Music Therapy

Background: I went to a concert recently at Mr. Small’s Funhouse in an area of Pittsburgh called Millvale and I was getting really into the music. I became aware of my body at one point and noticed a huge smile on my face. I started to think about how music seems to be something that is essential to the human experience. I wanted to dive deeper into the literature and understand how music effects mood. I found some super interesting studies that I will review below.

My experience:  I am fortunate because both the child psychiatric unit and adult psychiatric unit in Kansas City had a music therapist. I thought that this was a standard part of a psychiatric unit and I was surprised to learn that this is not the case. Plenty of psychiatric units don’t have a music therapist! I was able to see the benefits first hand and after reading the evidence to support music therapy, I think it should be a standard of psychiatric care.

The first music therapy session that I saw was a group session with adolescents. The song played was Mansion by NF. Unfortunately, a lot of the kids on the psychiatric unit have a history of being abused, a lot of anger, and a lot of issues with building relationships. This song addresses trust issues, and poetically discusses abuse, and opening up to others. The music therapist played the song, then went back to certain lyrics and asked the kids to interpret the lyrics and relate the lyrics to their experiences. It can be hard to get a group of adolescents to participate in a group activity, but I saw the emotions and passions that the music was evoking and I saw the kids actively participating.

The medical evidence is compelling and shows how effective music therapy can be.

Effectiveness:
(1) A Cochrane review was conducted with 9 trials of 411 patients. The goal of the meta analysis was to assess the short-term effects of adding music therapy to usual treatment as compared to just usual treatment for depression. The meta analysis showed that music therapy causes additional improvements in depression, anxiety and functioning over usual treatments. Patients were included from various age groups, 5 of the trials recruited from mental health services, one from a nursing home, one from a geriatric facility and 2 from high schools. 7 of the trials conducted music therapy in groups, and 2 studies preformed individual therapy. The effect size translates to a 9.8 point decrease on the Hamilton Rating Scale for Depression and an effect size that translates to 5 point decrease on the Hamilton Anxiety Scale. Music therapy was not associated with significant side effects.

This is huge! A 9.8 point decrease can be the difference between very severe depression and moderate depression. Music therapy seemed to show no side effects as well! If a medication came out that decreased depression symptoms by this much with no side effects, it would be a billion dollar drug.

(2) A study out of Thailand compared active versus receptive group music therapy for major depression. Active music therapy is playing an instrument or singing while receptive music therapy is listening to music. On top of standard care, 14 patients were randomized to receive active group music therapy, receptive group music therapy or group counseling once weekly for an hour. The participants were assessed at 1 month (after 4 sessions), at 3 months (after all sessions) and at 6 months. At all time points, the music therapy groups showed statistically non-significant reductions in the MADRS scale.

This study is interesting because it starts to address variables such as the type of music therapy. This small trial did show benefits in both passively and actively receiving music therapy.

(3) A study from Germany compared the effects of group music therapy to recreational group singing for the treatment of depression in nursing home patients. There were a total of 117 patients included in the study. The MADRS depression score decreased by 3.0 points more in the music therapy group at 6 weeks and by 4.5 points more at 12 weeks. The study showed that music therapy was more effective than recreational singing.

This study shows that a trained music therapist seems to be more effective for treating depression over unguided music singing. Listening or playing music can still be helpful, it just may be less effective than utilizing a trained music therapist’s skills.

I also wanted to show some other interesting trials that I came across.

(4) A study of 106 adolescents reviewed depression and type of media used (television, movies, music, video games, internet and print media such as magazines, newspapers and books). Of the 106 patients, 46 were diagnosed as having major depressive disorder. Each quartile of audio use was associated with an 80% increase in the odds of having major depressive disorder and conversely each quartile of print media use was associated in a 50% decrease in the odds of having MDD.

This does not mean that listening to more music leads to depression in adolescents. There are plenty of variables in the trial. It may mean just the opposite. It could mean that adolescents with depression seek out more music because the music is helpful in dealing with the symptoms of depression. Also, the more that the adolescent reads, the less chance of having depression. This could be because concentrating is difficult in the depressed kids, so they were not able to read as much. I found this article super interesting and had a good time theorizing what could be causing the differences between the groups.

(5) A study of 177 undergraduate students from a university in Australia participated in a study for course credit. Participants were randomized to the “Happy Listening Group” or the “Sad Listening Group”. Participants then listened to the playlist twice weekly for 4 weeks. The happy music showed a positive effect in the initial listening but the long term effect showed no mood differences in the happy or sad music group. People with high scores of rumination in the sad music group reported less positive effects from the music over time.

Does the type of music matter? This study points to a possibility that sad music is not helpful for people who tend to ruminate on negatives. I think personally, sometimes I feel better after listening to sad music. Sometimes, people feel nothing or even numb while in depression and for me, I would rather feel and experience sadness than nothing at all.

Sources:
1. Aalbers S, Fusar-Poli L, Freeman R, et al. Music therapy for depression. Cochrane Database Syst Rev. 2017 Nov 16;11:CD004517.

2. Atiwannapat P, Thaipisuttikul P, Poopityastaporn P, et al. Active versus receptive group music therapy for major depressive disorder-A pilot study. Complement Ther Med. 2016 Jun;26:141-5.

3. Werner J, Wosch T, Gold C. Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial. Aging Ment Health. 2017 Feb;21(2):147-155.

4. Primack B, Silk J, DeLozier C, et al. Using ecological momentary assessment to determine media use by individuals with and without major depressive disorder. Arch Pediatr Adolesc Med. 2011 Apr;165(4):360-5.

5. Garrido S, Schubert E, Bangert D. Musical prescriptions for mood improvement: An experimental study. The Arts in Psychotherapy Volume 51, Nov 16, pg 46-53.

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