"The wonderful thing about music is that we can use it as a metaphor for a lot of things in life."

-Joke Bradt

Joke (pronounced Yo-kay) Bradt is one of those few fortunate people who has proven it is possible to have your cake and eat it, too. As a high school senior she was torn between pursuing a degree in musical performance and a medical degree. But her piano teacher told Bradt that she wouldn't have to forfeit one dream for the other.

Bradt discovered she could meld her passions for healing and performing through medical music therapy. Born, raised and educated in Belgium, Bradt was twice awarded a Fulbright grant to study music therapy at Temple University. In her most recent music therapy research study, she investigated the effects of music entrainment on postoperative pain perception in pediatric patients. In addition to her research, Bradt has developed and implemented two clinical music therapy programs in Belgium, one involving adult psychiatric clients, the other children with cerebral palsy and muscular dystrophy.

Bradt, who said she was attracted to Montclair State's Music Therapy Program because it's one of the premiere programs in the country, recently discussed the work she's doing in music entrainment.

Q: What is medical music therapy?
A: The use of improvisational musical technique or intervention to help people improve or maintain their physical and emotional health. Medical music therapy requires the presence of a trained music therapist, the development of a relationship between the therapist and the patient, and a process that evolves during the course of treatment. In music therapy both the music and the therapeutic relationship are of primary importance. Music therapy also involves maintenance because for some people there are conditions in which no improvement can be achieved. For instance, Alzheimer's patients are not going to get better. But we can help them maintain quality of life through music. The wonderful thing about music is that we can use it as a metaphor for a lot of things in life. It allows us to not always have to verbalize because sometimes words don't do justice to what we're feeling, and music is just another way of expressing our emotions.

Q: How does music aid in pain management?
A: It is based on the entrainment principal, which involves two bodies that are vibrating in slightly different ways that will eventually catch up with each other to vibrate simultaneously. In music therapy we entrain heart rate with music by first matching the music to the heartbeat, then the music tempo is slightly altered. The heart rate follows the beat of the music as long as the music doesn't change too abruptly. This process has also worked with respiratory patterns.

The Gate Control Theory, the most widely accepted theory of pain perception, proposes that neural impulses triggered by music stimuli override pain signals carried by the smaller nerve fibers. By applying music entrainment to pain, eventually the perception of the pain also changes. Pain perception is influenced by several factors, including how you think about the pain, previous pain experience, how you control the pain and your emotions at the moment. So music entrainment works more than at the physiological level. It also works at the psychological level as well.

Q: Walk us through a music therapy session.
A: I begin by asking clients to describe the pain. The way we describe pain in our daily lives often translates easily into music because the pattern of pain implies that there's a rhythm to it. After listening to clients I may ask more questions, then I give them a drum and ask them to let me hear their pain. We experiment with sounds, eventually bringing them together to create an audio picture of the pain. After that we create soothing music and the entrainment process follows. My clients lie down in a comfortable position while I play improvisational music for them, starting with the pain sound, gradually moving toward the soothing music.

Q: What is the most challenging aspect of this therapy?
A: The improvisation, because music is individualized to a particular patient, and people from certain cultures ask for very different types of music. Pain is a subjective experience and it changes from day to day, or complications occur and it gets worse. So I can't come in knowing what to do for a particular patient based on what we did yesterday because it's completely different.

The wonderful thing about this type of intervention is that the client is in control. This is especially true of children, who feel completely out of control because the decisions are made for them. Doctors are talking to mom and dad about them and about the next procedure in technical language they can't understand. But then I come in and say, "Let's talk about your pain." I explain to the children what we're going to do and the first reaction I get from them is, "You're weird." They're surprised that somebody wants to sit down to talk with them about their pain and play with them for an hour and a half.

Q: This must be a welcome alternative to drugs.
A: Music entrainment is not a replacement for pain medication. It is complementary because pain medication doesn't take away all the pain. For instance, I worked with a 12-year-old girl on morphine who was in so much pain she couldn't stop crying. At first she resisted me, but by the end of the entrainment session she was telling me about her dog and how she plays the flute. Her mother was in tears because it was the first time in 48 hours that her daughter smiled.

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