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Music therapy improves symptoms in adults

hospitalised with schizophrenia
Christian Gold

Evid. Based Ment. Health 2007;10;77-

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THERAPEUTICS
Music therapy improves symptoms in adults hospitalised with
schizophrenia
Talwar N, Crawford MJ, Maratos A, et al. Music therapy for in-patients with schizophrenia: exploratory randomised controlled trial.
Br J Psychiatry 2006;189:4059.
...............................................................................................................................
Q Does music therapy improve symptoms in people hospitalised with schizophrenia?
METHOD
Design: Randomised controlled trial.
Allocation: Concealed.
Blinding: Single blind (assessors blinded).
Follow-up period: Three months (treatment period only).
Setting: Four London hospitals, UK; time period not stated.
Patients: Eighty one adult inpatients (>18 years old) with a
primary diagnosis of schizophrenia or schizophrenia-like
psychosis. Exclusions: secondary diagnoses of dementia or
organic psychosis.
Intervention: Music therapy (access to a range of musical
instruments and encouragement to express themselves
accompanied by a trained music therapist during weekly
individual sessions of up to 45 min) plus standard care (access to
occupational, social and other activities and nursing care) versus
standard care alone for up to 12 weeks.
Outcomes: Primary outcome measure: symptoms, total score on
the Positive and Negative Syndrome Scale (PANSS); secondary
outcome measures: satisfaction with care, Client Satisfaction
Questionnaire (CSQ); global function, Global Assessment of
Functioning Scale (GAF).
Patient follow-up: 85%.
MAIN RESULTS
In people hospitalised with schizophrenia, adding music therapy to
standard care lead to greater improvement in symptoms compared
with standard care alone at 12 weeks (change in PANSS total score
from baseline: 29.00 with music therapy plus standard care vs 22.96
with standard care alone; p = 0.045). There was no significant
difference in patient satisfaction with care and global function
between groups (change in CSQ score from baseline: +1.82 with
music therapy plus standard care vs +0.33 with standard care alone;
reported as non-significant; change in GAF score from baseline:
+4.74 with music therapy plus standard care vs +4.60 with standard
care; reported as non-significant).
.............................................................
For correspondence: Dr Mike Crawford, Department of Psychological
Medicine, Claybrook Centre, St Dunstans Road, London W6 8RP, UK;
m.crawford@imperial.ac.uk
Source of funding: Priory training grant.
EBMH Volume 10 August 2007
77
CONCLUSIONS
Adding music therapy to standard care improves symptoms
compared with standard care alone in people hospitalised with
schizophrenia. Adding music therapy to standard care did not have a
significant impact on overall patient satisfaction with care and global
function.
NOTES
In this issue, Crawford and Patterson review the evidence for arts
therapies in schizophrenia (see page 69).
Commentary
S
chizophrenia is a serious mental disorder that can take a chronic
course. Symptoms are classified as positive (such as hallucina-
tions) and negative (such as affective flattening or poor social
relationships). Treatment options for people with severe mental disorders
traditionally include medication and verbal psychotherapy, but these can
have limited effects in the most severely affected patients. Music therapy is
an approach that may help those who do not easily benefit from
exclusively verbal approaches to psychotherapy1 by using musical
interaction (usually combined with verbal reflection of the musical
processes) as a means of expression and communication. It may enable
patients to bring forth hidden resources and build social competencies,
potentially improving some symptoms and areas of functioning which are
not easily affected by traditional modes of therapy.2 Previous studies
showed beneficial effects of music therapy for people with chronic
schizophrenia in East Asia.3 4
The present study compares standard care plus music therapy (up to 12
individual sessions) to standard care alone. Results suggest that music
therapy helps to improve symptom level (but not global functioning and
satisfaction). This study confirms the validity of previous findings for
Western countries and the feasibility for acute psychosis. The authors
rightly conclude that their study justifies a larger trial to confirm the
findings and to examine mechanisms of change in music therapy as well
as predictors of its effects. However, an additional aspect that may be
hidden when looking at this study alone is the importance of a sufficient
number of sessions. Results from a systematic review (which included
data from this study) suggested that many patients will need more than
the 12 sessions provided in this study to reliably achieve meaningful
effects.2 This is important to consider in clinical practice and an important
issue for future research.
Christian Gold, PhD
University of Bergen, Bergen, Norway
Competing interests: None declared.
1 Gold C, Rolvsjord R, Aaro LE, et al. Resource-oriented music therapy for
psychiatric patients with low therapy motivation: protocol for a randomised
controlled trial [NCT00137189]. BMC Psychiatry 2005;5:39.
2 Gold C, Heldal TO, Dahle T, et al. Music therapy for schizophrenia or
schizophrenia-like illnesses. Cochrane Database Syst Rev
2005;2:CD004025.
3 Tang W, Yao X, Zheng Z. Rehabilitative effect of music therapy for residual
schizophrenia: A one-month randomised controlled trial in Shanghai. Br J
Psychiatry 1994;165(Suppl 24):3844.
4 Yang W-Y, Li Z, Weng Y-Z, et al. Psychosocial rehabilitation effects of music
therapy in chronic schizophrenia. HK J Psychiatry 1998;8:3840.
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