacy of music to treat other substance use / behaviours (Alcohol, Cannabis Efficacy of music to treat other substance use / behaviours (Alcohol, Cannabis and other drugs, Gambling).and other drugs, Gambling).

Music’s role in contributing to smoking uptake and prevalence (social Music’s role in contributing to smoking uptake and prevalence (social learning)learning)

Does music contribute to or compete with smoking prevalence? Does music contribute to or compete with smoking prevalence? (eg., 7 second rule = immediacy)(eg., 7 second rule = immediacy)

Learning drives development.. Learning drives development.. It is during the young adult stage of life that It is during the young adult stage of life that leisure routines and lifestyle appear to become leisure routines and lifestyle appear to become more stable and set for most people. Likewise, if more stable and set for most people. Likewise, if conscious awareness of leisure and a valuing of conscious awareness of leisure and a valuing of the phenomenon occurs, it most likely takes the phenomenon occurs, it most likely takes place at this stage of human developmentplace at this stage of human development (Peterson (Peterson and Stumbo, 2001, p. 37)and Stumbo, 2001, p. 37)

Compared with:Compared with:

Internalisation: a set of social relationships, transposed inside, and having Internalisation: a set of social relationships, transposed inside, and having become functions of personality become functions of personality and the forms of its structureand the forms of its structure

- Vygotsky (again, with emphasis added)Vygotsky (again, with emphasis added)

((Excerpt SST; Tr L tune; St Home Vid excerpt)Excerpt SST; Tr L tune; St Home Vid excerpt)

Future directions/Now what? Future directions/Now what?

‘‘Pleasure pathway’ (look for similarities on effects of Pleasure pathway’ (look for similarities on effects of each: cigarettes and music in key areas of Ventral each: cigarettes and music in key areas of Ventral Tegmental Area, nucleus accumbens)Tegmental Area, nucleus accumbens)

Re: ‘FITT’ principle and expectations: How do Re: ‘FITT’ principle and expectations: How do isolated, individual situations impact on motivation isolated, individual situations impact on motivation to continue/quit?to continue/quit?

What are the implications of small, seemingly What are the implications of small, seemingly insignificant insignificant events on health status? (as exemplified by smoking)events on health status? (as exemplified by smoking)

What are the effects of different voices, What are the effects of different voices, instrumentation… on people’s instrumentation… on people’s ‘quitability?‘quitability?’ and ’ and smoking prevalence?smoking prevalence?

Other relevant informationOther relevant information

www.bbc.co.ukwww.bbc.co.uk (Reith Lectures) (Reith Lectures) - The Brain – 2004 (V.K. Ramachandran)- The Brain – 2004 (V.K. Ramachandran)- Music – 2005 (D. Barenboim)- Music – 2005 (D. Barenboim)

www.mcgill.cawww.mcgill.ca (D. Levitin) (D. Levitin) NZ Assoc of Music Therapy.NZ Assoc of Music Therapy. Fair Go: Annual Ad awards (music factor)Fair Go: Annual Ad awards (music factor) Music and Lyrics Music and Lyrics (movie) starring Hugh Grant, Drew Barrymore(movie) starring Hugh Grant, Drew Barrymore Jim Jarmusch (1995) Jim Jarmusch (1995) Coffee and CigarettesCoffee and Cigarettes (movie): (movie):

The Earth is a conductor of acoustical resonanceThe Earth is a conductor of acoustical resonance(Nikola Tesla, inventor)(Nikola Tesla, inventor)

Blood, A.J. and Zatorre, R.J. (2001, Sept 25Blood, A.J. and Zatorre, R.J. (2001, Sept 25thth ) ) Intensely Intensely pleasureable responses to music pleasureable responses to music correlate with activity in correlate with activity in brain regions implicated in reward and emotion.brain regions implicated in reward and emotion. McGill McGill University, Montreal: CanadaUniversity, Montreal: Canada

Smith, N. (2006, November 11) Counting the beat. Smith, N. (2006, November 11) Counting the beat. The Listener,The Listener, p. 24p. 24

…….There is so much out there.There is so much out there

The hypothesis is maintainedThe hypothesis is maintained::(ie., due to the involvement of different brain regions, and subsequent (ie., due to the involvement of different brain regions, and subsequent physiological responses to both music listening and cigarette smoking, physiological responses to both music listening and cigarette smoking, music’s efficacy as a cessation aid will vary, music’s efficacy as a cessation aid will vary, dependingdepending on factors such as on factors such as the frequency, intensity, time and type of music listened to, interacting with the frequency, intensity, time and type of music listened to, interacting with personal levels of engagement with cigarette smoking).personal levels of engagement with cigarette smoking).

It is not simply a matter of playing any tune for any person over any length It is not simply a matter of playing any tune for any person over any length of time, but rather sequencing various types of music in such a way that of time, but rather sequencing various types of music in such a way that their effects combine to supersede the perceived benefits of smoking.their effects combine to supersede the perceived benefits of smoking.

Efficacy:Efficacy: ( (L. efficaxL. efficax) ) a.a. producing or able to produce the desired producing or able to produce the desired effect. (Thompson, 1992) Related to effect. (Thompson, 1992) Related to efficiency. efficiency. Three examples: Three examples: Mgmt, Stats, TRMgmt, Stats, TR

Presentation ReviewPresentation Review

QuestionsQuestions

SummarySummary

ConclusionConclusion

AcknowledgementsAcknowledgements:: Participants, Participants,

Public Health South, Public Health South, Smokefree Support Service, Smokefree Support Service,

SDHB, SDHB, Waihopai Runaka, Waihopai Runaka,

Nga Kete Matauranga, Nga Kete Matauranga, Baillie and Corkill,Baillie and Corkill,

Sherry Elton,Sherry Elton,Radio NZ, Radio NZ,

www.soundfeelings.comwww.soundfeelings.comMy Mum, Dad, and the Academy…My Mum, Dad, and the Academy…

(Thanks very much!)(Thanks very much!)

ReferencesReferences Baumgartner, T. and Hensley, L.Baumgartner, T. and Hensley, L. (2006) (2006) Conducting and reading Conducting and reading

research in health and social research in health and social sciences. sciences. New York: McGraw-HillNew York: McGraw-Hill

Cole, M. and Scribner, S.Cole, M. and Scribner, S. (1978) Introduction. In: L.S. Vygotsky, (1978) Introduction. In: L.S. Vygotsky, Mind Mind in Societyin Society

(Cambridge, MA: Harvard University Press)(Cambridge, MA: Harvard University Press)

Datillo, J.Datillo, J. (2000?) (2000?) Facilitation techniques in therapeutic recreationFacilitation techniques in therapeutic recreation

State College, PA: Venture publishing (Toynbee quote)State College, PA: Venture publishing (Toynbee quote)

Peterson, C.A., and Stumbo, N.J.Peterson, C.A., and Stumbo, N.J. (2001) (2001) Therapeutic Recreation: Therapeutic Recreation: principles and procedures. principles and procedures. Needham heights, MA: Allyn and BaconNeedham heights, MA: Allyn and Bacon

Vygotsky, L.Vygotsky, L. (1960, p. 198) In Linzey, T. (1991, p. 242) (1960, p. 198) In Linzey, T. (1991, p. 242) Growing up: the Growing up: the politics of human politics of human learning. learning. Auckland: Longman PaulAuckland: Longman Paul

Radio NZRadio NZ (2001/2002) (2001/2002) The British Invasion - The British Invasion - Simon Morris, presenterSimon Morris, presenter (Tape)(Tape)

Kampmann, S., and Aldis, W.Kampmann, S., and Aldis, W. (1988) (1988) Stealing homeStealing home (Warner home (Warner home video)video)