Music therapy for in-patients with schizophrenia

Talwar, Nakul; Crawford, Mike; Maratos, Anna; Nur, Ula; McDermott, Orii; Procter, Simon

doi:10.1192/bjp.bp.105.015073

Cited by 129 publications

(97 citation statements)

References 11 publications

(9 reference statements)

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“…Of the six studies included in the NICE review, 6 three studies [12][13][14] evaluated the effectiveness of music therapy, two studies 15,16 evaluated the effectiveness of art therapy and one study 17 evaluated the effectiveness of body-orientated psychotherapy. The BPT trial was an exploratory RCT, which tested a manualised form of the intervention in outpatients with persistent negative symptoms of schizophrenia.…”

Section: Body Psychotherapy and Schizophreniamentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Priebe

Savill

Wykes

et al. 2016

Health Technol Assess

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BackgroundThe negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control.DesignA parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted.ParticipantsEligibility criteria: age 18–65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. Exclusion criteria: inability to participate in the groups and insufficient command of English.SettingsParticipants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces.InterventionsControl intervention: a 10-week, 90-minute, 20-session group beginners’ Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist.OutcomesThe primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up.ResultsA total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) –1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI –1.23 to 0.00), and in extrapyramidal movement disorder symptoms –0.65 (95% CI –1.13 to –0.16) at the end of treatment and –0.58 (95% CI –1.07 to –0.09) at 6 months’ follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition.LimitationsOwing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care.ConclusionsIn comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms.Future workDetermining whether or not this lack of effectiveness extends to all types of art therapies would be informative.Trial registrationCurrent Controlled Trials ISRCTN842165587.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.

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Section: Body Psychotherapy and Schizophreniamentioning

confidence: 99%

“…A detailed study design description is available in the published protocol. 13 Prior to recruitment, the study was registered through the International Standard Randomised Controlled Trial Number (ISRCTN) system (ISRCTN84216587).…”

Section: Designmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Priebe

Savill

Wykes

et al. 2016

Health Technol Assess

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“…In 2011, the authors of the first RCT on music and acute psychosis (Talwar et al 2006) published a follow-up editorial in British Journal of Psychiatry where they asked, simply, 'music: it seems to work, but how?' (Talwar et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Music in action: tinkering, testing and tracing over time

DeNora

Ansdell

2017

Qualitative Research

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In this article we draw on a recent, six-year ethnographic study of community music therapy and mental health to highlight strategies and techniques for documenting music’s role in processes of change. We place these strategies in dialogue with the ethnographic work on arts and crafts by Paul Atkinson. In tandem with Atkinson, we propose a ‘slow’ approach focused on micro-processes of musical/para-musical bricolage whereby things are made and transformed over time. A three-cornered strategy in support of this approach is described: (1) a focus on musical-practical tinkering, (2) a focus on the modification and contention or testing of idiocultural musical space and, (3) two specific techniques for tracing music-related change, the music therapy ‘index’ and the ‘musical event’ schema.

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“…A systematic review of music therapy studies with patients who have schizophrenia or schizophrenia-like illnesses concluded that the music therapy intervention, in addition to standard care, could improve patient's global state (Gold, Heldal, Dahle & Wigram, 2005). Research into music therapy with mental health service users has demonstrated improved symptom scores among those randomised to music therapy, especially in general symptoms of schizophrenia (Talwar, et al, 2006).…”

Section: Music Therapy: the Evidencementioning

confidence: 99%

Is there a role for music therapy in the recovery approach in mental health?

McCaffrey

Edwards

Fannon

2011

The Arts in Psychotherapy

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The recovery approach in mental health care emphasises the importance of the service user leading a fulfilling, meaningful life beyond the limitations of illness or symptomatology. This approach to care is increasingly included as a central part of mental health policy and service provision in a number of countries including the UK and Ireland, to address the needs of people who have severe and enduring mental disorders. It is an autonomous, holistic and empowering way of working with individuals as they journey towards healing. Fundamental to this model is the relationship fostered between service users and health professionals. The recovery philosophy of care mirrors some of the core principles of music therapy, including the importance of the therapeutic relationship and the possibilities for change and growth within this. This paper explores the congruence between music therapy and the recovery approach by providing; 1. An overview of current published evidence for music therapy in mental health care, 2. A discussion of this psycho-social creative arts therapy intervention within the specialized area of recovery in psychiatry, and 3. Case vignettes to illustrate the application of this philosophy in music therapy work within a recovery service.

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Music therapy for in-patients with schizophrenia

Abstract: A randomised trial of music therapy for in-patients with schizophrenia is feasible. The effects and cost-effectiveness of music therapy for acute psychosis should be further explored in an explanatory randomised trial.

Cited by 129 publications

References 11 publications

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Music in action: tinkering, testing and tracing over time

Is there a role for music therapy in the recovery approach in mental health?

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