This is the published version Edwards, Jane 2006, Music therapy in the treatment and management of mental disorders, Irish journal of psychological medicine, vol. 23, no. 1, pp. 33-35. Available from Deakin Research Online http://hdl.handle.net/10536/DRO/DU:30066510 Reproduced with the kind permission of the copyright owner Copyright: 2006, Cambridge University Press

Irish Journal of Psychological Medicinehttp://journals.cambridge.org/IPM

Additional services for Irish Journal of Psychological Medicine:

Email alerts: Click hereSubscriptions: Click hereCommercial reprints: Click hereTerms of use : Click here

Music therapy in the treatment and management of mental disorders

Jane Edwards

Irish Journal of Psychological Medicine / Volume 23 / Issue 01 / March 2006, pp 33 - 35DOI: 10.1017/S0790966700009459, Published online: 13 June 2014

Link to this article: http://journals.cambridge.org/abstract_S0790966700009459

How to cite this article:Jane Edwards (2006). Music therapy in the treatment and management of mental disorders . Irish Journal ofPsychological Medicine, 23, pp 33-35 doi:10.1017/S0790966700009459

Request Permissions : Click here

Downloaded from http://journals.cambridge.org/IPM, IP address: 128.184.132.83 on 08 Dec 2014

Review

Music therapy in the treatment and management of mental disorders Jane Edwards

Abstract Objectives: An increasing number of research studies

support the benefits of providing music therapy in addition

to standard treatment for people who have mental

disorders. The objective of this paper was to review and

summarise recent research findings in relation to this work.

Method: A review of music therapy studies publ ished

since 1994 was undertaken. Criteria for including papers

were that they a) were published in English in an indexed,

peer-reviewed journal, and b) were conducted as a

randomised controlled trial (RCT) or a controlled trial (CT),

or c) provided a meta-analysis of existing studies. The large

number of papers pertaining to music therapy for older

adults who have mental disorders, including Alzheimer's

disease and other types of dementia was not included.

Results: The findings support a role for music therapy as

a structured interaction that patients are able to use to

participate successfully, manage some of their symptoms,

and express feelings relating to their experiences. Music

therapy is demonstrated to be a beneficial intervention for

people who have enduring mental il lness. Music therapy

invites and encourages participation from people of lower

functioning levels and employs a non-verbal medium with

which people have prior positive associations and in most

cases have l i felong experience of using music for self-

expression and pleasure. Additionally, the available peer

reviewed literature supports the proposit ion that clinical

outcomes are available through the use of music therapy

intervention in conjunction with standard, well-established

treatment methods.

Conclusions: Music therapy is beneficial for patients

receiving care for mental disorders and establishing this

therapy within mental health service provision should be

considered.

Music therapy; Psychotherapy; Psychotic

disorders; Therapeutics in mental disorders.

Introduction

This paper provides a review of evidence about music ther­

apy for people who have mental disorders. Music therapy is

the planned use of music to achieve therapeutic outcomes,

by a qualified practitioner who has graduated from an accred­

ited university programme of study, usually at postgraduate

Jane Edwards, PhD RMT, Senior Lecturer in Music Therapy, Irish World Academy of Music and Dance, University of Limerick, Ireland. SUBMITTED: DECEMBER 21, 2004. ACCEPTED: DECEMBER 10, 2005.

Ir J Psych Med 2006; 23(1): 33-35

level. In mental health services, music therapy is regularly

offered through group and individual programmes following

a process of referral and assessment.' Music therapists do

not work from a basis of systematised protocols, but rather

work with a patient's presenting needs, interests and history

and music therapy techniques are adapted accordingly to

facilitate the attainment of clinical goals.2 The past musical

experience of the patient is of interest to the music therapist

however the therapy does not require a client to have musical

skills. Group programmes offer structured opportunities for

patients to interact with others through the non-verbal

medium of music, while individual programmes offer musical

experiences to support direct clinical needs.23

In music therapy sessions music might be improvised freely

on a range of instruments, the patients might compose a

group piece, or songs may be written and sung.2 Sometimes

patients bring in music for the therapist or other group

members to listen to. Music therapists have specific skills in

using live, improvised music to elicit and manage responses

from clients who have difficulties with communication and

self-regulation.' The music therapist is ethically responsible

for the ways patients musical and non-musical material

emerging in sessions is treated, and has experience and

training to deal with the complexities of the therapeutic

relationship.2 Music therapists are trained to respond to

challenging behaviour with musical and non-musical

strategies, and to keep groups running smoothly and effec­

tively both within sessions and over time.23

In a prior review3 of music therapy group programmes it

was noted that published studies have reported positive

behaviour changes for a range of patients with mental health

conditions that require treatment in psychiatric services. An

examination of these studies, concluded that:

A consistent finding among these reports has been music

therapy's effectiveness with clients considered poor candi­

dates for traditional verbal group therapy. Specifically, music

therapy resulted in positive outcomes for clients known to

be ambivalent about or highly resistive to seeking treatment,

or who had difficulty in expressing feelings. These conclu­

sions suggest that music therapy may be helpful in the

treatment of adults with chronic mental illness, who often

demonstrate these same behaviours.3

Music therapy in the m a n a g e m e n t of psychotic

disorders

A recent Cochrane review of music therapy for patients

who have schizophrenia or schizophrenia-like illnesses

concluded that music therapy in addition to standard care

was superior to standard care alone in attainment of signifi­

cant improvements in patients' global state. It was found that

mental state and social functioning may also be improved if

33

Ir J Psych Med 2006; 23(1): 33-35

an adequate number of music therapy sessions are provided

to patients.4

A meta-analysis of 19 studies was performed to examine

the influence of music on symptoms of psychosis. Published

quantitative research that evaluated the influence of music on

these symptoms was analysed. Results were that music has

proven to be effective in addressing and diminishing the

symptoms of psychosis (fd = +0.71). It was found that there

were no differing effects between studies that used either live

or recorded music, and between structured music therapy

groups versus music listening programs. Nor did the studies

indicate differences in effects whether the patient or the

music therapist chose the musical materials.5

In a study of music therapy conducted at the Royal Edin­

burgh Hospital with adults who have chronic schizophrenia, a

treatment group received weekly individual music therapy

sessions over a period of 10 weeks. The treatment group

(n = 20) showed statistically significant improvement in their

clinical state, as measured by the Brief Psychiatric Rating

Scale, compared to a control group (n = 21) who attended

one session at the commencement of the 10-week period

and one at the end. It was concluded that music therapy

could have an important role for adults with chronic schizo­

phrenia. The authors proposed that since music participation

is based in reality through physical contact with instruments,

and in responding to others, and by its nature is a temporally

structured experience it is a suitable interaction to offer

people who have schizophrenia to address clinical needs.6

In a study published in the British Journal of Psychiatry, 76

in-patients diagnosed with the residual subtype of schizo­

phrenia were randomly assigned to a treatment group or a

control group. Both groups received standard medication as

prescribed by their treating physicians, but the treatment

group also received a one-month course of music therapy.

Outcomes were evaluated by four nurse practitioners using

the Chinese versions of the Scale for Assessment of Nega­

tive Symptoms and the in-patient version of the World Health

Organisation's Disability Assessment Scale. Music therapy

significantly diminished patients' negative symptoms,

increased their ability to converse with others, reduced their

social isolation, and increased their level of interest in external

events. The authors concluded that, "as music therapy has

no side-effects and is relatively inexpensive, it merits further

evaluation and wider application".7

In a music therapy study with people who have chronic

schizophrenia, 70 patients described as having a social

disability were randomly assigned to an experimental group

(n = 40) and a control group (n = 30). Individual and group

music therapy was provided, along with anti-psychotic

medications for the experimental group, while the control

group received medication only. All patients were evaluated

with the Present State Examination, Scale for the Assess­

ment of Negative Symptoms, Brief Psychiatric Rating Scale

and the Specialist Doctors Stress Inventory. Analysis of

videotapes was used to assess some of the behavioural

changes. Results suggested a more positive effect of music

therapy combined with medication on negative symptoms

and social disability than medication alone. The improvement

of negative symptoms was significant as reflected by scores

of sluggishness, blunted affect, and poverty of thought. There

was also a significant difference in the reduction of severity

in psychiatric disability three months after the music therapy

for the treatment group.8

A study was conducted to examine the effects of 15 music

therapy sessions provided over a four month period to

patients with chronic psychotic conditions, either DSM-IV

schizophrenia, or schizoaffective psychosis. Patients in the

treatment group (n = 34) were compared with a convenience

wait list control group (n = 32). Music therapy participants

achieved a significant improvement in quality of life scores

and a significant reduction in negative symptoms as

compared to control participants. Group music therapy

sessions were noted to activate participants' skills in inter­

personal relating and increased participation. These gains

were not evidenced at follow up.9

Music listening research Most music therapy approaches, especially those in Ireland

and other parts of Europe, primarily offer active music making

such as group improvisation led by a qualified music thera­

pist to address patients' needs. However, many reports of

patients' self-initiated strategies to manage auditory halluci­

nations (AH), such as music listening, have been published

and these are also of interest to music therapists. Arguably

the most comprehensive of these appeared in Schizophrenia

Research and showed that music listening was one of the

most common strategies reported by patients to manage

AH.10 The authors suggested this music listening is used by

patients as a "distraction technique" however given the devel­

oping knowledge of the neural processing involved in music,"

and the inherent structure and familiarity of the music

choices, it is perhaps time to start considering whether the

music listening strategy is effective and routinely chosen by

patients, not because it serves to 'drown out' hallucinations

but rather re-orders and structures patient perceptions and

experience, helping them to feel better oriented and more

engaged.

This suggestion is supported by a study of the music pref­

erences of 56 patients in a German psychiatric clinic. The

authors proposed that for the patients surveyed, music

played an 'important role' not just as a passive activity but

deliberately used in different situations for affect regulation.12

Music therapy for children and adolescents with psychopathology

A meta-analysis of 11 studies (188 subjects in total)

published in Journal of Child Psychology and Psychiatry

revealed that music therapy has a medium to large positive

effect on clinically relevant outcomes for children and adoles­

cents with psychopathology. This analysis concluded that:

Clients with behavioural or developmental disorders, or

with multiple psychopathologies may benefit from music

therapy. Music therapy for children and adolescents with

psychopathology seems to be particularly helpful when tech­

niques from different music therapy approaches are

combined™

Music therapy and depression Few research studies published during the period of this

review have investigated music therapy interventions with

people who have depression. The following studies outline

patients' responses to music listening interventions.

Ir J Psych Med 2006; 23(1): 33-35

Adolescent females, randomly assigned to either massage or therapy treatment, were noted to have a reduction in right frontal electroencephalography (EEG) scores after only twenty minutes of music listening while behaviour and self-report of mood states were unchanged.14

A study of depressed mothers found that music therapy was an 'extremely effective short term intervention', as reflected in attenuation of right frontal EEG activation, moving toward symmetry. It was suggested that the benefits observed from music therapy are due to the way that this therapy is 'mood altering' for the mothers and 'arousal reduc­ing' for the infants, allowing improved interaction in the dyad.15

Music listening was used over a two-week period with patients with major depressive disorders. Depressive scores for the music listening group were significantly reduced as were their subscores of depression in comparison with controls.16

Discussion A number of research studies and meta-analyses provide

evidence of beneficial outcomes provided by music therapy; a structured interaction that patients are able to use to partic­ipate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music listening is also noted to deliver benefits.

Music therapy is especially applicable for people who have enduring mental illness since it invites and encourages partic­ipation from people with a range of functioning levels. Music therapy employs a non-verbal medium with which people have prior positive associations and in most cases have life­long experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.

The mechanisms by which music therapy processes are deemed to be effective with people who have mental disorders require further investigation. One proposition is that its effectiveness lies in the way that music processing func­tions through accessing sub-cortical pathways, that bypass other areas of cognitive function, such as language; linked to fundamental physiological mechanisms." In general, music therapists have tended to describe the uses of music for this population in sociological and psychological terms within a psychotherapeutic framework, citing the positive associations most people have with music participation, and the capacity of music to allow for different levels of participation, from listening, to playing music and co-participation in music making. For patients accessing mental health services who may have very low functioning levels in social domains, this interaction is conceptualised as assisting the revitalisation of, and confidence in, the maintenance and stimulation of these skills.

While the published research provides evidence that music therapy contributes to the effective care and support of a range of patients who have psychiatric illnesses, currently in Ireland, very few music therapy services are available to mental health consumers. There has been no formal investi­gation of attitudes and knowledge of music therapy in mental health services here, however it is possible that music

therapy, as it is still relatively new, is considered an 'alterna­tive' therapy and this perception limits thoughtful consideration of its inclusion in service development. In addi­tion, where practitioners have not had exposure to the work of a qualified music therapist, there may be a perception that clinicians using music with patients are undertaking 'music therapy'. Where observed outcomes of this ad hoc applica­tion of music have been benign, or even problematic, practitioners may not give credence to the clinical benefits of music therapy programmes run by qualified practitioners.

No adverse effects for music therapy were reported in the above studies. It is important to note that in each report, music therapy services or music listening experiences were devised carefully with reference to a range of considerations for employing music with people who have mental disorders.

Conclusion The research literature indicates music therapy is

warranted as part of the total care of patients within psychiatric services, with emphasis on the capacity of this therapeutic intervention to address psychosocial needs and assist the development of individual competence. The qualified music therapist works alongside other health professionals and is a highly skilled clinical staff member with a unique contribution to make to team-based care. The research literature supports this role, and validates the need for a qualified practitioner to be employed in directing development of such services.

Acknowledgments Thanks are due to Helen Odell-Miller and Maeve Scahill for

assistance in preparation of this paper.

Declaration of Interest: None.

References 1. Odell-Miller H. Why provide Music Therapy in the community for adults with mental health problems? British Journal of Music Therapy. 1995; 9: 4-11. 2. Davies A, Richards E. Music Therapy in acute psychiatry. British Journal of Music Therapy. 1998;12:53-59. 3. de I'Etoile S. The effectiveness of music therapy in group psychotherapy for adults with mental illness. The Arts in Psychotherapy. 2002; 29(2): 69-78 4. Gold C, Heldal T, Dahle T, Wigram T. Music Therapy for schizophrenia or schizophrenia-like illnesses. The Cochrane Database of Systematic Reviews. 2005; Art no.: CD004025. DOI: 10.1002/14651858. 5. Silverman M. The influence of music on the symptoms of psychosis: A meta­analysis. Journal of Music Therapy. 2003; 40(1):27-40. 6. Pavlicevic M, Trevarthen C, Duncan J. Improvisational music therapy and the rehabilitation of persons suffering from chronic schizophrenia. Journal of Music Therapy. 1994;31 (2):86-104. 7. Tang W, Yao X, Zheng Z. Rehabilitative effect of music therapy for residual schizophrenia. A one-month randomised controlled trial in Shanghai. British Journal of Psychiatry Suppl. 1994; Aug;(24):38-44. 8. Yang VV, Li Z, Weng Y, Zhang H, Bio M. Psychosocial rehabilitation effects of music therapy in chronic schizophrenia. Hong Kong Journal of Psychiatry. 1988;8:38-40. 9. Hayashi N, Tanabe Y, Nakagawa S, Noguchi M, Iwata C, Koubucht Y, Watanabe M & Okui M. Effects of group musical therapy on inpatients with chronic psychoses: A controlled study. Psychiatry Clin Neurosci, 2002; 56:187-93 10. Shergill S, Murray R, McGuire P. Auditory hallucinations: A review of psychological treatments. Schizophrenia Research. 1998;32:137-150. 11. Trainor L, McDonald K, Alain C. Automatic and controlled processing of melodic contour and interval information measured by electrical brain activity. Journal of Cognitive Neuroscience. 2002; 14(3): 430-442. 12. Bertling R, Harenbrock S, Agelink M. Music hearing preferences of psychiatric in­patients. European Psych 1998 13 (Suppl 4): 252. 13. Gold C, Heldal T, Dahle T, Wigram T. Music Therapy for schizophrenia or schizophrenia-like illnesses. The Cochrane Database of Systematic Reviews. 2005; Art no.:CD004025. DOI: 10.1002/14651858. 14. Field T, Martinez A, Nawrocki T, Pickens J, Fox N, Schanberg, S. Music shifts frontal EEG in depressed adolescents. Adolescence. 1998, 34; 529-534 15. Field T. Maternal depression effects on infants and early interventions. Preventive Medicine. 1998;27:200-203. 16. Hsu, W. & Lai, H. Effects of music on major depression in psychiatric inpatients. Archives of Psychiatric Nursing, 2004; 18. 193-199 17. Berger D, Schneck D. The use of Music Therapy as a clinical intervention for physiologic functional adaptation. J- Scientif Exploration. 2003; 17, 687-703.

35