Individual music therapy for depression: randomised controlled trial
01 Aug 2011-British Journal of Psychiatry (Royal College of Psychiatrists)-Vol. 199, Iss: 2, pp 132-139
TL;DR: The results of this study indicate that music therapy with its specific qualities is a valuable enhancement to established treatment practices and is effective for depression among working-age people with depression.
Abstract: Background Music therapy has previously been found to be effective in the treatment of depression but the studies have been methodologically insufficient and lacking in clarity about the clinical model employed.
Aims To determine the efficacy of music therapy added to standard care compared with standard care only in the treatment of depression among working-age people.
Method Participants (n = 79) with an ICD–10 diagnosis of depression were randomised to receive individual music therapy plus standard care (20 bi-weekly sessions) or standard care only, and followed up at baseline, at 3 months (after intervention) and at 6 months. Clinical measures included depression, anxiety, general functioning, quality of life and alexithymia. Trial registration: [ISRCTN84185937][1].
Results Participants receiving music therapy plus standard care showed greater improvement than those receiving standard care only in depression symptoms (mean difference 4.65, 95% CI 0.59 to 8.70), anxiety symptoms (1.82, 95% CI 0.09 to 3.55) and general functioning (–4.58, 95% CI –8.93 to –0.24) at 3-month follow-up. The response rate was significantly higher for the music therapy plus standard care group than for the standard care only group (odds ratio 2.96, 95% CI 1.01 to 9.02).
Conclusions Individual music therapy combined with standard care is effective for depression among working-age people with depression. The results of this study along with the previous research indicate that music therapy with its specific qualities is a valuable enhancement to established treatment practices.
[1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN84185937
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TL;DR: In this paper, the effects of LTPP, especially in complex mental disorders, was examined by performing a meta-analysis, which showed that LTPP showed significantly higher outcomes in overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning than shorter forms of psychotherapy.
Abstract: Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking. Objective To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis. Data Sources Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsyclNFO, and Current Contents, supplemented by contact with experts in the field. Study Selection Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). Data Extraction Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment. Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of1.8 (95% confidence interval [Cl], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P= .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98). Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.
550 citations
TL;DR: A meta-analysis examining short-term effects of music therapy for depression found moderate-quality evidence of large effects favouring music therapy and TAU over TAU alone for both clinician-rated depressive symptoms and secondary outcomes.
Abstract: Background
Depression is a highly prevalent disorder associated with reduced social functioning, impaired quality of life, and increased mortality. Music therapy has been used in the treatment of a variety of mental disorders, but its impact on those with depression is unclear.
Objectives
To examine the efficacy of music therapy with standard care compared to standard care alone among people with depression and to compare the effects of music therapy for people with depression against other psychological or pharmacological therapies.
Search methods
CCDANCTR-Studies and CCDANCTR-References were searched on 7/11/2007, MEDLINE, PsycINFO, EMBASE, PsycLit, PSYindex, and other relevant sites were searched in November 2006. Reference lists of retrieved articles were hand searched, as well as specialist music and arts therapies journals.
Selection criteria
All randomised controlled trials comparing music therapy with standard care or other interventions for depression.
Data collection and analysis
Data on participants, interventions and outcomes were extracted and entered onto a database independently by two review authors. The methodological quality of each study was also assessed independently by two review authors. The primary outcome was reduction in symptoms of depression, based on a continuous scale.
Main results
Five studies met the inclusion criteria of the review. Marked variations in the interventions offered and the populations studied meant that meta-analysis was not appropriate. Four of the five studies individually reported greater reduction in symptoms of depression among those randomised to music therapy than to those in standard care conditions. The fifth study, in which music therapy was used as an active control treatment, reported no significant change in mental state for music therapy compared with standard care. Dropout rates from music therapy conditions appeared to be low in all studies.
Authors' conclusions
Findings from individual randomised trials suggest that music therapy is accepted by people with depression and is associated with improvements in mood. However, the small number and low methodological quality of studies mean that it is not possible to be confident about its effectiveness. High quality trials evaluating the effects of music therapy on depression are required.
483 citations
TL;DR: Moderate quality evidence was found that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a Clinical intervention alone and moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sickness absence compared to the usual care.
Abstract: Background
Work disability such as sickness absence is common in people with depression.
Objectives
To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.
Search methods
We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014.
Selection criteria
We included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome.
Data collection and analysis
Two authors independently extracted the data and assessed trial quality. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to pool study results in the studies we judged to be sufficiently similar. We used GRADE to rate the quality of the evidence.
Main results
We included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. We judged 14 studies to have a high risk of bias and nine to have a low risk of bias.
Work-directed interventions
We identified five work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone.
There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21).
There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work program did not reduce sickness absence compared to regular care by occupational physicians (non-significant finding: SMD 0.45; 95% CI -0.00 to 0.91).
Clinical interventions, antidepressant medication
Three studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results.
Clinical interventions, psychological
We found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01).
Clinical interventions, psychological combined with antidepressant medication
We found low quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months).
We found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05).
Clinical interventions, exercise
We found low quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). We found moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24).
Authors' conclusions
We found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. We also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management program that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement program did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers.
259 citations
TL;DR: Playing piano and learning to read music can be a useful intervention in older adults to promote cognitive reserve (CR) and improve subjective well-being, as well as the psychological and physical QOL of the elderly are evaluated.
Abstract: Reading music and playing a musical instrument is a complex activity that comprises motor and multisensory (auditory, visual, and somatosensory) integration in a unique way. Music has also a well-known impact on the emotional state, while it can be a motivating activity. For those reasons, musical training has become a useful framework to study brain plasticity. Our aim was to study the specific effects of musical training vs. the effects of other leisure activities in elderly people. With that purpose we evaluated the impact of piano training on cognitive function, mood and quality of life (QOL) in older adults. A group of participants that received piano lessons and did daily training for 4-month (n = 13) was compared to an age-matched control group (n = 16) that participated in other types of leisure activities (physical exercise, computer lessons, painting lessons, among other). An exhaustive assessment that included neuropsychological tests as well as mood and QOL questionnaires was carried out before starting the piano program and immediately after finishing (4 months later) in the two groups. We found a significant improvement on the piano training group on the Stroop test that measures executive function, inhibitory control and divided attention. Furthermore, a trend indicating an enhancement of visual scanning and motor ability was also found (Trial Making Test part A). Finally, in our study piano lessons decreased depression, induced positive mood states, and improved the psychological and physical QOL of the elderly. Our results suggest that playing piano and learning to read music can be a useful intervention in older adults to promote cognitive reserve (CR) and improve subjective well-being.
164 citations
Cites background from "Individual music therapy for depres..."
...ORIGINAL RESEARCH ARTICLE published: 01 November 2013 doi: 10.3389/fpsyg.2013.00810 Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults...
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...Moreover, active and passive musical activities in elderly people have been found to improve mood and reduce depression symptoms (Chan et al., 2010; Erkkilä et al., 2011)....
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TL;DR: In this paper, the authors investigated whether listening to sad music can induce sadness-related effects on memory and judgment, and found that music-induced sadness is associated with trait empathy.
Abstract: The present study addressed music’s disputed ability to induce genuine sadness in listeners by investigating whether listening to sad music can induce sadness-related effects on memory and judgment. Related aims were to explore how the different mechanisms of music-induced emotions are involved in sadness induced by familiar, self-selected music and unfamiliar, experimenter-selected music, and whether the susceptibility to music-induced sadness is associated with trait empathy. One hundred twenty participants were randomly assigned into four conditions with different tasks: listening to unfamiliar sad or neutral music, or to self-selected sad music, or recalling a sad autobiographical event and writing about it. The induced affective states were measured indirectly using a word recall task and a judgment task where participants rated the emotions expressed by pictures depicting facial expressions. The results indicate that listening to sad music can indeed induce changes in emotion-related memory and judgment. However, this effect depends, to some extent, on the music’s relevance to the listener, as well as on the personality attributes of the listener. Trait empathy contributed to the susceptibility to sadness induced by unfamiliar music, while autobiographical memories contributed to sadness induced by self-selected music.
164 citations
References
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TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
35,518 citations
TL;DR: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described, and its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change.
Abstract: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
11,923 citations
11 Feb 2013
TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
7,515 citations
TL;DR: There is growing interest in moving away from unidirectional models of the stress-depression association, toward recognition of the effects of contexts and personal characteristics on the occurrence of stressors, and on the likelihood of progressive and dynamic relationships between stress and depression over time.
Abstract: Improved methods of assessment and research design have established a robust and causal association between stressful life events and major depressive episodes. The chapter reviews these developments briefly and attempts to identify gaps in the field and new directions in recent research. There are notable shortcomings in several important topics: measurement and evaluation of chronic stress and depression; exploration of potentially different processes of stress and depression associated with first-onset versus recurrent episodes; possible gender differences in exposure and reactivity to stressors; testing kindling/sensitization processes; longitudinal tests of diathesis-stress models; and understanding biological stress processes associated with naturally occurring stress and depressive outcomes. There is growing interest in moving away from unidirectional models of the stress-depression association, toward recognition of the effects of contexts and personal characteristics on the occurrence of stressors, and on the likelihood of progressive and dynamic relationships between stress and depression over time-including effects of childhood and lifetime stress exposure on later reactivity to stress.
2,522 citations
TL;DR: The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance in severely mentally ill populations as discussed by the authors.However, there is little research on the reliability and validity of this measure in severely mental ill populations.
Abstract: Background The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations. Method Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period. Results Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating. Conclusion GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.
946 citations