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Music Therapy and Social Trauma
Abstract
Clinical experience and empirical evidence show, that music therapy can be beneficial to be included in the treatment of social trauma. The chapter that is based on a psychodynamic understanding demonstrates how suffered social trauma, be it obvious or nearly subliminal, can become sound in music. For the analysis of therapeutic scenes within two vignettes, one with a holocaust survivor and one with a former inhabitant of the GDR, the reflection of individual, social and societal functions of music is advised.
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Background
: Women with a history of physical, sexual, and/or emotional abuse often suffer from post-traumatic stress disorder (PTSD) or complex posttraumatic stress disorder (CPTSD). Meta-analyses report that cognitive behavioural therapies (CBTs), followed by eye movement desensitization and reprocessing (EMDR) are the most studied psychotherapies for trauma treatment. Focus primarily lies on individual therapy – even though some studies on group therapy for trauma treatment also exist. Few studies exist regarding other alternative therapy forms, such as art-based psychotherapies or body-focused therapies
. Aim
: This study investigated effects from the group music and imagery (GrpMI) method – a type of receptive music therapy – on trauma-related symptoms in women suffering from PTSD or CPTSD after physical, psychological, and/or sexual abuse
. Material and methods
: Using a randomized controlled parallel-group design, a sample of 45 women were either assigned to a treatment group (T) who received 12 weekly treatment sessions of GrpMI or to a waiting list control group (WLC). Self-report scales were administered immediately before and after the intervention and at a three-month follow-up
. Results
: A two-way mixed ANOVA showed a large group-by-time interaction effect on PTSD symptom severity (F(1, 42) = 8.68, p = .005 and Cohen's d = 0.94). A repeated-measures ANOVA showed a large effect within the T group (F(1, 20) = 16.6, p = .001, dav = 1.02), and the improvement remained at follow-up. The drop-out rate in the T group was as low as 4.5%
. Conclusion
: The findings suggest that GrpMI may be efficacious for treating women with PTSD/CPTSD, but further controlled studies with larger samples are warranted.
The study is registered at ClinicalTrials.gov ([Registration number: ANONYMIZED])
Nach einer kurzen Charakterisierung der psy-chodynamischen Musiktherapie und einem Überblick zum Stand der Forschung zur Mu-siktherapie mit psychotischen Patienten werden zwei Studien der Prozessforschung dargestellt. Dabei geht es um musikalische Abstimmungen innerhalb von freien Improvisationen, um den Zeitpunkt ihres Auftretens und ihre Qualität in Korrelation zur psychotischen Symptomatik so-wie um die Entstehungsbedingungen. Die Ergebnisse spiegeln die ko-kreativen Prozesse von Patient und Therapeut, die anhand der psycho-analytischen Psychosentherapie, der Prozess-merkmale der Boston Change Process Study Group sowie der Leibphänomenologie diskutiert werden und in den Kontext der Forschung zur motorisch-gestischen Synchronisierung gestellt werden.
About accordances-Insights of process-research in music therapy from a body-oriented phenomenological perspective: After a short description of psychodynamic music therapy and an overview of music therapy with patients with psychosis, two studies of process research are summarized. Goals and objectives deal with musical attunement within free improvisations, with the conditions of their development, time-points of appearance and their quality in correlation with psychotic symptoms. Findings show the co-creative processes of patient and therapist. They are interpreted within the concepts of psychoanalytic therapy of psychoses, process features discovered by the Boston Change Pro-cesss Study Group and by the phenomenologi-cal concept of intercorporeality. The results are discussed in the context of research on movement and gesture synchronisation.
Background:
Meta-analyses of studies on psychological treatment of refugees describe highly varying outcomes, and research on multi-facetted and personalized treatment of refugees with post-traumatic stress disorder (PTSD) is needed. Music therapy has been found to affect arousal regulation and emotional processing, and a pilot study on the music therapy method Trauma-focused Music and Imagery (TMI) with traumatized refugees resulted in significant changes of trauma symptoms, well-being and sleep quality. The aim of the trial is to test the efficacy of TMI compared to verbal psychotherapy.
Methods:
A randomized controlled study with a non-inferiority design is carried out in three locations of a regional outpatient psychiatric clinic for refugees. Seventy Arabic-, English- or Danish-speaking adult refugees (aged 18-67 years) diagnosed with PTSD are randomized to 16 sessions of either music therapy or verbal therapy (standard treatment). All participants are offered medical treatment, psychoeducation by nurses, physiotherapy or body therapy and social counseling as needed. Outcome measures are performed at baseline, post therapy and at 6 months' follow-up. A blind assessor measures outcomes post treatment and at follow-up. Questionnaires measuring trauma symptoms (HTQ), quality of life (WHO-5), dissociative symptoms (SDQ-20, DSS-20) and adult attachment (RAAS) are applied, as well as physiological measures (salivary oxytocin, beta-endorphin and substance P) and participant evaluation of each session.
Discussion:
The effect of music therapy can be explained by theories on affect regulation and social engagement, and the impact of music on brain regions affected by PTSD. The study will shed light on the role of therapy for the attainment of a safe attachment style, which recently has been shown to be impaired in traumatized refugees. The inclusion of music and imagery in the treatment of traumatized refugees hopefully will inform the choice of treatment method and expand the possibilities for improving refugee health and integration.
Trial registration:
ClinicalTrials.gov ID number NCT03574228, registered retrospectively on 28 June 2016.
Music therapy has been employed as a therapeutic intervention to facilitate healing across a variety of clinical populations. There is theoretical and empirical evidence to suggest that individuals with trauma exposure and posttraumatic stress disorder (PTSD), a condition characterized by enduring symptoms of distressing memory intrusions, avoidance, emotional disturbance, and hyperarousal, may derive benefits from music therapy. The current narrative review describes the practice of music therapy and presents a theoretically informed assessment and model of music therapy as a tool for addressing symptoms of PTSD. The review also presents key empirical studies that support the theoretical assessment. Social, cognitive, and neurobiological mechanisms (e.g., community building, emotion regulation, increased pleasure, and anxiety reduction) that promote music therapy’s efficacy as an adjunctive treatment for individuals with posttraumatic stress are discussed. It is concluded that music therapy may be a useful therapeutic tool to reduce symptoms and improve functioning among individuals with trauma exposure and PTSD, though more rigorous empirical study is required. In addition, music therapy may help foster resilience and engage individuals who struggle with stigma associated with seeking professional help. Practical recommendations for incorporating music therapy into clinical practice are offered along with several suggestions for future research.
This essay examines, with reference to the defense function of collective traumas, two examples of pieces composed after the two world wars of the 20th century. The starting point is a genea-logical concept of collective violence in which individuals and societies are seen as products of simultaneous individuation and socialisation processes. Abductive conclusions drawn from a first analysis of musical structures and contexts of origin suggest that a simple defense character or unilateral identification with the trauma-compensating pattern is unlikely. Systematic reception research on the effect and evaluation of the listener, which could throw further light on these issues, has yet to be undertaken. Zusammenfassung In diesem Essay werden exemplarisch zwei Kompositionen, die im 20. Jahrhundert nach den bei-den Weltkriegen entstanden sind, im Hinblick auf die Abwehrfunktion von kollektiven Traumata befragt. Ausgangspunkt ist ein genealogischer Begriff von kollektiver Gewalt, bei dem Individuen sowie Sozietäten als Resultate eines gleichzeitigen Individuierungs-und Sozialisierungsprozesses gesehen werden. Die aus einer ersten Analyse der musikalischen Strukturen und Entstehungs-kontexte abduktiv gewonnenen Schlussfolgerungen lassen einen einfachen Abwehrcharakter oder eine einseitige Identifikation mit dem traumakompensatorischen Schema als eher unwahrschein-lich erscheinen. Eine systematische Rezeptionsforschung zur Wirkung und Bewertung auf den Hörer, die weiteren Aufschluss geben könnte, ist bislang ein Desiderat.
In a world that is dominated by news of conflict, violence and natural disasters affecting millions of people around the globe, there is a need for effective strategies for coping with trauma. The effects of such trauma on both individuals and communities, are deep and long-lasting (Sutton, 2002). Cultural techniques play an important role in helping communities to recover from trauma. Sports and games, for example, have been used in numerous settings with individuals suffering from post-traumatic stress disorder (Lawrence et al., 2010). Other arts-based therapies such as reading or creative writing are also proving to be effective means for dealing with the aftermath of traumatic events. Music can also play a role in helping individuals and communities to cope with trauma, whether it be through the intervention of music therapists, community music making programs or individual music listening. However, despite the abundance of positive examples of the value of the arts in trauma recovery, music, and the arts receives little recognition by leaders in global health issues (Clift et al., 2010). This paper will argue, therefore, that there is a need for a solid empirical evidence base that can illuminate the mechanisms by which music and arts therapies are effective, as well as consideration of how individual differences in personality and coping style can moderate participant responses to such therapies. Trauma and Its Effects While the word " trauma " can refer to both physical and psychological trauma, in this paper we focus on the latter. However, defining psychological trauma is in itself problematic. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V, APA 2013), in the context of defining post-traumatic stress disorder (PTSD), defines a traumatic event as " actual or threatened death, serious injury or sexual violence, " whether personally experienced or witnessed, or experienced vicariously. This definition can include a variety of stressors of varying magnitude, frequency and duration. In addition, individual appraisal of an event can lead to differing levels of impact upon each person experiencing the event (Weathers and Keane, 2007). As described by Sutton (2002), however, most scholars agree that three aspects are central to an understanding of trauma: " shock, wound and a lasting effect " (p. 22). Two categories of trauma related disorders are included in the DSM: acute stress disorder, which relates to the acute and immediate effects of a traumatic event, and PTSD, a more chronic and long-lasting condition. However, many people may suffer from the impact of a traumatic event at sub-threshold levels. Among the disturbing effects at both clinical and sub-clinical levels of trauma may be emotional numbing, re-experiencing the event, survivor guilt and feelings of responsibility, anger, and heightened arousal levels (Honig et al., 1999). Trauma
The phenomenon of social phobia is considered in the context of social conditions and reflected on with reference to an east-west German encounter in music therapy. It becomes apparent that the musical action, rather than serving expression, self-discovery and self-determination, initiates a process in which the self, threatened by shame and shame phobia, becomes increasingly able to disregard itself, resulting in the restitution of awareness of being unified. Zusammenfassung Das Phänomen sozialer Angst wird im Kontext gesellschaftlicher Bedingungen betrachtet und anhand einer ost-westdeutschen Begegnung in einer Musiktherapie reflektiert. Es zeigt sich, dass das musikalische Handeln darin weniger der Expression, Selbstfindung und Selbstbestimmung dient als vielmehr einen Prozess anstößt, in dem das von Scham und Schamangst bedrohte Selbst mehr und mehr von sich selbst absehen kann, was zur Restitution des Gefühls, eine Einheit zu sein, beiträgt.
Vitality takes on many dynamic forms and permeates daily life, psychology, psychotherapy and the arts, yet what is vitality? We know that it is a manifestation of life, of being alive. We are very alert to its feel in ourselves and its expression in others. Life shows itself in so many different forms of vitality. But just how can we study this phenomenon? This title is divided into three parts. Part I is an introduction and background to vitality. Part II suggests a neuroscientific underpinning for forms of vitality, and shows how the time-based arts require and use these forms. Part III concerns the implications of forms of vitality for developmental and clinical work. This inquiry aims to further identify and explore this realm of dynamic forms of vitality, and to illustrate the breadth of its scope. This title may be helpful in approaching the dynamic dimension from psychological, neuroscientific, and phenomenological perspectives, and may be useful in reorienting some notions of emotion theory, memory structure, and social communication, as well as psychotherapeutic theory and practice.
Social traumatization is targeted at entire victim groups and occurs in a societal context. The classification of posttraumatic stress disorders in DSM-5, which intentionally fails to differentiate between different types of traumatic events, ignores the social factors of traumatogenic pathologies. Whereas clinical practice unanimously embraces the thorough exploration of patients’ individual life experiences and history of suffering, taking the relevant social and environmental factors into account, in the classification systems (DSM-5 and ICD-10) it has been decided to address posttraumatic disorders as individual pathologies and not as social phenomena. Even equating social trauma with a disease may foster this partial exclusion, which in turn can contribute to perpetuation of the posttraumatic condition.
This article celebrates Ed Tronick’s contribution to psychodynamic developmental psychology. Tronick’s ideas have implicitly and explicitly influenced late 20th-century and early 21st-century psychoanalytic thinking, and his contribution is here acknowledged in relation to the work on the developmental ideas concerning mentalizing. Tronick’s (1989, 2007) mutual regulation model (MRM) is outlined and examined from the point of view of the attachment-theory-based mentalization model of interpersonal interaction and psychopathology. The article identifies common ground between clinical implications of Tronick’s MRM and the mentalization model as independent but complementary ways of expanding ideas originating in attachment theory, and highlights ways in which the MRM provides greater clarity for several concepts which are frequently used in writings about mentalizing such as the background of safety and the holding environment.
The purpose of this study was to develop a song-writing technique which would reduce PTSD symptoms in abused children. Participants were patients of an inpatient psychiatric child/adolescent unit in the State of Florida. The participants were between the ages of 9 and 17 and had been physically and/or sexually abused. This research project was of a within-subjects, pre-/posttest design. The experimental condition (song writing) followed the control condition (recreational music). The dependent measures were a self-report questionnaire about selected PTSD symptoms, using a 4-point response scale, and a measure of off-task behavior. Results showed no significant change in overall scores due to treatment condition. However, a significant difference occurred between African-American and Caucasian scores, and a significant interaction occurred between age of participants and test conditions. Possible reasons for these results are explored.
More than a decennium after the reunion of East and West Germany, the psychological sequelae of traumatic experiences of East Germans are still evident. There were not only about 300000 people imprisoned for political reasons in the German Democratic Republic between 1945 and 1989, partly exposed to physical and psychological torture, but also much more people subject of subthreshold traumatic experiences by harassment in public and private life. As a result, under a psychiatric perspective it should be taken into account not only specific post-traumatic stress disorders (PTSD), characterized by reliving of the traumata in intrusive flashbacks, avoidance of circumstances associated with the traumatic experiences, and increased psychological sensitivity and arousal, but also specific Adjustment disorders, or cultural shocks: many people of the former GDR had to deal with adjustment difficulties of different types to the new cultural environment after the reunion, which could be characterized as becoming intimate with post-modern Western culture within a process of identity development. This process encloses different phases or stages discussed under psychopathologic and psychodynamic perspective.
Reviews some of Freud's texts to illustrate scenic understanding. Freud stated that the repressed unconscious results from the separation of object representations from word representations. The author strips the seeming objectivism from this terminology by invoking other of Freud's texts. The object representations are memory traces of nonverbalized interactions; they are precipitates of experienced actions and models for future actions. By participating in a patient's game, a therapist can employ scenic understanding to deal with presented material in an analogy of the interpretation of dreams. Scenic understanding is the road to the unconscious. (17 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Seit 1985 hat sich innerhalb der tiefenpsychologischen und analytischen Psychotherapie in Praxis und Theorie sowie beginnend
in der Forschung die psychodynamisch-imaginative Traumatherapie (PITT) als ein Verfahren herausgebildet, das heute im deutschsprachigen
Raum vielfach bei Patienten mit komplexen posttraumatischen Störungsbildern (▸ Abschn. 2.2.3) eingesetzt wird. PITT entwickelte
sich aus den Bedürfnissen der Praxis und erfüllt die Forderung nach einer traumaadaptierten Handhabung psychotherapeutischer
Verfahren (Flatten et al., 1998).
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