Music+Therapy

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__**Introduction**__

Music therapy is a relatively new and rising topic in the field of medicine. This particular type of treatment provides numerous benefits over more traditional means of treatment. Music therapy is non invasive, has no documented negative side affects, requires no painful procedures, and is often considered enjoyable. Music therapy is usually implemented, as a supplement to an ongoing, more traditional treatment, however there have been successful cases of music therapy replacing traditional treatments in extreme cases. Music therapy can be used to treat a wide spectrum of diseases and disorders, from mood disorders such as depression and bipolar disorder, to forms of dementia, such as Alzheimer’s disease and schizophrenia.

__**Means of Administration**__

There are a variety of methods for the administration of music therapy. Most forms of music therapy fall under two principle groups. The first group is social music therapy, and the next group is called individualistic music therapy. Both types of approaches provide different advantages. Social music therapy allows participants to engage with one another, while individualistic music therapy allows for personalization and self-reflection. In terms of how music therapy is preformed, there is a broad rage of activities. Singing, dancing, playing an instrument, writing music, and listening to music have all proven to be positive influence in treating patients.

__**Mood Disorders**__


 * Major Depressive Disorder**

Depression is one of the most prevalent mental health problems. In the United States approximately 6.7% percent of the nation’s adult population suffer from Major Depressive Disorder (1). This disorder ranges in severity, as well as symptoms. Some of the trademark symptoms include feelings of sadness, anxiety, hopelessness, restlessness, insomnia, and in the most severe cases thoughts and attempts of suicide. There are a variety of treatments available for depression. The most popular treatments used to treat depression are medications such as Selective Serotonin Reuptake Inhibiters (SSRIs), Serotonin and Norepinephrine Reuptake Inhibiters (SNRIs), and Monoamine Oxidase Inhibitors (MOIs). Other notable treatments are electroconvulsive therapy and psychotherapy (2). Apart from all of the mainstream treatments of Depression is music therapy.

While music therapy is a new and rising field, there have been many successful studies corroborating the effectiveness of music therapy in the treatment of Depression. In 2010 Jinliang Wang, Haizhen Wang, and Dajun Zhang conducted a study to test the effectiveness of music therapy on treating depression. In the experiment a total of 80 students were tested to have a SCL-90 depression factor score of 40 or higher along with a symptom checklist score of 2.18 or higher. Two groups were formed, one group of 40 people was labeled the control, and another group of 40 people was labeled intervention. The control group received no treatment for their depression, while the intervention group underwent a three-stage program, which was an introduction, implementation, and a feedback stage. In the third stage, intervention, participants received instruction on rhythm and movement training and music-painting training. After the experiment was conducted the SCL-90 depression factor score and symptom checklist score was again measured. The results showed that prior to the experiment the scores between control and intervention are the same, however after the intervention group received musical therapy treatment, the group scored much lower in both SCL-90 depression factor score and symptom checklist score. The control group showed no change in either SCL-90 depression factor score or symptom checklist score (3). This experiment is one of many that provide evidence that music therapy is an effective way to treat depression.

In another progressive experiment providing supportive evidence for the effectiveness of musical therapy, Sergio Castillo-Perez et. al from Mexico preformed a controlled experiment comparing music therapy treatment to psychotherapy. In the experiment a total of 79 participants were tested to have low to medium level depression according to the Zung Depression Scale. 41 of these patients where assigned to music therapy treatment, while 38 patients where assigned to psychotherapy. Participants taking part in musical therapy treatment were asked to listen to selections of classical and baroque music for 50 minutes at home every day, as well as an additional group session at the hospital every week. Participants taking part in the psychotherapy treatment attended personalized, one on one sessions with a trained expert psychologist for 30 minutes every week. In both groups, evaluations measuring depressive symptoms were conducted weekly as well. The results after 8 total sessions were in favor of musical therapy. Out of the original 41 participants undergoing musical therapy treatment, 29 reported improvement, 4 reported no improvement, and 8 had abandoned the study. Out of the original 38 participants undergoing psychotherapy treatment, 12 reported improvement, 16 reported no improvement, and 10 abandoned the study(4). This experiment provides more evidence supporting music therapy as a legitimate treatment option for depression.

__**Dementia**__


 * Schizophrenia**

Schizophrenia is one of the most recognizable metal disorders. In the United States approximately 1.1% of the population is affected by schizophrenia(6). Schizophrenia comes with a large variety of symptoms. Some of the symptoms of Schizophrenia are hallucinations, delusions, movement disorders, thought disorders, speaking conditions, mood conditions, and attention deficits. There are a large variety of treatments of depression, one of which are medications such as clozapine, risperidone, and olanzapine. Other treatments available are a avariety of psychotherapy(8). However again in this disorder we see evidence that music therapy can help treat this condition.

Schizophrenia is another dementia disease that can be treated with musical therapy. Nakul Talwar, Mike Crawford, et. al from London designed a controlled experiment to test the effectiveness of musical therapy on schizophrenia. In this experiment a total of 81 patients were selected for this study based selection criteria, and were randomized into a group receiving musical therapy or into a group that doesn’t receive musical therapy. All participants in this experiment continued to receive their regular treatment in addition to their group treatment. Those participants in the music therapy group received 12 individual sessions each lasting 45 minutes in which participants were asked to express themselves on a variety of instruments. Patients in the control group simply continued with their regular treatment. In order to track progression of Schizophrenia symptoms, the PANSS system is used, which is a 30 item rating scale. Out of the original 81 participants, 33 were placed into the music therapy group, and 48 were placed into the control group. Participants in the music therapy group had noticeable increase In PANSS positive symptom scores compared to the scores of the control group. In addition participants in music therapy group had a noticeable decrease in PANSS negative symptom scores (5). This experiment provides evidence that music therapy has some positive affect on schizophrenia symptoms.

In a second experiment in support of the effectiveness of music therapy in treating schizophrenia, Shu-Ming Peng, Malcolm Koo, et. al preformed a similar experiment in Taiwan. In this experiment 67 patients being treated in a hospital suffering from acute schizophrenia were selected bases on eligibility criteria. A total of 29 patients were set to undergo music therapy, while 33 patients joined the control group. Both experimental and control received standard medications during the duration of the experiment. The experimental group participated in a 2 week session of 50 minutes of daily music therapy, 5 days a week. This music therapy consisted of singing popular songs as well as listening to a variety of music in a group. An original 16 question BPRS was used to gauge the progression of schizophrenia symptoms of all the patients. What was discovered at the end of the experiment was a statistically significant drop in BPRS scores of patients in the experimental, music therapy program. In particular anxiety, hallucinatory behavior, and uncooperativeness was dramatically reduced (7). This provides more evidence supporting the effectiveness of treating schizophrenia with music therapy.


 * Alzheimer’s Disease**

Alzheimer’s disease is one of the hottest topics in the medical community as a large proportion of our population reaches old age. It is startling to learn that 1 in 8 older Americans currently have Alzheimer’s disease. There are multiple stages to the progression of symptoms of Alzheimer’s disease. First is a mild cognitive decline where you may undergo memory lapses, for example forgetting where you put your keys. Next is a moderate cognitive decline where memory loss is much more pronounced, for example forgetting your own childhood. Next is severe cognitive decline, for example an inability to remember events that just happened very recently (11). There are a variety of current treatments available today. Medications such as cholinesterase inhibitors and memantine are prescribed to treat memory loss. In addition psychotherapy is also effective means to treat Alzhiemer’s disease (12). Musical therapy in addition could provide valuable means of treating the disease.

In an effort to prove the effectiveness of music therapy on patients suffering from Alzheimer’s disease, Svansdottir and Snaedal of Iceland designed an experiment. In this experiment a total of 38 patients who had been diagnosed with Alzheimer’s disease were selected from nursing homes to participate in this experiment. 20 of these patients were blindly selected for music therapy group, and the rest of the 18 patients were collected into the control group. A standardized test to evaluate the symptoms of Alzheimer’s disease called BEHAVE-AD was used to test all participants in the experiment. The music therapy group was treated with 18 sessions of 30 minutes, which took place 3 times a week for a total of 6 weeks. The therapy consisted of small group sing along with the therapist on the guitar, as well as a variety of playable instruments. The results showed a significant decrease in Alzheimer’s symptoms of the music therapy group when compared to the control group (9).

In another case study, Guwtin, Portet, et. al perform a similar music therapy experiment on Alzheimer’s disease patients, and find different, yet beneficial results. In their experiment, patients of a Montpellier nursing home afflicted with moderate to mild form of Alzheimer’s disease were selected to take place in a controlled experiment. A total of 30 participants were accounted for all together, then were split up between a control group and a experimental group. The experimental group under went individual receptive music therapy. This particular type of music therapy is special in the way that music is chosen for each individual that reflects his or her personal experience. The control group simply participated in resting exercises. The results showed significant decrease in anxiety levels of Alzheimer’s disease patients who underwent music therapy according to the Hamilton Scale. In addition to decreased anxiety levels, music therapy patients had a significant decrease in depressive symptoms according to the GDS scale (10).


 * How It Works**

Music Therapy is a relatively new topic in the medical community. Relative to other treatments, not as much is known about music therapy. However groups have theorize that musical therapy works on 5 factors. The first factor is attention. Music by its vary nature, attracts the attention of the human brain. Music can provide both a ananxilytic or a algolytic. Ananxilytic refers to an effect that reduces anxiety, while algolytic does the opposite, by increasing anxiety. The next factor is emotion. Music has the ability to manipulate the emotions you feel. For example music has the ability to conjure emotional events associated with auditory stimuili. Music is processed within parts of limbic system, paralymbic cortical region, and the gyrus cinguli. The third factor is cognition. Your brain manufactures music, and with that we correlate it with experience and significance. The forth factor is behavior. Music has the power to stimulate certain behaviors. The fifth factor is communication. Music provides a medium in which thoughts and emotions can be transmitted nonverbally (13). All of these factors together show what music therapy is capable of.

1. "Major Depressive Disorder Among Adults." //National institute of Mental Health//. U.S. Department of Health and Human Services, 2008. Web. 3 Apr 2012. .

2.Nutt, David. "Relationship of neurotransmitters to the symptoms of major depressive disorder." //Journal of Clinical Psychiatry//. 69. (2008): 4-7.

3. Wang, Jinliang, Haizhen Wang, et al. "Impact of group music therapy on the depression mood of college students." //Health//. 3.3 (2011): 151-155.

4. Castillo-Perez, Sergio, Virginia Gomez-Perez, et al. "Effects of music therapy on depression compared with psychotherapy." //Arts in Psychotherapy//. 37.5 (2010): 387-391.

5. Talwar, Nakul, Mike Crawford, et al. "Music therapy for in-patients with schizophrenia." //British Journal of Psychiatry//. 189. (2006): 405-409.

6. "Schizophrenia." //National institute of mental health.// U.S. Department of Health and Human Services, 2008. Web. 3 Apr 2012. .

7. Peng, Shu-Ming, Malcum Koo, et al. "Effect of Group Music Activity as an Adjunctive Therapy on Psychotic Symptoms in Patients With Acute Schizophrenia." //Archives of Psychiatric Nursing//. 24.6 (2010): 429-434.

8. Os, Jim, and Shitij Kapur. "Schizophrenia." //Lancet//. 374. (2009): 635-645.

9. Svansdottir, H.B., and J. Snaedal. "Music therapy in moderate and severe dementia of Alzheimer’s type: a case–control study." //International Psychogeriatric Association//. 18.4 (2006): 613-621.

10. Guetin, Shu-Ming, and F Portet. "Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer's Type Dementia: Randomized, Controlled Study." //Dementia and Geriatric Cognitive Disorders//. 28. (2009): 46-46

11. "Alzheimers Facts and Figures." //Alzheimer's Association//. Alzheimer, 2012. Web. 6 Apr 2012. .

12. Geula, C., and MM. Mesilam. "Cholinesterases and the pathology of Alzheimer disease." //Alzheimer Disease and Associated Disorders//. 9. (1995): 23-28.

13. Hillecke, Thomas, and Anne Nickel. "Scientific Perspectives on Music Therapy." //Annals of the New York Academy of Sciences//. 1060. (2005): 271-282.