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Fachner J, Maidhof C, Murtagh D, De Silva D, Pasqualitto F, Fernie P, Panin F, Michell A, Muller-Rodriguez L, Odell-Miller H. Music therapy, neural processing, and craving reduction: an RCT protocol for a mixed methods feasibility study in a Community Substance Misuse Treatment Service. Addict Sci Clin Pract 2023; 18:36. [PMID: 37245018 DOI: 10.1186/s13722-023-00385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/01/2023] [Indexed: 05/29/2023] Open
Abstract
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.
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Affiliation(s)
- Jörg Fachner
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK.
| | - Clemens Maidhof
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Daniel Murtagh
- Innovation & Research Unit, Westminster Drug Project (WDP), London, UK
| | - Devon De Silva
- Innovation & Research Unit, Westminster Drug Project (WDP), London, UK
| | - Filippo Pasqualitto
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Paul Fernie
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Francesca Panin
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Andrew Michell
- Clinical Neurophysiology, Addenbrooke's Hospital, Cambridge, UK
| | | | - Helen Odell-Miller
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
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Hannibal N, Pedersen IN, Bertelsen LR, Nielsen RE, Gold C. Process-outcome relations in music therapy versus music listening for people with schizophrenia viewed through a mediational model: the role of the therapeutic alliance. Front Psychiatry 2023; 14:1120003. [PMID: 37200903 PMCID: PMC10185766 DOI: 10.3389/fpsyt.2023.1120003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/11/2023] [Indexed: 05/20/2023] Open
Abstract
Objectives Examine whether change in clinical outcomes for patients with schizophrenia and negative symptoms randomized to either Music Therapy (MT) or Music Listening (ML) is associated to moderators and mediators, with focus on alliance, attendance and dropout. Method An exploratory post-hoc analysis of data from an original randomized controlled trial (RCT) investigating the effect of MT vs. ML for people with schizophrenia and negative symptoms. Inclusion to the study was implemented through screening of referred patients for symptoms of schizophrenia and negative symptoms. A total of 57 patients were randomly assigned, 28 to MT and 29 to ML. Session logs and notes were included in this study. Statistical analysis investigated moderator and mediator relation to outcome variables: Negative symptoms, functioning, quality of life, and retention to treatment. Results On average, participants in MT attended 18.86 sessions (SD = 7.17), whereas those in ML attended 12.26 (SD = 9.52), a statistically significant difference (p = 0.0078). Dropout at 25 weeks was predicted by intervention, with dropout being 2.65 (SE = 1.01) times more likely in ML than in music therapy (p = 0.009). Helping alliance score at weeks was explained by intervention, with mean score being 0.68 (SE = 0.32) points lower in ML than in MT (p = 0.042). The number of sessions attended was also explained by intervention, with participants in ML attending on average 6.17 (SE = 2.24) fewer sessions than those randomized to MT (p = 0.008). Though both groups improved significantly, improvements in negative symptoms, depression, and functioning tended to be higher in ML, whereas improvements in alliance and quality of life tended to be higher in MT. Conclusion The analysis could not detect a direct link between helping alliance score and outcome variables. However, the analysis documented a stronger alliance developed in the MT group, a lower dropout rate, as well as higher attendance in treatment.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02942459.
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Affiliation(s)
- Niels Hannibal
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
- *Correspondence: Niels Hannibal,
| | - Inge Nygaard Pedersen
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
| | - Lars Rye Bertelsen
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
| | - René Ernst Nielsen
- Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Gold
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Norwegian Research Centre (NORCE), Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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Pedersen IN, Bonde LO, Hannibal NJ, Nielsen J, Aagaard J, Gold C, Rye Bertelsen L, Jensen SB, Nielsen RE. Music Therapy vs. Music Listening for Negative Symptoms in Schizophrenia: Randomized, Controlled, Assessor- and Patient-Blinded Trial. Front Psychiatry 2021; 12:738810. [PMID: 34992553 PMCID: PMC8724305 DOI: 10.3389/fpsyt.2021.738810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the efficacy of music therapy for negative symptoms in patients with schizophrenia. Methods: Randomized, participant- and assessor-blinded, multicenter, controlled trial including patients diagnosed with schizophrenia according to ICD-10 with predominantly negative symptoms, between 18 and 65 years. Participants were randomized to 25 successive weekly individual sessions (excluding holidays, including cancellation by the participant) of either music therapy conducted by trained music therapists, or music listening together with a social care worker. The primary outcome was reduction in negative symptoms as measured by The Positive and negative Syndrome Scale (PANSS) negative subscale total score, assessed by a blinded rater, utilizing mixed-effects model analysis. Results: In total, 57 participants were randomized; 39 completed the study's initial 15 weeks, and 30 completed follow-up at 25 weeks. On the primary outcome of PANSS negative subscale, no significant difference was observed between groups with a coefficient of -0.24 (95% CI -1.76 to 1.27, P = 0.754) in the intention to treat analysis, and -0.98 (95% CI -5.06 to 3.09, P = 0.625) when only analyzing completers. Both interventions showed significant reduction from baseline to 25 weeks on PANSS negative subscale. On secondary outcomes, no between group differences were observed in The Brief Negative Symptom Scale, WHOQOL-Bref (Quality of Life), The Helping Alliance Questionnaire and The Global Assessment of Functioning in the intention to treat or completers populations utilizing Mixed Effects Models. Conclusion: No difference between groups randomized to music therapy vs. musical listening was observed resulting in no clear recommendation for which intervention to use as the first choice for treatment of patients diagnosed with schizophrenia and predominantly having negative symptoms. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02942459.
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Affiliation(s)
- Inge Nygaard Pedersen
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
| | - Lars Ole Bonde
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
| | - Niels Jørgensen Hannibal
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
- The Music Therapy Research Clinic, Aalborg University, Aalborg, Denmark
| | - Jimmi Nielsen
- Department of Psychiatry, Mental Health Centre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Aagaard
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Christian Gold
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Norwegian Research Centre (NORCE), Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Lars Rye Bertelsen
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | | | - René Ernst Nielsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Pedersen IN, Bonde LO, Hannibal NJ, Nielsen J, Aagaard J, Bertelsen LR, Jensen SB, Nielsen RE. Music Therapy as Treatment of Negative Symptoms for Adult Patients Diagnosed with Schizophrenia-Study Protocol for a Randomized, Controlled and Blinded Study. MEDICINES (BASEL, SWITZERLAND) 2019; 6:E46. [PMID: 30939778 PMCID: PMC6631001 DOI: 10.3390/medicines6020046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/23/2022]
Abstract
Background: Three Cochrane reviews show that music therapy has a positive effect on schizophrenia concerning general functioning and positive/negative symptoms. This study aims to replicate these results in the Danish health system, a requirement for recommendation in guidelines from the Danish National Board of Health. Methods: The study is a randomized, controlled multi-site study, with a blinded design, aiming to include 90 participants who are 18⁻65 years in age, diagnosed according to ICD-10 with a schizophrenia diagnosis. The participants are randomized to one of two different music therapy activities for 25 weekly sessions. The study interventions are added to standard care. Outcome measures are rated at baseline, after 15 sessions and post therapy. A qualitative interview is performed as a one month follow up at the end of study. The primary intended outcome is a reduction in negative symptoms. The secondary intended outcome is progression in quality of life, alliance and psychosocial functioning. Results: As this study is still running, the results are not yet available. Conclusion: The study will investigate the direct effects of music therapy on negative symptoms as part of schizophrenia in a blinded, randomized trial. If proven effective, music therapy can be added to the small treatment armamentarium of effective therapies for negative symptoms in patients with schizophrenia.
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Affiliation(s)
- Inge Nygaard Pedersen
- Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark.
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Lars Ole Bonde
- Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark.
| | - Niels Jørgensen Hannibal
- Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark.
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Jimmy Nielsen
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Jørgen Aagaard
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Lars Rye Bertelsen
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | | | - René Ernst Nielsen
- Department of Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
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