The effects of group improvisational music therapy on depression in adolescents and adults with substance abuse: a randomized controlled trial**

The effect of rehabilitation interventions on freezing of gait in people with Parkinson's disease is unclear: a systematic review and meta-analyses

PURPOSE

To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease.

METHODS

A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework.

RESULTS

Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= -0.26, 95% CI= -0.38 to -0.14, 95% prediction interval (PI)= -0.38 to -0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= -0.58, 95% CI= -0.86 to -0.29, 95% PI= -1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= -0.56, 95% CI= -1.16 to 0.05); and dance to multimodal exercises (Hedges' g= -0.64, 95% CI= -1.53 to 0.25).

CONCLUSIONS

We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.Implications for rehabilitationFOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain.Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling.Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention.Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change.

Music therapy, neural processing, and craving reduction: an RCT protocol for a mixed methods feasibility study in a Community Substance Misuse Treatment Service

BACKGROUND

Music therapy has been shown to be effective for multiple clinical endpoints associated with substance use disorder such as craving reduction, emotion regulation, depression, and anxiety, but there are a lack of studies investigating those effects in UK Community Substance Misuse Treatment Services (CSMTSs). Furthermore, there is a demand for identifying music therapy mechanisms of change and related brain processes for substance use disorder treatment. The present study aims to evaluate the feasibility and acceptability of music therapy and a pre-test, post-test, and in-session measurement battery in a CSMTS.

METHODS

Fifteen participants, from a community service based in London, will take part in a mixed-methods non-blind randomized-controlled trial. Ten participants will receive six-weekly sessions of music therapy in addition to the standard treatment offered by the CSMTS-five of them will receive individual music therapy and five of them will receive group music therapy-while a further five participants will act as a control group receiving standard treatment only. Satisfaction and acceptability will be evaluated in focus groups with service users and staff members following the final treatment session. Moreover, attendance and completion rates will be monitored throughout the intervention. Subjective and behavioral indexes will be assessed before and after the interventions to explore the effects of music therapy on craving, substance use, symptoms of depression and anxiety, inhibitory control, and will be correlated with associated neurophysiological signatures. In-session analysis of two individual music therapy sessions will serve to explore how music and emotion are processed in the brain within the therapy. The data collected at each step will be included in an intention-to-treat analysis basis.

DISCUSSION

This study will provide a first report on the feasibility of music therapy as an intervention for participants with substance use disorder engaged within a community service. It will also provide valuable information regarding the implementation of a multifaceted methodology that includes neurophysiological, questionnaire-based, and behavioral assessments in this cohort. Notwithstanding the limitation of a small sample size, the present study will provide novel preliminary data regarding neurophysiological outcomes in participants with substance use disorder that received music therapy.

TRIAL REGISTRATION

ClinicalTrails.gov, NCT0518061, Registered 6 January 2022, https://clinicaltrials.gov/ct2/show/NCT05180617.

Music therapy for adolescents in a child welfare setting: A qualitative interview study

In this article, we explore challenges and possibilities as expressed by adolescents who participated in music therapy in an out-of-home setting. Music activities they reported participating in include listening to music, songwriting, playing in a band, and performing. The study is based on qualitative research methodology where we ask the following research question: What do adolescents in a child welfare setting consider as challenges and possibilities when reflecting on their participation in music therapy activities? To answer this question, we interviewed 11 adolescents between the ages of 16 and 23 years. The themes in the empirical sections emerged during the process of analyzing data. We propose 3 themes, each with 3 subthemes. Empirical findings are discussed in relation to relevant theories in child welfare, music therapy, and psychology, and more specifically, trauma-informed care. Practical and scientific implications are highlighted.

Neuroplastic Changes in Addiction Memory-How Music Therapy and Music-Based Intervention May Reduce Craving: A Narrative Review

Recent findings indicate that Music Therapy (MT) and Music-Based Interventions (MBIs) may reduce craving symptoms in people with Substance Use Disorders (SUD). However, MT/MBIs can lead SUD clients to recall memories associated with their drug history and the corresponding strong emotions (addiction memories). Craving is a central component of SUD, possibly linked to relapse and triggered by several factors such as the recall of memories associated with the drug experience. Therefore, to address the topic of what elements can account for an improvement in craving symptoms after MT/MBIs, we conducted a narrative review that (1) describes the brain correlates of emotionally salient autobiographical memories evoked by music, (2) outlines neuroimaging and neurophysiological studies suggesting how the experience of craving may encompass the recall of emotionally filled moments, and (3) points out the role of perineuronal nets (PNNs) in addiction memory neuroplasticity. We highlight how autobiographical memory retrieval, music-evoked autobiographical memories, and craving share similar neural activations with PNNs which represent a causal element in the processing of addiction memory. We finally conclude by considering how the neuroplastic characteristics of addiction memory might represent the ground to update and/or recalibrate, within the therapy, the emotional content related to the recall.

The Creative Drummer: An EEG-Based Pilot Study on the Correlates of Emotions and Creative Drum Playing

It is reasonable to assume that emotional processes are involved in creative tasks and the generation of creative ideas. In this pilot study, we investigate the emotional correlates in professional drummers during different degrees of creative music playing. Ten participants performed three tasks: repetitive rhythmic drum playing, pattern-based improvisation, and attention-intensive free improvisation, while their EEG activity was recorded. Arousal and valence levels were estimated from the EEG data at baseline and for the three tasks. Results show significantly increased levels of valence (i.e., increased prefrontal right alpha power compared to prefrontal left alpha power) during pattern-based and free improvisation relative to baseline, and significantly increased levels of valence during free improvisation relative to pattern-based improvisation. These results seem to indicate that positive emotion (characterized as increased valence) is associated with the creation of original ideas in drum playing and that the freer the creative process, the greater the positive effect. The implication of these results may be of particular relevance in the fields of music-based therapeutic interventions and music pedagogy.

Music therapy for people with substance use disorders

BACKGROUND

Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving.

OBJECTIVES

To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober.

SEARCH METHODS

We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology.

MAIN RESULTS

We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes.  We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size.  AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.

The efficacy of complementary and traditional practice on psychiatric patients with depression symptoms: A meta- analysis study

PURPOSE

This study examined the effect sizes of the complementary and traditional practices on the depressive symptom levels in psychiatric patients DESIGN AND METHODS: The "Health Evidence™ Quality Assessment Tool" and "Comprehensive Meta-Analysis 3" program was used.

FINDINGS

A total of 81 studies with 5934 patients were included. The effect size of the complementary and traditional methods applied to psychiatric patient on depressive symptoms was calculated as d = 0.718 (p = 0.000). According to Cohen, studies have moderate effect size.

PRACTICE IMPLICATIONS

Complementary and traditional practices were found to be significant and effective on depressive symptoms in psychiatric patients.

Beyond the death drive: Entropy and free energy

In this paper I offer an overview of the possible links between psychoanalytical metapsychology and contemporary work in neuroscience concerning entropy and the free energy principle. After briefly describing the theory of living systems put forward by the neuroscientist Karl Friston based on the notion of entropy, we sum up the use of the notion of free energy by Friston and Freud. I then analyze how these notions improve the intelligibility of psychic functioning and can be associated with several psychoanalytical concepts, in particular the death drive. I approach from the same perspective the regulation of free energy associated with psychic envelopes and early intersubjectivity. It thus appears that the psychic apparatus can be considered at its different levels, from the most primary to the most secondary, as having the essential function of reducing entropy and free energy. Various forms of "failure" of this process of linking, regulation and transformation of energy within the psychic apparatus could be considered as the origin of different psychopathological manifestations as suggested in the last part of this paper.

The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis

Purpose: Music therapy is increasingly being used to address physical, emotional, cognitive, and social needs of individuals. However, publications on the global trends of music therapy using bibliometric analysis are rare. The study aimed to use the CiteSpace software to provide global scientific research about music therapy from 2000 to 2019.

Methods: Publications between 2000 and 2019 related to music therapy were searched from the Web of Science (WoS) database. The CiteSpace V software was used to perform co-citation analysis about authors, and visualize the collaborations between countries or regions into a network map. Linear regression was applied to analyze the overall publication trend.

Results: In this study, a total of 1,004 studies met the inclusion criteria. These works were written by 2,531 authors from 1,219 institutions. The results revealed that music therapy publications had significant growth over time because the linear regression results revealed that the percentages had a notable increase from 2000 to 2019 (t = 14.621, P < 0.001). The United States had the largest number of published studies (362 publications), along with the following outputs: citations on WoS (5,752), citations per study (15.89), and a high H-index value (37). The three keywords “efficacy,” “health,” and “older adults,” emphasized the research trends in terms of the strongest citation bursts.

Conclusions: The overall trend in music therapy is positive. The findings provide useful information for music therapy researchers to identify new directions related to collaborators, popular issues, and research frontiers. The development prospects of music therapy could be expected, and future scholars could pay attention to the clinical significance of music therapy to improve the quality of life of people.

The Effect of Non-verbal Music on Posttraumatic Stress Disorder in Mothers of Premature Neonates

Background:

Hospitalization of a premature neonate in the Neonatal Intensive Care Unit (NICU) is stressful for mothers. They show symptoms of Post-Traumatic Stress Disorder (PTSD). It is important to use the proper strategy to manage PTSD. This study was designed to investigate the effect of non-verbal music on the PTSD in mothers of premature neonates hospitalized in NICU.

Materials and Methods:

In this clinical trial study, the convenience sampling method was applied and 45 mothers of premature neonates were selected and categorized randomly into the intervention (N = 23) and control (N = 22) groups in 2018. The babies were hospitalized in one of the NICUs in Yazd (Iran). The intervention group were supposed to listen to the non-verbal music for 20 minutes daily for two weeks using MP3 player and headphones. All participants completed the Perinatal PTSD Questionnaire (PPQ). The data were analyzed by SPSS 21 using paired t-test, independent t-test, and Chi-square test.

Results:

The PTSD mean (SD) scores before and after the intervention was 9.39 (1.67) and 4.39 (1.49), respectively, in experimental group. It was 8.54 (1.59) and 5.31 (1.71) in control group. The severity of PTSD decreased in the intervention (p = 0.003) and control (p < 0.001) groups after the intervention. The difference between the two groups was significant (F_1,07 = 1058, p < 0.03), which confirmed the significant effect of the non-verbal music on decreasing the PTSD severity (0.92).

Conclusions:

Non-verbal music can be used as an effective and low-cost intervention for managing PTSD in mothers of premature neonates hospitalized in the NICU.

On weakly informative prior distributions for the heterogeneity parameter in Bayesian random-effects meta-analysis

The normal-normal hierarchical model (NNHM) constitutes a simple and widely used framework for meta-analysis. In the common case of only few studies contributing to the meta-analysis, standard approaches to inference tend to perform poorly, and Bayesian meta-analysis has been suggested as a potential solution. The Bayesian approach, however, requires the sensible specification of prior distributions. While noninformative priors are commonly used for the overall mean effect, the use of weakly informative priors has been suggested for the heterogeneity parameter, in particular in the setting of (very) few studies. To date, however, a consensus on how to generally specify a weakly informative heterogeneity prior is lacking. Here we investigate the problem more closely and provide some guidance on prior specification.

Effect of executive music therapy on state and trait anxiety levels of patients in a psychiatric ward: A quasi-experimental study

AIM

This quasi-experimental study aimed to assess the effect of executive music therapy (EMT) on the state and trait anxiety levels of patients with psychiatric disorders.

DESIGN AND METHODS

The study sample consisted of 64 patients who were hospitalized in a psychiatric ward in Giresun, Turkey between January and April 2019.

FINDINGS

This study showed that EMT decreased the state anxiety levels of inpatients with psychiatric disorders (P < .05). However, the treatment caused no effect on trait anxiety levels (P > .05).

PRACTICE IMPLICATIONS

In line with these results, we recommend that EMT should be included in therapeutic nursing interventions in psychiatric ward.

Music therapy for stress reduction: a systematic review and meta-analysis

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

Effects of music therapy on depression: A meta-analysis of randomized controlled trials

Background

We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect.

Methods

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model.

Results

A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P<0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P<0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P<0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods.

Conclusions

A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.

The impact of a community-based music intervention on the health and well-being of young people: A realist evaluation

In recent years, music-based interventions have been utilised as a tool for improving public health, reducing inequalities and promoting well-being of young people. Although some researchers have begun to draw links between music-related interventions and positive health outcomes, there is little understanding as to how such effects are produced. Realist evaluations-understanding what works, for whom and under what circumstances-are a particularly apt means by which we can open this 'black box'. In this paper, we use a realist evaluation to assess a community-based music initiative designed and implemented to support the well-being of disadvantaged young people in Scotland. In order to gain perspectives on the range of contextual characteristics, mechanisms and outcomes, we collected quantitative and qualitative data in the form of pre- and post-questionnaires, as well as conducting interviews with beneficiaries and stakeholders. Our findings show that the intervention achieved a positive impact on the self-confidence, well-being and engagement of disadvantaged young people. This impact was achieved via an approach personally tailored to the individual needs of the young people; and an organisational environment characterised by trust, whereby young people felt safe to express themselves.

A salutogenic inquiry into positive aging - a longitudinal analysis

Objectives: Based on a gero-salutogenic approach, we investigated the stability of the sense of coherence over a time span of four years in active older individuals and long-term effects of this life orientation on three different indicators of positive aging-subjective well-being, psychological health and physical health. This is the first study to explore associations between gain in sense of coherence and future positive aging. Methods: Our longitudinal sample consisted of 125 physically active individuals (73.5% women) at the mean age of 71 years at follow-up (range: 64 to 87 years; response rate: 73.5%), who completed our questionnaire twice. There were no systematic differences between the follow-up responders and non-responders. Results: The sense of coherence increased over four years, disclosing a small effect size. The baseline sense of coherence had a substantial predictive value for future subjective well-being and psychological health, but not for physical health. Stepwise hierarchical regression analyses showed that both the baseline sense of coherence and gain in sense of coherence predicted future subjective well-being and psychological health. With respect to future physical health, only gain in sense of coherence was significant. Conclusion: Consistent with gero-salutogenic theory, the baseline sense of coherence is an effective predictor of future positive aging, and growth in sense of coherence within a time span of four years is reflected in improved positive aging. It is important to encourage experiences in older age that cultivate the three components of the sense of coherence-feelings of comprehensibility, manageability and meaningfulness.

Effectiveness of music therapy on improving treatment motivation and emotion in female patients with methamphetamine use disorder: A randomized controlled trial

OBJECTIVES

The purpose of the study was to investigate whether Group Music Therapy (GMT) could enhance the treatment motivation and change the negative emotion among female patients with methamphetamine use disorder in a randomized clinical trial. Methods: Participants (N = 60) were randomized to the group of GMT combined with treatment as usual (TAU) or the group with TAU only. Questionnaire of Motivation for Abstaining from Drugs was used to measure the motivation for abstaining from drugs of the female patients. And Self-Rating Depression Scale and Self-Rating Anxiety Scale were used to measure negative emotion of participants. The measurements were conducted at T0 (baseline), T1 (post 13 sessions of intervention) and T2 (3-month follow-up after T1) by the independent trained researcher. Results: The postintervention and 3-month follow-up results according to the intention-to-treat principle indicated that GMT + TAU intervention showed significantly positive group-by-time effect on the scores of the subscale-tending to rehabilitation-internal motivation (p = 0.01) and avoiding abuse-external motivation (p = 0.04). In 3-month follow-up, total scores of the questionnaire of motivation for abstaining from drugs (p = 0.02), scores of avoiding abuse-internal motivation subscale (p = 0.05), and scores of confidence of abstaining from drugs subscale (p = 0.01) in GMT + TAU were also presented with significantly positive group x time effect. The changes of total score of Questionnaire of Motivation for Abstaining from Drugs (from baseline to 3-month follow-up) was significantly positive association with the changes of scores of SAS in GMT + TAU group (r = -0.55, p = 0.00). Conclusions: The present study suggests that GMT could be used as an effective treatment strategy to enhance treatment motivation of female patients with methamphetamine use disorder.

Effects of preferred music therapy on peer attachment, depression, and salivary cortisol among early adolescents in Taiwan

AIMS

To explore the effects of preferred music therapy on peer attachment, depression, and salivary cortisol among early adolescents.

BACKGROUND

As adolescents enter puberty, they start to seek partnering relationships among peers. Peer attachment is central for adolescents and greatly influences their physical and psychological development.

DESIGN

A pre-test-posttest control group design.

METHODS

The data were collected from July - October 2016. A total of 65 individuals were included. The treatment group received 40 min of music therapy twice per week over the course of 10 weeks. The control group maintained its typical routine. The research data were collected using structured questionnaires, including basic information, the Inventory of Peer Attachment, the Beck Depression Inventory-II questionnaires, and salivary cortisol concentrations. Statistical analysis methods included percentages, chi-square tests, t tests, analyses of covariance, and the Johnson-Neyman technique.

RESULTS

There were statistically significant differences in peer attachment, depression, and salivary cortisol levels in the music group compared to the control group (p < 0.05). Additionally, the findings showed that early adolescents with more severe depression experienced greater improvement through preferred music therapy.

CONCLUSION

The results allude to the beneficial effects of receiving preferred music therapy in terms of the peer attachment, depression, and salivary cortisol levels of early adolescents. Adjustments should be made based on the characteristics of student groups to develop suitable and safe music therapy and to reduce the risks of poor mental health.

Embracing integration and complexity: placing emotion within a science of brain and behaviour

The present paper addresses conceptual issues that are central to emotion research. What is emotion? What are its defining characteristics? The field struggles with questions like these almost constantly. I argue that definitions, and deciding what is the proper status of emotion, are not a requirement for scientific progress - in fact, they can hinder it. Therefore, "emotion" researchers should strive to develop a science of complex behaviours, and worry less about their exact nature. But for interesting behaviours, is most of the explaining that is needed present at the level of isolated systems (perception, cognition, etc.) or at the level of interactions between them? I suggest that the level of interactions is where most of the work is needed. Accordingly, I advocate that it is important to embrace integration, and not to strive to necessarily disentangle the multiple contributions underlying behaviours. More generally, it is argued that we need to revise models of causation adopted when reasoning about the mind and brain. Instead, a "complex systems" approach is required where the interactions between multiple components lead to system-level - emergent - properties that cannot be isolated or attributed to more elementary parts.

The effect of music therapy on depression and physiological parameters in elderly people living in a Turkish nursing home: a randomized-controlled trial

OBJECTIVE

This study was carried out in an effort to determine the effect of music therapy on depression and physiological parameters in elderly people who were living in a nursing home.

METHOD

The study was a randomized controlled trial. The study sample consisted of 64 elderly people who complied with the criteria of inclusion for the study. The data were collected using the 'Elderly Information Form' and 'Geriatric Depression Scale'. The music group listened to music three days in a week during 8 weeks. The depression levels were assessed at baseline (week 0) and follow-up in the eight week.

RESULTS

It was found that the difference between post-test depression scores of the two groups was found to be statistically significant (t = -2.86, p <.01). The mean scores of post-test systolic blood pressure in the music group were found to be significantly lower than those of the control group (t = -3.11, p < .05).

CONCLUSION

It was concluded that music therapy decreased the depression level and systolic blood pressure in elderly people. The study results implies that music therapy can be an effective practice for public health and home care nurses attempting to reduce depression and control physiological parameters of elderly people.

Group Music Therapy as a Preventive Intervention for Young People at Risk: Cluster-Randomized Trial

Background

Music forms an important part of the lives and identities of adolescents and may have positive or negative mental health implications. Music therapy can be effective for mental disorders such as depression, but its preventive potential is unknown.

Objective

The aim of this study was to examine whether group music therapy (GMT) is an effective intervention for young people who may be at risk of developing mental health problems, as indicated via unhealthy music use. The main question was whether GMT can reduce unhealthy uses of music and increase potentials for healthy uses of music, compared to self-directed music listening (SDML). We were also interested in effects of GMT on depressive symptoms, psychosocial well-being, rumination, and reflection.

Methods

In an exploratory cluster-randomized trial in Australian schools, 100 students with self-reported unhealthy music use were invited to GMT (weekly sessions over 8 weeks) or SDML. Changes in the Healthy-Unhealthy Music Scale (HUMS) and mental health outcomes were measured over 3 months.

Results

Both interventions were well accepted. No effects were found between GMT and SDML (all p > 0.05); both groups tended to show small improvements over time. Younger participants benefited more from GMT, and older ones more from SDML (p = 0.018).

Conclusions

GMT was associated with similar changes as SDML. Further research is needed to improve the processes of selecting participants for targeted interventions; to determine optimal dosage; and to provide more reliable evidence of effects of music-based interventions for adolescents.

Music therapy for depression

BACKGROUND

Depression is a highly prevalent mood disorder that is characterised by persistent low mood, diminished interest, and loss of pleasure. Music therapy may be helpful in modulating moods and emotions. An update of the 2008 Cochrane review was needed to improve knowledge on effects of music therapy for depression.

OBJECTIVES

1. To assess effects of music therapy for depression in people of any age compared with treatment as usual (TAU) and psychological, pharmacological, and/or other therapies.2. To compare effects of different forms of music therapy for people of any age with a diagnosis of depression.

SEARCH METHODS

We searched the following databases: the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR; from inception to 6 May 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; to 17 June 2016); Thomson Reuters/Web of Science (to 21 June 2016); Ebsco/PsycInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed (to 5 July 2016); the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, the National Guideline Clearing House, and OpenGrey (to 6 September 2016); and the Digital Access to Research Theses (DART)-Europe E-theses Portal, Open Access Theses and Dissertations, and ProQuest Dissertations and Theses Database (to 7 September 2016). We checked reference lists of retrieved articles and relevant systematic reviews and contacted trialists and subject experts for additional information when needed. We updated this search in August 2017 and placed potentially relevant studies in the "Awaiting classification" section; we will incorporate these into the next version of this review as appropriate.

SELECTION CRITERIA

All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing music therapy versus treatment as usual (TAU), psychological therapies, pharmacological therapies, other therapies, or different forms of music therapy for reducing depression.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated standardised mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic.

MAIN RESULTS

We included in this review nine studies involving a total of 421 participants, 411 of whom were included in the meta-analysis examining short-term effects of music therapy for depression. Concerning primary outcomes, we found moderate-quality evidence of large effects favouring music therapy and TAU over TAU alone for both clinician-rated depressive symptoms (SMD -0.98, 95% CI -1.69 to -0.27, 3 RCTs, 1 CCT, n = 219) and patient-reported depressive symptoms (SMD -0.85, 95% CI -1.37 to -0.34, 3 RCTs, 1 CCT, n = 142). Music therapy was not associated with more or fewer adverse events than TAU. Regarding secondary outcomes, music therapy plus TAU was superior to TAU alone for anxiety and functioning. Music therapy and TAU was not more effective than TAU alone for improved quality of life (SMD 0.32, 95% CI -0.17 to 0.80, P = 0.20, n = 67, low-quality evidence). We found no significant discrepancies in the numbers of participants who left the study early (OR 0.49, 95% CI 0.14 to 1.70, P = 0.26, 5 RCTs, 1 CCT, n = 293, moderate-quality evidence). Findings of the present meta-analysis indicate that music therapy added to TAU provides short-term beneficial effects for people with depression if compared to TAU alone. Additionally, we are uncertain about the effects of music therapy versus psychological therapies on clinician-rated depression (SMD -0.78, 95% CI -2.36 to 0.81, 1 RCT, n = 11, very low-quality evidence), patient-reported depressive symptoms (SMD -1.28, 95% CI -3.75 to 1.02, 4 RCTs, n = 131, low-quality evidence), quality of life (SMD -1.31, 95% CI - 0.36 to 2.99, 1 RCT, n = 11, very low-quality evidence), and leaving the study early (OR 0.17, 95% CI 0.02 to 1.49, 4 RCTs, n = 157, moderate-quality evidence). We found no eligible evidence addressing adverse events, functioning, and anxiety. We do not know whether one form of music therapy is better than another for clinician-rated depressive symptoms (SMD -0.52, 95% CI -1.87 to 0.83, 1 RCT, n = 9, very low-quality evidence), patient-reported depressive symptoms (SMD -0.01, 95% CI -1.33 to 1.30, 1 RCT, n = 9, very low-quality evidence), quality of life (SMD -0.24, 95% CI -1.57 to 1.08, 1 RCT, n = 9, very low-quality evidence), or leaving the study early (OR 0.27, 95% CI 0.01 to 8.46, 1 RCT, n = 10). We found no eligible evidence addressing adverse events, functioning, or anxiety.

AUTHORS' CONCLUSIONS

Findings of the present meta-analysis indicate that music therapy provides short-term beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.Future trials based on adequate design and larger samples of children and adolescents are needed to consolidate our findings. Researchers should consider investigating mechanisms of music therapy for depression. It is important to clearly describe music therapy, TAU, the comparator condition, and the profession of the person who delivers the intervention, for reproducibility and comparison purposes.

Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review

Music therapy (MT) and music-based interventions (MBIs) are increasingly used for the treatment of substance use disorders (SUD). Previous reviews on the efficacy of MT emphasized the dearth of research evidence for this topic, although various positive effects were identified. Therefore, we conducted a systematic search on published articles examining effects of music, MT and MBIs and found 34 quantitative and six qualitative studies. There was a clear increase in the number of randomized controlled trials (RCTs) during the past few years. We had planned for a meta-analysis, but due to the diversity of the quantitative studies, effect sizes were not computed. Beneficial effects of MT/ MBI on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported, but results were inconsistent across studies. Furthermore, many RCTs focused on effects of single sessions. No published longitudinal trials could be found. The analysis of the qualitative studies revealed four themes: emotional expression, group interaction, development of skills, and improvement of quality of life. Considering these issues for quantitative research, there is a need to examine social and health variables in future studies. In conclusion, due to the heterogeneity of the studies, the efficacy of MT/ MBI in SUD treatment still remains unclear.

Reviewing the Effectiveness of Music Interventions in Treating Depression

Depression is a very common mood disorder, resulting in a loss of social function, reduced quality of life and increased mortality. Music interventions have been shown to be a potential alternative for depression therapy but the number of up-to-date research literature is quite limited. We present a review of original research trials which utilize music or music therapy as intervention to treat participants with depressive symptoms. Our goal was to differentiate the impact of certain therapeutic uses of music used in the various experiments. Randomized controlled study designs were preferred but also longitudinal studies were chosen to be included. 28 studies with a total number of 1,810 participants met our inclusion criteria and were finally selected. We distinguished between passive listening to music (record from a CD or live music) (79%), and active singing, playing, or improvising with instruments (46%). Within certain boundaries of variance an analysis of similar studies was attempted. Critical parameters were for example length of trial, number of sessions, participants' age, kind of music, active or passive participation and single- or group setting. In 26 studies, a statistically significant reduction in depression levels was found over time in the experimental (music intervention) group compared to a control (n = 25) or comparison group (n = 2). In particular, elderly participants showed impressive improvements when they listened to music or participated in music therapy projects. Researchers used group settings more often than individual sessions and our results indicated a slightly better outcome for those cases. Additional questionnaires about participants confidence, self-esteem or motivation, confirmed further improvements after music treatment. Consequently, the present review offers an extensive set of comparable data, observations about the range of treatment options these papers addressed, and thus might represent a valuable aid for future projects for the use of music-based interventions to improve symptoms of depression.

Core Themes in Music Therapy Clinical Improvisation: An Arts-Informed Qualitative Research Synthesis

Background

Although clinical improvisation continues to be an important focus of music therapy research and practice, less attention has been given to integrating qualitative research in this area. As a result, this knowledge base tends to be contained within specific areas of practice rather than integrated across practices and approaches.

Objective

This qualitative research synthesis profiles, integrates, and re-presents qualitative research focused on the ways music therapists and clients engage in, and make meaning from, clinical improvisation. Further, as a conduit for broadening dialogues, opening up this landscape fully, and sharing our response to the analysis and interpretation process, we present an arts-informed re-presentation of this synthesis.

Methods

Following an eight-step methodological sequence, 13 qualitative studies were synthesized. This included reciprocal and refutational processes associated with synthesizing the primary studies, and additional steps associated with an arts-informed representation.

Findings

Three themes, professional artistry, performing self, and meaning-making, are presented. Each theme is explored and exemplified through the selected articles, and discussed within a larger theoretical framework. An artistic re-presentation of the data is also presented.

Conclusions

Music therapists use complex frameworks through which to engage clients in, and make meaning from, improvisational experiences. Artistic representation of the findings offers an added dimension to the synthesis process, challenging our understanding of representation, and thereby advancing synthesis methodology.

Is restlessness best understood as a process? Reflecting on four boys' restlessness during music therapy in kindergarten

ADHD can be considered an internationally recognized framework for understanding children’s restlessness. In this context, children’s restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children’s restlessness. In this article, we explore four boys’ collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children’s restlessness.

Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial

BACKGROUND

Depression is of significant global concern. Despite a range of effective treatment options it is estimated that around one in five diagnosed with an acute depressive episode continue to experience enduring symptoms for more than 2 years. There is evidence for effectiveness of individual music therapy for depression. However, no studies have as yet looked at a group intervention within an NHS context. This study aims to assess the feasibility of conducting a randomised controlled trial of group music therapy for patients with long-term depression (symptom durations of 1 year or longer) within the community.

METHODS

This is a single-centre randomised controlled feasibility trial of group music therapy versus wait-list control with a nested process evaluation. Thirty participants will be randomised with unbalanced allocation (20 to receive the intervention immediately, 10 as wait-list controls). Group music therapy will be offered three times per week in a community centre with a focus on songwriting. Data will be collected post-intervention, 3 and 6 months after the intervention finishes. We will examine the feasibility of recruitment processes including identifying the number of eligible participants, participation and retention rates and the intervention in terms of testing components, measuring adherence and estimation of the likely intervention effect. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of process measures and end-of-participation interviews with participants and referring staff.

DISCUSSION

Whilst group music therapy is an option in some community mental health settings, this will be the first study to examine group music therapy for this particular patient group. We will assess symptoms of depression, acceptability of the intervention and quality of life. We anticipate potential challenges in the recruitment and retention of participants. It is unclear whether offering the intervention three times per week will be acceptable to participants, particularly given participants' enduring symptoms and impact upon motivation. This study will provide data to inform both development of the intervention and to assess and inform the design of a full trial.

TRIAL REGISTRATION

ISRCTN.com, ISRCTN18164037 . Registered on 26 September 2016.