BMC Psychiatry. 2008 Jun 28;8:50.

The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial.

Erkkilä J, Gold C, Fachner J, Ala-Ruona E, Punkanen M, Vanhala M.
University of Jyväskylä, Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, P,O Box 35, FI-40014, University of Jyväskylä, Finland

BACKGROUND: Music therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression. METHODS: 85 adults (18-50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months. DISCUSSION: This study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive client's improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research.

Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004517.

Music therapy for depression.

Maratos AS, Gold C, Wang X, Crawford MJ.
Central and Northwest London Foundation NHS Trust, Arts Therapies, Greater London House, Hampstead Road, London, UK, NW1 7QY

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 STRATEGY: 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.

J Nurs Res. 2006 Jun;14(2):93-102.

Exploring the listening experiences during guided imagery and music therapy of outpatients with depression.

Chou MH, Lin MF.
Department of Nursing, I-Shou University, Taiwan

The purpose of this preliminary study was to explore the listening experiences of outpatient depression sufferers who underwent guided imagery and music therapy (GIM). A purposive sampling method was performed at the psychiatric outpatient clinic of a medical center in southern Taiwan from April 2003 to June 2004. The five subjects in this study all underwent a total of eight sessions of individual GIM therapy. The researcher invited a therapist to implement the GIM therapy sessions. Researchers conducted a semi-structured, in-depth telephone interview with each subject within 24 to 48 hours after each therapy session. Eight interviews were accomplished and transcribed for each case, and then subject to content analysis. The results showed a total of 55 important listening episodes, which could be categorized into the following 5 themes: (1) leisurely wandering in very natural sceneries; (2) creation of surreal virtual surroundings; (3) recollection of past life experiences; (4) submersion in thematic music melodies; and (5) experiencing various physical relaxation events. The triggering effect represented a combination of multiple factors, including music, the individual, the therapist and environment. The theme of each patient's imagery episode was a result of the effect of the four factors, with music having the greatest impact. This study hopes to present the listening experiences of depression sufferers in GIM therapy; to make suggestions for future investigations into subsequent impacts and changes that GIM has on patients; and to, perhaps, serve as references for future clinical practice or studies.

Ann Readapt Med Phys. 2009 Feb;52(1):30-40. Epub 2008 Nov 6.

The effect of music therapy on mood and anxiety-depression: An observational study in institutionalised patients with traumatic brain injury.

Guétin S, Soua B, Voiriot G, Picot MC, Hérisson C.
Service de neurologie, centre Mémoire de ressources et de recherches (CMRR), Inserm U888, CHRU Montpellier, 34295 Montpellier, France

INTRODUCTION: A previous study (carried out in 2003-2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury. OBJECTIVE: To evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury. STUDY METHODOLOGY: A prospective, observational study. MATERIALS AND METHODS: Thirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods - one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety-depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session. RESULTS: Music therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6+/-3.2 to 2.6+/-2; p<0.01). Music therapy also led to a significant reduction in anxiety-depression (p<0.05) from week 10 onwards and up until the end of the study (week 20). CONCLUSION: These results confirm the usefulness of music therapy in the treatment of anxiety-depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.

Taehan Kanho Hakhoe Chi. 2006 Jun;36(4):630-6.

Effects of music therapy on pain, discomfort, and depression for patients with leg fractures.

Kwon IS, Kim J, Park KM.
Dongsan Medical Center, Korea

PURPOSE: To determine the effects of music therapy on pain, discomfort, and depression for patients with leg fractures. METHODS: Data were collected from 40 patients admitted in an orthopedic surgery care unit. The subjects included 20 intervention group members and 20 control group members. Music therapy was offered to intervention group members once a day for 3 days for 30-60 minutes per day. Pain was measured with a numeric rating scale and by measuring vital signs. Discomfort and depression were measured with self-administered questionnaires. RESULTS: Patients who received music therapy had a lower degree of pain than patients who did not receive music therapy as measured by the numeric pain score (p<0.001), systolic blood pressure (p<0.01), diastolic blood pressure (p<0.001), pulse rate (p<0.001) and respiration (p<0.001). Patients who were provided with music therapy also had a lower degree of discomfort than patients who were not provided with this therapy (p<0.01). CONCLUSIONS: These results demonstrate that music therapy is an effective method for decreasing pain and dis-comfort for patients with leg fractures.

J Adv Nurs. 2006 Jun;54(5):553-62.

Effect of music on power, pain, depression and disability.

Siedliecki SL, Good M.
Department of Nursing Research and Innovation, Cleveland Clinic Foundation, Ohio 44195, USA

AIM: This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music). BACKGROUND: Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated. METHOD: A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21-65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II). RESULTS: The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported. CONCLUSION: Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.

Arch Psychiatr Nurs. 2004 Oct;18(5):193-9

Effects of music on major depression in psychiatric inpatients.

Hsu WC, Lai HL.
Kaohsiung Kai-Suan Psychiatric Hospital, Tzu Chi University, Nursing Department, Taiwan, ROC

The study was to assess the effectiveness of soft music for treatment of major depressive disorder inpatients in Kaohsiung City, Taiwan. A pretest-posttest with a two-group repeated measures design was used. Patients with major depressive disorder were recruited through referred by the psychiatric physicians. Subjects listened to their choice of music for 2 weeks. Depression was measured with the Zung's Depression Scale before the study and at two weekly posttests. Using repeated measures ANCOVA, music resulted in significantly better depressive scores, as well as significantly better subscores of depression compared with controls. Depression improved weekly, indicating a cumulative dose effect. The findings provide evidence for psychiatric nurses to use soft music as an empirically based intervention for depressed inpatients.

Psychiatry. 2003 Fall;66(3):234-43

Music effects on EEG in intrusive and withdrawn mothers with depressive symptoms.

Tornek A, Field T, Hernandez-Reif M, Diego M, Jones N.
Touch Research Institutes, University of Miami School of Medicine, Miami, FL, USA

The EEG patterns of 48 intrusive and withdrawn mothers with depressive symptoms were assessed following a 20-minute music session to determine if the music had mood-altering effects. Half the mothers listened to classical music while half listened to rock music. Intrusive mothers were expected to have more positive responses and more symmetrical EEG following the calming classical music, while withdrawn mothers were expected to have a more positive response and symmetrical EEG following the energizing rock music. Although more positive EEGs were noted for rock music in both groups, only the withdrawn mothers showed a significant change in EEG toward symmetry following rock music, and only the intrusive mothers showed a decrease in cortisol levels following the rock music. Their State Anxiety Inventory (STAI) anxiety levels also decreased, while the Profile of Mood States (POMS) depressed mood levels decreased significantly for all four groups following music.

J Music Ther. 2000 Fall;37(3):170-82

The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia.

Ashida S.
The Florida State University, Florida, USA

This study examined the effectiveness of reminiscence focused music therapy treatment on depressive symptoms in elderly people with dementia. Twenty elderly (3 male & 17 female) who were diagnosed as having dementia and residing at 2 different residential care facilities in Florida were assigned to 1 of 4 small groups. Each of the participants served as his or her own control in an O1 O2 X O3 design. The depressive symptoms were measured using Cornell Scale for Depression in Dementia. The differences between the scores of pretest, posttest 1 after a week of 5-day no treatment, and posttest 2 after a week of 5-day reminiscence focused music therapy treatment were compared. A one-way analysis of variance (ANOVA) and Newman-Keuls Multiple Comparison Procedure indicated statistically significant differences between pretest and posttest 2 as well as posttest 1 and posttest 2, while no significant differences were found between pretest and posttest 1. Results indicated that participation in small group reminiscence focused music therapy groups might help to reduce depressive symptoms in elderly people with dementia. Results of behavioral observations and future implications are also discussed.

Adolescence. 1999 Fall;34(135):529-34.

Massage and music therapies attenuate frontal EEG asymmetry in depressed adolescents.

Jones NA, Field T.
Florida Atlantic University, Jupiter 33458, USA

EEG asymmetry, specifically greater relative right frontal activation, is associated with negative affect. Depressed adults show stable patterns of this asymmetry. The present study assessed the effects of massage therapy and music therapy on frontal EEG asymmetry in depressed adolescents. Thirty adolescents with greater relative right frontal EEG activation and symptoms of depression were given either massage therapy (n = 14) or music therapy (n = 16). EEG was recorded for three-minute periods before, during, and after therapy. Frontal EEG asymmetry was significantly attenuated during and after the massage and music sessions.

Adolescence. 1998 Spring;33(129):109-16.

Music shifts frontal EEG in depressed adolescents.

Field T, Martinez A, Nawrocki T, Pickens J, Fox NA, Schanberg S.
Touch Research Institute, University of Miami School of Medicine, Florida 33101, USA

Recent studies have found that positive affect is associated with greater relative left frontal EEG activation and negative affect is associated with greater relative right frontal EEG activation. Further, chronically depressed adults typically display stable right frontal EEG activation. The present study investigated the effects of music on mood state and right frontal EEG activation associated with chronic depression. Fourteen chronically depressed female adolescents listened to rock music for a 23-minute session. These adolescents were compared with a control sample of chronically depressed female adolescents who were simply asked to sit and relax their minds and their muscles for the same time period. EEG was recorded during baseline, music, and postmusic for three minutes each, and saliva samples were collected before and after the session to determine the effects of the music on stress hormone (cortisol) levels. No group differences or changes were noted for observed or reported mood state. However, cortisol levels decreased and relative right frontal activation was significantly attenuated during and after the music procedure. It was concluded that music had positive effects on the physiological and biochemical measures even though observed and self-reported mood did not change.

Health Psychol. 1997 Jul;16(4):390-400

Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults.

McKinney CH, Antoni MH, Kumar M, Tims FC, McCabe PM.
Department of Music Education/Music Therapy, University of Miami, USA

Healthy adults (N = 28) participated in a randomized trial of Bonny Method of Guided Imagery and Music (GIM; a depth approach to music psychotherapy) sessions on mood and cortisol. Participants in both GIM and wait-list control conditions completed the Profile of Mood States (POMS) and donated 15 cc of blood before and after the 13-week intervention period and again at a 6-week follow-up. Split-plot factorial and post hoc analyses demonstrated that after 6 biweekly sessions GIM participants reported significant decreases between pre- and postsession depression, fatigue, and total mood disturbance and had significant decreases in cortisol level by follow-up. Pretest to follow-up decrease in cortisol was significantly associated with decrease in mood disturbance. A short series of GIM sessions may positively affect mood and reduce cortisol levels in healthy adults. Such changes in hormonal regulation may have health implications for chronically stressed people. PMID: 9237092

J Gerontol. 1994 Nov;49(6):P265-9

Effects of a music therapy strategy on depressed older adults.

Hanser SB, Thompson LW.
Stanford University School of Medicine

A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1) a home-based program where participants learned music listening stress reduction techniques at weekly home visits by a music therapist; (2) a self-administered program where participants applied these same techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control. Participants in both music conditions performed significantly better than the controls on standardized tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and maintained over a 9-month follow-up period. The potential for this type of intervention with homebound elders and others who have limited access to services is discussed.

Z Gerontol. 1992 Nov-Dec;25(6):391-6

Depression in the elderly. Contribution of music therapy to grief work

Jochims S.
Abteilung für Psychosomatik und Psychotherapie, Klinik St. Irmingard, Prien am Chiemsee

If one understands the physical manifestation of minor depressions or multiple functional disorders in the elderly as being indirectly expressed dissatisfaction because of unfulfilled aims in life, a practical recovery process is necessary in order to confront the underlying psychic process. The aging person has to come to terms with his eventual demise. If he faces this, he will have a chance at renewed energy to accomplish incomplete aims. Many people need help in order to continue the recovery process. Even if speech or reflexive possibilities are inhibited, it is possible accomplish therapy by the medium of sound, which is a preverbal language. Music therapy is able to work at a psychotherapeutic level in persons seemingly unable to be influenced by conventional psychotherapeutic-methods. Two case studies with different techniques (singing of well known songs and free improvisation) illustrate this theses.

Zhonghua Shen Jing Jing Shen Ke Za Zhi. 1992 Aug;25(4):208-10, 252-3

Active music therapy for senile depression

Chen X.
Beijing Anding Hospital

68 cases with senile depression were divided randomly into two groups--test group and control group. Patients of both groups received same antidepressive drugs while for the patients in the test group active music therapy was provided everyday in addition and the course of music therapy was 8 weeks. Patients in the test group showed improvement of their symptoms at the end of first week while most patients in the control group were getting somewhat better at the 3rd-4th week. The effectiveness of combined treatment in the test group is better than that in the control group. Patients in the test group became calm and active and the atmosphere on the ward appeared to be somewhat harmonized so that it was beneficial to the nursing care.

Psychiatr Neurol Med Psychol (Leipz). 1982 Jul;34(7):414-21

Effect of music on depressed patients
Article in German

Reinhardt U, Lange E.

The effects of the performance of various forms of music and an acoustic non-musical comparative stimulus on the condition and efficiency of depressive persons were studied. These persons react in the mot uniform manner to the performance of Vienna waltzes and slow phrases of piano concertos by Mozart, partly with considerable improvements of their condition and increase in efficiency while contrary reactions were produced by other forms of music. Persons suffering from depressive defect schizophrenia with reduced drive showed positive effects after waltz music and folksongs. The results are encouraging to include suitable music under group therapeutic conditions in the complex psychiatric therapy rehabilitation strategy.

Psychiatr Neurol Med Psychol (Leipz). 1986 Sep;38(9):547-53

Regulative music therapy (RMT) in depressive diseases--a contribution to the development of psychotherapy in psychiatry

Reinhardt A, Röhrborn H, Schwabe C.

Regulative music therapy is interpreted as a psychotherapeutic method with underlying symptom centered psychotherapeutic action statement. Concerning depressive diseases is derived new action orientated concept for therapy.

Cancer. 2003 Dec 15;98(12):2723-9

Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial.

Cassileth BR, Vickers AJ, Magill LA.
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA

BACKGROUND: High-dose therapy with autologous stem cell transplantation (HDT/ASCT) is a commonly used treatment for hematologic malignancies. The procedure causes significant psychological distress and no interventions have been demonstrated to improve mood in these patients. Music therapy has been shown to improve anxiety in a variety of acute medical settings. In the current study, the authors determined the effects of music therapy compared with standard care on mood during inpatient stays for HDT/ASCT. METHODS: Patients with hematologic malignancy admitted for HDT/ASCT at two sites (Memorial Sloan-Kettering Cancer Center and Ireland Cancer Center in Cleveland, Ohio) were randomized to receive music therapy given by trained music therapists or standard care. Outcome was assessed at baseline and every 3 days after randomization using the Profile of Mood States. RESULTS: Of 69 patients registered in the study, follow-up data were available for 62 (90%). During their inpatient stay, patients in the music therapy group scored 28% lower on the combined Anxiety/Depression scale (P = 0.065) and 37% lower (P = 0.01) on the total mood disturbance score compared with controls. CONCLUSIONS: Music therapy is a noninvasive and inexpensive intervention that appears to reduce mood disturbance in patients undergoing HDT/ASCT. Copyright 2003 American Cancer Society.

J Music Ther. 2003 Fall;40(3):189-211.

The effects of music listening after a stressful task on immune functions, neuroendocrine responses, and emotional states in college students.

Hirokawa E, Ohira H.
Gifu Prefectural Music Therapy and Research Center, Japan

The purpose of this study was to examine the effects of listening to high-uplifting or low-uplifting music after a stressful task on (a) immune functions, (b) neuroendocrine responses, and (c) emotional states in college students. Musical selections that were evaluated as high-uplifting or low-uplifting by Japanese college students were used as musical stimuli. Eighteen Japanese subjects performed stressful tasks before they experienced each of these experimental conditions: (a) high-uplifting music, (b) low-uplifting music, and (c) silence. Subjects' emotional states, the Secretory IgA (S-IgA) level, active natural killer (NK) cell level, the numbers of T lymphocyte CD4+, CD8+, CD16+, dopamine, norepinephrine, and epinephrine levels were measured before and after each experimental condition. Results indicated low-uplifting music had a trend of increasing a sense of well-being. High-uplifting music showed trends of increasing the norepinephrine level, liveliness, and decreasing depression. Active NK cells were decreased after 20 min of silence. Results of the study were inconclusive, but high-uplifting and low-uplifting music had different effects on immune, neuroendocrine, and psychological responses. Classification of music is important to research that examines the effects of music on these responses. Recommendations for future research are discussed.