Music Therapy vs. Music Listening for Negative Symptoms in Schizophrenia: Randomized, Controlled, Assessor- and Patient-Blinded Trial

Five-week music therapy improves overall symptoms in schizophrenia by modulating theta and gamma oscillations

Introduction

Some clinical studies have shown that music therapy as an adjunctive therapy can improve overall symptoms in patients with schizophrenia. However, the neural mechanisms of this improvement remain unclear due to insufficient neuroimaging evidence.

Methods

In this work, 17 patients with schizophrenia accepted a five-week music therapy (music group) that integrated listening, singing, and composing, and required patients to cooperate in a group to complete music therapy tasks. Meanwhile, 15 patients with schizophrenia received a five-week visual art intervention as the control group including handicraft and painting activities. We collected the Manchester Scale (MS) and Positive and Negative Symptom Scale (PANSS) scores and electroencephalography (EEG) data before and after intervention in two groups.

Results

Behavioral results showed that both interventions mentioned above can effectively help patients with schizophrenia relieve their overall symptoms, while a trend-level effect was observed in favor of music therapy. The EEG results indicated that music therapy can improve abnormal neural oscillations in schizophrenia which is reflected by a decrease in theta oscillation in the parietal lobe and an increase in gamma oscillation in the prefrontal lobe. In addition, correlation analysis showed that in the music group, both reductions in theta oscillations in the parietal lobe and increases in gamma oscillations in the prefrontal lobe were positively correlated with the improvement of overall symptoms.

Discussion

These findings help us to better understand the neural mechanisms by which music therapy improves overall symptoms in schizophrenia and provide more evidence for the application of music therapy in other psychiatric disorders.

Inter-rater Agreement in Classifying Music According to a Guided Imagery and Music Taxonomy

Guided Imagery and Music (GIM) is a range of therapeutic practices in which clients listen to music selected by a trained practitioner with the aim of gaining cognitive insight through evoked imagery that may be beneficial in working through various inner experiences, pain, or trauma. It is crucial to this process that the chosen music is tailored to the client's therapeutic goals and receptiveness. Wärja and Bonde [(2014). Music as co-therapist: Towards a taxonomy of music in therapeutic Music and Imagery work. Music and Medicine, 6(2), 16-27.] developed a taxonomy consisting of nine categories of musical-psychological characteristics and constructs (e.g., tempo, instrumentation, and mood) aligning with various therapeutic contexts (e.g., supporting and exploring) for helping GIM practitioners select appropriate music; however, its reliability has never before been assessed. In this paper, we present a listening study carried out with 63 GIM therapists and trainees, in order to measure the inter-rater agreement in (1) classifying 10 randomly selected pieces from 30 into one or more categories of the Wärja and Bonde [(2014). Music as co-therapist: Towards a taxonomy of music in therapeutic Music and Imagery work. Music and Medicine, 6(2), 16-27.] taxonomy, and (2) identifying for each piece heard one or more adjectives from the Hevner mood wheel that best characterize it. Our results indicate participants who utilized all categories but with slight to fair overall agreement; however, largely moderate agreement was reported for less musically complex pieces as well as across all pieces when considering only the three primary categories. Our findings not only support the continued use of the taxonomy and mood for helping select GIM music but also suggest the possible need for clearer descriptions in its subcategories and further training of practitioners who employ it in practice.

Process-outcome relations in music therapy versus music listening for people with schizophrenia viewed through a mediational model: the role of the therapeutic alliance

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.

Associations between psychological responses and quality of life at early and late time of quarantine among residents of a collective quarantine facility in central Taiwan

OBJECTIVES

Few countries required people living in collective facilities to undergo quarantine during the COVID-19 pandemic, which could lead to more psychological effects than quarantine at home or hotels. This study assessed the changes in depression, anxiety, and quality of life (QOL) among residents of a collective quarantine facility in central Taiwan.

METHODS

Between April and November 2020, 660 collective quarantine facility residents participated in the survey conducted on the first and last days of the 14-day quarantine period. Questionnaires of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and WHO quality of life (WHOQOL)-BREF were used to measure depression and anxiety symptoms, and QOL, respectively. Linear regression model with generalization estimation equation method was for estimating the differences in depression, anxiety, and QOL between two surveys and to test the changes of associations between them over time.

RESULTS

PHQ-9 and WHOQOL-BREF scores showed no significant changes, but GAD-7 score decreased during quarantine (p = 0.011, Cohen's d = -0.11). Both PHQ-9 and GAD-7 were negatively associated with overall and domain-specific WHOQOL-BREF scores on both the first and last days of quarantine. Such associations did not significantly vary with time, except for the association between PHQ-9 and environmental domain WHOQOL-BREF score, being stronger on the first day than on the last day of quarantine (p = 0.041, η2 = 0.0021).

CONCLUSION

A significant decrease in anxiety among quarantined individuals over a 14-day quarantine period was found. While depression was negatively associated with overall QOL, the strength of association between depression and environmental domain QOL decreased over the period.