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Running head: MIXED METHODS RESEARCH ANALYSIS #4

Group Music Therapy for Patients with Persistent Post-Traumatic Stress Disorder – An Exploratory

Randomized Controlled Trial with Mixed Methods Evaluation

MUSC-4800: Research in Music Education and Music Therapy

Deidra Borus

Canadian Mennonite University

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Carr, C., D’Ardenne, P., Sloboda, A., Scott, C., Wang, D., & Priebe, S. (2011). Group music therapy for

patients with persistent post-traumatic stress disorder - an exploratory randomized controlled

trial with mixed methods evaluation. Psychology and Psychotherapy: Theory, Research and

Practice,85(2), 179-202.

Background Info/Purpose of the Study

This article is a mixed methods study regarding patients with Post-Traumatic Stress Disorder

(PTSD). There was literature that suggested that Cognitive Behavioural Therapy (CBT) could be beneficial

in working with individuals with PTSD in group music therapy. However, not all patients that are

diagnosed with PTSD respond positively to CBT. The two main objectives for this study were, “...to

assess whether group music therapy was feasible for patients who did not respond to CBT, and whether

it has an effect on PTSD symptoms and depression,” (Carr, d’Ardenne, Sloboda, Scott, Wang & Priebe,

2011, pg. 179). The design of this study used a mixed methods approach, as well as, “…an exploratory

randomized controlled trial, qualitative content analysis of therapy, and patient interviews,” (Carr,

d’Ardenne, Sloboda, Scott, Wang & Priebe, 2011, pg. 179).

About Post-Traumatic Stress Disorder (PTSD)

In short, PTSD is a condition in which the patient deals with constant emotional and mental

shock due to a traumatic event or experience. The patient will go through multiple episodes of vivid

memory or recall of the experience, and even go to the extent of re-enacting said event in real life

situations. When a patient is diagnosed with PTSD, these memory re-enactments dull the sound and

other people around them. It is a very difficult condition to live with, and studies like this are meant to

continue to find a cure for this diagnosis. Having gone through two traumatic experience myself, it is

difficult to go day-to-day and having something (a person, memory, a place or an object) trigger that
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event which could have happened many years ago. This study really spoke to me because I never really

thought that music therapy could help deal with a diagnosis such as this.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a person is

only diagnosed with PTSD when the individual, “must have directly experienced or witnessed a threat to

life, serious injury, or personal integrity, and responded with helplessness or horror,” (Carr, d’Ardenne,

Sloboda, Scott, Wang & Priebe, 2011, pg. 180). For example, robbing someone at a bank, or being a war

veteran out in Iraq would be an example of this. Individuals who are diagnosed with PTSD often have

feelings of guilt regarding the incident that they were involved in, and they feel upset or scared when

they must face their memories head on. It is also important to remember that mood swings are a big

factor regarding PTSD. Individuals can go through several episodes of emotions everyday, and it can

have a large issue on their mental health state.

This study believed that music therapy could be beneficial for multiple reasons. Firstly, as the

article states, music can reach out to others when other things or people cannot. In a real-life therapy

session, some clients might find talking about their feelings to be intrusive and uncomfortable. Music is

a way to cross that boundary and is almost its own language across the globe. Music therapy can relate

to clients and realize their own identity behind the trauma.

There are many symptoms that associate with PTSD, however, this article states three main

symptoms: Re-experiencing, avoidance and hyperarousal. In re-experiencing, individuals recall vivid

details of the event, such as certain smells, sounds or images related to that trauma. This can also

include something called flashbacks of the event, where the individual goes back in their mind to the

event where it all happened. Avoidance symptoms include avoiding the situation entirely, or a specific

place where the event happened, or even removing contact towards certain individuals to completely

forget about the traumatic event and everything associated with it. The study refers to this as numbing
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the pain. Hyperarousal symptoms include “sleeplessness, irritability, aggression, poor concentration,

and a general mistrust of others, often manifested by hypervigilance and exaggerated startle responses,”

(Carr, d’Ardenne, Sloboda, Scott, Wang & Priebe, 2011, pg. 181). Other symptoms of PTSD can include

different levels of functioning on social, occupational and interpersonal responses towards others. The

symptoms can be extremely severe, and must extend for 12 weeks after the traumatic event occurred.

Method

For this specific study, they conducted an exploratory randomized controlled trial with a waiting

group design. The group chosen for this study were given 10 weeks of music therapy session. The group

was assessed at the beginning and end of the 10-week period. The patients selected for this study were

in-between the ages of 18 and 65 years old, spoke English and at that time were not receiving any other

type of psychotherapy. Each patient had a diagnosis of PTSD.

The data from this study were collected prior to music therapy beginning as well as immediately

after the last session was completed. The PTSD symptoms were assessed again after the treatment was

completed. Some of the patients in this study did not attend all the sessions, therefore, telephone

conversations were had to fulfill the attendance requirement of each patient. They came to find that

even though only seven patients attended each session, the other three maintained phone contact with

the researchers, so their input was still valid to the study. Each patient had their own set of individual

challenges that made it difficult for the clients to attend sessions, but they could discuss those

challenges with the researchers throughout the study.

There were multiple sets of instruments used, such as a cabasa, djembe, tone bars, xylophones,

maracas, etc. There were also two pianos and a guitar that were available to the patients as well, which

is something that is not usually offered in a music therapy session. The therapeutic process of this study

was extremely interesting, because it was mostly about musical improvisation and allowing the patients
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to freely improvise while being in a safe and secure environment. There were several goals set, as well

as some secondary goals for the group. There was also a video camera that was placed in the corner of

the room, out of sight of the clients in order to videotape and record their process each week.

The Therapeutic Process

There were three main goals that the music therapists provided for the 10-week period (Carr,

d’Ardenne, Sloboda, Scott, Wang & Priebe, 2011, pg. 184-185):

1) Foster safety and encourage use of the setting and instruments to communicate, as manifest by

regular and complete attendance.

2) Increase self-agency and question assumptions of leadership in order to increase independence,

autonomy, and initiation of musical ideas.

3) Alleviate re-experiencing, avoidance, hyperarousal, associated depression.

Within the therapeutic setting, the instruments provided were arranged inside a large circle with

chairs on the outside of the circle. The patients were given the instruction that they could move around

freely, and improvise on any instrument of their choosing. The music therapists provided some musical

accompaniment based off the patients’ improvising. The therapists were able to respond to the music

by doing two main things: “imitating an aspect of an individual member’s music (e.g.: pitch, resonance,

or timbre) and providing a broader musical structure to encompass the expressions of the group as a

whole,” (Carr, d’Ardenne, Sloboda, Scott, Wang & Priebe, 2011, pg. 185). After the improvisation ended,

the patients were encouraged to provide a verbal discussion about what they had just experienced,

however, the music therapists did not make the patients discuss anything if they did not want to. Each

session was watched on video after the session, and the music therapists wrote down progress notes

every week in accordance to what they experienced within the music therapy sessions.
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During sessions 1 and 2, the clients were given instruments and the ability to improvise on any

instrument of their choosing. From session 3 until the end of session 7-8, the clients were able to use

drum circles to facilitate self-expression between group members, and relieve some tension throughout

the group as a whole. Sessions 8 through 10 were focused on relaxation and using music the express

specific emotions that the clients were feeling throughout the 10 weeks or even just on that specific day.

Results

A table was conducted that discussed the quantitative results of this study. This table included

the baseline, the 10-weeks follow up, and period 1 and 2. In all three categories of the symptoms re-

experiencing, avoidance and hyperarousal, the symptoms decreased dramatically, which shows that

allowing patients to engage in music therapy can be beneficial in decreasing symptoms of PTSD.

During the exit interviews, the patients were asked what they liked and didn’t like, and how

beneficial they found the 10-week process. There were many helpful factors that the clients enjoyed,

including the drum, meeting new people and sharing knowledge of their own personal traumatic

experiences. Each patient had a completely different response to music and the instruments used. Some

liked them, and some did not. Some did not enjoy the specific sounds that an instrument made, where

others stated that the instrument (a drum) could almost take them to another place and forget about

what is happening in the world around them. Some patients could state that they felt more focused on

the here and now instead of their past and the trauma associated with it. Even though not all patients

attended all the sessions, there was improvement throughout this study. The patients who were present

participated constantly, and even the ones who did not attend the session every week were still able to

participate over the phone. The most progress made was in the avoidance domain. This was done

through a process called grounding, and the clients could regulate their emotions through playing

instruments and sharing their experiences.

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Conclusion

Further research is still needed to fully understand the concept of a client with PTSD. However,

just from this study, it has been proven that music is able to take the patients to another place away

from the haunting symptoms of PTSD. However, the relationship between music therapy and depression

is still not clear. The study states that, “During treatment, patients increased their activity, reduced

avoidance, and generated their own social supports. Group dynamics may have contributed, as shown in

the qualitative outcomes. However, patients also reported music intrinsically altering their mood and

extrinsically motivating them to continue treatment,” Carr, d’Ardenne, Sloboda, Scott, Wang & Priebe,

2011, pg. 197). Basically, music therapy can positively impact the mood of a person, it does not

effectively show how it can treat depression. Further research is required on that front.

Overall, the study was a success. The patients that attended the study on a weekly basis really

benefited from music therapy. Even though their symptoms are not cured, they subside when exposed

to a music therapy setting, and I think that is important to remember. It is so amazing to me how music

can affect everyone in different ways, regardless of the diagnosis of a person.

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References

Carr, C., D’Ardenne, P., Sloboda, A., Scott, C., Wang, D., & Priebe, S. (2011). Group music therapy for

patients with persistent post-traumatic stress disorder - an exploratory randomized controlled

trial with mixed methods evaluation. Psychology and Psychotherapy: Theory, Research and

Practice,85(2), 179-202.