While music has been identified as a valuable tool for improving mood and reducing behavioural disturbances, it is important to recognise that not everyone will respond positively to music. In some instances, people may even become distressed or upset during music listening. Emotions such as sadness can provide useful opportunities for people to release or process negative emotions (Garrido, 2017). However, research has shown that people with a history of depression may find it more difficult to recover from negative emotions, and so these people may be vulnerable to undesirable after-effects from listening to music (Garrido, Bangert, & Schubert, 2016). In addition to this, some studies have found that some people with dementia may experience increased agitation as a result of listening to music (Nair et al., 2011; Park & Specht, 2009).
Negative reactions are substantially more common within groups that have been identified as being vulnerable. A person’s individual history, the stage of their cognitive decline, or their struggles with mental health can increase susceptibility to undesirable reactions. People with a history of or currently diagnosed depression are more prone to experiencing negative mood shifts when listening to music (Garrido & Schubert, 2015). Similarly, people in the middle stages of cognitive decline (Stages 5-6 of dementia) are more prone to experiencing negative reactions. People with a history of trauma or abuse are also particularly susceptible to the triggering of distressing memories if music is not carefully selected.
If someone is within one of these vulnerable groups, this does not suggest that they cannot be involved in a music program. However, it is an indication that appropriate measures need to be taken to minimise or manage undesirable reactions. This section will discuss identification of such individuals (but also see Chapter 5 for specific information regarding the monitoring and management of adverse responses).
People with a history or current symptoms of depression can be more vulnerable to undesirable outcomes from listening to music
Mental Health History & Current Symptoms
In order to determine a person’s vulnerability to negative responses to music, it is important to find out about their mental health history and/or their current symptoms.
This can be done by use of a screening tool called the Vulnerability Scale which can be accessed via the Music For Dementia website (www.musicfordementia.com.au) or printed out from Appendix 1. The screening tool can be used in one of two forms: the first is intended for use with the person with dementia themselves, and the second is intended for use by family and friends on behalf of the person living with dementia. We suggest that if the person scores a maximum of 1 item above neutral this would indicate they have Low vulnerability; if they score 2 items above neutral they may have Some vulnerability; if they score 3 or more items above neutral this would indicate that they have Significant vulnerabilities (see Table 1).
It is also possible to conduct a less formal assessment by speaking to the family of the person with dementia to ascertain whether they have a history of depression, trauma, anxiety, or agitation. Any of these factors, along with the presence of Stage 5 or 6 dementia, can be an indication of vulnerability to negative responses to music, which suggests that additional care needs to be taken in the development and implementation of their music care plan (see Appendix 2 for more information about the stages of dementia).
| Category | Vulnerability Scale Score |
| Low vulnerability | 1 item selected above neutral |
| Some vulnerability | 2 items selected above neutral |
| Significant vulnerabilities | ≥ 3 items selected above neutral |
N.B. an item selected ‘above neutral’ in the Vulnerability Scale refers to a response of either
‘Agree’ or ‘Strongly agree’, as shown in Appendix 1.
Screening tools can be used to determine whether persons with dementia are at risk for negative responses to music
Chapter 1 summary
- Responses to music are personal, so it is important to assess a person’s vulnerability to having a negative response to music.
- A history of depression, anxiety, agitation and trauma, as well as being in Stages 5-6 dementia can be indicators of vulnerability, suggesting that additional care needs to be taken in the development and implementation of the individual’s music care plan
- The Vulnerability Scale (Appendix 1) can assist with assessing an individual’s vulnerability
- The information in this chapter relates to the first part of ‘Step 1’ on the Music for Dementia website.