Influence of music therapy on coping skills and anger management in forensic psychiatric patients: An exploratory study

The effect of music therapy on anger management and coping skills is an innovative subject in the field of forensic psychiatry. This study explores the following research question: Can music therapy treatment contribute to positive changes in coping skills, anger management, and dysfunctional behavior of forensic psychiatric patients? To investigate this question, first a literature review is offered on music therapy and anger management in forensic psychiatry. Then, an explorative study is presented. In the study, a pre- and post-test design was used with a random assignment of patients to either treatment or control condition. Fourteen participants’ complete datasets were collected. All participants received “treatment as usual.” Nine of the participants received a standardized, music therapy anger management program; the five controls received, unplanned, an aggression management program. Results suggested that anger management skills improved for all participants. The improvement of positive coping skills and diminishing of avoidance as a coping skill were measured to show greater changes in music therapy participants. When controlling for the exact number of treatment hours, the outcomes suggested that music therapy might accelerate the process of behavioral changes

Developing and Evaluating a Musical Attention Control Training Game Application

Musical attention control training (MACT) is a Neurologic Music Therapy (NMT) technique to strengthen attention skills for people who may have attention defi-cits, for instance related to ADHD or Parkinson Disease (PD), activating different parts of the brain and stimulating neural connectivity. While multiple interventions per week would enhance the effect of MACT, attending sev-eral sessions a week with a therapist can be challenging. Applied game interventions implementing MACT, which can be played at home, could offer complementary training to the limited number of therapy sessions. While applied games have been shown to facilitate successful interventions for cognitive impairments, to date no game exists based on MACT. We propose a novel approach to research the plausibility of applied games to support NMT, conclude game requirements for the specific needs of People with PD (PwPD), and introduce a game that emulates a MACT session. We carried out a pilot experiment to gauge how users interact with the game and its efficacy in attention control training with non-PD participants, letting them play 10 game intervention sessions within two weeks. Although no significant short-term attention effects were observed in this timeframe, user evaluations and metrics of game performance suggest that gamified MACT could be a promising supplement to conventional MACT for improving attention skills to optimize quality of life of PwPD

Feasibility of Live-Performed Music Therapy for Extremely and Very Preterm Infants in a Tertiary NICU

Objective: We aimed to investigate the feasibility of live-performed music therapy for extremely and very preterm infants admitted to the neonatal intensive care unit (NICU), and their parents, starting the 1st-2nd week after birth. They may benefit from live-performed music therapy as comforting non-pharmacological intervention. Study Design: We included infants born before 30 weeks' gestation in a single center NICU study. Live-performed music therapy was provided three times per week, tailored to the infant's medical condition. Parents were actively involved. Feasibility was determined as a combination of participation, drop-out, overstimulation (based on COMFORT-Neo scores), and evaluations of the intervention by parents and nurses (using a questionnaire on perceived effects on the parent, their infant and the NICU sound environment). Results: We included 18 infants (90% participation rate), with a gestational age of median 27 weeks (IQR 26-28 weeks), 61% males. One infant (5.6%) dropped-out. Differences of COMFORT-Neo scores during and after sessions compared with before sessions were non-significant; overstimulation by music therapy did not occur. Parents reported high satisfaction (highest score possible of 7) with the interventions and reported improvements in both infant and their own respiratory rates. Nurses also reported high satisfaction with the intervention and perceived a quieter NICU sound environment during and after sessions. Conclusion: Live-performed music therapy for extremely and very preterm infants is feasible and well-tolerated, and is experienced as an added value to developmental care. Future studies should assess both short-term and long-term effects, to determine whether this intervention should be part of routine care at the NICU and whether it is most beneficial to start shortly after birth

Piano-improvisation skills of musicians versus non-musicians : implications for music therapy

The purpose of this study was to examine the improvisation skills of musicians and non-musicians. Fifteen musicians and 13 non-musicians completed a pre- and post-performance questionnaire and played a free improvisation on the piano. The free improvisations were rated by three independent observers using the Music Improvisation Rating scale, and the responses on the questionnaires were tabulated. Results showed no difference between musicians and non-musicians for duration, expectation, self-reported interaction and satisfaction. There was, however, a statistically significant difference for judged interactions between the two groups. This may suggest that a client should not be excluded from music therapy because of lack of musical skills. The therapeutic and musical interactions, however, have to be handled and interpreted differently by the therapist. Working with musically skilled clients may require different interventions from working with musically naive clients

Piano-improvisation skills of musicians versus non-musicians : implications for music therapy

The purpose of this study was to examine the improvisation skills of musicians and non-musicians. Fifteen musicians and 13 non-musicians completed a pre- and post-performance questionnaire and played a free improvisation on the piano. The free improvisations were rated by three independent observers using the Music Improvisation Rating scale, and the responses on the questionnaires were tabulated. Results showed no difference between musicians and non-musicians for duration, expectation, self-reported interaction and satisfaction. There was, however, a statistically significant difference for judged interactions between the two groups. This may suggest that a client should not be excluded from music therapy because of lack of musical skills. The therapeutic and musical interactions, however, have to be handled and interpreted differently by the therapist. Working with musically skilled clients may require different interventions from working with musically naive clients

Music therapy for people with substance use disorders (Protocol)

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Main objective To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. Secondary objective To assess the impact of the number of MT sessions on study outcomes

Music Therapy to Regulate Arousal and Attention in Patients With Substance Use Disorder and Posttraumatic Stress Disorder:A Feasibility Study

Patients diagnosed with both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) often experience hypervigilance, increased fear, and difficulties regulating emotions. This dual diagnosis increases treatment complexity. Recently, a short-term music therapy intervention for arousal and attention regulation (the SMAART intervention) was designed based on neurobiological findings. Twelve patients with SUD and PTSD (50% females) in outpatient treatment participated in six weekly one-hour sessions of the SMAART intervention. Six patients completed the study. PTSD symptom severity was evaluated with the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5) pre- and post-intervention, and sustained attention was evaluated with the Bourdon-Wiersma (BW) test. A significant difference in measurements for the PSSI-5 overall symptom severity was found pre- and post-intervention. Furthermore, participants showed significant improvement on subscales of hyperarousal, mood and cognition, and attention. The BW test completion time decreased significantly. Two participants dropped out before the end of the intervention due to craving. Concerning future research, it is recommended to define the role of the music more explicitly and to change the design to a randomized controlled trial. A risk for future larger studies is a high dropout rate (50%). Several limitations of the study are discussed

Paradoxical Benzodiazepine Response : A Rationale for Bumetanide in Neurodevelopmental Disorders?

The diuretic agent bumetanide has recently been put forward as a novel, promising treatment of behavioral symptoms in autism spectrum disorder (ASD) and related conditions. Bumetanide can decrease neuronal chloride concentrations and may thereby reinstate γ-aminobutyric acid (GABA)-ergic inhibition in patients with neurodevelopmental disorders. However, strategies to select appropriate candidates for bumetanide treatment are lacking. We hypothesized that a paradoxical response to GABA-enforcing agents such as benzodiazepines may predict the efficacy of bumetanide treatment in neurodevelopmental disorders. We describe a case of a 10-year-old girl with ASD, epilepsy, cortical dysplasia, and a 15q11.2 duplication who had exhibited marked behavioral arousal after previous treatment with clobazam, a benzodiazepine. We hypothesized that this response indicated the presence of depolarizing excitatory GABA and started bumetanide treatment with monitoring of behavior, cognition, and EEG. The treatment resulted in a marked clinical improvement in sensory behaviors, rigidity, and memory performance, which was substantiated by questionnaires and cognitive assessments. At baseline, the girl's EEG showed a depression in absolute α power, an electrographic sign previously related to ASD, which was normalized with bumetanide treatment. The effects of bumetanide on cognition and EEG seemed to mirror the "nonparadoxical" responses to benzodiazepines in healthy subjects. In addition, temporal lobe epilepsy and cortical dysplasia have both been linked to disturbed chloride homeostasis and seem to support our assumption that the observed paradoxical response was due to GABA-mediated excitation. This case highlights that a paradoxical behavioral response to GABA-enforcing drugs may constitute a framework for targeted treatment with bumetanide

Music therapy for people with substance use disorders

Background- Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. Objectives- To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. Search methods- We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. Selection criteria- We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. Data collection and analysis- We used standard Cochrane methodology. Main results- We included 21 trials involving 1984 people. We found moderate‐certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) –0.66, 95% confidence interval (CI) –1.23 to –0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small‐to‐medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD –0.33, 95% CI –0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI –0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) –0.17, 95% CI –4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI –0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI –0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD –0.04, 95% CI –0.56 to 0.48; 3 studies, 232 participants), depression (MD –1.49, 95% CI –4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one‐month follow‐up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self‐report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. Authors' conclusions- Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short‐term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate‐to‐low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings