Table 5.

Qualitative Findings

Themes and definitions	Categories and definitions	Example quotes
Theme 1 Pain management: The VMT program offers participants strategies to manage pain in their daily lives.	Enhanced physical functioning: Music engagement helps to improve activity levels and ability to do chores	But I use the soft jazz just to help with… I just sit there and listen to it and I close my eyes. And I just rub my knees […] and when I feel like the feeling is going to be okay and I can get up and not have a limp or anything, I get up. And then, I don't have no limp. The knee don't be bothering me.
		I use to could not even walk 2 or 3 blocks. I would have to like really sit down and take a breather. But it just seemed like once I came here […] and we just got into the mood…once everything was over, I'd go home and I'm like “I'm not in no pain at all.” And I never realize it and I'm like doing all this stuff (chores) in the house.
	Reducing pain: Music brings pain relief through its soothing qualities as well as through refocusing of attention	I would describe it [the music] as a de-stressor. A way to rethink, recharge your mind in a different direction and also to take your mind off the pain…I'm not going to say it can totally go away but it'll subside a little to a point where you're functional.
		I liked the ocean drum. That is really soothing, and it just relaxed my whole body. I just listened to the sound of it, and it takes you to sitting on the beach (in your imagination) and just watching the waves. It was really peaceful.
		When the pain begins to come, I try to hum […] just direct my attention to something else.
Theme 2 Improved psychological well-being: VMT strategies help manage difficult psychological and emotional states that contribute to pain.	Achieving mindfulness: Music helps participants be more present by creating a relaxed and clearer state of mind.	A lot of the music that we've used were meditative, so it kind of allows me to broaden like, my mind and my perception…with sounds.
		I do music for de-stress. And to take my mind off the pain…it's like a rethinking process… mindfulness. So when I'm mindful, first I do mindful exercises and breathing. Recognizing my own breath. My own heartbeat. And it tends to calm down.
	Empowerment: VMT empowers participants to prioritize self-care, helps to restore hope, and motivates to be active.	And there's this sign of hope. That's what I liked about the songs…that they're sign of hope, they're sign of welcoming.
		It helps your day to keep going. […] you look over at the other person, and you see that their struggles might be a little different than yours. But you see how they push through it. So to me, it makes me push through it even more because I'm like, “Okay, you know…I'm gonna keep going.”
		Also, just learning patience with my pain and being kinder to my body about it. In the sense of, you know, I feel like for a long time it was mostly just being mad and having that energy toward whatever part of my body was not feeling good or what I couldn't do, so I think a lot of what I took from that was, you know, focusing on what I can do now, what I can do to help myself, and something like that. Yeah. I do have, I have a lot more now.
		You were allowed to sing lousy or you were allowed to be off key. […] In the group it just didn't matter. I watched people's volume—as their confidence level went up, their volume increased. Their voices were being heard.
		The songs that we would sing, it really was so motivating. I felt like I was somewhere else.
	Enhanced mind-body connection: VMT music experiences and psychoeducation help participants gain greater awareness of the impact of emotional and cognitive state on their pain management	And I think most of the benefit that I got directly from the sessions themselves was probably for me more related to emotional issues related with pain.
		If you don't understand your feelings, how do you expect anyone else to? […] this music program will help you learn to get to know yourself. Then, other things will follow.
		When you sing, it release endorphins, so it helps to lift the mood and better manage the pain.
	Managing emotions: Participants learned music-based strategies to decrease, work through, and tolerate stressful and emotional situations.	But it really showed me how if you really take the time, music can really help with certain areas of pain. It didn't take away the pain completely, but I do have issues with PTSD and anxiety and things, and I get frustrated a lot, especially with the pain. So it taught me how to just take that time and take a moment.
		When the therapist had us doing the humming and the singing, it made you feel at peace.
Theme 3 Developing meaningful connections: The VMT program promotes social, cultural, and spiritual connections	Universal connection: music experiences promote deeper connections with spiritual and metaphysical entities.	Well, it (music) is a gift from God. And God shows you some of things that they're (peers) going through even though you might have been through it all ready, but that showed them how you can come out you strong. So it was a touching…it (music) was like a ministry thing to me…you know, within myself.
		The spiritual because I go to church. And we express ourselves through word and dance. I kept hearing his name. He's the minister of music at my church. And I just kept hearin’ him…every time she (the music therapist) would wave that water drum or whatever that thing is called…or somebody would hit the…whatever instrument they would have and I'm hearing him.
	Social connections: Group music engagement and sharing of experiences create a group bond, developing deep and meaningful relationships based on mutual support and learning.	Just being in a room with people and hearing their experiences and hearing their active listening affirmations of my experiences. We all probably have different kinds of pain, but chronic pain is still chronic pain. Hearing and being understood and sharing just felt real comfortable and in a way that I had not experienced.
		Being with other people that were going through similar situations and some that had worse.[…] to know that you weren't the only one. ‘Cuz sometimes you can feel like you're alone. Especially if someone else has not experienced what you're feeling are… Understand where you're coming from.
		Meeting other people, that was really good—just sit around a bunch of people where there is no arguing, no bitterness. Just singing and being happy at that moment and I liked that.
		We'd sing like we were on the choir together. We'd harmonize. I was like, wow! It was good. It was a joy.

PTSD, posttraumatic stress disorder.