Individual Music Therapy for Depression: Randomized Control Group

http://bjp.rcpsych.org/content/199/2/132

The British Journal of Psychiatry: The Journal of mental Science, Vol. 199(2) (2012), pp.132-9.
Individual Music Therapy for Depression: Randomized Control Group.
Erkkila J., Punkanen M., Fachner J., Ala-ruona E., Pontio I., Teraniemi M., Vanhala M., Gold C., The Grieg Academy Music Therapy Research Centre.

Abstract:

In Finland, depression has been developing commonly in people due to loss of occupation or the inability to no longer work. The prevalence rate of depression in Finland is approximately between 5-6.5% of the whole population. The use of medication with psychiatric treatment has been the most common way of treating clients with depression in Finland.
The location of this study was done in Finland. Psychotherapy has been effective with some clients dealing with depression. Conversely, for other depressive clients psychotherapy has not been successful because the verbal communication between the therapist and client has been difficult and in worst-case scenarios almost nonexistent. This may be due to the fact that depression decreases verbal speech and social interaction in individuals. It may also be due to the fact that people whether they are depressed or not, sometimes do not know how to exactly express what it is that they are feeling or experiencing through words. This group whom conducted this study thought that bringing music therapy to depressive clients might be effective because it conveys a non-verbal aspect during the therapeutic process. For that reason, this group thought that music therapy might possibly be a great alternative to psychotherapy. This way the clients were given a chance to express themselves and also get more in touch with their emotions through the music. By getting in touch with him or her inner self, this would also allow a client to open up and build a relationship with the therapist on a non-verbal musical level. The technique that was used in the conducted music therapy sessions was free improvisation. This theoretical perspective emphasizes on the client’s self-projection within the musical improvisations. What this means is that when a client improvises, he or she can trigger and connect with their own an emotional response, memories, thoughts, or images.
This study focused on working-age people because of the huge socioeconomic importance of this population. The working-age class was also chosen for this study because there is very little research that has been done for this massive population.
79 adults with unipolar depression were involved in this study. The DSM-III-R was used to diagnose these participants. One thing to keep in mind of this study is that some of the participants continued to be on medication and standard care during the study period. No musical skill was required by the participants to be involved in the music therapy sessions. All participants were fluent in the Finnish language and all were able to carry out a verbal conversation with the therapist. None of the participants had psychosis or were suicidal. The study was conducted at the University of Jyvaskyia, Finland.
During this study, the use of musical experiences and building the client-therapist relationship was the focal point throughout the therapeutic sessions. All participants had a one to one session with a music therapist. The musical experience range was broad within the free improvisation approach. Clients got to listen, play an instrument, or sing songs to free improvisation. The degree of verbal communication shared between the therapist and a client during a session varied between each client. Traditionally the psychodynamic approach includes both musical playing and a reflective discussion. This therapeutic approach requires the client to be very active in the music making. The basic principle of intervention for the psychodynamic perspective is to encourage and engage clients in an expressive musical interaction. The role of the therapist is to actively assist and support the client’s therapeutic process by using musical elements. Musical elements that can be used are open and broad such as, rhythm, melody, harmony, dynamics, and timbre. The therapeutic process should be built up with unity between the therapist and client especially during the music. Conceptualizing and further processing what occurred in the music is usually discussed at the end of a therapeutic session. Some of the common concepts that were discovered by the participants from their self-reflective analysis of their free improvisation were, feelings of a particular emotion, metaphors, and images.
This study held 20 bi-weekly music therapy sessions, and each session was 60 minutes. The instruments that were incorporated in the sessions were, mallet (digital mallet midi-controller), percussion instrument (digital midi-percussion), and an acoustic djembe drum. During this study the music therapist and client improvised with identical instruments. Further processing of the improvisations was possible due to recording the sessions. Most of the improvisations were in a duet style done by the therapist and client.
During this study the 79 participants were separated into two different groups. These groups were the music therapy group and control group (standard care). The outcome of the study showed that the music therapy group had a significantly higher score of improvement in clients compared to the control group. Music therapy in addition to standard care benefited these participants with mild, moderate, and severe depressive episodes. Overall it improved the levels of depression as well as anxiety and functioning. Other interesting findings form this study was that there was also a higher attendance rate in the music therapy group and less drop out rates of participants.

This particular study made conclusions that music therapy had characteristics that enabled client’s with meaningful nonverbal expression and interaction with another human being even though they could not verbally describe what they were experiencing internally. This study aligned with the psychodynamic theoretical perspective that music has the ability to activate the unconscious or subconscious part of the mind. What the clients were able to express during their improvisations became a way of symbolically expressing and communicating with another person. This study showed that music therapy could be used as a preverbal communication that can encompass and complement verbal communication. Some of the feedback that was directly given back by clients was that it gave insight into their inner thoughts and after the improvisations, the clients felt they were able to further process even deeper into their thoughts through verbalizing their musical experience. It was also evident from the conclusions that were drawn that the clients got to experience emotions associated with depression on a symbolic and nonverbal level. For example, emotional memories from their childhood were triggered during the musical interaction with the therapist. Many clients were reminded of their past (traumatic events) which were often acquainted with loss of a close relation and/or problems in a relationship concerning a significant other. Most clients also shared that they felt being active in the free improvisations was of primary importance. The simple act of being active seemed to hold strong value and meaning for these depressive clients. An interesting finding was that many of the patients commonly chose to express their inner feelings by playing the drums or mallet.
Limitations of music therapy that were drawn from this group conclusions from this study was that because many the participants were still on medication and stand care, they do not know the superiority of music therapy alone by itself when it comes to treating clients with depression especially in comparison to standard care.

Keywords: Music therapy, Depression, Mental health, Free Improvisation, Psychodynamic theoretical perspective