Saturday, November 8, 2014

The Effect Of Music Therapy On Mood And Anxiety–depression: An Observational Study In Institutionalised Patients With Traumatic Brain Injury

This article written by Guétin et. al., is a continuation of a previous study conducted in 2003-2004, where thirty-four patients with traumatic brain injury were examined in order to study the feasibility and usefulness of music therapy. The researchers begins the article by stating that traumatic brain injury is characterized by cognitive and behavioural disorders. And although neuropsychological and behavioural disorders affect two thirds of patients with traumatic brain injury, lack of knowledge of these conditions may affect the rehabilitation and social/professional reintegration of these individuals negatively. 

Previous clinical studies have demonstrated the positive impact of music therapy on the rehabilitation of patients with traumatic brain injury. The 2003-2004 study conducted sessions based on playing instruments (active therapy) that were able to stimulate both cognitive functions and psychomotor functions. That research also concluded that receptive therapy (based on listening to music) enabled an improvement in anxiety and/or depression and encouraged the verbal expression of the patients’ suffering. 

For this observational study, the researcher’s objective is to evaluate the effects of music therapy on mood, anxiety and depression in thirteen patients with traumatic brain injury. These patients at “Les-Fontaines-d’O” rehabilitation centre (Adages) in Montpellier, France, from September 2005 to June 2006, 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, playing music of the patient’s musical taste) 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.

This music therapy research displays a significant improvement in mood after the first session. It also leads to a significant reduction in anxiety–depression from week 10 onwards and up until the end of the study. It is useful in the treatment of anxiety–depression and mood in patients with traumatic brain injury. According to the study, music can modify the course of disorders through its sensory, cognitive, affective and behavioural effects. 

The study discusses on how the effects of receptive music therapy are related to the fact that individualized musical listening markedly relieves painful experiences. The effects of music therapy are based on the impact of music on different components in the painful experience and changes in the perception of pathological disorders.

Ultimately, the goal after this study is to add a new “therapeutic weapon” (p. 35) -- devoid of side effects) -- to the resources available for rehabilitating patients with traumatic brain injury.  Music therapy will then, enable a comparison with other similar therapeutic interventions, such as speaking or singing.

Research on the effects of music therapy is comforting for me, to know that continuous scientific and theoretical research is made to record and publish the results of improvements through music therapy. These findings are a tangible way to recognize the importance and use for music therapy. It makes me wonder all the more, when research in music therapy began, and if significant findings were established before music therapy was officially used in medical centres. It also encourages me to continuously recognize that much more research on the brain with the use of music therapy is needed. 

What I find interesting is the fact that certain aspects of this paper that isn’t very specific. Some descriptions are quite confusing. For example, the paper explains the 2003-2004 study (of what was researched and its results), but does not state who researched it. A number of their references were published by 2005, making it all the more, challenging to determine which journal article they are referring to. The assumption is then, a possible study that the team conducted. Also, the researchers states “new, validated, “U-based” music therapy technique.” (p. 32) What is this “U-based” music therapy technique? How is it validated? What makes it new? The researchers has the assumption that the reader understands what a “U-based” music therapy technique is. Also, I am quite confused by the fact that “music (chosen according to the patient's personal taste) was played into headphones” (p. 32) was mentioned. Firstly, why did the researchers decide to have the patients choose music according to the patient’s taste”? And given that there’s great amounts of research on how styles of music affects people’s mood, heart rate, and emotions; won’t that alter the study? Secondly, the research then mentions the variants of taking select instrumentalists out of the orchestra in the music. Does that mean all the music actually have an orchestra playing in it? In that case, the patient’s personal taste in choice of music is then, limited in style? The study near the end, does state that the music is chosen by patient's personal taste and listening needs. They talked to the patients following a session, giving an opportunity for some of them to free themselves of their problems and encourage a supportive, listening relationship.

Regardless of the confusion in certain aspects of this paper, the research is focusing mainly on mood, and the study found results in positive mood changes (even if temporary). This research is made out of good intention, to prove the positive results music therapy has on patients with traumatic brain injury. I appreciate the fact that solid, scientific findings are continuously proven of the use of music therapy, and that as an observational study, relationships between the medical professional and subjects are being made. A trust factor is developed between the patient and the therapist. 

Guétin, S., B. Soua, G. Voiriot, M.-C. Picot, and C. Hérisson. "The Effect Of Music Therapy On Mood And Anxiety–depression: An Observational Study In Institutionalised Patients With Traumatic Brain Injury." Annals of Physical and Rehabilitation Medicine 52.1 (2009): 30-40. 

1 comment:

Eventide said...

Thank you for including this article about the effect of music therapy on mood and anxiety-depression in patients with TBI. There is a need for more research pertaining to the efficacy of music therapy in psychotherapy; you mention a number of inconsistencies in this particular study. I’m wondering why the researchers didn’t choose to run a randomized controlled trial with two different groups, one participating in receptive music therapy, the other in active playing, and compare the outcomes? The authors appear to infer causation from an observational study, when they report significant improvements in mood and significant reductions in anxiety-depression. It would have been better to have had a RCT to ascertain significance. Also, for the listening component, why would they play music through headphones, essentially isolating the patient? The methodology chosen for the study and techniques used with the patients seem unusual, and as you indicate, at times “confusing.” That being said, I am quite certain that both receptive and active music therapy are effective in mediating improvements in affect in persons who have sustained a TBI - we just need studies with better designs to prove it!