Taotlus

Sotsiaalministri 17.03.2026 määrus nr 1.2-2/27-1 „Väheintensiivsete psühholoogiliste sekkumiste rakendamise toetus“ Lisa 1 Taotlusvorm 1. Taotleja andmed 1.1. Asutuse/ettevõtte nimetus: Ojaveere Nõustamine OÜ 1.2. Registrikood: 14576910 1.3. Postiaadress: Rapla maakond, Rapla vald, Rapla linn, Tallinna mnt 22, 79512 1.4. Arvelduskonto (IBAN): EE972200221070258412 1.5. Esindaja nimi ja ametikoht: Siiri Viil, juhatuse liige 1.6. Kontaktisiku andmed (nimi, e-post, telefon): Siiri Viil [email protected] 55 155 78 1.7. Taotletav toetuse kogusumma (käibemaksuta): 62 550 eur 1.8. Projekti elluviimise periood: 1.6-31.12.2026 2. VIPS-i kirjeldus 2.1. Nimetus: Music Therapy Micro-Interventions 2.2. Lühikirjeldus (sh metoodiline alus): Music Therapy Micro-Interventions (MTMI) sobib rakendamiseks madala lävega vaimse tervise teenustes tänu oma lühiformaadile, struktureeritusele ja skaleeritavusele. MTMI defineeritakse kui lühiajaline, struktureeritud terapeutiline sekkumine, milles kasutatakse spetsiifilisi muusikateraapia tehnikaid kliendi konkreetse eesmärgi saavutamiseks (de Witte et al., 2022). RECEPTIVE MICRO-INTERVENTION (kuulamisel põhinev) struktuur: 1) eesmärgi seadmine (nt ärevuse vähendamine) 2) juhendatud muusika kuulamine 3) füsioloogilise ja emotsionaalse seisundi jälgimine (nt hingamise aeglustumine) 4) refleksioon ja tähenduse loomine. ACTIVE MICRO-INTERVENTION (aktiivne variant) struktuur: 1) emotsionaalse seisundi kaardistamine 2) aktiivne muusikaline tegevus (rütm, improvisatsioon, hääl) 3) emotsioonide väljendamine ja reguleerimine 4) refleksioon. 2.3. Sihtrühm (vanuserühm jne): 15-64. Gruppide korral vanusepõhiselt 15–24, 25–44, 45–64. 2.4. Piirkond: Saaremaa, Rapla maakond 2.5. Formaat (individuaal, grupi, kombineeritud): nii individuaal kui grupp 2.6. Struktuur (seansside arv, ühe seansi kestus minutites, grupisekkumiste korral inimeste arv grupis): Individuaalne 1–8 sessiooni; seansi pikkus 45-60 minutit. Grupisekkumise korral 4-8 sessiooni, grupis kuni 12 osalejat ning sekkumise pikkus 90 minutit. 2.7. Vorm (kohapeal, veebis jne): kohapeal (individuaalne ja grupp), veebis (individuaalne) 2.8. Tõenduspõhisus (viidata uuringutele, rahvusvahelisele kasutusele; lisada viited või allikad): MTMI on teaduspõhiselt arendatud ja ekspertide poolt valideeritud muusikateraapia lühisekkumine, mis sisaldab struktureeritud receptive ja active sekkumist (de Witte et al., 2022). Sekkumine töötati välja 52 empiirilise uuringu analüüsi ning praktikute kogemuse põhjal ning valideeriti Delphi meetodil 16 eksperdi hinnangute kaudu. Tulemused näitavad olulist mõju stressi ja ärevuse vähendamisel. Hinnates aktiivse variandi mõju depressioonile (Erkkilä et al., 2011) leiti depressiooni, ärevuse ja stressi vähenemist. Sekkumise mõju põhineb: närvisüsteemi regulatsioonil (tempo, rütm); 1  emotsionaalsel väljendusel ja töötlemisel; terapeutilisel attunement’il (muusikaline kooskõla spetsialisti ja kliendi vahel). Meta-analüüsid ja süstemaatilised ülevaated näitavad, et muusikateraapia sekkumised vähendavad ärevust (SMD ≈ -0.36) ning parandavad emotsionaalset regulatsiooni ning on efektiivsed ka lühiformaadis sekkumistena sh Cochrane Collaboration (Bradt et al., 2016; de Witte et al., 2020; de Witte et al., 2022; Gold et al., 2009). Muusikateraapia sekkumised on seotud: kortisooli taseme vähenemisega; südamerütmi ja erutuse regulatsiooniga; emotsionaalse seisundi paranemisega. isegi üksikseansid võivad vähendada ärevust ja füsioloogilist stressi (de Witte et al., 2022). Lisaks näitavad meta-analüüsid, et muusikateraapia vähendab ärevust ja stressi, parandab emotsionaalset regulatsiooni ning on efektiivne ka lühiformaadis sekkumistena (Bradt et al., 2016; de Witte et al., 2020; de Witte et al., 2022; Gold et al., 2009; Lee et al., 2025). Muusikateraapia tõenduspõhisust on kirjeldatud ka Põld, Kleinberg et al. 2024 tuues välja, et muusikateraapia on depressiooniga noorukitel lastel tavaraviga võrreldes oluliselt efektiivsem. 2.9. Kinnitus sekkumise juhendi olemasolu kohta (lisada näidis või kirjeldus): MTMI protokoll on kirjeldatud de Witte et al. 2022 ning lisatud ka taotlusele (Lisa 1) 2.10. Varasem rakendamine (rakendamise maht ja kestus): MTMI on rakendatud siiani muusikaterapeutide poolt nii lühisekkumisena, sotsiaalses rehabilitatsioonis, tööalases rehabilitatsioonis kui haiglaravis. Kuna eraldi ei ole mõõdetud sekkumise mahtu, siis seda välja tuua on keeruline. Samas on nii sotsiaalses rehabilitatsioonis kui KOV vaimse tervise teenustena loovteraapiad üheks enimkasutatud teenuseks, mistõttu võib väita, et sekkumist on rakendatud olulises mahus. 2.11. Tagasiside kogumise viis: Eraldiseisvalt ei ole sekkumise osas tagasisidet kogutud vaid tulemusi on mõõdetud kõigi kliendile võimaldatud sekkumiste kogumine. Edaspidi saab VIPS rakendamisel mõju mõõtmisel kasutatakse EEK-2 või WHO-5 heaolu indeks (enne ja pärast). Mõlemad hindamismeetodid on valideeritud ning sobilikud sihtgrupile (Allgaier et al, 2012; Streimann et al. 2021). 3. Nimetus: Music-Based Relaxation Interventions 3.1. Lühikirjeldus (sh metoodiline alus): Music-Based Relaxation Interventions (MBRI) on struktureeritud madala intensiivsusega sekkumine, mis ühendab muusika kuulamise (keskmiselt tempoga 60-80bpm) ja lõõgastus- ja regulatsioonitehnikatega (nt hingamine, juhendatud kujutluspildid või progressiivne lihaslõdvestus). Sekkumine sobib rakendamiseks lühiformaadis ning sisaldab eesmärgistamist, füsioloogilise rahustamise faasi, muusikapõhist regulatsiooni (10– 20 min, tempo 60–80 bpm) ning refleksiooni. Protokoll põhineb meta-analüüsidel ja kontrollitud uuringutel, mis näitavad, et muusikapõhised sekkumised vähendavad stressi ja ärevust ning mõjutavad autonoomset närvisüsteemi. 3.2. Sihtrühm (vanuserühm jne): 15-64 3.3. Piirkond: Saaremaa, Rapla maakond 3.4. Formaat (individuaal, grupi, kombineeritud): individuaalne, grupp 3.5. Struktuur (seansside arv, ühe seansi kestus minutites, grupisekkumiste korral inimeste arv grupis): 6-10 korda sagedusega 1-2 korda nädalas, kestvus 30 minutit. Grupi puhul kestvus 60 minutit ning grupis kuni 8 osalejat. Sekkumine on eelneval juhendamisel ka kliendi poolt iseseisvalt rakendatav. 3.6. Vorm (kohapeal, veebis jne): kohapeal 3.7. Tõenduspõhisus (viidata uuringutele, rahvusvahelisele kasutusele; lisada viited või allikad: Meta- analüüsid ja randomiseeritud uuringud näitavad ärevuse ja stressi vähenemist ning emotsionaalse regulatsiooni paranemist (de Witte et al., 2020, Giordano et al, 2022, Nguyen et l., 2023, Eckhouse et al. 2014, Chi et al., 2015, Bradt et al., 2013). 2  3.8. Kinnitus sekkumise juhendi olemasolu kohta (lisada näidis või kirjeldus): Lisatud fail – Lisa 3. MBRI protokoll 3.9. Varasem rakendamine (rakendamise maht ja kestus): MBRI on rakendatud siiani muusikaterapeutide poolt nii lühisekkumisena, sotsiaalses rehabilitatsioonis, tööalases rehabilitatsioonis kui haiglaravis. Kuna eraldi ei ole mõõdetud sekkumise mahtu, siis seda välja tuua on keeruline. Samas on nii sotsiaalses rehabilitatsioonis kui KOV vaimse tervise teenustena loovteraapiad üheks enimkasutatud teenuseks, mistõttu võib väita, et sekkumist on rakendatud olulises mahus. 3.10. Tagasiside kogumise viis: Eraldiseisvalt ei ole sekkumise osas tagasisidet kogutud vaid tulemusi on mõõdetud kõigi kliendile võimaldatud sekkumiste kogumine. Edaspidi saab VIPS rakendamisel mõju mõõtmisel kasutatakse EEK-2 või WHO-5 heaolu indeks (enne ja pärast). Mõlemad hindamismeetodid on valideeritud ning sobilikud sihtgrupile (Allgaier et al, 2012; Streimann et al. 2021). 4. Nimetus: Vibroakustilise teraapia 4.1. Lühikirjeldus (sh metoodiline alus): Vibroakustiline teraapia (VAT) on ravimeetod, mille puhul kasutatakse madalasageduslikke siinushelisid vahemikus 30–120Hz kombineerituna muusikaga (Rüütel, 1998a). Tänapäeval on madalsagedusega helivibratsiooniteraapia üks muusikateraapia rakendusi, mida praktiseeritakse kogu maailmas. Rüütel (1998a) toob välja, et vibroakustilises teraapias kasutatav muusika on reeglina mahe, improviseeritud ja ilma rõhutatud rütmita. VAT sekkumise ajal kasutatakse juhendatud relaksatsiooni samaaegselt muusikaga. Kliinilises praktikas ja teadusuuringutes kasutatakse tüüpprotokolli: Eesmärgistamine (2–5 min), Lõõgastusinduktsioon (5–10 min), Muusikapõhine lõõgastus (15–25 min), Refleksioon (5–10 min) 4.2. Sihtrühm (vanuserühm jne): 15-64 4.3. Piirkond: Saaremaa, Rapla maakond 4.4. Formaat (individuaal, grupi, kombineeritud): individuaalne 4.5. Struktuur (seansside arv, ühe seansi kestus minutites, grupisekkumiste korral inimeste arv grupis): 8-10 korda sagedusega 1-2 korda nädalas, kestvus 45-60 minutit. 4.6. Vorm (kohapeal, veebis jne): kohapeal 4.7. Tõenduspõhisus (viidata uuringutele, rahvusvahelisele kasutusele; lisada viited või allikad: Teadusuuringutes on tõendatud VAT sekkumiste abistavat mõju nii ühekordse sekkumise korral (Kantor et al, 2022, Bergström-Isacsson et al, 2007) kui ka pikemate sekkumiste võimaldamisel (Sigurdardóttir et al, 2019; Ahonen, Deek, Kroeker, 2012; Rogers et al, 2007; Leandertz et al, 2021, Skille ja Wigram, 1995; Rüütel ja Vinkel (2011). Bartel ja Mosabbir (2021) metanalüüs toob ulatuslikult välja uurimistööde rohkuse helivibratsiooni kasutamisel füsioloogilisest, neuroloogilisest ja biokeemilisest mõjust, sh 40Hz kasutamisest. Lõõgastustehnikad koos juhitud kujutlustega on osutunud tõhusaks valu, ärevuse, depressiooni ja ravimite kasutamise vähendamisel (Tusek et al, 1997) nii täiskasvanutel kui lastel (Álvarez-García ja Yaban, 2020) ning seda eriti juhul, kui muusika ja juhitud kujutlust kasutatakse VAT sekkumise ajal (Alam et al, 2016). Sigurdardóttir et al (2019) uuringus oli 18 depressiivset klienti vanuses 18–70 a, kellele võimaldati tavapärasele depressiooniravile lisaks 3–4 nädala jooksul kaheksa 20 minutilist VAT seanssi koos muusikaga. Uuringus oli ka 20 liikmega kontrollgrupp, kes sai tavapärast depressiooniravi. Tulemusena leiti, et võrreldes kontrollgrupiga oli VAT sekkumist saanud patsientide depressioon vähenenud oluliselt rohkemal määral kui kontrollgrupis. Tegemist on ühe kvaliteetseima uuringuga viimastel aastatel, mis valideerib VAT ravi depressiooniravis. Ahonen, Deek, Kroeker (2012) viisid samuti läbi uuringu hindamaks VAT mõju stressi korral. 10 3  muusikavaldkonna üliõpilasega (vanuste vahemikkus ei ole esitatud) uuringus oli sekkumise pikkuseks 30–60 minutit sõltuvalt osaleja vajadustest, sekkumiste arv oli 6–8 seanssi ning kasutati sagedusi vahemikus 27–113Hz. Uuringu tulemusel nenditi, et sekkumisgrupil suurenes subjektiivne heaolutunne (füüsiline ja emotsionaalne lõõgastus, vähenenud valu ja stress, suurenenud emotsionaalne võimekus ja kontsentreerumine). Kantor et al (2022) uurisid ühekordse VAT ja muusika sekkumise mõju 22 akuutsete stressinäitajatega ülikooli üliõpilasega, vanuses 18–40. a. Kasutatud sagedus sekkumisgrupis oli 0–100Hz ning seansi pikkus kuni 50 minutit. Uuringus oli ka 28 osalejaga kontrollgrupp, kes kuulas sekkumisgrupiga sama muusikat kuid ilma madalsagedusliku vibratsioonita. Stressinäitajatena kasutati pulsi sagedust, stressiga seotud valu (hindamise mõõdik Visual analogue scales) ja lihaste lõdvestust. Selle pilootuuringu tulemused näitasid, et madala sagedusega heli võib kasutada stressijuhtimise vahendina hariduskeskkonnas, nt ülikoolis. Leiti, et madala sagedusega heli suurendab parasümpaatilise närvisüsteemi aktiivsust ning toetab subjektiivse stressireaktsiooni ja lihaspingete leevendamist. Soomes asub meetodi arendamise eestvedaja (https://www.vibrac.fi/vibroacoustic-therapy/ ) ning Soomes rakendatakse VAT rehabilitatsioonis muusikateraapia teenuse raames. Teadustöid on rohkelt kajastatud ka Next Wave Physio veebilehel. 4.8. Kinnitus sekkumise juhendi olemasolu kohta (lisada näidis või kirjeldus): VAT protsess on kirjeldatud Rüütel et al (2004). Sekkumise protokoll lisatud failina – „Lisa 2. VAT seansi struktuur_TLÜ VAT laboris“ ning Lisa 4 – VAT protokoll, Skille-Wigram mudel. 4.9. Varasem rakendamine (rakendamise maht ja kestus): VAT on rakendatud siiani muusikaterapeutide poolt nii lühisekkumisena, sotsiaalses rehabilitatsioonis kui haiglaravis. 4.10. Tagasiside kogumise viis: mõju mõõtmisel kasutatakse EEK-2, ESDS-6, NRS. Mõõtmisvahendid on toodud kompaktsena Rüütel 2002; Rüütel et al, 2004; Viil. S., 2023. 5. Kavandatud maht 5.1. Seansside koguarv toetusperioodil: 789 5.2. Teenusesaajate arv: 155 (95 individuaalselt ja 60 gruppides) 5.3. Keskmine seansside arv ühe teenusesaaja kohta: 5,1 5.4. Maht piirkondade kaupa: Saaremaal 35 individuaalselt ja 20 grupis, Raplamaal 60 individuaalselt ja 40 grupis 5.5. Sihtrühmani jõudmise ja suunamise kanalid: sotsiaalmeedia, KOV teavituskanalid (KOV ajaleht, osavaldade ajalehed Saaremaal), Raplamaal Raplamaa Sõnumite podcast, perearstid ja sotsiaaltöötajad 6. Meeskond ja rakendusvõimekus 6.1. Spetsialistide arv (vähemalt 5, lisada viie inimese info allolevasse tabelisse): Ees- ja perekonnanimi Haridus (eriala, kraad) Lepingu (nt töö-, töövõtu- või käsundusleping) sõlmimise kuupäev Siiri Viil Terviseteaduste magister, loovteraapia kutse 10.2019 7, pereterapeut, kogemusnõustaja Kaili Inno Terviseteaduste magister, loovteraapia kutse 1.7.2025 7, pereterapeut, suprviisor Kadi Uibo Muusikapedagoogika magister, 28.6.2025 muusikaterapeut Epp Sussen Terviseteaduste magister, loovteraapia kutse 15.12.2023 7 4  Liisi-Katarina Verk Lõpetamas Tallinna Ülikoolis sotsiaalse 12.3.2026 rehabilitatsiooni BA, varasem kogemus sotsiaaltöötajana ning juhtumikorraldajana Ave Verk Sotsiaalpedagoogika magister, pereterapeut 1.7.2025 (superviseeritav) Laima Parik Psühholoogia magister, loovterapeut 1.7.2025 6.2. Spetsialistide kvalifikatsioon: spetsialistid, kes muusikateraapia sekkumisi rakendavad on kõik asjakohase baasharidusega ning kogemustega vaimse tervise valdkonnas. Kõik töötavad igapäevaselt klientidega. 6.3. Superviisorite arv ja kvalifikatsioon: Superviisor Kaili Inno (loovterapeut kutse 7) 6.4. Supervisiooni sagedus ja korraldus: grupi supervisioonina vähemalt kord kvartalis. Individuaalse supervisioonina vastavalt vajadusele. 6.5. Riskijuhtimise plaan: Keskus on tegutsenud aastaid ning meie meeskond on laiem kui taotluses välja toodud. Seega on risk, et teenuseosutajal tekib personali puudus, väike. Seadmed VAT osutamiseks on olemas ning vajadusel on olemas võimekus ka soetada seadmeid juurde. Samuti on muusikateraapiliste lühisekkumiste osutamiseks vajalikud töövahendid olemas. Ruumid on keskusel olemas nii Raplas kui Saaremaal (Orissaares ja Kuressaares). Teenuse järjepidevuse tagamiseks on keskusel piisaval arvul spetsialiste, kes on kvalifitseeritud teenuseid osutama. Teenuse kättesaadavuse osas informatsiooni jagamisel kasutatakse kohalikke tervishoiu- ja sotsiaalvõrgustikke, sotsiaalmeediat, haridusvaldkonna asutusi, valdkonnas elanikke koondavaid MTÜsid. Samuti on mõlemas piirkonnas TERVIK ettevalmistuseks loodud koostöömudelid, mille kaudu informatsiooni teenuse olemasolust on võimalik jagada. 6.6. Kinnitus metoodika kasutusõiguse kohta: Kinnitame õigust metoodikaid rakendada. Spetsialistid on väljaõppe läbinud 7. Ühe seansi maksumuse ja kulude põhjendus 7.1. Ühe seansi maksumus (koos seansi formaadiga, kui sama taotlus/VIPS sisaldab erinevaid formaate): MTMI 45-60min 90eur; grupp 90 min 200eur. MBRI 30 min 60eur; grupp 60 minutit 170eur. VAT 60min 70eur 7.2. Keskmine kulu ühe teenusesaaja kohta: 403,55 eur 7.3. Seansi maksumuse struktuur – esitada kulude jaotus, sh tööjõukulud, supervisioon, koolitus, koordineerimine, litsentsi- ja platvormikulud ning kaudsed kulud (kuni 7% taotletava toetuse üldmahust): üldkulud (ruumid, vahendid, taristukulud) 28,24 spetsialisti tööjõukulud 262,24 supervisioonifond 40,34 REHA litsensikulu 4,8 koordineerimine 67,82 kokku 1 teenusesaaja keskmine kulu 403,44 8. Koolitustegevused (vajaduse korral) 8.1. Koolituste kirjeldus ja maht (tundides): 8.2. Koolitatavate spetsialistide arv: 8.3. Koolitatavate superviisorite arv: 8.4. Seos kavandatud rakendamisega ja proportsionaalsuse põhjendus: 8.5. Koolituskulude kogusumma (eurodes) ja osakaal toetuse eelarvest (%): 5 9. Selgitus, kuidas kavandatav tegevus aitab tervikuna suurendada VIPS-i rakendamise võimekust Eestis (nt spetsialistide ettevalmistus, sekkumise kättesaadavus, rakendamise maht või organisatsiooniline suutlikkus). Muusikateraapia lühisekkumiste laiem rakendamine loob laialdasemad võimalused klienditele, kellel on raskendatud verbaalne eneseanalüüs või väljendus. Samuti toovad loovteraapia meetodid nähtavale alateadvusest selle, mida inimene ise ei oska sõnastada. Piisava ja asjakohase täiendõppe korral on võimalik neid sekkumisi laiapõhjaliselt rakendada alates koolieelsetest lasteasutustest kuni elukaare lõpufaasis olevatele inimestele. Eeldus väljaõppe läbimiseks on varasem muusikaga kokkupuude (nt muusikaõpetajad, laste muusikakoolis käimine, individuaalne pilliõpe vms). Perspektiivis näeme 2027 koolitusprogrammi koostamist ja väljeõppe võimaluse pakkumist spetsialistide väljaõppeks mahus 50- 60h sh praktika, mille järel on võimalik taotluses toodud sekkumisi uutel spetsialistidel rakendada. Õppekava eelnõu on meil koostamisel ning pädevused koolitust läbi viia olemas sh koolitustegevuse kogemus. Leiame, et muusikateraapia lühisekkumiste kättesaadavuse suurendamisel vähendab see ühiskonnas uskumust, et ainult kliiniline psühholoog ja psühhiaater on mõjusad vaimse tervise abivahendid ning keskendumine kahele piirkonnale, mis ei ole nn keskused, tooma kvaliteetsed teenused elanikkonnale kogukonnas kättesaadavaks laiendades sellega elanikkonna ja sihtrühmade kaetust vaimse tervise teenustega. VAT – lühisekkumisena rakendatav kogu elukaare ulatuses ning selle lühisekkumisena rakendamiseks on uutele spetsialistidele vajalik VAT väljaõpe kättesaadav VIBRAC I mooduli veebikoolitusena1 või Eestis kohapealse koolitusena (koolitaja pädevus Ivar Vinkel’l). Vajalikud seadmed on võimalik ühekordse ostuga hankida ning nende hinnaskaala on erinev vastavalt sekkumise pakkuja võimalustele. Seadmete osas on olemas nii väikesed kaasaskantavad seadme, kaasaskantavad madratsid kuni püsival asukohaga voodid. Nt Next Wave Physio (Soome tootja), Multivib (Norra tootja), Vibracare. Üheks võimaluseks on VAT rakendada ka koolides ja lasteaedades, kus on loodud eraldi sensoorsed ja/või nn rahunemistoad. Seega perspektiivis spetsialistide ettevalmistuse korraldus on lihtne ja ei ole kulukas ning sekkumine saab olla kättesaadav nii kogukonna teenusena kui haridus- ja sotsiaalasutustes kohapeal. Kinnitused Kinnitan, et esitatud andmed on õiged ning vastan määruses sätestatud nõuetele. Kinnitan, et taotluses esitatud kulude katteks ei ole saadud ega taotleta toetust Euroopa Liidu fondidest, riigieelarvest ega muudest avaliku sektori vahenditest. /digitaalselt allkirjastatud/ Siiri Viil Viited • Alam, M., Roongpisuthipong, W., Kim. N. A., Goyal. A., Swary. J. H., Brindise, R. T., Iyengar.S., Pace, N., West. D. P., Polavarapu, M. & Yoo. S. (2016). Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. Journal of the American Academy of Dermatology, 75(3), 585–589. https://doi.org/10.1016/j.jaad.2016.02.1143 • Ahonen H. , Deek, P., & Kroeker, J. (2012). Low frequency sound treatment promoting physical and emotional relaxation qualitative study. International Journal of Psychosocial Rehabilitation. International Journal of Psychosocial Rehabilitation, 17(1), 45–58 Rogers et al, 2007; 1 https://www.vibrac.fi/vibrac-webinar-level-i/ Koolitus sisaldab baasteadmisi madalsagedusliku heli kasutamisest, VAT lähenemistest, meetoditest, sagedustest, terapeutilise suhte loomisest, keha tajust, muusika kasutamisest, tulemuste hindamisest, terapeudi vastutusest ning kasutatavate seadmete ja juhtumite näidetest. 6 • Álvarez-García, C. & Yaban, Z.S. (2020). The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complementary Therapies in Clinical Practice, 38, 101077. https://doi.org/10.1016/j.ctcp.2019.101077 • Bartel, L., Mosabbir, A. (2021). Possible Mechanisms for the Effects of Sound Vibration on Human Health. Healthcare (Basel). 18;9(5), 597. https://doi.org/10.3390/healthcare9050597 • Bergström-Isacsson, M., Julu, P.O.O. & Witt-Engerström, I. (2007). Autonomic Responses to Music and Vibroacoustic Therapy in Rett Syndrome. Nordic Journal of Music Therapy, 16(1), 42–59. https://doi.org/10.1080/08098130709478172 • Bradt, J., Dileo, C., Magill, L., & Teague, A. (2016). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, (8), CD006911. https://doi.org/10.1002/14651858.CD006911.pub3 • Bradt, J., Dileo, C., & Potvin, N. (2013). Music interventions for improving psychological and physical outcomes. Cochrane Database of Systematic Reviews. • Chi, G. C. H., et al. (2015). Effects of music relaxation on anxiety: A randomized controlled trial. Journal of Research in Nursing, 20, 129–144. • Eckhouse, D. R., et al. (2014). Effects of music and relaxation interventions on anxiety: A randomized controlled trial. Orthopaedic Nursing, 33, 342–351. • de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. J. J. M. (2020). Effects of music interventions on stress-related outcomes: A systematic review and two meta-analyses. Health Psychology Review, 14(2), 294–324. https://doi.org/10.1080/17437199.2019.1627897 • de Witte, M., Pinho, A. S., Stams, G. J. J. M., Moonen, X., Bos, A. E. R., & van Hooren, S. (2022). Development of a music therapy micro-intervention for stress reduction. The Arts in Psychotherapy, 77, 101873. https://doi.org/10.1016/j.aip.2021.101873 • de Witte, M., Pinho, A. d. S., Stams, G.-J., Moonen, X., Bos, A. E. R., & van Hooren, S. (2022). Music therapy for stress reduction: A systematic review and meta-analysis. Health Psychology Review, 16(1), 134–159. https://doi.org/10.1080/17437199.2020.1846580 • Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., Vanhala, M., & Gold, C. (2011). Individual music therapy for depression: Randomised controlled trial. The British Journal of Psychiatry, 199(2), 132–139. https://doi.org/10.1192/bjp.bp.110.085431 • Giordano F, Losurdo A, Quaranta VN, Campobasso N, Daleno A, Carpagnano E, Gesualdo L, Moschetta A, Brienza N. Effect of single session receptive music therapy on anxiety and vital parameters in hospitalized Covid-19 patients: a randomized controlled trial. Sci Rep. 2022 Feb 24;12(1):3154. DOI: 10.1038/s41598-022-07085-8 • Gold, C., Solli, H. P., Krüger, V., & Lie, S. A. (2009). Dose–response relationship in music therapy for people with serious mental disorders: Systematic review and meta-analysis. Clinical Psychology Review, 29(3), 193–207. https://doi.org/10.1016/j.cpr.2009.01.001 • Kantor, J., Vilímek, Z., Vítězník, M., Smrčka, P., Campbell, E. A, Bucharová, M., Grohmannová, J., Špinarová, G., Janíčková, K., Du, J., Li, J., Janátová, M., Regec, V., Krahulcová, K. & Kantorová, L. (2022). Effect of low frequency sound vibration on acute stress response in university students-Pilot randomized controlled trial. Frontiers in Psychology. Oct 13:980756. doi:10.3389/fpsyg.2022.980756 • Leandertz, M., Joukainen, J., Pesonen, T. & Ala-Ruona, E. (2021). Psychotherapeutically Oriented Vibroacoustic Therapy for Functional Neurological Disorder: A pilot study. Music & Medicine. 13(1), 20–30. DOI: https://doi-org.ezproxy.tlu.ee/10.47513/mmd.v13i1.754 • Lee YJ, Kim SJ, Yoon J, Lee JH. Music therapy for patients with depression: systematic review and meta-analysis of randomised controlled trials. BJPsych Open. 2025 Sep 9;11(5):e201. doi: 10.1192/bjo.2025.10822 • Nguyen, T. K., Hoang, H., Bui, Q. V., & Chan, C. W. H. (2023). Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life: A randomized controlled trial. PLOS ONE. • Põld M, Kleinberg A, Koiduaru K, Jürisson M. (2024). Loovteraapiad laste ja noorukite psüühikahäirete ravis: tervisetehnoloogiate hindamise raport TTH69. Tartu: Tartu Ülikooli peremeditsiini ja rahvatervishoiu instituut. ISBN 978-9985-4-1427-9 • Rüütel, E. (1998a). Vibroakustiline teraapia: Teoreetilised lähtekohad ja rakendusvõimalused. Tallinna Pedagoogikaülikool. 7 • Rüütel, E., Ratnik, M., Tamm, E. & Zilensk, H. (2004). The experience of vibroacoustic therapy in the therapeutic intervention of adolescent girls. Nordic Journal of Music Therapy, 13(1): 33–46 https://doi.org/10.1080/08098130409478096 • Rüütel, E. (2002). The psychophysiological effects of music and vibroacoustic stimulation. Nordic Journal of Music Therapy, 11(1), 16–26. https://doi.org/10.1080/08098130209478039 • Rüütel, E. ja Vinkel, I. (2011). Vibro-acoustic therapy – research at Tallinn University. Miroslav, P (toim.). Art and science in life potential development, 42−44. Croatian Assosation for Sophrology, Creative Therapies and Arts-Expressive Therapies; University of Zagreb. • Sigurdardóttir, G. A., Nielsen, P. M., Rønager, J. & Wang, A. G. (2019). A pilot study on high amplitude low frequency–music impulse stimulation as an add-on treatment for depression. Brain Behavior. 9(10):e01399. doi: 10.1002/brb3.1399 • Skille, O. & Wigram, T. (1995). The effects of music, vocalization and vibration on brain and muscle tissue: Studies in vibroacoustic therapy. In T. Wigram, B. Saperston, & R. West (Eds.), The art & science of music therapy: A handbook. Chur, Switzerland: Harwood Academic Publishers. • Tusek, D., Church, J. M. & Fazio, V. W. (1997) Guided imagery as a coping strategy for perioperative patients. AORN Journal. 66(4), 644–649. https://doi.org/10.1016/S0001-2092(06)62917-7 • Viil, S (2023), Vibroakustilise teraapia sekkumistulemuste püsivus gümnaasiumiõpilaste depressiooni, ärevuse ja vaimse kurnatuse sümptomaatikas. Tallinna Ülikool https://www.etera.ee/s/44SmWN5Kmy 8  The Arts in Psychotherapy 77 (2022) 101872 Contents lists available at ScienceDirect The Arts in Psychotherapy journal homepage: www.elsevier.com/locate/artspsycho Development of a music therapy micro-intervention for stress reduction Martina de Witte a, b, c, d, *, 1, Anne Knapen b, Geert-Jan Stams a, Xavier Moonen a, e, Susan van Hooren d, e, f a Research Institute of Child Development and Education, University of Amsterdam, PO Box 19268, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands b HAN University of Applied Sciences, PO Box 6960, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands c Stevig, Expert Treatment Centre for People with Mild Intellectual Disabilities, PO Box 9, 6591 RC Gennep, The Netherlands d KenVaK, Research Centre for the Arts Therapies, PO Box 550, 6400 AN Heerlen, The Netherlands e Zuyd University of Applied Sciences, Faculty of Healthcare, PO Box 550, 6400 AN Heerlen, The Netherlands f Open University, Faculty of Psychology, PO Box 2960, 6401 DL Heerlen, The Netherlands A R T I C L E I N F O A B S T R A C T Keywords: Negative stress is a serious risk factor for the onset and progression of a wide range of physical illnesses and Music therapy emotional problems. In the literature, an increasing examination of music therapy interventions for stress Stress reduction over the past decade is seen, yet music therapy interventions for stress reduction have not been sys­ Arousal tematically developed and described. Moreover, there is a growing need for micro-interventions, which are defined Micro-intervention Literature Review as short-term interventions in which the therapist uses specific therapeutic techniques to work on a client’s goals. Delphi Method In this study, a music therapy micro-intervention for stress reduction was developed based on both empirical and practice-based knowledge. First, the micro-intervention was described based on both findings from empirical studies (N = 52) focused on the effects of music therapy on stress reduction, and from a previously conducted focus group study focused on the perspectives of music therapists. Second, the Delphi technique was applied to collect feedback on the micro-intervention described, by surveying a panel of 16 music therapy experts. This procedure resulted in an improved description of the music therapy micro-intervention for stress reduction, including a receptive and an active intervention variant. Implications for clinical practice and recommendations for future research are discussed. Introduction 2004). However, no specific music therapy intervention for stress reduction has yet been systematically described or protocolized. From a The negative impact of stress can be a serious risk factor for the onset scientific point of view, clear intervention descriptions are needed to and progression of a wide range of physical and emotional problems further investigate what is effective in music therapy interventions (American Psychological Association [APA], 2017; Australian Psycho­ (Hoffmann et al., 2014). logical Society [APS], 2015). It is well known that music can provide relaxation and calmness, which ensures that music therapy in­ The impact of stress terventions are increasingly used to reduce stress and enhance the well-being of clients across a variety of clinical populations (Agres et al., In daily life, almost everyone experiences stress from time to time. In 2021; Bainbridge et al., 2020; Juslin & Västfjäll, 2008; de Witte et al., the short term, stress can lead to reduced concentration and difficulty 2020). Several reviews show positive effects of music therapy in­ learning new information (The American Institute of Stress, n.d.). terventions on stress reduction (e.g. Bradt, Dileo, Magill, & Teague, Long-term stress can lead to psychopathology such as anxiety disorders, 2016; de Witte, da Silva Pinho et al., 2020; de Witte, Spruit et al., 2020; depression, addictions and burnout (Akin & Iskender, 2011; Pittman & Landis-Shack, Heinz, & Bonn-Miller, 2017; Martin et al., 2018; Pelletier, Kridli, 2011; Wang, Wang, & Wang, 2019), as well as to health issues, * Corresponding author at: Research Institute of Child Development and Education, University of Amsterdam, PO Box 19268, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands E-mail addresses: [email protected] (M. de Witte), [email protected] (A. Knapen), [email protected] (G.-J. Stams), [email protected] (X. Moonen), [email protected] (S. Hooren). 1 https://orcid.org/0000-0002-6385-9563. https://doi.org/10.1016/j.aip.2021.101872 Received 25 June 2021; Received in revised form 10 November 2021; Accepted 27 November 2021 Available online 1 December 2021 0197-4556/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 such as high blood pressure, cardiovascular disease, insomnia and an recognition that one-size-fits-all approaches to intervention may be increase or decrease in weight (Bally, Campbell, Chesnick, & Tranmer, suboptimal for the patient and healthcare system alike (Gauthier et al., 2003; Keech, Cole, Hagger, & Hamilton, 2020; Pittman & Kridli, 2011). 2017; Rush et al., 2004). Moreover, it is assumed that intervention ef­ To cope with stressors, millions of people around the world use tran­ fects are variable across patients both in magnitude and time (Cuijpers quilizing medications, which are associated with numerous contraindi­ et al., 2012; Kessler et al., 2017). This argues for the need to develop cations and negative side effects (e.g., Bandelow et al., 2015; Olfson, more flexible and more widely applicable interventions in accordance King, & Schoenbaum, 2015; Puetz, Youngstedt, & Herring, 2015). It is with the patient’s needs, such as micro-interventions. A music therapy therefore important to develop and examine promising micro-intervention can be regarded as a short part of a session in which non-pharmacological interventions for the prevention and management the music therapist uses specific therapeutic techniques or steps to work of stress, such as experiential approaches which focus on the “here and on specific patient’s goals (Hakvoort & van der Eng, 2020; Hakvoort, now” while guided by a therapist through stress responses and real-time 2020). Despite the fact that micro-interventions are short-lived, they emotional regulation. Through safely structured active experiences, have been systematically described and follow a step-by-step approach stress inducing situations can be co-navigated, and stress reducing based on both recent theoretical models as well as the latest scientific strategies can be developed and/or practiced (de Witte, Bellemans, evidence. Tukker, & van Hooren, 2017; de Witte, da Silva Pinho et al., 2020). The development of music therapy micro-interventions is important to music therapy practice, on the one hand because the way of inter­ Music therapy for stress reduction vening in micro-interventions is strongly linked to core components of music therapy, on the other hand because describing interventions helps Music therapists are specifically trained to use the unique qualities of to further develop the profession. As the level of a clients’ perceived music, also known as musical components, (e.g., melody, rhythm, stress can differ from session to session, it is important that music tempo, dynamics, pitch) in the therapeutic relationship to work on the therapists can respond directly to their clients’ stress levels, at the time it patient’s treatment goals (Bruscia, 1987; de Witte, da Silva Pinho et al., is needed in the specific context of that moment. This fits well with the 2020; Wheeler, 2015). During music therapy sessions, music therapists specific way of patient-therapist attunement widely used in music attune to the patient by adjusting the way of music-making as an im­ therapy and which can be seen as one of the main characteristics of mediate response to the client’s needs (Aalbers et al., 2019; Magee, 2019). music therapy. Therefore, short-term therapeutic interventions that This can be related to the term “synchronization,” meaning that the align easily with the existing structure of the session or clients’ musical music therapist and the patient interact simultaneously and are regu­ preferences are particularly suitable. Describing micro-interventions lated through time, yielding a similar expression in movement, match­ may also stimulate transferability of valuable clinical practices which ing pulse, rhythm, dynamics and/or melody (Aalbers et al., 2019; in turn may strengthen thinking about the relationship between clinical Bruscia, 1987; de Witte, da Silva Pinho et al., 2020; Schumacher & practice, theory, and research (Aigen, 1999; Smeijsters & Vink, 2006; Calvet, 2008). For example, the music therapist may influence patients’ Stige, 2015). perceived stress during musical improvisation by synchronizing with the patient’s music-making, subsequently changing the musical expression Purpose of the present study by playing slower and less loudly (de Witte, da Silva Pinho et al., 2020). This specific form of patient-therapist attunement is commonly used in In the literature, we have seen an increasing examination of music music therapy practice and refers to the so-called Iso Principle (e.g., therapy for stress reduction in the last decade (de Witte, Spruit et al., Altshuler, 1948; Heiderscheit & Madson, 2015). The literature shows 2020; de Witte, da Silva Pinho et al., 2020). In addition, there is a that the tempo and loudness are important for the experienced intensity growing need for music therapists to be more explicit about their’ tacit of the music (Gabrielsson & Lindström, 2010), and music with a slow knowledge in order to create more transferability in the way they work steady rhythm may provide stress reduction by altering inherent body on a client’s stress relief (see also: de Witte, Lindelauf et al., 2020). rhythms, such as heart rate (Thaut & Hoemberg, 2014; Thaut, Kenyon, Without these descriptions, music therapists face difficulties in reliably Schauer & McIntosh, 1999). Thus, the stress reducing effect of music implementing interventions in their clinical practices and researchers therapy interventions can be explained by music itself as well as the can experience difficulties replicating studies (Hoffmann et al., 2014). continuous attunement of music by the music therapist to the individual By developing a micro-intervention in this context, we are in line with needs of a patient. the recent developments in healthcare that emphasize the importance of There has been a rapid increase of research on the effects of music short-term and flexible therapeutic interventions in general. In addition, therapy on stress reduction. Results of a recent meta-analytic review (de the development of a micro-intervention is an important first step to­ Witte, da Silva Pinho et al., 2020), including 47 quantitative controlled wards achieving more insight into which specific therapeutic factors studies, showed an overall medium-to-large effect of music therapy on lead to change, which is becoming increasingly important in the field of stress-related outcomes (d = 0.723, [.51–0.94]). This is in line with music therapy research (de Witte et al., 2021). previous reviews and meta-analyses, which show positive effects of In order to provide a comprehensive analysis of music therapists’ music interventions on the reduction of stress or state-anxiety (Bradt & stress-reducing interventions, it is necessary to integrate the available Dileo, 2014; Bradt, Dileo, & Shim, 2013; Bradt, Dileo, Grocke, & Magill, practice-based knowledge. Published trials often demonstrate a lack of 2011; Bradt, Dileo, Potvin et al., 2013; Carr, Odell-Miller, & Priebe, transparency in reporting detailed information on the content of the 2013; de Witte, Spruit et al., 2020; Gold, Solli, Krüger, & Lie, 2009; music therapy interventions (Aalbers et al., 2019; Robb, Carpenter, & Kamioka et al., 2014). Burns, 2011). This is also evident in the recent meta-analysis by de Witte, da Silva Pinho et al. (2020) in which the included studies mainly The need for music therapy micro-interventions examined receptive (music listening) interventions, whereas in daily practice music therapists prefer to use active (music making) in­ In music therapy literature, the term “intervention” may refer to both terventions to reduce their clients’ stress (de Witte, Lindelauf et al., a specified therapeutic action and a process of intervening characterized 2020). In addition, developing a music therapy micro-intervention by a structured and coherent collection of therapeutic actions (Aalbers through an iterative process aimed at integrating theory-based, evi­ et al., 2019; de Witte, Lindelauf et al., 2020). Music therapy in­ dence-based, and practice-based knowledge is consistent with how other terventions may thus vary from one single technique or action within a creative arts therapy interventions have been successfully developed (e. single music therapy session to therapy programs or protocols consisting g., Aalbers et al., 2019; Bellemans et al., 2018; Haeyen, van Hooren, of multiple therapy sessions. In the last decade, there has been a growing Dehue, & Hutschemaekers, 2017). The main purpose of the present 2 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 study is therefore to provide a detailed description of a music therapy intervention were selected. See De Witte, da Silva Pinho, et al. (2020) for micro-intervention for stress reduction, which can be used directly by more information about the applied search strategy and selection music therapists as well as provide a clear basis for future research. criteria; an overview of the characteristics of the 52 studies included in our study can be found in the Supplemental materials. Method We then analyzed the extracted intervention descriptions using the coding principles of qualitative content analysis, which is frequently In this study, two developmental phases can be distinguished, applied to answer questions such as what, why, and how, whereby the namely, (a) describing the micro-intervention by analyzing and inte­ common patterns in the data were deduced using a consistent set of grating the perspectives from both literature and clinical practice, and codes to organize text into identified categories of similar meanings (b) consulting experts in the field of music therapy to reach consensus on (Cho & Lee, 2014; Moretti et al., 2011). To first gain more insights into the content and application of the micro-intervention developed. See how the initial data related to the particular sections of the format for Fig. 1 for the procedural diagram of the method of the current study. the micro-interventions described by Hakvoort and van der Eng (2020), the open codes were grouped into “interventions and methods”, Phase 1: the development of the micro-intervention “non-musical interventions”, “preconditions”, “instruments and genres”, and “treatment goals”. Open codes either identical or very similar to We used a recently developed format by Hakvoort and van der Eng each other were then grouped, such as “patient chooses song”, “patient (2020) to describe the micro-intervention as this was particularly selects songs” and “patient chooses music”. If a code could not be designed for describing music therapy micro-interventions. The use of merged with others, we left it separate. This axial coding step led to the this format ensures a comprehensive and detailed description and en­ categorization of codes based on their overarching similarities to prop­ courages a grounded scientific rationale. The format consists of several erty levels (Corbin & Strauss, 2008). sections that must be described, such as specification of the target group, treatment domains, function of music, requisites, therapeutic attitude, the scientific / theoretical foundation, and a stepwise description of the Integrating practice-based data micro-intervention. After the analysis of intervention descriptions, the next step was the Describing the rationale examination of practice-based knowledge, as outcome studies do not always reflect clinical practice in all its facets. For this purpose, we used To describe a theoretical rationale for the use of the music therapy an existing dataset of a previous qualitative study. The aim of this micro-intervention, we needed both to clearly understand the problem particular study was to gain insights into how music therapists reduce of stress as well as a framework for how music therapy leads to stress their clients’ stress, especially in people with mild intellectual disabil­ reduction. To make both the origins and consequences of stress more ities. It consisted of three focus groups held in three different countries concrete, we searched for literature in common online databases.2 To in which 13 music therapists participated (see de Witte, Lindelauf et al., provide a theoretical framework on the relationship between music and 2020). The data from this study was transcribed and open coded by stress, we mainly used the rationales of two recent meta-analytic reviews topic. The topic “interventions used within the music” proved particu­ on the effects of music interventions and music therapy on stress-related larly relevant for purposes of the present study. The open codes were outcomes (de Witte, Spruit et al., 2020; de Witte, da Silva Pinho et al., extracted and then added to the initial categories that emerged from the 2020). Both studies can therefore be regarded as providing key input to analysis of the intervention descriptions from the literature. describing the scientific rationale for the micro-intervention. In addi­ tion, the introductory sections of the empirical studies on the effects of music interventions on stress included in the analysis of this study, were Analysis of combined data screened for additional theoretical background information. Due to the differing amounts of data, the categories consisting of Analyzing Intervention Descriptions based on Literature either at least 4 codes from intervention descriptions from the empirical literature or at least 2 codes from the practice-based data were included The following step involved analyzing the intervention descriptions of as an intervention component. The categories formed by practice-based 52 empirical studies examining the effects of music therapy in­ codes only were counted twice compared to those from the literature. terventions on stress-related outcomes to create a solid basis for the Selective coding was then applied to create an integrated model in content of the micro-intervention. The majority of the studies (n = 47) which those categories of intervention components could be linked to correspond to those included in the recently performed meta-analysis by each other to interpret the steps of the micro-intervention (Charmaz, de Witte, da Silva Pinho et al. (2020). The primary aim of this earlier 2003). To minimize possible bias on the part of the researcher who study was to demonstrate the overall effect of music therapy in­ analyzed the data, the entire process of data analysis was continuously terventions on stress-related outcomes, in which a detailed analysis of monitored by two co-authors (SH and MDW) and decisions were made in the interventions examined was not taken into account. In this study, we consensus to ensure that the confirmability criteria were met. therefore provide an in-depth analysis of particularly the content of the music therapy interventions examined. Five studies were initially excluded in the meta-analysis due to lack of quantitative data, however, Description of the micro-intervention we included them for the purpose of our study. The included studies concerned both clinical controlled trials (CCT) and randomized Based on the analyzes of the empirical literature and the qualitative controlled trials (RCT) conducted in medical and mental health care data, the micro-intervention was described following Hakvoort and van settings, examining the effects of music therapy interventions on phys­ der Eng (2020), consisting of a theoretical rationale, intervention goals, iological and/or psychological stress-related outcomes. Only those type of setting, treatment phase in which it can be applied, and con­ studies in which a trained and qualified music therapist offered the traindications. In order to further shape the specific intervention con­ tent, we used the integrated model of intervention components that emerged from data analysis. To establish consensus on the summarized 2 PubMed, PsycINFO, Web of Science, Wiley Online Library, ScienceDirect narratives, we organized a final member check of a subgroup of the and Google Scholar research team (MdW, AK, SvH). 3 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 Fig. 1. Procedural diagram of the method. Phase 2: expert consultation questionnaire was focused on all sections of the described micro- intervention. For each topic, the level of agreement could be indicated In the second phase, the Delphi technique was applied in order to with a four-point scale. In addition, the participants could add com­ arrive at a group opinion by surveying a panel of experts, and to reach ments in each section, e.g. on reason of disagreements, new suggestions, consensus through an iterative process of collecting feedback (Linstone and other feedback. In addition, the questionnaire included questions on & Turoff, 1975; McMillan et al., 2016; Skulmoski et al., 2007). As in the participants’ professional background to gain more insights into other studies, we used a modified Delphi technique to better fit the ob­ their individual perspectives. The amount of agreement was calculated jectives of the current study (Mullen, 2003; Wheeler et al., 2019). One of for each section. All suggestions and comments were listed in a file and the modifications is that we did not use measures of central tendency analyzed by content. Then, every suggested change from the original and dispersion of the rankings by the respondents, which is usually re­ micro-intervention description was discussed (MdW, AK, SvH) and de­ ported in Delphi studies. Although the first consultation round collected cisions were made in consensus with each other. This procedure resulted individual rankings, the second round was sent by e-mail to check in a renewed and improved description. whether the adjustments made met respondents’ expectations. There­ fore, calculating central tendency and dispersion was not feasible in the The second consultation round present study (see also Wheeler et al., 2019). Another modification concerns the use of a structured questionnaire to obtain focused feed­ For the second consultation round, the adapted version of the micro- back from the respondents. Because the present study was designed to intervention was sent again to the participants with a brief summary of consult music therapists to strengthen the description of the the processed feedback and suggestions. They were asked to respond micro-intervention, rather than to develop the intervention as a whole, a within two weeks if they disagreed with aspects of the new version of the modified Delphi technique best suited our purposes. micro-intervention. Participants Results Participants were sixteen music therapists and researchers in the The first phase: the development of the micro-intervention field of music therapy. All had at least eight years of working experience as a music therapist. Six of them had already participated in one of the Describing the rationale focus group interviews from our recent qualitative study (de Witte, Lindelauf et al., 2020). Ten participants were recruited through the in­ Identifying the problem of stress. In the short term, it is known that the ternational network of music therapists and researchers associated with negative impact of stress can lead to reduced concentration and diffi­ Kenvak – a research center for arts therapies (www.kenvak.nl). Selected culties when learning and memorizing new information (Schwabe & participants were located in four different countries, namely Belgium, Wolf, 2010). As a result, working on treatment goals when the client is Germany, the Netherlands and the United States. All participants gave experiencing stress will be less effective and inefficient (de Witte, Lin­ informed consent and anonymity of the participants was ensured, both delauf et al., 2020). It is therefore important to first reduce stress and among the included participants and the researchers who analyzed the tension so that the client is able to focus on the initial treatment goals. data. An overview of related health consequences of both long term and short term stress are described in the introduction of this study. A leaner The first consultation round narrative of this information is described in the format of the micro-intervention at “Specific domain that is targeted or treated” (see An online questionnaire3 (available in Dutch and English) along with Table A.1 in Appendix). the described micro-intervention was sent to the experts. The Clarifying the stress-reducing effect of music interventions. Both music listening and music making/singing have been associated with a 3 The questionnaire can be requested from the first author. reduction of physiological arousal which increases during stress; this is 4 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 visible in a reduction of cortisol levels or decrease in heart rate and music therapists mainly use many active interventions (14 in­ blood pressure (e.g. Hodges, 2011; Koelsch et al., 2016; Kreutz, Murcia, terventions) and few receptive interventions (one mentioned) for stress & Bongard, 2012; Linnemann, Ditzen, Strahler, Doerr, & Nater, 2015; reduction. The active interventions included musical improvisation, Nilsson, 2009). In addition, a large body of neuroimaging studies show playing existing music, songwriting, recording own music, and singing that music can influence stress-related emotional states by modulating mantras or preferred songs. In addition, data showed that the following activity in brain structures, such as the amygdala, that are known to be therapeutic techniques are most often used to reduce a client’s stress: involved in emotional processes (e.g. Blood & Zatorre, 2001; Hodges, synchronization, pacing, structuring, increasing and decreasing dy­ 2011; Koelsch, 2015; Levitin, 2009; Moore, 2013; Zatorre, 2015). An namics and tempo, repeating themes, simple musical structures, and increased dopamine activity in the mesolimbic reward brain system has using familiar instruments and songs. The first coding step resulted in 33 been shown to be associated with feelings of happiness in response to categories and remaining single codes. listening to favorite/own-preferences music (e.g., Blood & Zatorre, 2001; Salimpoor et al., 2013; Salimpoor, Benovoy, Larcher, Dagher, & Analysis of the combined data Zatorre, 2011; Zatorre, 2015). Plausible explanations for the positive effects of music interventions The final analysis resulted in a total of 14 categories of intervention on stress, can also be sought in psychological and behavioral oriented components, which we present in order of the total number of codes scientific theories. Listening to pleasant music may have a positive in­ counted: music based on preferences (10), patient chooses song (7), fluence on emotional valence, which can be explained by the degree of expressing emotions (5), recording music (4), patient chooses intervention attraction that an individual feels towards a specific object or event (4), therapist chooses intervention (4), verbal processing of emotions (4), (Jäncke, 2008; Juslin & Västfjäll, 2008). Music experienced as pleasant using familiar songs (4), music based on emotional state (4), accelerating increases the intensity of emotional valence (the felt happiness), which tempo (4), keeping appropriate physical distance (4), simplicity in harmony has a stress-reducing effect (Jiang, Rickson, & Jiang, 2016; Rohner & (4), slowing down tempo (4), and lower register (4). These intervention Miller, 1980; Sandstrom & Russo, 2010; Witvliet & Vrana, 2007). components formed input for the further design of the micro- Listening to music can also provide direct distraction from stressful intervention. feelings or thoughts (Bernatzky, Presch, Anderson, & Panksepp, 2011; Chanda & Levitin, 2013). Research that shows the benefits of music to Description of the micro-intervention distract people from aversive states is supported by short-term music interventions for acute stress reduction (de Witte, Spruit et al., 2020; The next step was to describe the music therapy micro-intervention Fancourt, Ockelford, & Belai, 2014; Linnemann et al., 2015). Lastly, in detail. Information on the theoretical background of the problem of music listening or music making together with others is also related to stress and the rationale for using music interventions to lower people’s stress relief (Juslin, Liljeström et al., 2008). This can be explained by the stress levels were added in the format for music therapy micro- fact that people synchronize with each other during music activities interventions (Hakvoort and van der Eng, 2020). Then, the interven­ which evokes feelings of togetherness and social cohesion during the tion goal, the target population and field, possible contra-indications, music experience (Boer & Abubakar, 2014; Linnemann, Strahler, & requisites, and specification of the setting, were supplemented. In Nater, 2016). This in turn may be explained by the release of the neu­ order to remain as close as possible to the results of the data analysis, we rotransmitters endorphin and oxytocin (e.g., Dunbar, Kaskatis, Mac­ described both an active and a receptive variant of the music therapy Donald, & Barra, 2012; Freeman, 2000; Tarr, Launay, & Dunbar, 2014; micro-intervention. This allows music therapists to choose the variant Weinstein, Launay, Pearce, Dunbar, & Stewart, 2016), which are posi­ that best suits the client’s needs and possibilities at that moment. tively associated with the defensive response to stress (e.g. Amir, Brown, Because the micro-intervention is specifically designed to directly & Amit, 1980; Dief, Sivukhina, & Jirikowski, 2018). A short narrative of reduce the client’s stress, i.e., in the music therapy session itself, the these findings is presented in the format of the micro-intervention at intervention goal was formulated as follows: “reducing tension and “Function of music during the intervention” (see Table A.1 in the stress directly in the music therapy session”. We consider the micro- Appendix). intervention as transdiagnostic and therefore it does not only relate to the treatment of one specific condition or disorder. However, as research Analysis of the interventions from literature shows that some client populations are more vulnerable to stress, such as people with mild intellectual disabilities or those with impaired cogni­ Some of the included studies only offered limited descriptions of the tive functions (e.g., Emerson, 2003; Scott & Havercamp, 2014), we examined intervention, whereas others offered detailed and rich inter­ expect that the music therapy micro-intervention might be particularly vention descriptions or even intervention protocols. However, each suitable for these client groups. Precisely because of this broad appli­ intervention description led to one or more open codes. Intervention cability and the fact that we developed two variants, there were no descriptions showed both receptive interventions (n = 22), such as contra-indications. However, clients with severe autism, severe intel­ listening to live or pre-recorded music, as well as active interventions lectual disabilities, or clients suffering from acute psychosis are expected (n = 10), such as improvisation, playing existing songs, and song­ to have difficulty participating because of their reduced ability to be in writing. A combination of both receptive and active interventions was contact with the therapist. The main prerequisites for applying the found in 20 of the intervention descriptions. In addition, in 20 of the micro-intervention include a sound-isolated room (especially in clinical studies, a complementary intervention/technique was offered along settings), chairs for the client(s) and music therapist, access to a suffi­ with music therapy, such as breathing exercises, muscle relaxation, and cient selection of musical instruments (active variant), and sheet music mindfulness exercises. In 38 intervention descriptions, the specific use of of the client’s preferred music (receptive variant). Furthermore, the music (musical instruments or singing) was reported. Singing was micro-intervention can be applied both individually and in groups. See mentioned in most studies (n = 28), followed by percussion instruments the Appendix for more details of the abovementioned content of the (n = 21), guitar (n = 15), and piano (n = 10). After the open coding micro-intervention. step, categories were formed through axial coding by similar codes being All 14 intervention components were included in one of the micro- grouped. intervention variants (see Figs. 2 and 3). However, analysis showed that the intervention components “patient chooses the intervention” and Integration of the practice-based data “therapist chooses the intervention” appeared to contradict each other. If the client chooses the intervention, often used to appeal to client au­ Data-analysis of the focus groups indicated that the participating tonomy, it means that the therapist is not able to decide to use the micro- 5 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 Fig. 2. The active variant of the micro-intervention. intervention. As music therapists use the micro-intervention precisely choose the intervention, we decided to offer them the choice of the song when it is needed to lower their client’s stress levels, it is not possible to in the receptive variant and that they could take the lead role in the have the client choose the intervention themselves. However, to active variant by building up the music tempo and dynamics. encourage client autonomy in another way, instead of letting them 6 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 Fig. 3. The receptive variant of the micro-intervention. The second phase: expert consultation The second consultation round The first consultation round The second round of consultation resulted in consensus among all Analysis of the experts’ feedback led to significant changes in the experts, meaning that no further changes had to be made. The final description of the micro-intervention.4 Based on their suggestions, we description of the micro-intervention can be found in the Appendix. added information, i.e. “voice” as one of the main instruments, allowing the client to experience the present stress before reducing it, specifying Discussion the therapeutic role and attitude with four functional domains, and the supporting role of the group when the micro-intervention is offered to In our study, we systematically developed a music therapy micro- just one of the group members. A note was added on contra-indications intervention aimed at stress reduction based on findings from theoret­ regarding clients suffering from trauma or anxiety disorders and on the ical and empirical studies as well as practice-based knowledge. The function of the concepts “synchronizing” and “containing” which are micro-intervention was developed for and evaluated by music therapists related to stress reduction. for use during the music therapy session when it is necessary to lower clients’ stress levels. Although the micro-intervention does not relate only to the treatment of one specific condition or disorder and can be considered as broadly applicable, the literature indicates that some 4 An overview of the feedback given can be requested from the first author. 7 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 client populations may benefit more due to their higher vulnerability to gap between what is applied in clinical practice and what is investigated stress, such as people with mild intellectual disabilities (MID) or those in robust research designs (de Witte, Lindelauf et al., 2020). However, it with impaired cognitive functions (e.g., Emerson, 2003; Scott & may also be related to the context of a specific target group, such as Havercamp, 2014). For them, an experiential approach may be more clients with MID, who were central in the practice-based data. Because appropriate than the cognitive approach (de Witte, Lindelauf et al., we wanted to stay as close as possible to the initial data, this led to the 2020; Didden et al., 2016). To our knowledge, this is the first study in development of two different variants of the micro-intervention: the which a music therapy micro-intervention has been systematically active and the receptive variant (see Figs. 2 and 3). developed with the aim of direct stress reduction in the music therapy session. Recommendations for future research Strengths and limitations of the present study Clear intervention descriptions are needed to further investigate what is effective in music therapy interventions (Hoffmann et al., 2014). The way the micro-intervention was developed has several strengths. Future research should focus on whether the developed music therapy First, the systematic and comprehensive approach, which relied on data micro-intervention for stress reduction does lead to stress reduction both from empirical studies as well as from clinical practice, resulted in a during the session. However, methods that can measure the direct ef­ well-described micro-intervention. This approach has many similarities fects of the micro-intervention on stress-related outcomes will be to the “Intervention Mapping” approach, a systematic method for the needed. Previous reviews of stress measures show that many researchers development, implementation, and evaluation of health interventions emphasize the importance of measuring stress outcomes related to both by constructing programs grounded both in theory and on empirical physiological arousal as well as to people’s subjective experiences (Scott data (Bartholomew, Parcel, Kok, & Gottlieb, 2006). However, Inter­ and Havercamp, 2014; de Witte, Spruit et al., 2020; de Witte et al., vention Mapping was originally designed to create larger or longer-term 2021). intervention and treatment programs (Bartholomew-Eldridge et al., As it is still unclear how and why music therapy interventions lead to 2016), and therefore does not fully align with the concept of certain outcomes such as stress reduction, more research on therapeutic micro-interventions, which are short-term interventions and can even be factors5 is needed to further develop music therapy micro-interventions. used as stand-alone techniques in existing treatment programs (de Witte, In our micro-intervention, music tempo can be seen as one of the most Lindelauf et al., 2020). Second, the inclusion of data derived from important elements, and therefore we expect it to be an important controlled outcomes studies (RCTs and CCTs: N = 52) offered a scien­ therapeutic factor leading to stress relief. This is in line with previous tifically robust foundation for the core elements of the research showing that music tempo can be considered one of the most micro-intervention. This is relevant so that the basic claims made in the significant moderators of music-related arousal and relaxation effects (e. present study are clear (Aalbers et al., 2019; Crooke, Smyth, & McFer­ g., Bringman, Giesecke, Thörne, & Bringman, 2009; de Witte, Spruit ran, 2016). Moreover, the included outcome studies were derived from a et al., 2020). We therefore recommend that future research includes a recently conducted meta-analytic review (de Witte, da Silva Pinho et al., secondary research question that focuses on therapeutic factors, such as 2020) in which the inclusion criteria exactly matched the aims of this the tempo of the music, in order to increase knowledge not only study. It can also be argued that this study strengthens the overall sci­ regarding efficacy, but also regarding what contributes to these effects. entific basis of music therapy for stress reduction, as the previous Micro-interventions also allow researchers to conduct a micro-anal­ meta-analysis looked primarily at effects using quantitative analyses, ysis of specific parts of the music therapy session (Lee, 2000; Wosch & while in this study we qualitatively analyzed the content of the inter­ Wigram, 2007). The most important questions are: “what exactly vention, thus answering the how music therapeutic interventions can happened and why?”. Through micro-analysis, therapy processes can be lead to stress reduction. Third, in the second phase of this study, the better understood or clarified, for example by analyzing the musical micro-intervention was submitted for consultation to music therapy activity, social interaction, or nonmusical behavior of a short segment of experts from different countries in order to reach consensus in a a session (Wosch & Wigram, 2007). Micro-interventions are therefore collaborative process. Thus, thanks to this expert evaluation, the highly suitable for pinpointing specific therapeutic factors that cannot micro-intervention does not rely solely on pre-existing data. This be examined when testing over a larger period of time (de Witte et al., strengthens its generalizability and makes it more plausible that the 2021). micro-intervention can be implemented easily in clinical practice. Some limitations need to be noted. Through the years, several Implications for clinical practice theoretical models have been developed to provide insights into the influence of music on stress. One of the most widely used models of the Micro-interventions lend themselves well to music therapy practice last decade involves models rooted in biological and neurological the­ because of their flexible character and the way in which the therapist ories, so we also used these models to provide theoretical explanations of can respond to the client’s needs in the moment itself. By offering a the relationship between stress and music. These models formed the musical frame, any musical expression produced by the client can be basis of two earlier meta-analytical reviews of music interventions for musically encouraged and responded to in a musical dialogue (e.g., stress reduction (de Witte, Spruit et al., 2020; de Witte, da Silva Pinho Aigen, 2005; MacDonald, Kreutz, & Mitchell, 2013; Nordoff & Robbins, et al., 2020). However, we are aware that the general construct of stress 1965). Most components of our developed micro-intervention are integrates many scientific fields, in which both environmental, psy­ strongly related to certain therapeutic factors of music therapy, namely chological, and biological/physical factors are interrelated within a “musical dialogue” and “shared musical experiences”. Other important comprehensive framework (Aldwin, 2007; Cohen, Janicki-Deverts, & therapeutic factors concern the structuring nature of music, such as Miller, 2007). In this sense, the strength of exclusively including inter­ tempo. A recent review shows that it is precisely these therapeutic fac­ vention information from controlled outcome studies can be seen as a tors that are often associated with positive change in music therapy (de limitation; information on the content of interventions can also be ob­ Witte et al., 2021). In addition, the content of the micro-intervention is tained from less robust designs, such as case studies or one group de­ also in line with Bruscia’s (1987) principles, who developed 64 musical signs. However, the importance of analyzing intervention content that demonstrates positive effects was paramount in our study. Related to the previous, the data from this large number of outcome studies mainly 5 Therapeutic factors are those factors identified by empirical studies that showed descriptions of receptive interventions, while the practice-based lead to therapeutic change and are associated with particular outcomes (Kaz­ data almost exclusively showed active interventions. This may indicate a din, 2009; Elliot, 2010). 8 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 improvisation techniques based on using the unique qualities of music to Bradt, J., & Dileo, C. (2014). Music interventions for mechanically ventilated patients. Cochrane Database of Systematic Reviews, 12, Article CD006902. https://doi.org/ establish or influence the musical dialogue with the client; these still 10.1002/14651858.CD006902.pub3 form the basis of global music therapy education. However, the concept Bradt, J., Dileo, C., Grocke, D., & Magill, L. (2011). Music interventions for improving of the micro-intervention provides more insights into (a) the needs and psychological and physical outcomes in cancer patients. Cochrane Database of abilities of certain client populations that the intervention is focused on, Systematic Reviews, 8, Article CD006911. https://doi.org/10.1002/14651858. CD006911.pub3 (b) particular outcomes, (c) specific characteristics of the intervention, Bradt, J., Dileo, C., Magill, L., & Teague, A. (2016). Music interventions for improving and (d) the underlying theoretical models that explain the relationship psychological and physical outcomes in cancer patients. Cochrane Database of between music (therapy) and the targeted outcome. By describing this Systematic Reviews, 8, Article CD006911. https://doi.org/10.1002/14651858. CD006911.pub3 information, which is mainly subconsciously understood and applied by Bradt, J., Dileo, C., & Potvin, N. (2013). Music for stress and anxiety reduction in music therapists, it may stimulate them to strengthen the transferability coronary heart disease patients. Cochrane Database of Systematic Reviews, 12, Article of their clinical work and may provide more insights into the relation­ CD006577. https://doi.org/10.1002/14651858.CD006577.pub3 Bradt, J., Dileo, C., & Shim, M. (2013). Music interventions for preoperative anxiety. ship between clinical practice, theory, and research (Aigen, 1999; Cochrane Database of Systematic Reviews, 6, Article CD006908. https://doi.org/ Smeijsters & Vink, 2006; Stige, 2015). 10.1002/14651858.CD006908.pub2 Bringman, H., Giesecke, K., Thörne, A., & Bringman, S. (2009). Relaxing music as pre- medication before surgery: A randomised controlled trial. Acta Anaesthesiologica Appendix A. Supporting information Scandinavica, 53(6), 759–764. https://doi.org/10.1111/j.1399-6576.2009.01969.x Bruscia, K. E. (1987). Improvisational models of music therapy. Charles C Thomas. Supplementary data associated with this article can be found in the Carr, C., Odell-Miller, H., & Priebe, S. (2013). A systematic review of music therapy practice and outcomes with acute adult psychiatric in-patients. PLoS One, 8(8), online version at doi:10.1016/j.aip.2021.101872. Article e70252. https://doi.org/10.1371/journal.pone.0070252 Chanda, M. L., & Levitin, D. J. (2013). The neurochemistry of music. Trends in Cognitive References Sciences, 17(4), 179–193. https://doi.org/10.1016/j.tics.2013.02.007 Charmaz, K. (2003). Grounded theory: Objectivist and constructivist methods. In Aalbers, S., Vink, A., Freeman, R. E., Pattiselanno, K., Spreen, M., & van Hooren, S. N. K. Denzin, & Y. S. Lincoln (Eds.), Strategies for qualitative inquiry. Sage (2019). Development of an improvisational music therapy intervention for young Publications. adults with depressive symptoms: An intervention mapping study. The Arts in Cho, J. Y., & Lee, E.-H. (2014). Reducing confusion about grounded theory and Psychotherapy, 65, Article 101584. https://doi.org/10.1016/j.aip.2019.101584 qualitative content analysis: Similarities and differences. The Qualitative Report, 19 Agres, K., Schaefer, R., Volk, A., Van Hooren, S., Holzapfel, A., Dalla-Bella, S., … (64), 1–20. Magee, W. L. (2021). Music, computing, and health: A roadmap for the current and Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. future roles of music technology for healthcare and well-being. Music & Science. Journal of the American Medical Association, 298(14), 1684–1687. https://doi.org/ https://doi.org/10.31219/osf.io/mgjwv 10.1001/jama.298.14.1685 Aigen, K. (2005), 3. Playin’ in the band: A qualitative study of popular music styles as clinical Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures improvisation. The Nordoff-Robbins music therapy monograph series. Barcelona for developing grounded theory (3rd ed.). Sage Publications. Publishers. Crooke, A., Smyth, P., & McFerran, K. S. (2016). The psychosocial benefits of school Aigen, K. (1999). Revisiting Edward: An exemplar of tacit knowledge. Nordic Journal of music: Reviewing policy claims. Journal of Music Research Online, 1, 1–15. Music Therapy, 8(1), 89–95. Cuijpers, P., Reynolds, C. F., III, Donker, T., Li, J., Andersson, G., & Beekman, A. (2012). Akin, A., & Iskender, M. (2011). Internet addiction and depression, anxiety and stress. Personalized treatment of adult depression: medication, psychotherapy, or both? A International Online Journal of Educational Sciences, 3(1), 138–148. systematic review. Depression and Anxiety, 29(10), 855–864. https://doi.org/ Aldwin, C. M. (2007). Stress, coping, and development: An integrative perspective (2nd ed.). 10.1002/da.21985 Guilford Press. Didden, R., Lindsay, W. R., Lang, R., Sigafoos, J., Dab, S., & Wierma, J. (2016). Altshuler, I. M. (1948). The past, present, and future of musical therapy. In E. Podolsky Aggressive behavior. In N. N. Singh (Ed.), Clinical handbook of evidence-based (Ed.), Music therapy (pp. 24–35). Philosophical Library. practices for individuals with intellectual and developmental disabilities (pp. 727–750). American Psychological Association. (2017). Stress in America: Coping with change. APA. Springer. 〈https://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf〉. Dief, A. E., Sivukhina, E. V., & Jirikowski, G. F. (2018). Oxytocin and stress response. Amir, S., Brown, Z. W., & Amit, Z. (1980). The role of endorphins in stress: Evidence and Open Journal of Endocrine and Metabolic Diseases, 8(3), 93–104. https://doi.org/ speculations. Neuroscience & Biobehavioral Reviews, 4(1), 77–86. https://doi.org/ 10.4236/ojemd.2018.83010 10.1016/0149-7634(80)90027-5 Dunbar, R. I. M., Kaskatis, K., MacDonald, I., & Barra, V. (2012). Performance of music Australian Psychological Society. (2015). Stress and wellbeing: How Australians are coping elevates pain threshold and positive affect: Implications for the evolutionary with life. 〈http://www.psychology.org.au/Assets/Files/PW15-SR.pdf〉. function of music. Evolutionary Psychology, 10(4), 668–702. https://doi.org/ Bainbridge, C. M., Bertolo, M., Youngers, J., Atwood, S., Yurdum, L., Simson, J., … 10.1177%2F147470491201000403. Mehr, S. A. (2020). Infants relax in response to unfamiliar foreign lullabies. Nature Elliot, R. (2010). Psychotherapy change process research: Realizing the promise. Human Behaviour, 5, 256–264. https://doi.org/10.1038/s41562-020-00963-z Psychotherapy Research, 20, 123–135. https://doi.org/10.1080/ Bally, K., Campbell, D., Chesnick, K., & Tranmer, J. E. (2003). Effects of patient- 10503300903470743 controlled music therapy during coronary angiography on procedural pain and Emerson, E. (2003). Mothers of children and adolescents with intellectual disability: anxiety distress syndrome. Critical Care Nurse, 23(2), 50–57. https://doi.org/ Social and economic situation, mental health status, and the self-assessed social and 10.4037/ccn2003.23.2.50 psychological impact of the child’s difficulties. Journal of Intellectual Disability Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Research, 47(4–5), 385–399. https://doi.org/10.1046/j.1365-2788.2003.00498.x Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Fancourt, D., Ockelford, A., & Belai, A. (2014). The psychoneuroimmunological effects of Psychopharmacology, 30(4), 183–192. https://doi.org/10.1097/ music: A systematic review and a new model. Brain, Behavior, and Immunity, 36, YIC.0000000000000078 15–26. https://doi.org/10.1016/j.bbi.2013.10.014 Bartholomew-Eldredge, L. K., Markham, C. M., Ruiter, R. A. C., Fernández, M. E., Freeman, W. J., III (2000). A neurobiological role of music in social bonding. In Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: An intervention N. Wallin, B. Merkur, & S. Brown (Eds.), The origins of music (pp. 411–424). MIT mapping approach (4th ed.). Jossey-Bass. Press. Bartholomew, L. K., Parcel, G. S., Kok, G., & Gottlieb, N. H. (2006). Planning health Gabrielsson, A., & Lindström, E. (2010). The role of structure in the musical expression of promotion programs: An intervention mapping approach. Jossey-Bass. emotions. In P. N. Justlin, & J. A. Sloboda (Eds.), Series in affective science. Handbook Bellemans, T., Didden, R., Visser, R., Schaafsma, D., Totsika, V., & van Busschbach, J. T. of musicand emotion: Theory, research, applications (pp. 367–400). Oxford University (2018). Psychomotor therapy for anger and aggression in mild intellectual disability Press. or borderline intellectual functioning: An intervention mapping approach. Body, Gauthier, G., Guérin, A., Zhdanava, M., Jacobson, W., Nomikos, G., Merikle, E., … Movement and Dance in Psychotherapy, 13(4), 234–250. https://doi.org/10.1080/ Perez, V. (2017). Treatment patterns, healthcare resource utilization, and costs 17432979.2018.1471006 following first-line antidepressant treatment in major depressive disorder: A Bernatzky, G., Presch, M., Anderson, M., & Panksepp, J. (2011). Emotional foundations retrospective US claims database analysis. BMC Psychiatry, 17(1), Article 222. of music as a non-pharmacological pain management tool in modern medicine. https://doi.org/10.1186/s12888-017-1385-0 Neuroscience & Biobehavioral Reviews, 35(9), 1989–1999. https://doi.org/10.1016/j. Gold, C., Solli, H. P., Krüger, V., & Lie, S. A. (2009). Dose-response relationship in music neubiorev.2011.06.005 therapy for people with serious mental disorders: Systematic review and meta- Blood, A. J., & Zatorre, R. J. (2001). Intensely pleasurable responses to music correlate analysis. Clinical Psychology Review, 29(3), 193–207. https://doi.org/10.1016/j. with activity in brain regions implicated in reward and emotion. Proceedings of the cpr.2009.01.001 National Academy of Sciences, 98(20), 11818–11823. https://doi.org/10.1073/ Haeyen, S., van Hooren, S., Dehue, F., & Hutschemaekers, G. (2017). Development of an pnas.191355898 art-therapy intervention for patients with personality disorders: An intervention Boer, D., & Abubakar, A. (2014). Music listening in families and peer groups: Benefits for mapping study. International Journal of Artelor Therapy, 23(3), 125–135. https://doi. young people’s social cohesion and emotional well-being across four cultures. org/10.1080/17454832.2017.1403458 Frontiers in Psychology, 5, Article 392. https://doi.org/10.3389/fpsyg.2014.00392 Hakvoort, L. (2020). Foundations of music therapy: towards a more specific description of music-based interventions in therapeutic settings. Paper presented at the 10th 9 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 IAMM online-conference, May 2020. Retrieved from 〈https://www.music-medicine. Nilsson, U. (2009). The effect of music intervention in stress response to cardiac surgery net/presentations/mentalhealth/〉. in a randomized clinical trial. Heart & Lung, 38(3), 201–207. https://doi.org/ Hakvoort, L., & van der Eng, C. (2020). Micro-interventies voor de vaktherapeutische 10.1016/j.hrtlng.2008.07.008 beroepen: het systematiseren van praktijkkennis voor onderzoek. Tijdschrift voor Nordoff, P., & Robbins, C. (1965). Improvised music for children. Music Journal, 23(8). Vaktherapie, 16(1), 14–21. Olfson, M., King, M., & Schoenbaum, M. (2015). Benzodiazepine use in the United States. Heiderscheit, A., & Madson, A. (2015). Use of the iso principle as a central method in JAMA Psychiatry, 72(2), 136–142. https://doi.org/10.1001/ mood management: A music psychotherapy clinical case study. Music Therapy jamapsychiatry.2014.1763 Perspectives, 33(1), 45–52. https://doi.org/10.1093/mtp/miu042 Pelletier, C. (2004). The effect of music on decreasing arousal due to stress: A meta- Hodges, D. A. (2011). Psychophysiological measures. In P. N. Juslin, & J. Sloboda (Eds.), analysis. Journal of Music Therapy, 41(3), 192–214. https://doi.org/10.1093/jmt/ Handbook of music and emotion: Theory, research, applications (pp. 279–311). Oxford 41.3.192 University Press. Pittman, S., & Kridli, S. (2011). Music intervention and preoperational anxiety: An Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., … integrative review. International Nursing Review, 58(2), 157–163. https://doi.org/ Michie, S. (2014). Better reporting of interventions: Template for intervention 10.1111/j.1466-7657.2011.00888.x description and replication (TIDieR) checklist and guide. BMJ. , Article 348. https:// Puetz, T. W., Youngstedt, S. D., & Herring, M. P. (2015). Effects of pharmacotherapy on doi.org/10.1136/bmj.g1687 combat-related PTSD, anxiety, and depression: A systematic review and meta- Jäncke, L. (2008). Music, memory and emotion. Journal of Biology, 7, Article 21. https:// regression analysis. PLoS One, 10(5), Article e0126529. https://doi.org/10.1371/ doi.org/10.1186/jbiol82 journal.pone.0126529 Jiang, J., Rickson, D., & Jiang, C. (2016). The mechanism of music for reducing Robb, S. L., Carpenter, J. S., & Burns, D. S. (2011). Reporting guidelines for music-based psychological stress: Music preference as a mediator. The Arts in Psychotherapy, 48, interventions. Journal of Health Psychology, 16(2), 342–352. https://doi.org/ 62–68. https://doi.org/10.1016/j.aip.2016.02.002 10.1177/1359105310374781 Juslin, P. N., Liljeström, S., Västfjäll, D., Barradas, G., & Silva, A. (2008). An experience Rohner, S. J., & Miller, R. (1980). Degrees of familiar and affective music and their sampling study of emotional reactions to music: Listener, music, and situation. effects on state anxiety. Journal of Music Therapy, 17(1), 2–15. https://doi.org/ Emotion, 8(5), 668–683. https://doi.org/10.1037/a0013505 10.1093/jmt/17.1.2 Juslin, P. N., & Västfjäll, D. (2008). Emotional responses to music: The need to consider Rush, A. J., Fava, M., Wisniewski, S. R., Lavori, P. W., Trivedi, M. H., Sackeim, H. A., … underlying mechanisms. Behavioral and Brain Sciences, 31(5), 559–575. https://doi. Niederehe, G. (2004). Sequenced treatment alternatives to relieve depression org/10.1017/S0140525×08005293 (STAR* D): Rationale and design. Controlled Clinical Trials, 25(1), 119–142. https:// Kamioka, H., Tsutani, K., Yamada, M., Park, H., Okuizumi, H., Tsuruoka, K., … Mutoh, Y. doi.org/10.1016/S0197-2456(03)00112-0 (2014). Effectiveness of music therapy: A summary of systematic reviews based on Salimpoor, V. N., Benovoy, M., Larcher, K., Dagher, A., & Zatorre, R. J. (2011). randomised controlled trials of music interventions. Patient Preference and Adherence, Anatomically distinct dopamine release during anticipation and experience of peak 8, 727–754. https://doi.org/10.2147/PPA.S61340 emotion to music. Nature Neuroscience, 14, 257–262. https://doi.org/10.1038/ Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. nn.2726 Psychotherapy Research, 19, 418–428. https://doi.org/10.1080/ Salimpoor, V. N., van den Bosch, I., Kovacevic, N., McIntosh, A. R., Dagher, A., & 10503300802448899 Zatorre, R. J. (2013). Interactions between the nucleus accumbens and auditory Keech, J. J., Cole, K. L., Hagger, M. S., & Hamilton, K. (2020). The association between cortices predict music reward value. Science, 340(6129), 216–219. https://doi.org/ stress mindset and physical wellbeing: Testing a stress beliefs model in police 10.1126/science.1231059 officers. Psychology and Health, 35(11), 1306–1325. https://doi.org/10.1080/ Sandstrom, G. M., & Russo, F. A. (2010). Music hath charms: The effects of valence and 08870446.2020.1743841 arousal on recovery following an acute stressor. Music and Medicine, 2(3), 137–143. Kessler, R. C., van Loo, H. M., Wardenaar, K. J., Bossarte, R. M., Brenner, L. A., https://doi.org/10.1177/1943862110371486 Ebert, D. D., … Zaslavsky, A. M. (2017). Using patient self-reports to study Schumacher, K., & Calvet, C. (2008). Synchronisation. Music therapy with children on the heterogeneity of treatment effects in major depressive disorder. Epidemiology and autistic spectrum. Vandenhoeck & Ruprecht. Psychiatric Sciences, 26(1), 22–36. https://doi.org/10.1017/S2045796016000020 Schwabe, L., & Wolf, O. T. (2010). Learning under stress impairs memory formation. Koelsch, S. (2015). Music-evoked emotions: principles, brain correlates, and implications Neurobiology of Learning and Memory, 39(2), 183–188. https://doi.org/10.1016/j. for therapy. Annals of New York Academy of Sciences, 1337, 193–201. https://doi. nlm.2009.09.009 org/10.1111/nyas.12684 Scott, H. M., & Havercamp, S. M. (2014). Mental health for people with intellectual Koelsch, S., Boehlig, A., Hohenadel, M., Nitsche, I., Bauer, K., & Sack, U. (2016). The disability: The impact of stress and social support. American Journal on Intellectual impact of acute stress on hormones and cytokines and how their recovery is affected and Developmental Disabilities, 119(6), 552–564. https://doi.org/10.1352/1944- by music-evoked positive mood. Scientific Reports, 6, Article 23008. https://doi.org/ 7558-119.6.552 10.1038/srep23008 Skulmoski, G. J., Hartman, F. T., & Krahn, J. (2007). The Delphi method for graduate Kreutz, G., Murcia, C. Q., & Bongard, S. (2012). Psychoneuroendocrine research on music research. Journal of Information Technology Education: Research, 6, 1–21. https://doi. and health: An overview. In R. A. R. MacDonald, D. Kreutz, & L. Mitchell (Eds.), org/10.28945/199 Music, health, and wellbeing (pp. 457–476). Oxford University Press. Smeijsters, H., & Vink, A. (2006). Research in practice. Music Therapy Today, 7, 791–838. Landis-Shack, N., Heinz, A. J., & Bonn-Miller, M. O. (2017). Music therapy for Stige, B. (2015). The practice turn in music therapy theory. Music Therapy Perspectives, 33 posttraumatic stress in adults: A theoretical review. Psychomusicology: Music, Mind, (1), 3–11. https://doi.org/10.1093/mtp/miu050 and Brain, 27(4), 334–342. https://doi.org/10.1037/pmu0000192 Tarr, B., Launay, J., & Dunbar, R. I. M. (2014). Music and social bonding: “Self-other” Lee, C. (2000). A method of analyzing improvisations in music therapy. Journal of Music merging and neurohormonal mechanisms. Frontiers in Psychology, 5, Article 1096. Therapy, 37(2), 147–167. https://doi.org/10.1093/jmt/37.2.147 https://doi.org/10.3389/fpsyg.2014.01096 Levitin, D. J. (2009). The neural correlates of temporal structure in music. Music and Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of neurologic music therapy. Medicine, 1(1), 9–13. https://doi.org/10.1177/1943862109338604 Oxford University Press. Linnemann, A., Ditzen, B., Strahler, J., Doerr, J. M., & Nater, U. M. (2015). Music Thaut, M. H., Kenyon, G. P., Schauer, M. L., & McIntosh, G. C. (1999). The connection listening as a means of stress reduction in daily life. Psychoneuroendocrinology, 60, between rhythmicity and brain function. IEEE Engineering in Medicine and Biology 82–90. https://doi.org/10.1016/j.psyneuen.2015.06.008 Magazine, 18, 101–108. https://doi.org/10.1109/51.752991 Linnemann, A., Strahler, J., & Nater, U. M. (2016). The stress-reducing effect of music The American Institute of Stress. (n.d.). Stress effects. 〈https://www.stress.org/stress listening varies depending on the social context. Psychoneuroendocrinology, 72, -effects〉. 97–105. https://doi.org/10.1016/j.psyneuen.2016.06.003 Wang, X., Wang, C., & Wang, J. (2019). Towards the contributing factors for stress Linstone, H. A., & Turoff, M. (Eds.). (1975). The Delphi method: Techniques and confronting Chinese Ph.D. students. International Journal of Qualitative Studies on applications. Addison-Wesley. Health and Well-Being, 14(1), 1–12. https://doi.org/https://dx.doi.org/10.1080% MacDonald, R. A. R., Kreutz, G., & Mitchell, L. (2013). Music, health & wellbeing. Oxford 2F17482631.2019.1598722. University Press. Weinstein, D., Launay, J., Pearce, E., Dunbar, R. I. M., & Stewart, L. (2016). Singing and Magee, W. L. (2019). Why include music therapy in a neuro-rehabilitation team. social bonding: Changes in connectivity and pain threshold as a function of group Advances in Clinical Neuroscience & Rehabilitation, 19(2), 10–12. size. Evolution and Human Behaviour, 37(2), 152–158. https://doi.org/10.1016/j. Martin, L., Oepen, R., Bauer, K., Nottensteiner, A., Mergheim, K., Gruber, H., & evolhumbehav.2015.10.002 Koch, S. C. (2018). Creative arts interventions for stress management and prevention Wheeler, B. L. (Ed.). (2015). Music therapy handbook. Guilford Publications. – A systematic review. Behavioral Sciences, 8(2), 28. https://doi.org/10.3390/ Wheeler, B. L., Cassity, M. D., Lesiuk, T. L., Rosetti, A., Burns, D. S., & Hanser, S. B. bs8020028 (2019). Music therapy and music medicine studies in oncology: Part II: The use of McMillan, S. S., King, M., & Tully, M. P. (2016). How to use the nominal group and the delphi technique. Music and Medicine, 11(3). https://doi.org/10.47513/mmd. Delphi techniques. International Journal of Clinical Pharmacy, 38(3), 655–662. v11i3.672 https://doi.org/10.1007/s11096-016-0257-x de Witte, M. D., Bellemans, T., Tukker, K., & van Hooren, S. A. H. (2017). Vaktherapie. In Moore, K. S. (2013). A systematic review on the neural effects of music on emotion J. de Bruijn, J. Vonk, & A. van den Broek (Eds.), Handboek emotionele ontwikkeling en regulation: Implications for music therapy practice. Journal of Music Therapy, 50(3), verstandelijke beperking [Handbook emotional development and intellectual disability] 198–242. https://doi.org/10.1093/jmt/50.3.198 (pp.277–90). Amsterdam: Boom. Moretti, F., van Vliet, L., Bensing, J., Deledda, G., Mazzi, M., Rimondini, M., … de Witte, M., da Silva Pinho, A., Stams, G.-J., Moonen, X., Bos, A. E. R., & van Hooren, S. Fletcher, I. (2011). A standardized approach to qualitative content analysis of focus (2020). Music therapy for stress reduction: a systematic review and meta-analysis. group discussions from different countries. Patient Education and Counseling, 82(3), Health Psychology Review. https://doi.org/10.1080/17437199.2020.1846580 420–428. https://doi.org/10.1016/j.pec.2011.01.005 de Witte, M., Kooijmans, R., Hermanns, M., van Hooren, S., Biesmans, K., Hermsen, M., Mullen, P. M. (2003). Delphi: Myths and reality. Health Organization Management, 17(1), … Moonen, X. (2021). Self-Report Stress Measures to Assess Stress in Adults With 37–52. https://doi.org/10.1108/14777260310469319 10 M. de Witte et al. The Arts in Psychotherapy 77 (2022) 101872 Mild Intellectual Disabilities—A Scoping Review. Frontiers in Psychology, 12, Article analyses. Health Psychology Review, 14(2), 294–324. https://doi.org/10.1080/ 742566. https://doi.org/10.3389/fpsyg.2021.742566 17437199.2019.1627897 de Witte, M., Lindelauf, E., Moonen, X., Stams, G.-J., & van Hooren, S. (2020). Music Witvliet, C. V. O., & Vrana, S. R. (2007). Play it again Sam: Repeated exposure to therapy interventions for stress reduction in adults with mild intellectual disabilities: emotionally evocative music polarises liking and smiling responses, and influences Perspectives from clinical practice. Frontiers in Psychology, 11, Article 572549, other affective reports, facial EMG, and heart rate. Cognition and Emotion, 21(1), 10.3389%2Ffpsyg.2020.572549. 3–25. https://doi.org/10.1080/02699930601000672 de Witte, M., Orkibi, H., Zarate, R., Karkou, V., Sajnani, N., Malhotra, B., … Koch, S. C. Wosch, T., & Wigram, T. (2007). Microanalysis in music therapy: Introduction and (2021). From therapeutic factors to mechanisms of change in the creative arts theoretical basis. In Microanalysis: Methods, techniques and applications for clinicians, therapies: A scoping review. Frontiers in Psychology. https://doi.org/10.3389/ researchers, educators and students (pp. 13–28). Jessica Kingsley. fpsyg.2021.678397 Zatorre, R. J. (2015). Musical pleasure and reward: Mechanisms and dysfunction. Annals de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. J. (2020). Effects of of the New York Academy of Sciences, 1337(1), 202–211. https://doi.org/10.1111/ music interventions on stress-related outcomes: A systematic review and two meta- nyas.12677 11  VAT seansi struktuur TLÜ VAT laboris Lülitada sisse tehnikatorni kõik seadmed. NB: taustamuusika CD- mängijat on võimalik sisse lülitada ainult siis, kui taustamuusika võimendi on sisse lülitatud. Seada voodiruum korda (enne kliendi saabumist): lülitada sisse lisaks suurele põrandalambile ka väiksed põrandalambid tehnikatorni laua all, korrastada voodi. 1. Pakkuda kliendile istet. Ainult esimesel seansil 2. Lühike selgitus VAT meetodist kliendile. Igal seansil 3. Jäädvustada kliendi hetkeseisund mõõdikute/intervjuu jne abil. 4. Paluda kliendil VAT voodile selili heita nii, et tema jalad jäävad taustamuusika kõlarite poolsesse otsa. Kui selili ei ole mugav (on valus, ei ole võimalik), siis leida mugavaim kehaasend. Öelda, et seansi ajal võib soovi korral kehaasendit muuta: võib keerata külili või kõhuli, kui selliselt on mugavam. 5. Küsida padja kõrguse sobivuse kohta – vajadusel panna lisapadi või võtta padi ära. 6. Küsida, kas soovib tekki peale. Asetada tekk vastavalt kliendi soovile (pikka kasvu klientidele 2 tekki – üks nii, et katab ülakeha, teine nii, et katab alakeha ja jalad). 7. Selgitada, et järgnevalt lülitad sisse madalasagedusliku vibratsiooni (vibatsiooniprogrammi CD-mängija on tehnikatornis kõige ülemine seadeldis, vastava kleebisega esipaneelil; muusika CD-mängija on tehnikatornis alt kolmas seadeldis, samuti varustatud vastava kleebisega; CD-mängija nupud: ▲ - plaadisahtli avamise/sulgemise nupp, ►∕║ - plaadi mängima-/pausilepanemise nupp, ■ - plaadi peatamise nupp, |<< - eelmise heliraja valiku nupp, >>| - järgmise heliraja valiku nupp). 8. Reguleerida vibratsiooni helitugevus patsiendile sobivaks. Selleks kasutada vibratsiooniprogrammi helivõimendit, mis tehnikatornis on kõige alumine seadeldis (vastava kleebisega). Järgnevalt võimendi helinivoode regulaatorite tähised:  CH1 – turjapiirkonna valjuhääldi;  CH2 – nimmepiirkonna valjuhääldi;  CH3 – reitepiirkonna valjuhääldigrupp;  CH4 – säärtepiirkonna valjuhääldigrupp. Aja kokkuhoiu mõttes võib kõik neli regulaatorit mõjutusele eelnevalt keerata tähiseni „1“. Kui klient on juba voodis pikali, siis vibratsiooni helitugevuse reguleerimist alustada säärtepiirkonna valjuhääldigrupist – kui regulaator on juba tähiseni „1“ keeratud, siis küsida, kas klient juba vibratsiooni tunnetab. Kui jah, siis küsida, kas vibratsioon säärte piirkonnas on paraja tugevusega või tuleks seda tugevamaks/nõrgemaks seada. Kui säärtepiirkonna vibratsiooni sobiv tugevus (mitte liiga nõrk ega ebameeldivalt tugev) on leitud, siis sarnaselt äsjatoodule reguleerida vibratsiooni helitugevused ka ülejäänud valjuhääldigruppide jaoks (NB! Kuna peale viimase valjuhääldigrupi sobiva helitugevuse leidmist tajub inimene kehas kõigi valjuhääldigruppide helitugevuste summat, siis küsida, kas helitugevus summaarselt on sobiv). Kui sobivad nivood on leitud, siis esimese (paari) seansi puhul keerata kõigi valjuhääldigruppide helitugevus veidi vähemaks, sest mõjutuse jooksul keha vibratsioonitundlikkus suureneb. 9. Selgitada, mis protseduuri ajal edasi toimub, nt: „Kui järgnevalt taustamuusika helitugevus on sobivaks reguleeritud, jään mina mõjutuse ajaks kuuldeulatusse samasse ruumi, kus praegu viibin. Kui midagi juhtub või on ebamugav, siis andke häälega märku, reageerin kohe.“ 10. Reguleerida taustamuusika helitugevus kliendile sobivaks. Selleks kasutada taustamuusika helivõimendit, mis tehnikatornis on alt teine seadeldis (vastava kleebisega). Kui taustamuusika heli hakkab kostma, küsida, kas see on kliendi jaoks sobiv helitugevus. Reguleerida vastavalt kliendi antud tagasisidele. 12. Küsida kliendilt, kas tal on mugav, kas kõik on sobiv. Eitava vastuse korral kõrvaldada puudujäägid, positiivse vastuse korral nt soovida „Head lõdvestumist“. 13. Jääda laua taha kuni VA mõjutuse lõpuni (umbes 23 min, jälgida kellalt). 14. Kui VA mõjutus on lõppenud, siis keerata taustamuusika helitugevus aeglaselt ja sujuvalt „nulli“. 15. Kui klient on uinunud, siis äratada rahulikult. 16. Jäädvustada kliendi hetkeseisund mõõdikute/intervjuu jne abil. Küsida mõjutuse ajal kogetu kohta. NB! Kliendi hetkeseisundit võib jäädvustada ka pärast kliendi voodist tõusmist laua ääres istudes. 17. Kui kliendi hetkeseisund on jäädvustatud, siis paluda kliendil aeglaselt ja rahulikult voodis istuli tõusta, ja mõne aja pärast püsti tõusta. Pärast seansi muude formaalsuste lõpetamist (nt järgmise seansi aja kokku leppimine) võib klient VAT ruumist lahkuda. Enne VAT ruumist lahkumist keerata nii vibratsiooniprogrammi kui taustamuusika võimendi helinivoo regulaatorid „nulli“, seejärel lülitada kõik seadmed ja lambid välja.  Music-Based Relaxation Intervention (MBRI) – Protokoll ja tõenduspõhisus Lühikirjeldus: Music-Based Relaxation Intervention (MBRI) on struktureeritud lühisekkumine, mis kombineerib juhendatud lõõgastuse ja muusika kuulamise. Sekkumine on suunatud ärevuse, stressi ja emotsionaalse erutuse vähendamisele ning sobib madala intensiivsusega teenustesse. Protokoll (20–30 min sessioon) 1. Eesmärgistamine (1–3 min) - kliendi seisundi kaardistamine - eesmärgi sõnastamine (nt ärevuse vähendamine) 2. Lõõgastusinduktsioon (5–10 min) - juhendatud hingamine või progressiivne lihaslõdvestus - tähelepanu suunamine kehale 3. Muusikapõhine regulatsioon (10–20 min) - rahustava muusika kuulamine (tempo 60–80 bpm) - tähelepanu hingamisel ja kehatunnetusel - tempo ja struktuur toetavad autonoomse närvisüsteemi regulatsiooni tähelepanu: hingamisel, kehal, kujutluspiltidel. - muusika võib olla terapeudi valitud või individuaalselt kohandatud 4. Refleksioon (3–5 min) - kogemuse sõnastamine - seos igapäevaeluga Toimemehhanism ✓ autonoomse närvisüsteemi regulatsioon ✓ südamerütmi ja hingamise sünkroniseerimine ✓ emotsionaalse erutuse vähenemine ✓ stressihormoonide (nt kortisool) vähenemine Tõenduspõhisus: Meta-analüüsid ja süstemaatilised ülevaated näitavad, et muusikapõhised sekkumised vähendavad stressi ja ärevust ning parandavad emotsionaalset regulatsiooni. Efektid on keskmise suurusega ning ilmnevad ka lühiformaadis sekkumiste puhul. Uuringud näitavad, et isegi üksikseansid võivad vähendada ärevust ja füsioloogilist stressireaktsiooni. Muusika mõju autonoomsele närvisüsteemile hõlmab südamerütmi, vererõhu ja kortisooli taseme muutusi. Viited: • de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. J. J. M. (2020). Effects of music interventions on stress-related outcomes: A systematic review and two meta- analyses. Health Psychology Review, 14(2), 294–324. https://doi.org/10.1080/17437199.2019.1627897 • Pelletier, C. L. (2004). The effect of music on decreasing arousal due to stress: A meta- analysis. Journal of Music Therapy, 41(3), 192–214. https://doi.org/10.1093/jmt/41.3.192 • Thoma, M. V., La Marca, R., Brönnimann, R., Finkel, L., Ehlert, U., & Nater, U. M. (2013). The effect of music on the human stress response. PLoS ONE, 8(8), e70156. https://doi.org/10.1371/journal.pone.0070156 • de Witte, M., Pinho, A. S., Stams, G. J. J. M., Moonen, X., Bos, A. E. R., & van Hooren, S. (2022). Development of a music therapy micro-intervention for stress reduction. The Arts in Psychotherapy, 77, 101873. https://doi.org/10.1016/j.aip.2021.101873  Vibroakustilise muusikateraapia sekkumise protokoll Skille–Wigram mudel on vibroakustilise teraapia (VAT) kõige mõjukam ja laialdasemalt kasutatav teoreetiline-kliiniline raamistik, mille töötasid välja Olav Skille ja Tony Wigram 1980.–1990. aastatel. 1. Hindamine (Assessment) Vibroakustilise muusikateraapia (VAT) sekkumine algab kliendi põhjaliku hindamisega. Hindamine hõlmab anamneesi kogumist (neuroloogiline, psühholoogiline ja füüsiline seisund), vastunäidustuste välistamist (nt ägedad põletikud, tromboos, teatud raseduse etapid) ning terapeutiliste eesmärkide seadmist (nt valu vähendamine, ärevuse leevendamine, lihaspinge alandamine). 2. Seadistus (Equipment & Setup) VAT sekkumiseks kasutatakse vibroakustilist lamamistooli või madratsit, mis edastab madalsageduslikku heli kehale. Kasutatakse sagedusvahemikku 20–120 Hz. Keskkond peab olema rahulik, vaikne ja minimaalse stimulatsiooniga. 3. Sagedusprotokoll Tüüpiline sessioon kestab 20–45 minutit, sagedusega 1–3 korda nädalas. Sagedused valitakse vastavalt eesmärgile: 20–50 Hz lõõgastuseks, 40 Hz neuroloogiliseks stimulatsiooniks, 60–80 Hz lihaspinge reguleerimiseks. Sageli kasutatakse sweep-tehnikat (muutuv sagedus). 4. Muusikaline komponent Muusika valitakse terapeutiliselt: aeglane tempo (60–80 BPM), madal dünaamika ja harmooniline stabiilsus. Muusika võib olla eelnevalt salvestatud või live-esitus. 5. Terapeutiline protsess Klient lamab seadmel ning terapeut jälgib füsioloogilisi reaktsioone, kohandab sagedusi ning juhendab vajadusel hingamist või kujutluspilte. 6. Järelhindamine Seansi järel hinnatakse subjektiivseid ja objektiivseid muutusi, sealhulgas valu (VAS), ärevust ja füsioloogilisi näitajaid. Viited • Chesky, K., & Michel, D. (1991). The effect of music and vibrotactile stimulation on perception of pain. Journal of Music Therapy, 28(4), 191–202. • Grocke, D., & Wigram, T. (2007). Receptive methods in music therapy. Jessica Kingsley Publishers. • King, L. K., et al. (2009). The effects of vibroacoustic therapy on motor function in Parkinson’s disease. Journal of Rehabilitation Research. • Naghdi, L., et al. (2015). The effectiveness of vibroacoustic therapy in rehabilitation: A systematic review. Journal of Rehabilitation Research. • Punkanen, M., & Ala-Ruona, E. (2012). Contemporary vibroacoustic therapy: Perspectives on clinical practice. Music and Medicine. • Skille, O. (1989). Vibroacoustic therapy. Music Therapy, 8(1), 61–77. • Wigram, T. (1996). The effects of vibroacoustic therapy on clinical populations. Music Therapy Perspectives, 14, 20–28. • Wigram, T. (2005). Music therapy research and practice in medicine. Jessica Kingsley Publishers. Supportive Counseling kui madala intensiivsusega sekkumine Lühikirjeldus Supportive counseling on madala intensiivsusega psühholoogiline sekkumine, mis põhineb aktiivsel kuulamisel, empaatilisel suhtlemisel ja emotsionaalsel toetamisel. Supportive counseling sekkumine põhineb mitte-direktiivse toetava nõustamise (non-directive supportive therapy) mudelil, mille keskmes on aktiivne kuulamine, peegeldamine ja emotsionaalne valideerimine. Sekkumine on sobiv kerge kuni mõõduka psühholoogilise distressi (nt ärevus, stress, depressiivsed sümptomid) leevendamiseks ning on struktureeritud lühiformaadis (1–6 sessiooni) rakendatav kogukonna- ja esmatasandi teenustes. Sekkumisel on selgelt kirjeldatud struktuur ja korduvad komponendid, mida rakendatakse kindlas järjekorras. Sekkumise protokoll (35–50 min sessioon) 1. Avamine ja kontakti loomine (5 min) - turvalise keskkonna loomine - avatud küsimuste kasutamine 2. Probleemi eksploratsioon (15–20 min) - aktiivne kuulamine - peegeldamine (sisu ja emotsioonide tasandil) 3. Emotsionaalne tugi (10–15 min) - valideerimine - normaliseerimine - empaatia 4. Kokkuvõte ja sulgemine (5–10 min) - põhipunktide kokkuvõte - lihtsad toimetuleku sammud Rakendatavad tehnikad - aktiivne kuulamine (active listening) - peegeldamine (reflection) - valideerimine (validation) - normaliseerimine (normalization) - toetav tagasiside (encouragement) Tõenduspõhisus Sekkumise efektiivsust toetavad meta-analüüsid, mis näitavad, et mitte-direktiivne supportive therapy on efektiivne kerge kuni mõõduka depressiooni korral ning avaldavad olulist mõju depressiooni ja psühholoogilise distressi vähendamisel (Cuijpers et al., 2012; Wampold & Imel, 2015). Supportive counseling aktiveerib “common factors” mehhanismid, milleks on terapeutiline suhe, empaatia, kuulamine, mis omakorda on olulised sekkumise mõju ennustajad (Bruce Wampold & Imel, 2015) Viited • Cuijpers, P., Driessen, E., Hollon, S. D., van Oppen, P., Barth, J., & Andersson, G. (2012). The efficacy of non-directive supportive therapy for adult depression: A meta- analysis. Clinical Psychology Review, 32(4), 280–291. https://doi.org/10.1016/j.cpr.2012.01.003 • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge. • Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/h0045357  Sotsiaalministri 17.03.2026 määrus nr 1.2-2/27-1 „Väheintensiivsete psühholoogiliste sekkumiste rakendamise toetus“ Lisa 1 Taotlusvorm 1. Taotleja andmed 1.1. Asutuse/ettevõtte nimetus: Ojaveere Nõustamine OÜ 1.2. Registrikood: 14576910 1.3. Postiaadress: Rapla maakond, Rapla vald, Rapla linn, Tallinna mnt 22, 79512 1.4. Arvelduskonto (IBAN): EE972200221070258412 1.5. Esindaja nimi ja ametikoht: Siiri Viil, juhatuse liige 1.6. Kontaktisiku andmed (nimi, e-post, telefon): Siiri Viil [email protected] 55 155 78 1.7. Taotletav toetuse kogusumma (käibemaksuta): 22 500 eur 1.8. Projekti elluviimise periood: 1.6-31.12.2026 Kui taotlus sisaldab mitut VIPS-sekkumist, esitatakse allolev info iga sekkumise kohta eraldi (vajaduse korral dubleerides vastavad väljad). 2. VIPS-i kirjeldus: 2.1. Nimetus: Supportive counceling (Kogukonna psühholoogiline lühinõustamine) 2.2. Lühikirjeldus (sh metoodiline alus): Supportive counseling on madala intensiivsusega struktureeritud psühholoogiline sekkumine, mis põhineb aktiivsel kuulamisel, peegeldamisel ja emotsionaalsel valideerimisel. Sekkumine järgib struktureeritud sessioonimudelit, mis hõlmab probleemi uurimist, empaatilist peegeldamist ja toetavat kokkuvõtet (Cuijpers et al., 2012; Wampold & Imel, 2015). Sekkumise eesmärk on parandada kliendi emotsionaalset heaolu, toetada toimetulekuoskusi ning pakkuda turvalist ruumi kogemuste jagamiseks. Erinevalt kõrgema intensiivsusega psühhoteraapiatest ei keskendu supportive counseling sügavale psühhodünaamilisele analüüsile ega keerukatele kognitiivsetele tehnikatele, vaid emotsionaalsele kohalolule ja toetavale suhtele. Empaatial ja reflektiivsel kuulamisel põhinev lähenemine toetab emotsionaalset regulatsiooni ja enesemõistmist ning tugevdab sekkumise mõju. Sekkumine on sobiv kerge kuni mõõduka psühholoogilise distressi (nt ärevus, stress, depressiivsed sümptomid) leevendamiseks ning rakendatav lühiformaadis (1–6 sessiooni) kogukonna- ja esmatasandi teenustes. Supportive counseling on mitte-direktiivne, emotsionaalset tuge pakkuv sekkumine, mis keskendub a) aktiivsele kuulamisele, b) emotsioonide valideerimisele c) toimetuleku toetamisele. Uuringutes on toodud korduv selge sessiooni struktuur ja komponendid. 2.3. Sihtrühm (vanuserühm jne): 15-64. Gruppide korral vanusepõhiselt 15–24, 25–44, 45– 64. 2.4. Piirkond: Saaremaa, Rapla maakond 2.5. Formaat (individuaal, grupi, kombineeritud): nii individuaalne 1 2.6. Struktuur (seansside arv, ühe seansi kestus minutites, grupisekkumiste korral inimeste arv grupis): individuaalse kohtumise pikkus 30-60 minutit. Tegemist võib olla ühekordse sekkumise või pikemaajalise (kuni 6 kohtumist). 2.7. Vorm (kohapeal, veebis jne): kohapeal ja veebis 2.8. Tõenduspõhisus (viidata uuringutele, rahvusvahelisele kasutusele; lisada viited või allikad): Juhendatud sekkumised (st sekkumised, kus osalejat toetab juhendaja või nõustaja) on osutunud oluliselt efektiivsemaks kui täielikult iseseisvad eneseabivormid, näidates suuremat mõju sümptomite vähenemisele ning paremat sekkumises püsimist (Baumeister et al., 2014). Madala lävega kogukonnakeskustes pakutav psühholoogiline lühinõustamine ja aktiivne kuulamine on kooskõlas rahvusvaheliselt tunnustatud low-intensity psychological interventions mudeliga, mille efektiivsust toetavad arvukad randomiseeritud kontrolluuringud ja süstemaatilised ülevaated. Eriti tugev tõendus on kognitiiv- käitumuslikel ja juhendatud eneseabi sekkumistel, mis on efektiivsed kerge kuni mõõduka depressiooni ja ärevuse vähendamisel. Aktiivne kuulamine ja empaatiline suhtlus on nende sekkumiste keskne komponent, toimides terapeutilise liidu ja muutuse mehhanismina. Meta-analüütilised uuringud on ka näidanud, et terapeutiline liit, empaatia ja valideerimine on olulised ennustajad positiivsetele ravitulemustele sõltumata konkreetsest teraapiameetodist (Wampold & Imel, 2015). Supportive counseling põhineb teaduskirjanduses kirjeldatud ja manualiseeritud lähenemistel, sh Brief Supportive Psychotherapy (BSP), mida on kasutatud randomiseeritud uuringutes ning mille keskmes on empaatia, aktiivne kuulamine ja fookus emotsioonidel (Markowitz, 2022). Madala intensiivsusega sekkumistes täidab aktiivne kuulamine mitut funktsiooni: loob turvalise ja toetava keskkonna, suurendab osaleja motivatsiooni ja kaasatust, toetab eneserefleksiooni ja probleemilahendust. Seetõttu on aktiivne kuulamine käsitletav mitte üksnes toetava elemendina, vaid olulise toimemehhanismina, mille kaudu sekkumine avaldab mõju. Mõju: 1) kognitiivsete mustrite muutus (nt mõttemustrite muutmine); 2) Käitumuslik aktivatsioon (rohkem tegevust → parem meeleolu); 3) sotsiaalse toe ja kuuluvustunde kasv; 4) Enesetõhususe kasv (inimene õpib ise toime tulema). Tõenduspõhisus näitab, et sellised mitte-direktiivsed sekkumised on efektiivsed kerge kuni mõõduka distressi vähendamisel (Cuijpers et al., 2012; Wampold & Imel, 2015). 2.9. Kinnitus sekkumise juhendi olemasolu kohta (lisada näidis või kirjeldus): Sekkumise protokoll lisatud failina – Lisa 1 Supportive counceling protokoll. Samuti rakendame vajadusel täiendava materjalina Tervisekassa töövihikuid (depressioon, unevihik (sh noorte unevihik), ärevus jt). 2.10. Varasem rakendamine (rakendamise kirjeldus, maht ja kestus): Oleme sekkumist kasutanud mitme aasta vältel erinevate spetsialistide poolt klientidega, kes ei vaja psühhoteraapiat. Samuti noorte nõustamisel. Näeme, et sageli on piisavalt abistav see, kui klient saab väljendada enda mõtteid ja tundeid ning teda kuulatakse ja peegeldatakse (ei rakendata suhtlemistõkkeid) ning läbi turvalise keskkonna ja toetuse leiab inimene ise lahendused või ressursi. On hulk sihtgruppe, keda veebipõhised sekkumised ei toeta, kuna nad ei kasuta neid ega ka hakka kasutama. Meie kogemusel on äärmiselt oluline, et kogukonnapõhises madala lävendiga vaimse tervise keskustes on elanikul võimalus tulla ja saada kohest abi. Meie keskusesse on selliselt tulnud emotsionaalselt madalseisus olevad inimesed, sõprade poolt kohale toodud suitsiidsete mõtetega inimesed, noorukid, kes kogevad üksildust jne. Sealjuures erinevates vanusegruppides. Senise kogemuse baasil 2  oleme näinud teadusuuringutes toodud psühholoogilise nõustamise kohest mõju ning näeme vajadust seda püsivalt pakkuda. 2.11. Tagasiside kogumise viis: seni läbi keskuse rahulolu uuringu, mis ei ole sekkumise põhine. Iga spetsialist on kliendiga kohtumiste lõppedes suuliselt teinud kokkuvõtte eesmärkide saavutamisest või enesetunde muutusest. 3. Kavandatud maht 3.1. Seansside koguarv toetusperioodil: 250 3.2. Teenusesaajate arv: 50 3.3. Keskmine seansside arv ühe teenusesaaja kohta: 5 3.4. Maht maakondade kaupa: Raplamaal 30 ja Saaremaal 20 inimest 3.5. Sihtrühmani jõudmise ja suunamise kanalid: sotsiaalmeedia, KOV teavituskanalid (KOV ajaleht, osavaldade ajalehed Saaremaal), Raplamaal Raplamaa Sõnumite podcast, perearstid ja sotsiaaltöötajad 4. Meeskond ja rakendusvõimekus 4.1. Spetsialistide koguarv (vähemalt 5, lisada viie inimese info allolevasse tabelisse): Ees- ja perekonnanimi Haridus (eriala, kraad) Lepingu (nt töö-, töövõtu- või käsundusleping) sõlmimise kuupäev Siiri Viil Terviseteaduste magister, loovteraapia 10.2019 kutse 7, pereterapeut, kogemusnõustaja Kaili Inno Terviseteaduste magister, loovteraapia 1.7.2025 kutse 7, pereterapeut, superviisor Marianne sotsiaalpedagoogika ja lastekaitse 27.4.2023 Mändmets-Tuvikene magister, pereterapeut (superviseeritav) Epp Sussen Terviseteaduste magister, loovteraapia 15.12.2023 kutse 7 Liisi-Katarina Verk Lõpetamas Tallinna Ülikoolis sotsiaalse 12.3.2026 rehabilitatsiooni BA, varasem kogemus sotsiaaltöötajana ning juhtumikorraldajana Ave Verk Sotsiaalpedagoogika magister, 1.7.2025 pereterapeut (superviseeritav) Laima Parik Psühholoogia magister, loovterapeut 1.7.2025 Greta Vaus Usuteaduste magister, meditsiiniõde 16.4.2024 1.1. Spetsialistide kvalifikatsioon: spetsialistid, kes muusikateraapia sekkumisi rakendavad on kõik asjakohase baasharidusega ning kogemustega vaimse tervise valdkonnas. Kõik töötavad igapäevaselt klientidega. 1.2. Superviisorite arv ja kvalifikatsioon: Superviisor Kaili Inno (loovterapeut kutse 7) 1.3. Supervisiooni sagedus ja korraldus: grupi supervisioonina vähemalt kord kvartalis. Individuaalse supervisioonina vastavalt vajadusele. 3  1.4. Riskijuhtimise plaan: Keskus on tegutsenud aastaid ning meie meeskond on laiem kui taotluses välja toodud. Seega on risk, et teenuseosutajal tekib personali puudus, väike. Seadmed VAT osutamiseks on olemas ning vajadusel on olemas võimekus ka soetada seadmeid juurde. Samuti on muusikateraapiliste lühisekkumiste osutamiseks vajalikud töövahendid olemas. Ruumid on keskusel olemas nii Raplas kui Saaremaal (Orissaares ja Kuressaares). Teenuse järjepidevuse tagamiseks on keskusel piisaval arvul spetsialiste, kes on kvalifitseeritud teenuseid osutama. Teenuse kättesaadavuse osas informatsiooni jagamisel kasutatakse kohalikke tervishoiu- ja sotsiaalvõrgustikke, sotsiaalmeediat, haridusvaldkonna asutusi, valdkonnas elanikke koondavaid MTÜsid. Samuti on mõlemas piirkonnas TERVIK ettevalmistuseks loodud koostöömudelid, mille kaudu informatsiooni teenuse olemasolust on võimalik jagada. 1.5. Kinnitus metoodika kasutusõiguse kohta: Kinnitame õigust metoodikaid rakendada. Spetsialistid on väljaõppe läbinud 2. Ühe seansi maksumuse ja kulude põhjendus 2.1. Ühe seansi maksumus (koos seansi formaadiga, kui sama taotlus/VIPS sisaldab erinevaid formaate): 90eur 2.2. Keskmine kulu ühe teenusesaaja kohta: 450eur 2.3. Seansi maksumuse struktuur – esitada kulude jaotus, sh tööjõukulud, supervisioon, koolitus, koordineerimine, litsentsi- ja platvormikulud ning kaudsed kulud (kuni 7% taotletava toetuse üldmahust): üldkulud (ruumid, vahendid, taristukulud) 31,5 spetsialisti tööjõukulud 292,5 supervisioonifond 45 REHA litsentsikulu 3 koordineerimine 78 kokku 1 teenusesaaja keskmine kulu 450,00 3. Koolitustegevused (vajaduse korral) 3.1. Koolituste kirjeldus ja maht (tundides): 3.2. Koolitatavate spetsialistide arv: 3.3. Koolitatavate superviisorite arv: 3.4. Seos kavandatud rakendamisega ja proportsionaalsuse põhjendus: 3.5. Koolituskulude kogusumma (eurodes) ja osakaal toetuse eelarvest (%): 4. Selgitus, kuidas kavandatav tegevus aitab tervikuna suurendada VIPS-i rakendamise võimekust Eestis (nt spetsialistide ettevalmistus, sekkumise kättesaadavus, rakendamise maht või organisatsiooniline suutlikkus). Saaremaa piirkonnas ei ole vaimse tervise tugi KOV ja riiklike teenustega kaetud mujal kui ainult Kuressaares. Ka haridusvõrgu tugiteenused on tsentraliseeritud ning kättesaadavad vaid Kuressaares. Seetõttu on oluline osa hajaasustusega piirkonnast selline, kus kogu elanikkonnal elukaare ulatuses ei ole vaimse tervise abi kättesaadav. Meie keskus osutab teenuseid Ida-Saaremaal ning vajadus teenuste 4  järele on suur. Kuna aga Saaremaa on palgavaesuse osas Valga järel teisel kohal, siis elanikel teenuste eest ise tasumiseks ressurssi ei ole. Raplamaal on küll teenuste kättesaadavus Tallinna lähedusest tulenevalt parem, kuid potentsiaali astmelise abi mudeli I ja II astme rakendamisel meditsiinisüsteemi koormuse vähendamisel on oluline. Raplas piloteeritakse ka perearstiteenuse osas pilootmudelit Confidoga, kus inimestel puudub võimalus saada kontakti oma perearstiga või rääkida telefonitsi enda pereõega. See on viinud esmatasandi terviseteenused inimestest veel kaugemale ning tekitab tunde, et kellegagi ei ole võimalik rääkida. Seetõttu on äärmiselt oluline võimaldada antud perearstiteenuse mudeliga piirkonnas VIPSe, kus on võimalik inimesel kellegagi päriselt rääkida. Psühholoogilise lühinõustamise kättesaadavuse suurendamisel vähendab see ka ühiskonnas laiemalt uskumust, et ainult kliiniline psühholoog ja psühhiaater on mõjusad vaimse tervise abivahendid ning keskendumine kahele piirkonnale, mis ei ole nn keskused, tooma kvaliteetsed teenused elanikkonnale kogukonnas kättesaadavaks laiendades sellega elanikkonna ja sihtrühmade kaetust vaimse tervise teenustega. Kinnitused Kinnitan, et esitatud andmed on õiged ning vastan määruses sätestatud nõuetele. Kinnitan, et taotluses esitatud kulude katteks ei ole saadud ega taotleta toetust Euroopa Liidu fondidest, riigieelarvest ega muudest avaliku sektori vahenditest. /allkirjastatud digitaalselt/ Siiri Viil Viited • Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014). The impact of guidance on Internet-based mental health interventions — A systematic review. Internet Interventions, 1(4), 205–215. • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge. • Winston, A., Rosenthal, R. N., & Pinsker, H. (2004). Learning supportive psychotherapy: An illustrated guide. American Psychiatric Publishing. • Cuijpers, P., Driessen, E., Hollon, S. D., van Oppen, P., Barth, J., & Andersson, G. (2012). The efficacy of non-directive supportive therapy for adult depression: A meta-analysis. Clinical Psychology Review, 32(4), 280–291. 5 Saatja: [email protected] Saaja: "Info - SOM" <[email protected]> Teema: VIPS taotlus Kuupäev: 2026-04-28 19:18 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. Tere Esitame kaks VIPS taotlust 4 erinevale VIPSile. Siiri Viil Muusikaterapeut (kutsetase 6) Loovterapeut (kutse 7) Neuroloogilise rehabilitatsiooni spetsialist (NMT) Pereterapeut Kogemusnõustaja Gordoni perekooli koolitaja Ojaveere Vaimse Tervise Keskus <http://www.ojaveere.ee/> www.ojaveere.ee Tel 55 155 78