Managing Negative Responses to Music
- Identify individuals with significant vulnerability
- Have monitoring, support, and strategies for counteracting a negative response in place before the music listening begins
- If a negative reaction occurs stop playing the music
- Keep a record of the music that was being played, the time of day, listening situation and the response of the person
- Try some different music or apply strategies that have previously been found to distract or cheer up the person to counteract the immediate response
- Working from the records that have been taken, modify the playlists, listening situation or time of day the music is played based on observations, and try again
As noted in Chapter 1, people in Stages 5-6 of dementia and those who are experiencing or have a history of depression or trauma, are more likely to experience a negative response to music. This can occur for various reasons, such as the triggering of memories. Of course, it is not always detrimental for someone to cry when listening to music; people cry for many reasons, including when enjoying nostalgic memories, or as part of a natural and healthy grief response. However, at times a negative emotional reaction to music can be less helpful. For example, some women who have a history of traumatic or abusive relationships may experience distress when listening to songs featuring intimate sounding male voices (such as the ‘crooners’ like Bing Crosby or Dean Martin). Others with clinical levels of depression may also become more depressed after listening to such music. However, these groups of people are still able to experience the benefits of music if appropriate strategies are put into place.
Firstly, extra care should be taken during the music selection phase to ensure that playlists do not contain music likely to trigger distressing memories, or contain features such as minor modes that may be more likely to create a negative response (see Chapter 4).
Additionally, it is also important that these individuals are closely monitored during music listening. This will allow adverse reactions to be quickly identified and appropriate support offered, and for playlists to be adjusted so that more helpful music is used in future. Where possible a trained psychologist, geriatric psychiatrist, pastoral care worker, or a nurse or caregiver familiar to the person with dementia should be on hand to offer support to those identified as more vulnerable, in the case of an adverse reaction. Alternatively, caregivers may keep on hand something that has been known to soothe the person with dementia in the past, such as a favourite object or activity.
The process of monitoring and adjusting playlists should be followed for all people with dementia involved in a music playlist program. However, this is particularly crucial for those identified as having Significant Vulnerabilities. The process can be thought of as a circular one in which playlists are monitored and updated as individual needs change or become clearer (Steps 3 to 5 on the Music for Dementia website). Keeping a written record of responses can help with identifying particular pieces of music that trigger negative responses, as well as music that is enjoyable and effective for the listener. Evidence suggests that as cognitive functioning declines the number of songs that will have a positive effect on that individual may narrow. In the early to mid stages of dementia the individual may respond to a wide variety of music, yet as the condition progresses, they may begin to respond to only one or two key songs. Thus noting the songs that induce a particularly positive response for the listener is also helpful (see Appendices 6 and 7 for listening diary templates). If a negative response does occur, it is best to stop the music immediately (if that’s what the individual wants) and offer the person something else to listen to, or another form of support. It may be that the same music will be invoke a different response on another occasion. Or, with some slight adjustments to the time of day, the listening situation or the music selections, the experience may be more positive on subsequent occasions. While the benefits of music listening are experienced by many, if a person continues to have a negative response with these measures in place, then it is possible that music may not be the right thing for that person. Regardless, it is always important to have a support system in place for the person, such as ensuring that a familiar person is nearby.
Chapter 6 summary
- While negative emotional responses to music are not always detrimental, particular care needs to be taken in the case of people identified as being especially vulnerable.
- Of key importance is the need to monitor the responses of vulnerable individuals when listening to music and to have pre-planned strategies in place for support should a negative reaction occur.
- Playlists should not be thought of as ‘fixed’ once created; instead they can be updated over time to maintain as individual needs and preferences become clearer or change over time.
- A listening diary such as the Music Care Plan (Appendix 7) can assist in monitoring responses and identifying songs or playlists that are effective in specific scenarios. As with playlists, the Music Care Plan should not be considered ‘fixed’, and can be changed over time.
- The information in this chapter relates to ‘Steps 3 to 5’ on the Music for Dementia website.