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Music and the general activity of apathetic schizophrenics
Abstract
Both individually and as a group the patients showed significant increase in activity when livelier music was played to them It is concluded that the therapeutic effects of music such as used in this experiment are temporary, and its probable main use would be as an adjuvant to other therapy.
... 64 One study found that listening to music reduced apathy. 65 A positive reinforcement intervention with social behavior being rewarded by trained nursing staff did not reduce apathy. 74 ...
... 67,[69][70][71][72]75,76 Furthermore, compensatory cognitive strategy training, Goal Management Training, social skill training and music therapy have been studied less often, but the majority of the included studies showed positive effects on apathy in people with schizophrenia. 65,68,73,[77][78][79][80][81] In the field of TBI, positive evidence was found for Goal Management Training and behavioral activation combined with structuring techniques and/or Motivational Interviewing. 36,85,88 Psychoeducation, external cuing and Motivational Interviewing were also found to reduce apathy. ...
Apathy is a quantitative reduction of goal-directed activity, which can be observed in relation to behavior, cognition, emotions and social interaction. It is an invalidating behavioral symptom that is frequently present across different psychiatric conditions and neurocognitive disorders including Korsakoff’s Syndrome (KS). In fact, apathy is one of the most severe behavioral symptoms of KS and has a major impact on the lives of patients and their relatives and other informal caregivers. However, guidelines for the treatment of apathy in KS are currently not available. This systematic narrative review provides a transdiagnostic overview of the effectiveness of different types of non-pharmacological interventions on apathy across different study populations that at symptom-level share characteristics with KS. This evidence may inform the development of an intervention targeting apathy in KS. The included study populations are dementia (due to Alzheimer’s disease, or vascular dementia), Parkinson’s disease, schizophrenia and traumatic brain injury. Through a stepped selection approach and with regard to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 22 systematic reviews and 32 empirical articles on the non-pharmacological treatment of apathy were identified. The results show a variety of effective non-pharmacological interventions on apathy. In conditions with severe cognitive impairments, successful interventions did not rely on intrinsic motivation, self-monitoring, or illness insight of the patients, but depend on external stimulation and behavioral activation. Since apathy is a multidimensional construct, identification of the extent and type of apathetic behavior before starting an intervention is highly recommended. Furthermore, it is important to adjust the treatment to the patients’ personal interests and needs and embedded in daily care.
Trial registration
CRD42022298464 (PROSPERO).
... Courtright, Johnson, Baumgartner, Jordan, and Webster (1990) noted that background music while eating significantly increased cooperation of clients diagnosed with schizophrenia. In a study attempting to decrease inactivity, Skelly and Haslerud (1952) found music to be effective in escalating the activity of apathetic clients with schizophrenia. Weissenberg (1974) attempted to use music to facilitate digitspan memory in people with schizophrenia at a state psychiatric institution. ...
... The statistical value for each dependent variable of each study was isolated and determination of between or within group comparisons was established. If statistical data were given in the form of a graph, the researcher measured the data points on the graph and Skelly (1952) Catatonic behavior Music listening Cook (1973) Catatonic behavior Contingent music Weissenberg (1974) Cognitive symptoms Music to aid in learning Cassity (1976) Catatonic behavior Guitar lessons Margo (1981) General symptoms Music listening Steinberg (1985) Cognitive symptoms Active music making Brotons (1987) Catatonic behavior Music therapy Thaut (1989) Cognitive symptoms Music therapy Courtright (1990) Catatonic behavior Music listening Hustig (1990) Cognitive symptoms Music listening McInnis (1990) General symptoms Music listening Steinberg (1991) Cognitive symptoms Music therapy Gallagher (1994) General symptoms Music listening Pavlicevic (1994) Catatonic behavior Music therapy Chambliss et al. (1996) Cognitive symptoms Music listening Cognitive Symptoms Music listening Hodgson (1996) Catatonic behavior Music therapy Glickson (2000) Cognitive symptoms Music listening Silverman (2003) Catatonic behavior Contingent music computed means and standard deviations for subsequent data analysis. ...
The purpose of this study was to analyze the existing quantitative research evaluating the influence of music upon the symptoms of psychosis. A meta-analysis was conducted on 19 studies. Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis (d = +0.71). However, there were no differing effects between live versus recorded music and between structured music therapy groups versus passive listening. Nor were there differing effects between preferred versus therapist-selected music. Additionally, classical music did not prove as effective as nonclassical music in reducing psychotic symptoms. This supports the therapeutic potential of popular music while dispelling the theory that classical music provides the form and structure that can contribute to mental health and well-being. Further quantitative research is recommended and strongly warranted to refine unique aspects of music therapy interventions effective for those with psychotic symptoms.
... Already a very early study about the value of music in 'successful psychotherapy of a schizophrenic patient' (Wenger, 1952) witnessed the close relation between psychotic processes and music-based 'counteractions'. During that period of modern music therapy, the topic of 'music, & schizophrenia' was seen in the context of activity and activation in apathetic patients (Skelly, & Haslerud, 1952), specific musical aspects such as effects of 'rhythmic and non-rhythmic' music in patients with chronic schizophrenia (Gillis, Lascelles, & Crone, 1958), and the use of music therapy in day care centres, which was a very modern model in those days. ...
Considering typical limitations of systematic reviews and meta-analyses, the present article provides a narrative outline of psychiatric diagnosis-orientation in music therapy. It deals with creativity and experience, pathological core issues, socio-cultural well-being, music for and music with patients, various schools and concepts of music therapy, and musical heritage as crucial perspectives in music therapy. The paper tries to display the huge variety of music therapeutic approaches for psychiatric purposes and the broad spectrum of related research. Indicating contradictions and tensions between standardised diagnostic criteria and common music therapeutic structures, it also involves issues of traumatisation and coping strategies, psychosomatic circuitries, homeostatic equilibrium, and vital energies. The paper considers selected DSM-diagnoses and highlights the wealth of research on music therapy in patients with depressive and psychotic disorders.
... In psychiatric settings, music has been used to increase verbalization (Dollins, 1956;Michel, 1977;Sears, 1968); to calm patients (Altshuler, 1944;Hope 1971); to change patients' moods (Gilman & Paperte, 1949;Shatin, 1970); to induce activity in the apathetic (Skelly & Haselrud, 1952); to increase interaction (Parriott, 1969;Sears, 1968); to bring patients back to reality (Bigelow & Ruben, 1970;Mann, 1950); to provoke feelings and introspection (Baumel, 1973), and to promote a positive attitude toward the therapist (Kahans & Calford, 1982;Michel, 1977). ...
... Many of the excluded studies involved passive use of art media. These studies frequently made assumptions that certain music forms were relaxing, although one of the rejected papers (Skelly and Haslerud, 1952) did attempt to evaluate their programme of music for passive listening before it was applied in the intervention. Often there was no attempt to investigate objectively the perception of music or literature before it was applied to the participants. ...
There is a long history of academic and evaluation research into health and the arts and culture, both within the UK and in other countries (Fraser and al Sayah, 2011). This evidence includes individual impacts, covering therapeutic and clinical outcomes for patients, and broader community impacts (e.g. reduced health care needs) in both clinical and non-clinical populations.
Within the body of research on arts and healthcare, there have been attempts at measuring and valuing the effects of the arts on clinical outcomes, although often this is context specific (e.g. for specific amenities or initiatives/programmes in specific locations) and lacking a policy purpose. This project was an extensive review of the literature on the use of arts in therapy. In this paper the use of 'AT' refers to a range of arts applications in therapy. This report focuses on the quantitative components of this literature.
Background:
Music therapy is a therapeutic approach that uses musical interaction as a means of communication and expression. Within the area of serious mental disorders, the aim of the therapy is to help people improve their emotional and relational competencies, and address issues they may not be able to using words alone.
Objectives:
To review the effects of music therapy, or music therapy added to standard care, compared with placebo therapy, standard care or no treatment for people with serious mental disorders such as schizophrenia.
Search methods:
We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (December 2010 and 15 January, 2015) and supplemented this by contacting relevant study authors, handsearching of music therapy journals and manual searches of reference lists.
Selection criteria:
All randomised controlled trials (RCTs) that compared music therapy with standard care, placebo therapy, or no treatment.
Data collection and analysis:
Review authors independently selected, quality assessed and data extracted studies. We excluded data where more than 30% of participants in any group were lost to follow-up. We synthesised non-skewed continuous endpoint data from valid scales using a standardised mean difference (SMD). We employed a fixed-effect model for all analyses. If statistical heterogeneity was found, we examined treatment dosage (i.e. number of therapy sessions) and treatment approach as possible sources of heterogeneity.
Main results:
Ten new studies have been added to this update; 18 studies with a total 1215 participants are now included. These examined effects of music therapy over the short, medium, and long-term, with treatment dosage varying from seven to 240 sessions. Overall, most information is from studies at low or unclear risk of biasA positive effect on global state was found for music therapy compared to standard care (medium term, 2 RCTs, n = 133, RR 0.38 95% confidence interval (CI) 0.24 to 0.59, low-quality evidence, number needed to treat for an additional beneficial outcome NNTB 2, 95% CI 2 to 4). No binary data were available for other outcomes. Medium-term continuous data identified good effects for music therapy on negative symptoms using the Scale for the Assessment of Negative Symptoms (3 RCTs, n = 177, SMD - 0.55 95% CI -0.87 to -0.24, low-quality evidence). General mental state endpoint scores on the Positive and Negative Symptoms Scale were better for music therapy (2 RCTs, n = 159, SMD -0.97 95% CI -1.31 to -0.63, low-quality evidence), as were average endpoint scores on the Brief Psychiatric Rating Scale (1 RCT, n = 70, SMD -1.25 95% CI -1.77 to -0.73, moderate-quality evidence). Medium-term average endpoint scores using the Global Assessment of Functioning showed no effect for music therapy on general functioning (2 RCTs, n = 118, SMD -0.19 CI -0.56 to 0.18, moderate-quality evidence). However, positive effects for music therapy were found for both social functioning (Social Disability Screening Schedule scores; 2 RCTs, n = 160, SMD -0.72 95% CI -1.04 to -0.40), and quality of life (General Well-Being Schedule scores: 1 RCT, n = 72, SMD 1.82 95% CI 1.27 to 2.38, moderate-quality evidence). There were no data available for adverse effects, service use, engagement with services, or cost.
Authors' conclusions:
Moderate- to low-quality evidence suggests that music therapy as an addition to standard care improves the global state, mental state (including negative and general symptoms), social functioning, and quality of life of people with schizophrenia or schizophrenia-like disorders. However, effects were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided. Further research should especially address the long-term effects of music therapy, dose-response relationships, as well as the relevance of outcome measures in relation to music therapy.
Background:
Both language and music are thought to have evolved from a musical protolanguage that communicated social information, including emotion. Individuals with perceptual music disorders (amusia) show deficits in auditory emotion recognition (AER). Although auditory perceptual deficits have been studied in schizophrenia, their relationship with musical/protolinguistic competence has not previously been assessed.
Method:
Musical ability was assessed in 31 schizophrenia/schizo-affective patients and 44 healthy controls using the Montreal Battery for Evaluation of Amusia (MBEA). AER was assessed using a novel battery in which actors provided portrayals of five separate emotions. The Disorganization factor of the Positive and Negative Syndrome Scale (PANSS) was used as a proxy for language/thought disorder and the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognition.
Results:
Highly significant deficits were seen between patients and controls across auditory tasks (p < 0.001). Moreover, significant differences were seen in AER between the amusia and intact music-perceiving groups, which remained significant after controlling for group status and education. Correlations with AER were specific to the melody domain, and correlations between protolanguage (melody domain) and language were independent of overall cognition.
Discussion:
This is the first study to document a specific relationship between amusia, AER and thought disorder, suggesting a shared linguistic/protolinguistic impairment. Once amusia was considered, other cognitive factors were no longer significant predictors of AER, suggesting that musical ability in general and melodic discrimination ability in particular may be crucial targets for treatment development and cognitive remediation in schizophrenia.
The literature over the last 40 years is briefly reviewed. A few major research studies have indicated that one should not underestimate the capacity of the handicapped to respond as do normals to music. Although the effects of music seem to result in brief changes in behaviour it is felt that music used over a longer period could be employed to regulate patients’ behaviour.
Modern psychology has much to offer performing artists in terms of understanding themselves and optimizing their art. It examines the unique two-way relationship between audience and performer, describes the way in which emotions are communicated to an audience by non-verbal processes, such as posture and facial expression, and explains the instinctual origins of the impulse to perform and the mechanisms by which music and comedy gain their emotional impact. It tells who is attracted to performing and why, and the particular stresses to which they are subject. It offers help in dealing with stage fright and in the achievement of optimum performance. This thoroughly revised and updated second edition provides a unique and up-to-date analysis of what psychology has to offer actors, musicians, singers and dancers. Newly provided examples, or
Spotlights, give a focussed discussion of interesting topics that are self-contained in the text. Drawing on numerous practical examples from the arts, as well as scientific and clinical research, this book has proved to be an invaluable resource for student, professional and amateur alike. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Music therapy is a therapeutic method that uses musical interaction as a means of communication and expression. The aim of the therapy is to help people with serious mental disorders to develop relationships and to address issues they may not be able to using words alone.
To review the effects of music therapy, or music therapy added to standard care, compared with 'placebo' therapy, standard care or no treatment for people with serious mental disorders such as schizophrenia.
We searched the Cochrane Schizophrenia Group Trials Register (December 2010) and supplemented this by contacting relevant study authors, handsearching of music therapy journals and manual searches of reference lists.
All randomised controlled trials (RCTs) that compared music therapy with standard care, placebo therapy, or no treatment.
Studies were reliably selected, quality assessed and data extracted. We excluded data where more than 30% of participants in any group were lost to follow-up. We synthesised non-skewed continuous endpoint data from valid scales using a standardised mean difference (SMD). If statistical heterogeneity was found, we examined treatment 'dosage' and treatment approach as possible sources of heterogeneity.
We included eight studies (total 483 participants). These examined effects of music therapy over the short- to medium-term (one to four months), with treatment 'dosage' varying from seven to 78 sessions. Music therapy added to standard care was superior to standard care for global state (medium-term, 1 RCT, n = 72, RR 0.10 95% CI 0.03 to 0.31, NNT 2 95% CI 1.2 to 2.2). Continuous data identified good effects on negative symptoms (4 RCTs, n = 240, SMD average endpoint Scale for the Assessment of Negative Symptoms (SANS) -0.74 95% CI -1.00 to -0.47); general mental state (1 RCT, n = 69, SMD average endpoint Positive and Negative Symptoms Scale (PANSS) -0.36 95% CI -0.85 to 0.12; 2 RCTs, n=100, SMD average endpoint Brief Psychiatric Rating Scale (BPRS) -0.73 95% CI -1.16 to -0.31); depression (2 RCTs, n = 90, SMD average endpoint Self-Rating Depression Scale (SDS) -0.63 95% CI -1.06 to -0.21; 1 RCT, n = 30, SMD average endpoint Hamilton Depression Scale (Ham-D) -0.52 95% CI -1.25 to -0.21 ); and anxiety (1 RCT, n = 60, SMD average endpoint SAS -0.61 95% CI -1.13 to -0.09). Positive effects were also found for social functioning (1 RCT, n = 70, SMD average endpoint Social Disability Schedule for Inpatients (SDSI) score -0.78 95% CI -1.27 to -0.28). Furthermore, some aspects of cognitive functioning and behaviour seem to develop positively through music therapy. Effects, however, were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided.
Music therapy as an addition to standard care helps people with schizophrenia to improve their global state, mental state (including negative symptoms) and social functioning if a sufficient number of music therapy sessions are provided by qualified music therapists. Further research should especially address the long-term effects of music therapy, dose-response relationships, as well as the relevance of outcomes measures in relation to music therapy.
In our clinical ward programmes we have utilized music rhythm instruments in rhythm groups to stimulate long-term schizophrenic patients and to induce their participation in social group endeavour. These clinical experiences together with various observations in this same connection, heightened our interest in the actual physiologic and motoric response of the schizophrenic patient to music rhythms. The evidence is strong that mentally “normal” persons do respond behaviourally and physiologically to music and its rhythms. Does the long-term schizophrenic patient manifest an objectively measurable response to such rhythm? If it could be demonstrated that the activity and the physiological functioning of the schizophrenic did respond to musical rhythms, then these stimuli might constitute a valid method for the modification of the behaviour of the schizophrenic patient.
Using GSR as a measure of emotionality, 2 groups of patients (depressives and schizophrenics) were exposed to 2 kinds of music (exciting and calming). In general, the music was seen to have the predicted effect on all the patients. The depressives responded more to the music characterized as exciting than the schizophrenics. Music was seen to be a factor which could alter the subjective emotional experience of psychotic patients.
Our folklore and mythology have attributed a potent effect to musical stimulation, and in modern terminology the musical effect has often been said to be therapeutic. Despite the present widespread use of musical stimulation as a therapeutic agent, and as a method to increase man's personal comfort, little is known about its actual usefulness in these situations, and still less is known about the psychological dynamics that may intervene between the stimulus and the hypothesized responses.
Some of the current applications of musical stimulation, and some of the research findings have been presented and reviewed critically. The meaning of the term “therapy”, as it has been used in the concept of music therapy, has been discussed.
The observations, that subjects performing an experimental task with music were oblivious to fairly loud background noises which would normally have obtruded into their awareness, led to the formulation of an explanatory hypothesis. This phenomenon suggested that the musical stimulation affected a narrowing of the focus of attention, a limiting of the over-all range of available stimulation.
It has been postulated that this effect ofnarrowed attention, produced by the musical stimulation, is similar to the psychological narrowing effect caused by central nervous system stimulation, by strong emotions, and also by a number of pharmacological agents. This theoretical formulation is consistent with the findings of other researchers who have studied the narrowed attention effect on the electrophysiological level.
It has been proposed that what has been vaguely termed the musical therapy effect is in actuality this effect of narrowed attention, and that many research findings and common observations in the area of human responses to musical stimulation are best explained on this basis.
Music therapy is a psychotherapeutic method that uses musical interaction as a means of communication and expression. The aim of the therapy is to help people with serious mental illness to develop relationships and to address issues they may not be able to using words alone.
To review the effects of music therapy, or music therapy added to standard care, compared to placebo, standard care or no treatment for people with serious mental illnesses such as schizophrenia.
The Cochrane Schizophrenia Group's Register (July 2002) was searched. This was supplemented by hand searching of music therapy journals, manual searches of reference lists, and contacting relevant authors.
All randomised controlled trials that compared music therapy with standard care or other psychosocial interventions for schizophrenia.
Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 30% of participants in any group were lost to follow up. Non-skewed continuous endpoint data from valid scales were synthesised using a standardised mean difference (SMD). If statistical heterogeneity was found, treatment 'dosage' and treatment approach were examined as possible sources of heterogeneity.
Four studies were included. These examined the effects of music therapy over the short to medium term (1 to 3 months), with treatment 'dosage' varying from 7 to 78 sessions. Music therapy added to standard care was superior to standard care alone for global state (medium term, 1 RCT, n = 72, RR 0.10 CI 0.03 to 0.31, NNT 2 CI 1.2 to 2.2). Continuous data suggested some positive effects on general mental state (1 RCT, n=69, SMD average endpoint PANSS -0.36 CI -0.85 to 0.12; 1 RCT, n=70, SMD average endpoint BPRS -1.25 CI -1.77 to -0.73),on negative symptoms (3 RCTs, n=180, SMD average endpoint SANS -0.86 CI -1.17 to -0.55) and social functioning (1 RCT, n=70, SMD average endpoint SDSI score -0.78 CI -1.27 to -0.28). However these latter effects were inconsistent across studies and depended on the number of music therapy sessions. All results were for the 1-3 month follow up.
Music therapy as an addition to standard care helps people with schizophrenia to improve their global state and may also improve mental state and functioning if a sufficient number of music therapy sessions are provided. Further research should address the dose-effect relationship and the long-term effects of music therapy.
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