Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses

Impact of Music Therapy on the Depression Mood of 3rd Year Student

Nurses

A Research Paper

Presented to the Faculty of College of Nursing

Arellano University – Jose Abad Santos Campus, Pasay City

In Partial Fulfillment of the Requirements for the

Degree of Bachelor of Science in Nursing

Tulawie, Yushra

Dr. Gina Pardilla

Research Adviser

October 2011

APPROVAL SHEET

The research entitled “Impact of Music Therapy on the Depression Mood

of College Students” prepared and submitted by Yushra Tulawie has been

examined and hereby recommended for acceptance and approval in partial

fulfillment of the requirements for the degree of Bachelor of Science in Nursing.

Dr. Gina Pardilla, MD, MPH

Research Adviser

Panel Examiner

Gina F. Pardilla, MD, MPH August I. Manzon RN, MAN

Member Member

Jennifer H. Mesde RN, MAN

Chaiman

Accepted in partial fulfillment of the requirements for the Degree of

Bachelor of Science in Nursing.

Dr. Arlene Blaise T. Cortez RN, MAN

Dean, College of Nursing

ACKNOWLEDGEMENT

This dissertation would not have been possible without the guidance and

the help of several individuals, who in one way or another have contributed and

extended their valuable assistance in the preparation and completion of this

study, and my utmost gratitude for them will forever be in my heart:

To Dr. Arlene Blaise T. Cortez, whose consideration, sincerity and

encouragement I will never forget.

To Dr. Gina Pardilla, for her guidance, patience, and moral support. For

being an inspiration as I hurdle all the obstacles in the completion of this

research work.

To Mr. August Manzon, Ms. Jennifer Mesde, and Mr. Ernie A. Gale for

their assistance and valuable insights to better my research.

To the student respondents, for their selfless cooperation and participation

all through out the study.

To my family for their never-ending guidance and support.

And mostly, all praise is due to Allah, whose will must be done, and peace

and blessings be upon our Prophet Muhammad and upon his family and his

Companions.

TABLE OF CONTENTS

Preliminaries Page

Title Page i

Approval Sheet ii

Acknowledgement iii

Table of Contents iv

List of Tables vii

List of Figures ix

Abstract x

Chapter 1 The Problem and Its Setting

A. Introduction 1

B. Statement of the Problem 3

C. Hypothesis 3

D. Conceptual Framework 4

E. Scope and Delimitations of the Study 9

Limitations of the Study 10

F. Definition of Terms 11

G. Significance of the Study 12

Chapter 2 Review of Related Literature and Studies 13

Chapter 3 Research Method and Procedures

A. Setting 20

B. Research Design 20

C. Respondents of the Study 21

D. Sampling Design 21

E. Research Instrument 22

F. Data Gathering Procedure 23

G. Data Processing 24

H. Statistical Treatment 24

Chapter 4 Presentation, Analysis and Interpretation of Data 26

Chapter 5 Summary of Findings, Conclusions

and Recommendations

Summary of Findings 43

Conclusions 45

Recommendations 46

Bibliography xiv

Appendices

A. Letter to the Dean xxi

B. Letter to the Respondents xxii

C. Instrument Used xxiv

D. Scoring of Depression Tests xxvii

E. Results of the Collected Data xxx

Before the Experiment

F. Computations xxxii

G. Approval and Interviews xxxviii

H. Researcher’s Profile xlii

LIST OF TABLES

Table 1 Profile of Respondents According to Age 27

Table 2 Level of Depression Scale Before Music Therapy

According to Zung Self-Rated Anxiety Scale 30

Table 3 Level of Depression Before Music Therapy

According to Goldberg’s Depression Scale 32

Table 4 Level of Depression of Experimental Group

According to Zung’s Self-Rated Anxiety Scale,

Before and After Music Therapy 34

Table 5 Level of Depression of Experimental Group

According to Goldberg’s Depression Scale


Table 6 Level of Depression of Controlled Group

According to Zung’s Self-Rated Anxiety Scale


Table 7 Level of Depression of Controlled Group



Table 8 Zung’s Self-Rated Scale Tool xxiv

Table 9 Goldberg’s Depression Scale Tool xxv

Table 10 Scoring for Zung’s SAS Tool xxvii

Table 11 Scores on Zung’s SAS Before the Experiment xxx

Table 12 Scores on Goldberg’s Depression Scale

Before the Experiment xxxi

Table 13 Correlation on Experimental Group (Zung’s SAS) xxxii

Table 14 Correlation on Experimental Group (Goldberg’s DS) xxxiii

Table 15 Correlation on Controlled Group (Zung’s SAS) xxxv

Table 16 Correlation on Controlled Group (Goldberg’s DS) xxxvi

LIST OF FIGURES

Figure 1 EEG Pattern 4

Figure 2 Therapeutic Relationship Model 7

Figure 3 Profile of Respondents According to Gender 26

Figure 4 Profile of Respondents According to Age 28

Figure 5 Number of Respondents With and Without

Depression During the 1st Stage of the Experiment 29

Figure 6 Level of Depression Before Music Therapy

According to Zung’s Self-Rated Anxiety Scale 31

Figure 7 Level of Depression Before Music Therapy

According to Goldberg’s Depression Scale 33

Figure 8 Difference Between Zung’s Self-Rated Anxiety Scale

and Goldberg’s Depression Scale of

Controlled Group and Experimental Group 39

Figure 9 Correlation Between Music Therapy and the Student’s

Depression Scale According to Zung’s Self-Rated Anxiety Scale

of Experimental Group Vs Controlled Group 40

Figure 10 Correlation Between Music Therapy and the Student’s

Depression Scale According to Goldberg’s Depression Scale of

Experimental Group and Controlled Group 41

Abstract

Name of Institution: Arellano University, Jose Abad Santos Campus

Address: 3058 Taft Avenue, Pasay City, Metro Manila, Philippines

Title: Impact of Music Therapy on the Depression Mood of 3rd Year Student

Nurses

Author: Yushra S. Tulawie

Date Started: July 30, 2011

Date Finished: October 17, 2011

General Objectives: To measure the depression mood of 3rd year student

nurses as an indicator on the impact of music therapy on their mental function.

Specific Objectives:

To measure the depression scale between male and female, and their

age.

To measure the depression scale of the respondents who took the tests.

To compare the depression scale of the experimental group against

controlled group.

To compare the results showed in Zung’s Self-Rated Anxiety Scale versus

Goldberg’s Depression Scale.

To measure the correlation between music therapy and depression scale

of the respondents included in the experiment.

Scope and Limitations: This study evaluated the depression scale of 3rd year

student nurses of Arellano University, Jose Abad Santos Campos using Zung’s

Depression Test and Goldberg’s Depression Test in correlation to music therapy

that will be applied. The age and gender of respondents were determined in the

survey.

The research used tools to assess the depression mood of the

respondents included to be a basis of the criteria required. The tools were the

Zung’s Self-Rated Anxiety Scale (SAS), which have 20-item questions with a

scale of less likely to most likely, and the Goldberg’s Depression Scale (DS) with

a. 18-item questions with a scale of 0-5. The tools were not a determinant to

diagnose a person’s mental function but just an assessment and results were just

a basis of the possible mental function. However, results are still valid during the

context of the study when taken.

Methodology: The research is quantitative study on the impact of music

therapy on the depression mood of 3rd year student nurses. It is a true

experimental using a control group and an experimental group.

Through the use of two-staged samplings which are the non-probability,

convenience sampling, and the non-probability, purposive sampling, respondents

were chosen according to a set of criteria. For the first stage non-probability,

convenience sampling was used to look for third year nursing students who were

readily available to be included in the study. The students were administered the

Zung’s Self-Rated Anxiety Scale and Goldberg’s Depression Scale tests. For the

2nd stage non-probability, purposive sampling was used. All those who met the

following criteria: 1. are screened from without use of medication related to

depression; and 2. who had depression score on both depression tests

administered by the researcher were included in the second stage.

The researcher had 30 respondents in total included in the 2nd stage from

which 15 were in the controlled group and the other 15 were in the experimental

group. The controlled group was asked to continue their usual daily routine or

whatever schoolwork they were doing. Then the experimental group was also

asked to do their usual daily routine or whatever schoolwork they were doing,

while the researcher played a variety of music from classical, to pop to rock

according to the subjects’ preference. After an hour, both groups were asked to

answer the depression tests one more time.

Findings: The study came up with the average depression scale of 39.96

according Zung’s SAS and 30.7 according to Goldberg’s DL.

Student’s who are part of the experimental group and have received music

therapy showed an improvement on their depression scale from 42.2 to 38.6

according to Zung’s SAS, and from 34.6 to 30.13 according to Goldberg’s

Depression Scale. While students who are part of the controlled group who had

not received music therapy had a slight difference of depression scale from 37.72

to 38.26 according to Zung’s SAS, and from 28.53 to 28.47 according to

Goldberg’s DS.

Both the tools that were used showed a little difference in the results of

data in every group. The overall correlation between music therapy and

depression had a result of r=0.90393 according to Zung’s Self-Rated Anxiety

Scale, and r=0.94725 according to Goldberg’s Depression Scale for the

experimental group. While controlled group had a result of r=0.99124 according

to Zung’s Self-Rated Anxiety Scale, and r=0.98699 according to Goldberg’s

Depression Scale.

Conclusions: Of the respondents who took the exam during the 1st stage of the

experiment to see who are depressed there were only 2 students who are not

depressed aside from the 30 students target of this study.

The students who were part of the experimental group and had received

music therapy had showed an improvement in the depression scale compared to

the students who were part of the controlled group and had not received any

music therapy.

Music therapy generally can help improve a student’s mental function,

where the researcher has proven the hypothesis that it has a therapeutic effect.

Recommendations: Awareness of the level of depression should be increased

among students and school administrators. Music therapy as an intervention,

which has a therapeutic effect on an individual, is encouraged to help student be

mentally healthy. Further studies can also be taken to show the impact of music

therapy and the cause of depression on college students.

CHAPTER 1

The Problem and Its Setting

Introduction

“Mental health problems, which are featured by the disturbance and

disorder of mental and psychological activities, refer to the undesirable

psychological factors or psychological states that affect the normal behavior and

activity efficacy of individuals. According to study done by Wen, H., Li, X. and Ge,

J.J entitled Research on Students’ Psychology and Mental Health Condition, a

special group that undertakes the high expectation from the society and parents,

college students are obviously under more psychological pressure than other

peer groups. A review on previous investigations about college students’ mental

problems showed that college students suffer from different types of

psychological problems, especially depression, anxiety, somatization, and

interpersonal sensitivity. Depression ranks the top among these mental problems

that disturb college students in the order of seriousness. Therefore, this study

chose depression as the target of intervention of music therapy.” (Wang, J.,

Wang, H. and Zhang D., 2011).

According to previous research on college students’ depressive

symptoms, depression may be closely relate to various life events and

individuals’ ways of coping with these psychological stimuli. For instance, social

competition, academic pressure, interpersonal communication pressure,

quarrelling with others, serious defeat, being not smooth or being disappointed in

love, and disordered close family relationship can contribute to the depressive

symptoms of college students. Among these reasons, negative coping method,

health adaptation factor, active coping methods, punishment and study pressure

have most impact on depressive symptoms. Research also showed that

individual variables are important to depression, such as high sensitivity to loss

and being overlooked, low self-esteem, difficulty in admitting and mobilizing the

emotions, intrapsychic conflict caused by dependence, frequent bouts of tension,

and long exposure to depression-induction environment (Chinese Journal of

Clinical Psychology).

“At its worst, depression can lead to suicide, a tragic fatality associated

with the loss of about 850 000 lives every year. Depression is the leading cause

of disability as measured by YLDs (Years Lived with Disability) and the 4 th

leading contributor to the global burden of disease (DALYs) in 2000. By the year

2020, depression is projected to reach 2nd place of the ranking of DALYs

(Disability Adjusted Life Years) calculated for all ages, both sexes. Today,

depression is already the 2nd cause of DALYs in the age category 15-44 years for

both sexes combined” (WHO, 2011).

Instead of using drugs to relieve mental problems, there are already other

options without side effects like meditation, and therapies. Music therapy is a

well-established health care profession that uses music to help meet the

physical, emotional, cognitive, and social needs of individuals of all ages. The

American Music Therapy Association (2004) has a mission to “advance public

awareness of the benefits of music therapy and increase access to quality music

therapy services in a rapidly changing world”.

The researcher has chosen this topic from her love of music to looking

ways on how music can affect an individual, on how music can be just more than

a song you can listen to a radio but a song that will explain how it can create a

space for healing. As a college student, the researcher has had her share of

having sleepless night studying, finishing school work and trying to handle

personal problems at the same time has put her in a state of depression due to

stress. Without her knowledge of her situation, knowing she was mentally healthy

before taking the depression test, now the researcher questions if all students

are the same as her. The question of how students really have knowledge of

depression and if they are already in a state of it has been now a curiosity to the

researcher.

http://www.who.int/entity/mental_health/management/depression/daly/en/

Statement of the Problem

To measure the depression level of 3rd year student nurses as an indicator

of the impact of music therapy on their mental health.

1. What is the profile of the student respondents according to:

1.1 Gender

1.2 Age

2. What is the number of respondents that had a depression result against to

those who did not had depression result on the Depression Test that was taken?

3. What is the level of depression of student nurses before the music therapy?

4. What is the level of depression of college students after an hour of usual

routine and activity with music therapy?

5. What is the level of depression of college students after an hour of usual

routine and activity without music therapy?

6. What is the difference in result of the respondents between the Zung Self-

Rated Anxiety Scale and the Goldberg’s Depression Scale?

7. Is there a correlation between the students’ depression scale and the music

therapy?

Hypothesis

Music therapy may promote the overall mental health of college students

by alleviating the depressive symptoms.

Conceptual Framework

Improve: Emotional, Physiological, and Psychological of an Individual

Improve and Develop: Communication and Relationhip-Building Skills of an Individual

Improve: Emotional, Physiological, and Psychological of an Individual

Improve and Develop: Communication and Relationhip-Building Skills of an Individual

EEG PatternEEG Pattern

Left Frontal AsymmetryLeft Frontal Asymmetry

Right Frontal Asymmetry

Right Frontal Asymmetry

DepressionDepression

Music TherapyMusic Therapy

StimulantStimulant Decreased Cortisol Level

Decreased Cortisol Level

RelaxantRelaxant

High Level Cortisol

High Level Cortisol

Figure 1. EEG Pattern in Correlation Between Depression and Music Therapy

Paradigm

Figure 1 shows the EEG or the Electroencephalogram Pattern relating to

depression. EEG is a test that shows and records the measure of electrical

activity in the brain. Cortisol is a hormone that is secreted by the adrenal gland,

in which it is also known as the “stress hormone” because it is secreted in higher

levels during the body’s “fight or flight” response to stress; and small increase of

this hormone may have some positive effects like sudden burst of energy,

heightened memory function, lower sensitivity to pain, and so forth. And it is

always present when the right frontal asymmetry (part of the brain) is having a

negative experience and when this hormone continues to increase it causes

depression. So when music therapy is applied the effect of its vibrating waves

trigger the electrical activity in the brain, specifically the left asymmetry that

activates the positive experiences which lessens the cortisol that the right brain is

producing, thus the overall results improves an individuals emotional and mental

function.

“Music therapy can be considered as a complimentary or alternative

means of treatment for the benefit of depressed patients in view of high

prevalence of depression. Music therapy is innovative, artistic, scientific and

evidenced based method of restoring, maintaining and improving emotional,

physiological and psychological well-being of individuals of all ages and abilities

through the power of music” (Aigen, 1998). Music therapy had been effective in

alleviating various symptoms of depression and improved overall behavior and

mental state of the patients. It aims at exerting a possible beneficial effect on

social, emotional, and cognitive skills and helps in reducing the behavioral

problems of patient s with depression (Aldridge, et al. 2001).

A definition of evidence-based clinical practice, in which the patient, in

addition to the health care professional, plays an active role in clinical decision-

making: Evidence-based clinical practice is an approach to decision-making in

which the clinician uses the best evidence available, in consultation with the

patient, to decide upon the option which suits that patient best like its preference

of music when music therapy is applied. (Abrams, 2010)

According to Darrow and Cohen music therapy has been found to be

effective and beneficial. There is much documented material on the efficacy of

music therapy intervention to improve and develop communication and

relationship-building with individuals with depression. Behavioral approaches in

music therapy have frequently developed the use of music as a stimulant, a

relaxant, or a reward. In addition, the structure and properties of music have

been applied and manipulated to achieve development, growth and improvement

in depressed patient. In this sense, therapeutic process does not involve a

dynamic and responsive interaction with the patient, but the music is structured in

order to help the patient overcome emotional, physical, or psychological

problems from which they are suffering.

Field, et al have discussed how music reduces stress and anxiety levels,

and even enhances performances on abstract/ spatial reasoning tests. Music has

improved mood according to self-report, and heart rate and systolic blood

pressure have also been shown to improve. According to some researchers

these effects can be attributed to music’s ability to alter mood states of

individuals. In addition, music therapy has altered ‘behavior in depressed

individuals’. The question for this study was whether music could alter

electrophysiological and biochemical measures of depression, namely right

frontal EEG activation and stress hormone (cortisol) levels.

In continuation, recent studies suggest that affective states are associated

with EEG patterns in the frontal region of the brain. Specifically, left frontal

asymmetry has been associated with positive affect or decreased negative affect,

whereas right frontal asymmetry has been associated with negative affect or

decreased positive affect. In addition, chronically depressed adults are noted to

have right frontal activation even during remission of depressed behavior

symptoms. Elevated cortisol has also been associated with depression, and

relaxation interventions have been noted to decrease cortisol levels in depressed

adolescents. He found that relaxing and listening to about 20 minutes of music

changed their brainwave state and their stress hormones (Field, 1998)

Recent studies examined the effectiveness of music therapy in short-term

group psychotherapy with chronic mental illness (depressed phase). Results

show that group music therapy for adults with mental illness may help to reduce

psychiatric symptoms related to anxiety (Wigram, 2002). That the therapeutic

effect of music is through the response of an individual’s brain processing

information just like when a person tries to memorize a sentence from reading it

aloud. Also, patients perceive music therapy as helpful and improve attitudes

toward help seeking and openness about one’s problem. Music is widely

used to enhance well-being, reduce stress, and distract individuals from

unpleasant symptoms. Although there are wide variations in individual

preferences, music appears to exert direct physiologic effects through autonomic

nervous system. It also has indirect effects by modifying behavior. Music

effectively reduces anxiety and improves mood for adolescents.

Other clinical trials have revealed a reduction in heart rate, blood

pressure, breathing rate, insomnia, depression, and anxiety with music therapy.

No one knows all the ways music can benefit the body, but studies have shown

that music can affect brain waves, brain circulation, and stress hormones. These

effects are usually seen during and shortly after the music therapy.

Figure 2. Therapeutic Relationship Model

Therapeutic Relationship that is shown in figure 2 explains the concept of

the music therapy itself. It is balance by the therapist who will be a mediator

between a client and the music that is preferred or is according to the client’s

needs. The figure also explains that every case of the client is different, and it

emphasizes that music therapy like nursing practice is client-based; each

individual is unique and so as the application of the therapy.

Overall the process – of using musical experiences to reach non-musical

goals – is at the core of Music Therapy. The practice is goal-driven, customized

for the client, and based on observable and measurable outcomes. The musical

experiences, coupled with the relationship with the therapist, are the vehicles that

helps motivate and transform the client. When the client, the therapist, and the

music are all working together, Music Therapy is taking place. Other examples of

music therapy at work include: Inviting a group of adults in addiction recovery

listen to and discuss the lyrics of specific songs. (The Therapist chooses songs

because of their potential to open up discussions on various topics related to the

therapeutic goals.), helping a client in physical rehabilitation learns and

participates in a traditional dance. (The therapist chooses the dance based on

the inclusion of specific types of movements.), and showing a group of young

mothers how to sing to and move with their infants. (The therapist writes songs

that help the mothers bond with their babies and provides the infants with an

important developmental foundation that will increase their chances to do well in

school later on).

“Music Therapy applies to almost any setting where a client is working

towards a goal. General areas include physical (developmental, rehabilitation,

habilitation, maintaining functioning, etc.), cognitive (educational, insight,

psychiatric, remembrance, environmental, etc.), emotional (stress-reduction,

coping skills, elevation of mood, adjusting to transitions, etc.)” (Kalani, 2011).

Scope and Delimitations of the Study

This study evaluated the depression scale of 3rd year student nurses of

Arellano University, Jose Abad Santos Campus using Zung’s Self-Rated Anxiety

Scale Test Goldberg’s Depression Scale in correlation to music therapy that were

applied. The age and gender of respondents were determined in the survey.

The subjects of the study were students’ who were readily available to

participate, both male and female, and were qualified during the 1st stage of the

experiment where the researcher used a non-probability, convenience sampling.

Then on the 2nd stage, students who got a depressed score on both the

depression tests they took in the beginning, and also those who were not taking

any medication for depression or affecting it were included in the study to avoid

other interventions aside from the music therapy that the researcher had applied.

Expectedly, results and conclusions are limited to this group of samples. The

study was also delimited to the following demographic characteristics: 18-26

years old, full-time student nurses who were enrolled in a 22-25 unit with at least

1 major subject, and is currently enrolled in the 1st semester of Level III-BSN

course of school year 2011.

Through the use of a two-staged non-probability sampling, the researcher

selected the respondents who met the criteria of the study which was explained

above, then a total of 30 students were included in 2nd stage of the study. Then

by random distribution, 15 respondents were asked to just continue their normal

routine, schedule and activity as a student while the other 15 respondents were

also asked to do the same but the researcher had applied music therapy. After

an hour while being observed by the researcher, all 30 students were asked to

take the Depression Tests one more time to compare from the 1st result they had.

The survey was conducted at Arellano University, Jose Abad Santos

Campus at 3058 Taft Avenue Extension, Pasay City. And the music therapy,

where the researcher observed their activity for an hour of the week of October

10-14, 2011 for both the control and experimental group was also held at the

same school stated above.

Limitations of the Study

The Depression Tests that was used, both Zung’s Self-Rating Anxiety

Scale and Goldberg’s Depression Test, are a screening tool to assess the

individual’s general gauge of anxiety and depression but in no way should be

used as a substitute for the clinical expertise or health provider’s diagnosis. It is

just a basis of a possibility of the individuals’ state of mental function.

The music that was used is according to related research that have shown

improvement on an individuals’ response but results still vary because of the

different preferences on music on each respondents. Music was chosen

according to the respondent reaction by first playing a classical, to rock, to pop,

to rnb in 5 minutes that was observed by the researcher and then it was

continued to play for a whole hour according to their preference, and this was

suggested by one of the music therapist, named Jennifer Buchanan, BMT, MTA,

that was interviewed by the researcher and the interview was attached in

Appendix G.

The technique used in the research is simply by listening to a preferred

music of the respondents that is already recorded in the mp3. Since there are

many other ways of how music therapy works, like using music that is recorded

or is live may also differ in result. Or playing the instrument, memorizing the lyrics

to a song, songwriting, and so forth are other ways music therapy also works,

which is not included in this study.

The researcher alone, who is not a certified music therapist, had only

imitated the process done from the previous research, executed the experiment,

and had followed some process that was advised by the 5 music therapists that

were interviewed by the researcher, which is also attached in Appendix G.

And a major limitation of this study is the small sample size, which may

affect the power to detect statistically significant differences between groups.

Definitions of Terms

The following terminologies are defined in a lexical manner:

Depression - is a common mental disorder that presents with depressed mood,

loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or

appetite, low energy, and poor concentration. These problems can become

chronic or recurrent and lead to substantial impairments in an individual's ability

to take care of his or her everyday responsibilities. (WHO, 2011)

Music Therapy - is a technique of complementary medicine that uses music

prescribed in a skilled manner by trained therapist. Programs are designed to

help patients overcome physical, emotional, intellectual, and social challenges.

Applications range from improving the well being of geriatric patients in nursing

homes to lowering the stress level and pain of women in labor. Music therapy is

used in many settings, including schools, rehabilitation centers, hospitals,

hospice, nursing homes, community centers, and sometimes even in the home.

Zung Self-Rating Anxiety Scale (SAS) - was designed by William W. K. Zung, a

psychiatrist from Duke University, to quantify a patient's level of anxiety.

Goldberg’s Depression Scale - is a depression test developed by the American

psychiatrist Ivan K. Goldberg. The test is an 18 question scaled multiple-choice

test where a score above 15 indicates the possible need for a psychiatric

evaluation.

Regular college students – students enrolled in a college or university.

http://en.wikipedia.org/w/index.php?title=Ivan_K._Goldberg&action=edit&redlink=1

http://www.facebook.com/pages/w/106017832763741



http://medical-dictionary.thefreedictionary.com/Rehabilitation

http://medical-dictionary.thefreedictionary.com/Pain

http://medical-dictionary.thefreedictionary.com/Stress

Significance of the Study

This study is significant to the following target populations:

To college students, who is willing to learn more on how to cope with

depressions while handling school and personal responsibilities.

To the school administrators, to give importance on the mental health of

their students and practice such exercises on how to help their students balance

the activities and schedules.

To the parents, to help their children be mentally healthy by applying such

intervention like music therapy to avoid severe depression.

To the future researchers, who will be able to further research on this

study.

CHAPTER 2

Review of Related Literature and Studies

Depression is described as 'a broad and heterogeneous diagnostic

grouping, central to which is depressed mood or loss of pleasure in most

activities'. The International Classification of Diseases (ICD) uses an agreed list

of ten depressive symptoms and provides a guide for assessing the severity of

an episode based on the number of symptoms present. The common form of

major depressive episode is divided into four groups: mild depression, moderate

depression, severe depression and severe depression with psychotic symptoms.

Depression is the most common mental disorder in community settings and is a

major cause of disability across the world. It is projected to become the second

leading contributor to the global burden of disease by 2020. The condition affects

approximately 121 million people worldwide and is associated with the loss of

850,000 lives per year. Apart from the subjective suffering experienced by people

who are depressed, the impact on social and occupational functioning, physical

health and mortality is substantial (Pilkington, et al, 2006).

An inspection on literature showed that some effective means of

intervention into depressive symptoms of college students are applied from the

perspectives of cognition, will, behavior, and society, which involve change of

cognition, tempering of will, enhancement of behavior, and adaptation to society.

Zhang (2008) also pointed out that current mental health education inclines to

"highlighting behavior training while overlooking the internalization of

experiences" during specific practice. Therefore, the important role of

internalization of emotion and experiences shall be emphasized properly.

According to the analysis on the literature, depressive symptoms are a type of

sad emotion experienced by the individual, with subjective negative emotional

experience as its core element. Therefore, the key to reducing depressive

symptoms is to transfer the negative emotional experience into positive

emotional one, and this is where music comes in.

Studies from the University of Jyväskylä in Finland reveal that by

combining counselling sessions with classes that teach music skills - such as

learning to play the drums - people with anxiety disorders and depression make

greater progress and respond better to treatment than they would with

counselling alone. "Music therapy has specific qualities that allow people to

express themselves and interact in a non-verbal way," lead researcher professor

Christian Gold explained upon the release of the findings. "Even in situations

when the subjects cannot find words to describe their inner experiences, the

music sessions help them to open up." The Finnish study, carried out on 79

people engaged in ongoing treatment for the symptoms of depression, isn't the

first of its type to examine therapy that involves playing music. In 2008, a review

of existing studies into the treatment of depression - which is thought to affect as

many as 121 million people worldwide - highlighted four out of five separate

studies, which found reduced depression symptoms in people who took part in

music therapy. Prof Christian Gold said: "Our trial has shown that music therapy,

when added to standard care including medication, psychotherapy and

counselling, helps people to improve their levels of depression and anxiety (The

National Newspaper, 2011).

In addition to the advantage of music therapy, Richard et al’s study have

concluded that music therapy can become a universal practice due to its low

cost, ease of administration, minimal-to-no risk of harmful side effects, and

potential to improve the hospital experience for patients. He did his experiment

by applying music therapy and letting post-operative patients listen to a different

variety of upbeat music. Findings did suggest that patients were more satisfied

with their care when music therapy was utilized. The literature implies potential

for enhanced patient satisfaction in areas such as the emergency department

when music is used to decrease stress levels.

A study entitled Anti-Depressant Potential of Music Therapy by Arya &

Parle have concluded and provided clinical evidence for the application of

devotional music in managing patients suffering from depression. The patients

involved in their study had positive influence on the cognitive parameters and

patients showed stable mind, better perception, improved expression, good

intellect, fine decision making ability and sharp memory after five days of

receiving music therapy. The study have concluded that music has the unique

capability of bringing back the charm and making the life worth living for

depressed patients. And this therapy is now being recognized globally.

This study was overall anchored from Impact of Group Music Therapy on

the Depression Mood of College Students by Wang, et al (2011) that was done in

China to show how music can be a tool to alleviate college students’ mental

function such as depression. The study examined the depression scores

between the experimental group and control group before and after the

application of music therapy. And the final conclusion on this research found that

music therapy could improve mental health. Participant’s feedback to the study

was generally good and they were satisfied with the experiment as a whole.

Aside from the improvement of mental health of the students involve, academic

and extra curricular activity was later on had an impact to the overall response.

The students were more active and the average grade from before the

experiment showed improvement as well.

Related Studies

According to Hirokawa et al (2003), music therapy stimulates

neurohormonal and neurotransmitter systems resulting in the levels of serum

melatonin, plasma norepinephrine, and epinephrine. Effects of music listening on

neuroendocrine responses were reported in several studies. Previous studies

reported a significant decrease in the epinephrine level after listening to the

meditative type of music and a significant decrease in the norepinephrine level of

hypertensive subjects after listening to modern classical music. Results of other

studies included a significant decrease in norepinephrine levels in college

students after listening to both joyful and peaceful music, and a significant

increase in norepinephrine level in healthy young subjects after listening to

techno-music. Although the types of music used in these studies are different, it

is clear that music has influences on these neuroendocrine levels.

In continuation, Hirakawa et al have examined the different effect of two

different types of music on college students after a stressful task. High-uplifting

music may have positive effects on psychological states, as indicated in

decreased depression and increased liveliness. Results suggest that this type of

music appears to be effective in improving one's mood by gradually increasing

the uplifting qualities of the musical selections. Low- uplifting music may also

have a positive effect on the psychological states in college students. Music that

has soothing qualities is known to suppress excitement of the autonomic nervous

system and enhance relaxation responses. In this study, low-uplifting music,

which had soothing qualities, increased the sense of wellbeing. Low-uplifting

music did not necessarily affect the subjects' emotional state negatively. Instead,

it enhanced a calm and soothing mood in subjects. This type of music, therefore,

has potential to enhance a sense of wellbeing.

Research in music's effect on the human psychological system has

demonstrated that slow, quiet, patient-preferred music is an effective means to

promote relaxation and reduce state anxiety (Robb, 2000). State anxiety is the

amount of anxiety that one is experiencing in the moment; it is not a personality

trait. Thus, the level of state anxiety fluctuates based on the amount of stress an

individual is currently experiencing. Consequently, much research has been

conducted to explore the effects of music listening to reduce state anxiety due to

depression in medical settings. Music listening is a variable of interest in many

relaxation studies. Labbé, Schmidt, Babin, and Pharr (2007) reported that

listening to either classical music or music selected by the individual reduced

state anxiety scores and increased relaxation ratings after a stressor more than

listening to heavy m etal music or sitting in silence. Researchers have begun to

examine the effect of live music therapy sessions to reduce patient anxiety in

hospitals.

Even from Gadberry’s study titled Steady Beat and State Anxiety

published last fall of 2011, have discussed how music with steady beat can be

more effective in decreasing anxiety which can be cause of depression than an

individual relaxing in silence. Experimental anxiety was induced in healthy

subjects who then either sat in silence or listened to a steady beat per their

treatment group. Though no statistical differences existed between the groups

prior to the treatment phase, posttest results indicated that listening to a steady

beat was significantly more effective in reducing anxiety than was silence. The

implications of steady beat decreasing state anxiety include a cost-effective and

accessible means to self-regulation for the many persons who suffer from

anxiety. It follows that the amygdala is an important brain center for regulating

anxiety and music is shown to affect the amygdala and other part of the brain like

the frontal asymmetry through the use of EEG.

Mei-Hsien and Mei-Feng (2006) studied the relation between level of

depression and quality of sleep in middle-aged women. Their results showed a

significant correlation between quality of sleep and depression, so that as level of

depression rose, quality of sleep decreased and vice versa. They proposed two

explanations for the positive impact of music on depression: first, Musical stimuli

activate particular brain areas, including the insular and cingulated cortex, the

hypothalamus, the hypocampus, the amygdale and the prefrontal cortex, which

are all linked to emotional behavior. Second, endorphins and dopamine are

released while a person listens to music, thus improving mood and creating a

pleasant feeling. As mentioned, the current research revealed that music reduces

depression.

Taking notes on how music affects the brain waves of an individual,

another study were worth taking into consideration related on the frontal

asymmetry that causes the positive and negative experience of a person or how

emotional is co-existent with mental function, and that is DiGiacomo & Kirby’s

study entitled The Effect of Musical Mode on Emotional State. The results of their

study show that there are consistent effects of musical mode on emotional state.

The major musical mode results in high accounts of vigor, indicating a positive

and energizing effect. As hypothesized, the major musical mode is associated

with a positive emotional response. The minor musical mode results in high

accounts of anger, depression, and tension. As hypothesized, the minor musical

mode is associated with a negative emotional response. The mixed musical

mode results in moderate accounts of anger, depression, and tension. However,

the mixed musical mode also results in low accounts of confusion and fatigue,

which are considered positive emotional responses. As hypothesized, the mixed

musical mode is associated with a range of moderate emotional responses. The

instrumental noise results in highly elevated scores of anger and tension, and a

moderate score for depression. However, the noise also results in low accounts

of fatigue, which is considered to be a positive emotional response. The results

indicate that the noise is linked with extreme emotional states. As hypothesized,

the noise is associated with a range of extreme emotional responses. Overall this

study shows that there is different effect on the human brain with regards to the

different of mode or beats of music used.

One study that is significant on this research is done by Block et al entitled

The Effects of Music Relaxation on Sleep Quality and Emotional Measures in

People Living with Schizophrenia. The subjects may differ but this specific study

had explained how music therapy is done and applied during the sleeping time of

the patients. That even when a person is sleeping, the music used was still

working in the human brain that activates and releases such hormones like

epinephrine and norepineprhine. And found significant results on decreased

anxiety level and improved sleep efficiency. With the curiosity of what more if the

person is awake, how would music work in the human brain, would it be the

same as when it is sleeping or faster in neuron-to-neuron activity since the

individual is awake.

A study done by Martinez, J. have been about the anxiety and depression

of patients receiving hemodialysis. By changing the environment of the clinic

where the experiment was done, Martinez chose patients with challenging issues

such as anxiety, depressions and anger. And by the end of the experiment,

100% of the patient have reported that music therapy have relieved all or most of

their anxiety, 80% stated that music made treatment easier and more relaxing,

estimated of 80% decrease in aggression, anger and depression were reported

by the staff nurse, and all new patients were encourage to try the music therapy

session where some adjusted quickly while others requested for more music

therapy.

Effects of a Single-Session Assertiveness Music Therapy Role Playing

Protocol for Psychiatric Inpatients by Silverman, M. have studied the

effectiveness of a single-session assertiveness music therapy on his subjects.

He divided his subjects into four groups with different variance according to the

time admitted, number of patients per group, their age and the preference of

music. With just a single-session of music therapy, Silverman have concluded

that even a slightest change in a human behavior it still exists. He even saw

enjoyment as an effective intervention for developing assertive behaviors in

psychiatric patients.

CHAPTER 3

Research Method and Procedures

This chapter explains how the researcher chose the overall plan or the

blueprint, like the research and sampling design. The criteria and process of

choosing the respondents were also included, the instruments used in the entire

experiment, the data procedure as well as how it was processed, and the

statistics that was used to calculate the data that was gathered was also stated in

this chapter. All this was important to answer the questions stated in Chapter 1

and to validate if the hypothesis is the same as the outcome that will be

discussed in later chapter.

Setting

The test was carried out in a natural setting to the respondents. They were

carried in Arellano University, Jose Abad Santos Campus-College of Nursing

during their free time in their perspective classroom located in MB building. While

the application of music therapy was also a natural setting for the respondents

since it was played while they were doing their normal routine, activity as a

student in the same location.

Research Design

The research is a quantitative study because it investigates a

phenomenon that lend themselves to a precise measurements and

quantification, often involving a rigorous and controlled design in correlation with

this study is on the impact of music therapy on the depression mood of 3rd year

student nurses (Polit & Beck, 2008). It is a true experimental since it focuses the

study in the future or what will be when variables are carefully controlled or

manipulated (Paler-Calmorin & Calmorin-Piedad, 2008). And it uses a Before-

and-After Experimental Technique that compares the results of the beginning

and end data of the Two-group design, which are the control group that

represents subjects under study on which no experiment is conducted, and an

experimental group, that represents the subjects in which one variable is altered

(Salustiano, 2009).

Respondents of the Study

Respondents was 3rd year student nurses of Arellano University, ages

ranges from 18-26 years old was included in the 1st stage of the experiment, and

they were chosen through the use of non-probability, convenience sampling

since they were readily available to participate. While later on the 2nd stage, non-

probability, purposive sampling was used by the researcher to filter the students

on the criteria required which are a full-time 3rd year student nurses, free of use of

any medication related to depression, and have a score of depressed on both the

depression tests that have given. The researcher had a total of 30 respondents

from which 15 students were randomly assigned in the controlled group, and the

other 15 students were also randomly assigned in the experimental group.

The controlled group was asked to continue their usual daily routine or

whatever schoolwork they were doing. Then the experimental group was also

asked to do their usual daily routine or whatever schoolwork they were doing,

while the researcher played a variety of classical and modern music according to

the subjects’ preference. After an hour, both groups were asked to answer the

depression tests one more time to compare the difference of score from the 1st

time they took it.

Sampling Design

The researcher used a two-stage Non-Probability design to 1st initially

measure depression on 3rd year student nurses where a Convenience sampling

was used because those who were readily available and convenient to

participate in the study was included. Then on the 2nd stage, a Purposive or

Judgmental sampling is used in selecting the respondents who are to participate

in the study because the researcher selects and studies a specific number of a

special group that represents the target population with regards to certain

characteristics such as age, sex, and economic status or in relation to this

research are the depression scales (Venzon, 2004). They are chosen according

to a set of criteria mentioned above. And from then on the researcher randomly

assigned the total of 30 respondents in which 15 students were in the controlled

group and the other 15 students were in the experimental group.

Research Instrument

The respondents were asked to answer the demographic profile such as

the age and gender. A structured 3-item question was also included in the survey

to screen if the respondent is free from medication related to depression, and if

they are a full time student at Arellano University. Depression tests are also

asked of respondents to answer to screen who qualify in a depression scale.

These depression tests were: Zung Self-Rated Anxiety Scale that

evaluates a person’s mental function with a 20 question, and a scale of less-likely

to most-likely. Score 20 and above reflects that a person is depressed, 50-70

score is the usual range of depression, and 70-80 score reflects severe

depression. And Goldberg’s Depression Scale is a tool used to quantify a

person’s mental function with an 18 question, and a scale of 0-5 (0 as never and

5 as the most). Both test have also been asked permission to use by the

researcher for this study and is attached in Appendix G, while the copy of both

the tools used was attached in Appendix C.

To maintain confidentiality and privacy, the questionnaires were numbered

so that respondents can opt to not state their name. The number on the

questionnaires corresponds to the number on the data collection sheet where it

was used as their identity all throughout the study.

The experimental group who received music therapy had a music played

for a whole hour while they were doing their schoolwork. The mp3-recorder is

contained of different types of classical, pop, rock, rnb and western music from

high-uplifting music to low-uplifting to satisfy the different preferences, and effect

of music to each individual. The strategy used by the researcher to find the

preference of each respondent was by observing the respondents reaction in the

music played; if they showed positive behavior like singing along, dancing, or

sudden change of facial reaction like smiling in 5 minutes the researcher then

continues the type of music to play for an hour. But if the respondent showed a

negative behavior like nothing changed in their reaction, or a sudden change in

facial reaction like smirking, then the researcher changes the type of music till the

respondents showed a positive reaction.

For the last part, all 30 respondents took the depression tests one more

time to check any changes from the 1st scores they had. And respondents used

their corresponding number they had from the beginning of the study to be able

to compare the data.

Data Gathering Procedure

Students who participated were given a brief summary of the process of

the study; the explanation of the depression tests, and written consent was

obtained from all participants. The 3-item questionnaire plus the depression tests

was then collected from each participant and then they were screened who were

part of the 2nd stage of the study that involved music therapy.

There were 30 students who were randomly assigned to experimental and

control group to continue the study. 15 students were part of the experimental

group; the researcher applied music therapy for an hour while they were doing

their schoolwork. The researcher played different classical and modern music

according to the subjects’ preference by observing their mood for 5 minutes.

While the other 15 students who were part of the controlled group, were asked to

continue their schoolwork while the researcher plainly observed them for an hour.

Both groups were asked to take the depression test after an hour. They

used the number they had from the beginning of the test as their identity to

maintain confidentiality. Then both the tests they had from the beginning and the

end have been then compared by calculating and tabulating the changes of

scores they had.

Data Processing

The tabulated data of the first and last depression scale grade of the

respondents was inputted against demographic data of both the groups using

Microsoft Excel-SPSS. The score each respondent had was based on the

scoring of each tool, which is attached in Appendix D.

SPSS (Statistical Package for the Social Science) sheets were created to

compare sets of data and create corresponding line graphs or circle graphs to

answer questions outlined in the statement of the problem.

Statistical Treatment

The profile of the respondents according to gender and age were

measured in ratio, and both circle and bar graph was used to illustrate the

percentage distribution of each variable in reference to the whole sample. The

formula for computing percentage was used:

% = ( Amount) x100

Total

The level of depression scale grade of respondents was computed by

getting the central tendency or the weighted mean of distribution using the

following Mean formula:

M = X1 + X2 + X3 + X4 + X5

5

or the sum of all scores divided by the number of scores.

Interval measurement was used in treating data on the respondents’ first

depression scale grade and the last depression scale grade. Both the first and

last depression scale grade of the respondents will be to determined casual

relationship between the two variables. The relationships of data collected are

then illustrated in a table and line graph.

Final depression scale grade of experimental group and the controlled

group were processed by first plotting the final depression grade of experimental

group on the x-axis and the other being considered on the y-axis. The

relationship between the x and y variables are then illustrated using both bar and

line graphs.

The correlation between music therapy and the depression scale of the

respondents will be computed using the formula:

r = NΣXY - (ΣX)(ΣY) / Sqrt([NΣX2 - (ΣX)2][NΣY2 - (ΣY)2])

Charting with the use of a bar and line graph was used to illustrate the

result from this formula wherein the numbers will be inputted in the x-axis and the

tool used and the event will be considered in the y-axis.

CHAPTER 4

Presentation, Analysis and Interpretation of Data

On this chapter, all the tabulated data collected from the experiments were

recorded in Microsoft Excel-SPSS to show and compare the difference if there is

improvement or not. This was shown in a table and graphs to simply and better

understand its measurement, comparisons, difference and correlations.

Figure 3. Profile of Respondents According to Gender

As seen in the figure above, the student respondents were mostly female

with 21 students or 70% of the sample, while males consisted only of 9 students

or 30% of the total respondents.

From Dixon, et al’s study they stated that men and women differed in their

perceptions of perceived college stress and level of depression. “These findings

lend support to the report by the American Psychiatric Association (2000) as well

as previous research that has indicated that women experience, or at least

report, more depression than do men and typically experience more stress than

do men. In a recent study comparing anxiety scores of college students from

various countries, American females had the highest mean anxiety score among

males and females in Germany, Spain, the United Kingdom, and the United

States (Abdel-Khalek & Maltby, 2009).

Table 1. Profile of Respondents According to Age

Age Frequency Percentage

18-20 year-olds 10 33%

21-23 year-olds 13 44%

24-26 year olds 7 23%

Table 1 shows the age profile of the respondents according to age in

manner that it is clustered in a group. Ages 18-20 year-olds have 10 respondents

or 33%, while majority of the respondents were from 21-23 year olds who have

13 respondents, or 44%, and 7 were 24-26 year-olds or 23%.

Figure 4. Profile of Respondents According to Age

The age of the student respondents ranges from 18-26 years old, with 21

year-olds making the majority of the respondents with 24%. There were 4

respondents on each age group of 18, 20 and 24 year-olds, making up 13% and

3 respondents on each age group of 22 and 23 year-olds or 10%. 7% of the

respondents were 19 and 25 year-olds followed by 3% of a 26 year-old student.

Fatigue in older people is related to anxiety, low physical activity,

and high levels of nutritional risks (Martin, Bishop, Poon, & Johnson,

2006). The older the person reached, the deterioration in mental function is

most likely, and the denial of acquiring this is a battle.

Figure 5. Number of Respondents With and Without Depression

During the 1st Stage of the Experiment

The graph shows that from a convenient sampling, aside from the 30

students target as part of the 2nd stage of the experiment that had a purposive

sampling, only 2 students were not included for the reason of the result that they

did not met the criteria required. As explained in the procedure, right after the

respondent takes the test it was immediately checked if they qualify in the test as

having a score of being depressed, and two respondents had scores of being not

depressed.

As explained, Wang et’s study have expressed how college students were

most prone in have a deficit in mental function due to stress in school, personal

life, financial and social life. This is also the stage where an individual starts to

adjust on being independent while coping with demanding schedules and tasks.

Table 2. Level of Depression Scale Before Music Therapy

According to Zung Self-Rated Anxiety Scale

Score/s Frequency Percentage

20-30 3 10%

31-40 11 37%

41-50 14 47%

51-60 2 6%

61-70 0 -

71-80 0 -

Table 2 shows the level of depression before the experiment of the 30

respondents included. According to Zung’s Self-Rated Anxiety Scale, 3 students

have scored between 20-30 or 10%, scores 31-40 have 11 students or 37%, the

majority scale was 47% or the 14 students who scored around 41-50, and 2

remaining students, or 6% have scored around 51-60.

Figure 6. Level of Depression Before Music Therapy

According to Zung’s Self-Rated Anxiety Scale

Figure 6 shows the level of depression of the 30 respondents from the scores

they had according to Zung’s Self-Rated Anxiety Scale. The longer the line stays

on the x-axis meant the bigger of the respondents had received the scored

indicated on y-axis. From the results collected the average or weighted mean is

39.96.

From Naomi et al’ study they explained that the shortened version of the

Zung depression questionnaire, which includes 20 questions, was used in the

study. Participants are asked to rate on a 4-point scale the frequency (ranging

from less likely to most likely) of various symptoms of depression, such as

sadness, fatigue, feelings of emptiness, and so forth. And added, “The

questionnaire was found to be highly correlated with the Depression scale of the

MMPI (r = .7), and distinguishes between depression and anxiety (Zung &

Durham, 1965)”.

39.96

Table 3. Level of Depression Before Music Therapy


Score Frequency Percentage

18-21

(Bordeline Depressed)

5 17%

22-35

(Mild to Moderate)

15 50%

36-53

(Moderate to Severe)

10 33%

54+

(Severely Depressed)

0 -

Table 3 shows the level of depression before the experiment of the 30

respondents included. According to Goldberg’s Depression Scale, 5 students

have scored between 18-21 (Borderline Depressed) or 17%, the majority scale

was 50% or the 15 students who scored around 21-35 (Mild to Moderate

Depressed), and 10 remaining students, or 33% have scored around 36-53

(Moderate to Severe Depressed).

Figure 7. Level of Depression Before Music Therapy


Figure 7 shows the level of depression of the 30 respondents from the scores

they had according to Goldberg’s Depression Scale. The longer the line stays on

the x-axis meant the bigger of the respondents had received the scored indicated

on y-axis. From the results collected the average or weighted mean is 30.7.

From Wang et al’s study, the result in the beginning of the also showed no

difference between the control and experimental group because the intervention

was not yet applied.

Table 4. Level of Depression of Experimental Group


30.7

Before and After Music Therapy

Before Music Therapy After Music Therapy

45 39

42 34

49 45

48 46

40 29

50 42

55 52

42 39

32 31

37 33

45 44

40 36

40 39

35 32

33 30

42.2 38.06

Table 4 shows a significant difference obtained from the data before the

experiment which is 42.2, and the data after the application of music therapy

which is 38.06 of the 15 respondents of experimental group using the Zung’s

Self-Rated Anxiety Scale. This shows how music therapy that was applied as an

intervention decreased the depression scale of the respondents’ part on this

group.

Table 5. Level of Depression of Experimental Group

According to Goldberg’s Depression Scale,


Before Music

Therapy

After Music Therapy Interpretation

50 45 Mild-moderate to Mild-moderate

27 19 Mild-moderate to Borderline

Depressed


Depressed

41 35 Mild-severe to Mild-moderate



38 36 Mild-severe to Mild-severe

19 17 Borderline Depressed to Possible

Mild Depression



Depressed






34.6 30.13

Table 5 shows a significant difference obtained from the data before the

experiment which is 34.6, and the data after the application of music therapy

which is 30.13 of the 15 respondents of experimental group using the Goldberg’s

Depression Scale. Using this tool also shows the impact of music therapy on the

respondents included on this group because there is a decrease in the

depression scale, which also shows the effectiveness of the intervention used.

Table 6. Level of Depression of Controlled Group



Before Music Therapy After Music Therapy

38 36

35 36

43 43

37 41

42 40

28 30

27 27

34 34

41 43

27 27

31 31

42 44

53 53

46 47

42 42

37.73 38.26

Table 6 shows a slight difference obtained from the data before the

experiment which is 37.73, compared from the data after the one hour of

experiment which is 38.26 of the 15 respondents of controlled group using the

Zung’s Self-Rated Anxiety Scale. With this slight difference, the researcher

concludes that respondents who were part of the controlled group had small

improvement of depression.

Table 7. Level of Depression of Controlled Group

According to Goldberg’s Depression Scale,


Before Music

Therapy

After Music Therapy Interpretation





21 23 Borderline Depressed to Mild-

moderate

20 20 Borderline Depressed to Borderline

Depressed


Depressed




Depressed






28.53 28.47

Table 7 shows a slight difference obtained from the data before the

experiment which is 28.53, compared from the data after the one hour of

experiment which is 28.47 of the 15 respondents of controlled group using the

Goldberg’s Depression Scale. Without music therapy, the respondents belonged

in this group have not shown any improvement of decreased in depression

versus the experimental group.

Figure 8. Difference Between Zung’s Self-Rated Anxiety Scale and

Goldberg’s Depression Scale of Controlled Group and Experimental Group

According to the data collected from both the tools Zung’s Self-Rated

Anxiety Scale and Goldberg’s Depression Scale, figure 8 shows a bar graph of

the before and after the experiment. The blue bar indicates the before of the

experiment from both tools which have a difference of 0.04, wherein from

0.90393 (Zung’s SAS) and 0.94725 (Goldberg’s DS), while the red bar indicates

the results after the experiment which shows a slight difference of 0.01 from

0.99124 (Zung’s SAS) and 0.98699 (Goldberg’s DS). This shows that both tool

have been in used, is effective in data collection and is significant because only

small amount of difference had shown.

Both the tool had been used on different experiments. Wang et al have

used the Zung’s Self-Rated Depression Scale in his study and have also shown

a result that correlates from the observed behavior. And Dixon et al have used

the Goldberg’s Depression Scale as a tool to filter the college students they need

in their experiment. Both studies that have been mentioned had used these tools

on students as their respondents and have a positive conclusion according from

the data itself.

Figure 9. Correlation Between Music Therapy and the Student’s Depression

Scale According to Zung’s Self-Rated Anxiety Scale of

Experimental Group Vs Controlled Group

Table 9 interprets the correlation of music therapy to depression according

to Zung’s Self-Rated Anxiety Scale. The blue line represents the experimental

who have received music therapy, r=0.90393 while the controlled group who

have not received any therapy represents the red line, r=0.99124. Meaning that

the experimental group have decreased in depression since the music therapy

was applied while the controlled group who did not receive any intervention have

a slight change in the depression scale.

Figure 10. Correlation Between Music Therapy and the Student’s

Depression Scale According to Goldberg’s Depression Scale of

Experimental Group Vs Controlled Group

Table 10 interprets the correlation of music therapy to depression

according to Goldberg’s Depression Scale. The blue line represents the

experimental who have received music therapy, r=0.94725, while the controlled

group who have not received any therapy represents the red line, r=0.98699.

Similar to the result in Zung’s SAS, the experimental group have shown an

improvement in their depression scale when music therapy was applied

compared to the controlled group who have a slight change in the depression

scale.

Similar to Wang et al study, the overall result was similar showing that

music therapy shows result of improvement in the student’s depression mood.

Hence, the application is short-term the outcome is equal to the hypothesis

stated earlier.

CHAPTER 5

Summary of Findings, Conclusions and Recommendations

Summary of Findings

1. Profile of Respondents

1.1 According to Gender

Majority of the respondents are female with 70% or 21 respondents, and

males completing the number 30% or 9 of the total 30 respondents.

1.2 According to Age

Age of respondents varied from 18-26 years old, showing a

heterogeneous sampling population. 21 year-olds have the majority of

respondents, which have 7 out of 30 or 24%.

2. Number of Respondents With or Without Depression According to Both

Zung’s SAS and Goldberg’s Depression Scale

Respondents who got depression on both the Depression Scale were 30

students, and which was included in the proper experiment. While 2 students

showed no depression on both the Depression Tests taken.

3. Level of Depression of 30 Respondents Before the Experiment

Thirty (30) students who got the depression test had a computed average

of 39.96 on Zung’s SAS with a maximum of 80 as a score, and a computed

average of 30.7 on Goldberg’s Depression Scale with a maximum of 90 as a

score.

4. Level of Depression Scale of Students Receiving Music Therapy

Students showed a remarkably improvement with consideration of a

single-session music therapy with an average of depression scale from 42.2 to

38.06 using a Zung’s Self-Rated Anxiety Scale, and from 34.6 to 30.13 using the

Goldberg’s Depression Scale.

5. Level of Depression Scale of Students Who Did Not Receive Music

Therapy

Students showed a slight difference of result because of the absence of

the intervention, which is the music therapy. The controlled group have an

average of depression scale from 37.73 to 38.26 using a Zung’s SAS, and from

28.53 to 28.47 using the Goldberg’s Depression Scale.

6. Difference Between Zung’s Self-Rated Anxiety Scale and Goldberg’s

Depression Scale

Comparisons of the results of the data from the beginning to the end was

only a small difference in numbers between Zung’s Self-Rated Anxiety Scale and

Goldberg’s Depression Scale, which also shows that both tools have given a

conclusion that is required by this study.

7. Correlation Between Music Therapy and Depression Scale of Students

Students who received music therapy showed a decrease of depression

showing its correlation of r=0.90393 using the Zung’s Self-Rated Anxiety Scale

and r=0.94725 using the Goldberg’s Depression Scale. While the students who

did not receive any music therapy or any intervention showed a high result with

comparisons of a correlation of r=0.99124 using the Zung’s Self-Rated Anxiety

Scale and r=0.98699 using the Goldberg’s Depression Scale.

Conclusions

Based on the findings of the study, the following conclusions were arrived at:

1. Over 93% of students (30 out of 32) may be depressed.

2. The tools Zung’s Self-Rated Anxiety Scale and Goldberg’s Depression

Scale showed a slight difference in results.

3. Music therapy has a therapeutic effect on students when depression

mood rises.

The study found that there was no significant difference in the mental

health scores between the experimental group and control group before the

intervention. However, after the intervention, a significant difference between the

pre-test and post-test was obtained for the experimental group, while no related

and little significant difference between the pre-test and post-test was obtained

for the controlled group. This indicates that, music therapy, through amelioration

of the depressive symptoms of the participants in the experimental group,

improves the overall mental health of the participants in the experimental group

and realizes another purpose of the experiment. The researcher’s finding is in

consistent with previous research showing that music therapy can improve

mental health.

Recommendations

In light of significant findings and conclusions of the study, the following

recommendations are hereby offered:

1. An information campaign targeting students must be launched to

stress the importance of being not at risk of depression, like a seminar

relating depression or counseling to every student.

2. An event showing the therapeutic effect of music aside from being

recreational, like a musical or a free session like voice lesson, guitar

lesson, and so forth.

3. A practice of such therapy, by encouraging students with different

activities related to music, like when doing a seatwork or review time,

encourage and allow students to listen to a music even for 5 minutes

just to relax them mentally.

4. Encourage parents to practice such therapy, like playing music in the

morning to stimulate their children’s mood, or even spending time with

their children and doing fun stuff like karaoke time or dancing time.

5. Further studies can be undertaken on the subject to show the casual

relationship between depression mood and music therapy, like

knowing the main reasons of the depression, or the time the

experiment had done, the depression scale of per level of student

nurses, the depression scale of student in different courses, and so

forth.

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APPENDICES

Appendix A

Appendix B

Informed Consent to Participate in a Research Study

Arellano UniversityJose Abad Santos Campus

3058 Taft Avenue, Pasay City

Title of Research: Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses

Name of Researcher: Yushra Tulawie

Phone Number of Researcher: 0927-5143215; 0933-2599697

A. PURPOSE AND BACKGROUNDUnder the supervision of Dr. Gina Pardilla, Professor of Introduction to Research at Arellano University, Yushra Tulawie, a student in nursing research is conducting research on the impact of music therapy on mental function. The purpose of this interview and survey is to help the researcher gather data on college students’ depression mood.

B. PROCEDURESIf I agree to participate in this research study, the following will occur:

1. I will be asked to answer a questionnaire regarding my mental condition.

2. I will also be asked if I am talking any medication related to depression.

C. RISKS1. Risks:

I will be asked questions of a personal nature and I might feel uncomfortable talking about some things. I am free to decline to answer any questions that I do not wish to answer, or I may stop my participation in the discussion at any time without penalty.

2. ConfidentialityThe records from this study will be kept as confidential as possible. No individual identities will be used in any reports or publications resulting from the study. All transcripts and summaries will be given codes and stored separately from any names or other direct identification of participants. Research information will be kept in locked files at all times. Only the researcher who will have access to the files and only those with an essential need to see names will have access to that particular file. After the study is completed and all data has been transcribed from the questionnaires, the questionnaires and results sheet will be held for one year and then destroyed.

D. DIRECT BENEFITS

There will be no direct benefit to me from participating in this research study except knowing my depression scale results.

E. ALTERNATIVESI am free to choose not to participate in this research study and to withdraw from the study at any time.

F. COSTSThere will be no costs to me as a result of taking part in this research study.

G. QUESTIONSI have spoken with Yushra Tulawie about this study and have had my questions answered. If I have any further questions about the study, I can contact her by calling 0927-5143215 or 0933-2599697.

H. CONSENTI have been given a copy of this consent form to keep.

PARTICIPATION IN RESEARCH STUDY IS VOLUNTARY. I am free to decline to participate in this research study, or I may withdraw my participation at any point without penalty.

Participant’s Name (optional) & Signature:_______________________________

Date: ________________ No: ____________

Interviewer’s Signature: ____________________________________

Date: _____________

Appendix C

Instruments Used

Name (optional): ___________________________ Participant No: _______Age: ______ Gender: ( ) Male ( ) Female

> Are you a full-time college student?( ) YES ( ) NO

> Do you think you are suffering from depression?( ) YES ( ) NO

> Are you taking any medication related to depression (with serotonin or norepinephrine)?

( ) YES ( ) NO

>Zung Self-Rated Anxiety Scale (SAS)Put a check mark on the column you think best relates to you for this past

month.

Place check mark in correct column. A little of the

time

Some of the

time

Good part of

the time

Most of the

time

1 I feel downhearted and blue.

2 Morning is when I feel the best.

3 I have crying spells or feel like it.

4 I have trouble sleeping at night.

5 I eat as much as I used to.

6 I still enjoy sex.

7 I notice that I am losing weight.

8 I have trouble with constipation.

9 My heart beats faster than usual.

10 I get tired for no reason.

11 My mind is as clear as it used to be.

12 I find it easy to do the things I used to.

13 I am restless and can’t keep still.

14 I feel hopeful about the future.

15 I am more irritable than usual.

16 I find it easy to make decisions.

17 I feel that I am useful and needed.

18 My life is pretty full.

19 I feel that others would be better off if I were

dead.

20 I still enjoy the things I used to do.

Table 8. Zung’s Self-Rated Scale Tool

> Goldberg’s Depression ScaleEncircle: 0 = Not at all; 1 = Just a little; 2 = Somewhat; 3 = Moderately; 4 =

Quite a lot; 5 = Very much

1 I do things slowly. 0 1 2 3 4 5

2 My future seems hopeless. 0 1 2 3 4 5

3 It is hard for me to concentrate on reading. 0 1 2 3 4 5

4 The pleasure and joy has gone out of my life. 0 1 2 3 4 5

5 I have difficulty making decisions. 0 1 2 3 4 5

6 I have lost interest in aspects of life that used to be important to me. 0 1 2 3 4 5

7 I feel sad, blue, and unhappy. 0 1 2 3 4 5

8 I am agitated and keep moving around. 0 1 2 3 4 5

9 I feel fatigued. 0 1 2 3 4 5

10 It takes great effort for me to do simple things. 0 1 2 3 4 5

11 I feel that I am a guilty person who deserves to be punished. 0 1 2 3 4 5

12 I feel like a failure. 0 1 2 3 4 5

13I feel lifeless - - - more dead than alive. 0 1 2 3 4 5

14 My sleep has been disturbed too little, too much, or broken sleep. 0 1 2 3 4 5

15 I spend time thinking about HOW I might kill myself. 0 1 2 3 4 5

16 I feel trapped or caught. 0 1 2 3 4 5

17 I feel depressed even when good things happen to me. 0 1 2 3 4 5

18 Without trying to diet, I have lost, or gained, weight. 0 1 2 3 4 5

Table 9. Goldberg’s Depression Scale

Appendix D

Scoring of Depression Tests

Scoring for Zung Depression Scale

Scoring Directions:

1) For each statement, look up for response and corresponding score (1-4).

2) Fill in the score for each statement under the last column labeled “Score”.

3) Calculate the Total Score by adding up all 20 scores.

4) Scoring: 50-69 is the common range for people with depression. 70 or

higher indicates severe depression (range 20-80).

Place check mark in correct column. A little of the

time

Some of the

time

Good part of

the time

Most of the

time

Score

1 I feel downhearted and blue. 1 2 3 4

2 Morning is when I feel the best. 4 3 2 1

3 I have crying spells or feel like it. 1 2 3 4

4 I have trouble sleeping at night. 1 2 3 4

5 I eat as much as I used to. 4 3 2 1

6 I still enjoy sex. 4 3 2 1

7 I notice that I am losing weight. 1 2 3 4

8 I have trouble with constipation. 1 2 3 4

9 My heart beats faster than usual. 1 2 3 4

10 I get tired for no reason. 1 2 3 4

11 My mind is as clear as it used to be. 4 3 2 1

12 I find it easy to do the things I used to. 4 3 2 1

13 I am restless and can’t keep still. 1 2 3 4

14 I feel hopeful about the future. 4 3 2 1

15 I am more irritable than usual. 1 2 3 4

16 I find it easy to make decisions. 4 3 2 1

17 I feel that I am useful and needed. 4 3 2 1

18 My life is pretty full. 4 3 2 1

19 I feel that others would be better off if I

were dead.

1 2 3 4

20 I still enjoy the things I used to do. 4 3 2 1

Table 10. Scoring for Zung’s SAS Tool

Scoring for Golberg’s Depression Scale

1) Calculate the Total Score by adding up all 18 scores.

2) Equivalent are the following:

54+ = Severely Depressed

36-53 = Moderate to Severe

22-35 = Mild to Moderate

18-21 = Borderline Depressed

10-17 = Possible Mild Depression

0-9 = Likely Not Depressed

Appendix E

Collected Scores on each Tool Before the Experiment

A. According to Zung’s Self-Rated Anxiety Scale

0-19

Score/s

20-30

Scores

31-40

Scores

41-50

Scores

51-60

Scores

61-70

Scores

71-80

Sores

16 28 32 45 55

19 27 37 42 53

27 40 49

40 48

35 40

33 50

38 42

35 45

37 43

34 42

31 41

42

46

42

17.5 27.3 35.6 44 54 0 0

Table 11. Scores on Zung’s SAS Before Music Therapy

B. According to Goldberg’s Depression Scale

0-9

(Likely Not

Depressed)

10-17

(Possible Mild

Depression)

18-21

(Borderline

Depressed)

22-35

(Mild to

Moderate)

36-53

(Moderate to

Severe)

54+

(Severely

Depressed)

17 19 27 50

16 21 26 41

20 34 39

21 23 38

21 30 52

24 52

25 39

34 36

27 40

26 37

29

25

28

30

33

0 16.5 20.4 28.07 42.4 0

Table 12. Scores on Goldberg’s Depression Scale Before Music Therapy

Appendix F

Correlation Between Music Therapy and Depression Scale

A. According to Zung Self-Rated Anxiety Scale (Experimental group)

Zung Anxiety Scale

Before Music Therapy (X)

Zung Anxiety Scale

After Music Therapy (Y)

45 39

42 34

49 45

48 46

40 29

50 42

55 52

42 39

32 31

37 33

45 44

40 36

40 39

35 32

33 30

Table 13. Correlation on Experimental Group (Zung’s SAS)


r= (15)(24657)-(633)(571)/ Sqrt([(15)(27315)-(633)2][(15)(22375)-(571)2])

r= 369855-361443/ Sqrt([409725-400689][335625-326041])

r= 8412/ Sqrt([(9036)(9584)])

r= 8412/ Sqrt(86601024)

r= 8412/ 9305.9671

r= 0.9039361

Table 13 shows the correlation of the before and after data of correlation

between music therapy and the student’s depression scale (who recived music

therapy) using Zung’s SAS, which is r=0,9039361.

B. According to Goldberg’s Depression Scale (Experimental group)

Goldberg's Depression scale

Before Music Therapy (X)

Goldberg's Depression scale

After Music Therapy (Y)

50 45

27 19

26 19

41 35

39 27

34 27

38 36

19 17

52 50

23 21

52 49

39 34

30 28

34 22

25 23

Table 14. Correlation on Experimental Group (Goldberg’s DS)


r= (15)(17474)-(529)(452)/ Sqrt([(15)(20207)-(529)2][(15)(15310)-(454)2])

r= 262110-239108/ Sqrt([303105-279841][229650-204304])

r= 23002/ Sqrt([(23264)(25346)])

r= 23002/ Sqrt(589649344)

r= 23002/ 24282.69639

r= 0.9472589


between music therapy and the student’s depression scale (who received music

therapy) using the Goldberg’s Depression Scale, which is r=0,9472589.

C. According to Zung’s Self-Rated Anxiety Scale (Controlled group)

Zung Anxiety Scale w/o Music Therapy(X) (Y)

38 36

35 36

43 43

37 41

42 40

28 30

27 27

34 34

41 43

27 27

31 31

42 44

53 53

46 47

42 42

Table 15. Correlation on Controlled Group (Zung’s SAS)


r= (15)(22435)-(566)(574)/ Sqrt([(15)(22144)-(566)2][(15)(22744)-(574)2])

r= 336525-324884/ Sqrt([332160-320356][341160-329476])

r= 11641/ Sqrt([(11804)(11684)])

r= 11641/ Sqrt(137917936)

r= 11641/ 11743.8467

r= 0.9912425


between music therapy and the student’s depression scale (who did not received

music therapy) using the Zung’s SAS, which is r=0.9912425.

D. According to Goldberg’s Depression Scale (Controlled group)

Goldberg's Depression Scale w/o Music Therapy

(X) (Y)

34 34

27 25

26 26

29 27

21 23

20 20

21 21

25 25

28 28

21 20

30 31

35 36

40 41

33 33

37 37

Table 16. Correlation on Controlled Group (Goldberg’s DS)


r= (15)(12731)-(427)(427)/ Sqrt([(15)(12717)-(427)2][(15)(12761)-(427)2])

r= 190965-182329/ Sqrt([190755-182329][191415-182329])

r= 8636/ Sqrt([(8426)(9086)])

r= 8636/ Sqrt(76558636)

r= 8636/ 8749.77919

r= 0.98699


between music therapy and the student’s depression scale (who did not received

music therapy) using the Goldberg’s Depression Scale, which is r=0.98699.

Appendix G

Approval to use the tool

1. Zung Self-Rated Anxiety ScaleIt have a banket permission on using the tool as long as you do not own the tool and should credit the author, and there should in no other way that the title or the test itself should be changed.

2. Goldberg’s Depression ScaleHi . . .

You are welcome to reproduce the Goldberg Depression Scale so long as you also reproduce my copyright notice on each copy.

Best regards . . .

Ivan K. Goldberg, M.D.

Interview with Music Therapist

Good day Sir/Ma'am,

Hi my name is Yushra Tulawie and I'm a third year nursing student. I'm doing a research about "Impact of Music Therapy on the Depression Mood of College Students" since you are a music therapist i was wondering if there is any genre of

music that you would greatly recommend for me to use on my research.Thank You for your kind consideration.

Yushra Tulawie

1. Jennifer Buchanan, BMT, MTA

Date: Monday, September 26, 2011, 7:01 PM

Hi Yushra,

Thank you so much for your email.Congratulations on being a 3rd year in Nursing.I have written a few short articles on music and stress that can be found here: http://www.jbmusictherapy.com/?s=stressIt comes down to preferences - and ensuring that music is used with intention (not doing other things - but focusing on the music).If you have more questions after reading these articles please do not hesitate to send them to me.

Jennifer

Date: Sunday, October 2, 2011, 3:58 PM

Hi Yushra.

This is difficult as it still depends on preferences. Perhaps give people the choice of listening to a Beethoven, Bach, Vivaldi or Rachmoninov piece and see what they feel is the most relaxing. try to get them to at least 5 minutes of listening.

Goodluck,Jennifer Buchanan, BMT, MTAPresident and Professional Speakert: 403.240.3877f: 403.290.2394 www.jenniferbuchanan.cawww.jbmusictherapy.com

2. Susan Hadley, PhD, MT-BC

Date: Wednesday, October 12, 2011 3:59 AM

Dear Tulawie:

http://www.jbmusictherapy.com/

http://www.jenniferbuchanan.ca/

http://www.jbmusictherapy.com/?s=stress

Thank you for your message. It is interesting that you are doing a paper on music therapy for your nursing program. I cannot answer your question as that is not how we do music therapy. We use music which is preferred by an individual and which meets the needs of the patient. So, what I might use to relax a person would be different from what I might use to help in pain reduction. It also would be different from what I would use to help a patient who needs physical rehabilitation or who might need to work on emotional or personal issues. Also, as music therapists we advocate the use of live music rather than recorded music. So, it may be best to consult nursing journals for this. Nurses tend to use music differently with patients than music therapists.

I hope this is helpful.

Best,

Dr. Hadley

Professor Susan Hadley, PhD, MT-BCMusic Therapy ProgramSlippery Rock University222 Swope MusicSlippery Rock, PA 16057724.738.2446 (w)724.738.4469 (f)

3. Julie M. Guy, M.M., NMT-F, MT-BC

Date: Friday, September 30, 2011, 3:18 PM

“Music therapy” implies that a trained music therapist is involved administering music in your study so I’d recommend changing your wording to “Impact of music for decreasing depression...” or just the impact of music.

I recommend that you look up similar studies involving music and replicate the music that they used. In general research shows that there isn’t one kind of music that helps with this, that it’s patient preferred. So this could be anything from rock, to relaxation to classical to country. Best to you in your research. Julie

Julie M. Guy, M.M., NMT-F, MT-BCBoard Certified Neurologic Music TherapistVice-President | The Music Therapy Center of CaliforniaM| 7840 Mission Center Court Suite 205 | San Diego, CA | 92108W| www.themusictherapycenter.comT| 619.299.1411

http://www.themusictherapycenter.com/

F| 619-299-1412

4. Anne Vitort, MT-BC

Date: Wedenesday, October 12, 2011, 6:37 AM

Hello Yushra,What kind of research are you doing? What are your treatment goals and objectives? And who is the client? These factors are important in choosing a piece of music. Research consistently shows client-preferred music is the most effective at achieving desired results. If your clients don't like classical, your interventions aren't likely to succeed. I don't tend to use classical as much as jazz, big band, and country/western because those are the genres my clients prefer. I have used Vivaldi's Four Seasons, however, for movement activities targeted at gross motor skills and flexibility.Hope that helps.

Anne

Anne Vitort, MT-BC upbeat Music Therapy Services LLC 16200 SE 18th Way Vancouver, WA 98683 360-607-8187 www.upbeatmusictherapist.com

5. Kimberly Sena Moore, MM, MT-BC

Date: Wednesday, October 12, 2011, 12:34 PM

Hello Yushra,

As a general rule, we try to use patient-preferred music in our work, which may or may not be classical. Additionally, the music we use also depends heavily on our treatment goal (e.g. pain management, anxiety reduction, spiritual support, procedural support, etc.). For these two reasons, it's difficult to suggest a particular piece I'd recommend.

This Cochrane Review may help point you in the direction of some studies that may help: http://www2.cochrane.org/reviews/en/ab006911.html

Good luck!Kimberly

Kimberly Sena Moore, MM, MT-BCMusic Therapist: Neurosong Music Therapy

http://www.neurosong.com/

http://www2.cochrane.org/reviews/en/ab006911.html

http://www.upbeatmusictherapist.com/

Blogger: Music Therapy MavenPT Blog: Your Musical SelfPodcast: Music Therapy Round TableMusic Therapy [email protected]

Appendix H

Researcher’s Profile

Name: Yushra Tulawie

Address: Block 7 Lot 3 Maguindanao St.

Maharlika Village, Taguig City, Philippines 1633

Learning Feedback:

Taking this subject, Introduction to Research, had taught me lessons more

than this course have offered.

First, was how to make a proper nursing research, the step-by-step process,

the different designs, and why it is important.

Even simple things, like making a graph and the different uses of it, and the

techniques used to search data in the internet so I can find the things I needed

was unexpectedly rewarding for me that I can use in the future.

During data collection, I was able to communicate well with the respondents

and learn more from them.

http://us.mc1124.mail.yahoo.com/mc/[email protected]

http://www.musictherapypro.com/

http://www.musictherapyroundtable.com/

http://www.musictherapyroundtable.com/

http://www.psychologytoday.com/blog/your-musical-self

http://www.musictherapymaven.com/

The research alone, which is about music therapy and depression, that I

have done was also a lesson that I can apply for myself, and I can share with

other people.

And the most important things that I had learned were patience and

dedication. This research needed a lot of these things for me to be able to make

it, not to give up and just move forward.

All these lessons were not just to pass the subject, but it is also something

that I have acquired and achieve in which I can use in my daily life for the rest of

my life.

Impact of Music Therapy on the Depression Mood of 3rd Year Student Nurses

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