Music Therapy and Schizophrenia

Burleson, Sharon J., David B. Center, and Harolyn Reeves. “The Effect of Background Music on Task Performance in Psychiatric Children.” Journal of Music Therapy. Vol. 26, No. 4 (1989): 198-205.

This study involves four males, ages five through nine, two white and two black, who were either autistic or schizophrenic and had problems with task performance. Background music, defined as instrumental music without a strong rhythmic beat, was played while the children were given a task to sort colour-coded chips. The study showed that the music reduced off-task responses that interfered with task performance, therefore increasing task accuracy. The possible explanation for this is that the music masked distracter stimuli that interfere with task accuracy. The results support using background music with mentally ill children.

Cassidy, Michael David. “The Influence of a Music Therapy Activity Upon Peer Acceptance, Group Cohesiveness, and Interpersonal Relationships of Adult Psychiatric Patients.” Journal of Music Therapy. Vol. 13, No. 2 (1976): 66-76.

A study was done to see if group musical activities enhance interpersonal relationships more than non-musical group activities. The subjects were institutionalized female psychiatric patients at Southeast Louisiana State Hospital. Changes in peer acceptance, group cohesiveness and social relationships were measured. All of the definitions, settings, and procedures of the experiment were given. Collection and treatment of data was explained. The experiment showed that the group interacted better during group guitar lessons when compared to the non-musical control group. The only design problem with this study is that the groups had volunteered to participate, so a random sample was not used. This study reveals that musical activities are beneficial to therapeutic communities. Interpersonal relationships seem to be a problem for psychiatric patients, so group guitar lessons may be one solution for helping to develop skills in this area.

Chey, Jeanyung, and Philip S. Holzman. “Perceptual Organization in Schizophrenia: Utilization of the Gestalt Principles.” Journal of Abnormal Psychology. Vol. 106, No. 4 (1997): 530-538.

This article discusses several experiments used to see if schizophrenic patients used Gestalt principles when performing perceptual organization tasks. The principles studied were: laws of proximity, similarity, and collinearity. The inability to focus consistently on relevant stimuli and the inability to filter out irrelevant stimuli are schizophrenic characteristics. These studies concluded that the schizophrenic subjects used all three of the previously mentioned principles when performing perceptual organization tasks. The only area in which they had significant trouble in was identifying obscured parts of a given figure. Knowing that schizophrenics have an inability to filter out irrelevant stimuli, a music therapist could develop activities where the client had to concentrate on certain instrumental noises while ignoring others. Another activity could be creating a game using related instruments such as different drums along with other non-related instruments such as a harmonica and a keyboard. The therapist could give directions for the game, and the goal would be to get the client to concentrate on one group of related instruments and ignore the other unrelated instruments. Another activity could be a trust walk with voices.

T. Reker, “Music therapy evaluated by schizophrenic patients,” Psychiatrie Praxis, vol. 18, no. 6, (1991), 216-221.

Abstract: Music therapy is presented as an integral part of the therapeutic program of an open reception ward at a state-funded psychiatric hospital. The target group for music therapy comprises schizophrenic patients whose primary psychopathological symptoms are characterized by basic disorders, autistic withdrawal, anergia and limited means of verbal communication. A sample of 30 schizophrenic patients selected for music therapy is described. The subjective evaluation and rating of the music therapy was registered using a specially developed questionnaire. The primary results are:

1. Music therapy has a high level of subjective acceptance among patients.
2. No negative effects are recorded despite the therapy being introduced in the post-acute phase.
3. The positive therapeutic effects quoted are relaxation, activation, reduced anxiety, easier contact-making, and improve opportunities for emotional expression. The duration of the effects is limited.
4. The training-related concept and the clearly structuring behavior of the group leader are given a positive rating by the patients.

Hadsell, Nancy. “A Sociological Theory and Approach to Music Therapy with Adult Psychiatric Patients.” Journal of Music Therapy. Vol. 11, No.3 (1974): 113-124.

Music Therapy here is defined as “the use of the unique properties and potential of music in a therapeutic situation for the purpose of changing human behaviour so that the individual affected will be more able to function as a worthwhile member of today’s as well as tomorrow’s society.” The therapist should operate in three areas: rehabilitation, education, and treatment. The theories of the etiology of schizophrenia fall into three basic categories: genetic and chemical factors, psychological factors, and interpersonal and social factors. Abnormal amounts of adrenaline and taraxein have been found in schizophrenics. Early childhood trauma and deprivation may cause it. Some say the person’s relationships or breakdown in communication may cause schizophrenia. All three of the categories together actually seem to cause schizophrenia. A schizophrenic may not be able to see how he fits into society and may not be able to deal with surroundings. The music therapist has to help in these ways: re-establish the patient with reality, draw him away from hallucinations and delusions, open communication with people around him, and learn adaptive behaviour patterns which allow him to function more normally in society. Groups in therapy should be small to help rebuild communication skills. Let patients make decisions.

North, Elmer F. “Music Therapy as an Important Treatment Modality With Psychotic Children.” Journal of Music Therapy. Vol. 3, No. 1 (1966): 22-24.

We need to first establish relationships with these children. Use music to engage their interest and then build further relationships with it. Let children write notes on staff paper and then play for them what they have written. They will feel they have accomplished something. Introduce safe and interesting variations to them so they can deal with the varying everyday world. If you work with a catatonic child you can place a drumstick in his hand and bang a drum for him. Eventually the child should initiate movement with certain instruments. If the child has no direction and random behaviour, music will bring structure, stimulation, and something that will help him or her relate to other people.

Smith, Glen L., Matthew M Large, David J Kavangh, Frini Karayanidis, Nicholas A Barrett, Patricia T. Michie, and Brendan T. Sullivan. “Further Evidence for a Deficit in Switching Attention in Schizophrenia.” Journal of Abnormal Psychology. Vol. 107, No. 3, (1998): 390-398.

This study involved testing different types of attention such as attention to different colours, patterns, and switching attention in schizophrenic people. A newly developed Visual Attention Battery (VAB) was used. The six tasks of the VAB are:

1) a control task requiring sustained attention to stimuli which was a test of simple reaction time
2) a task requiring selective attention to a colour
3) a task requiring selective attention to a pattern
4) a task requiring divided attention to both colour and a pattern
5) a task requiring switching attention between colour and pattern

6) a task requiring attention to pattern but with regular updating of target patterns in working memory. Simple sustained memory was unaffected by schizophrenia; however, patients were impaired on tasks of switching attention and reloading of working memory. Switching attention deficit was the prominent attention deficit in schizophrenia. Attention and memory do improve with medication but patients who are no longer acutely ill may still have cognitive deficits when returning to the community. A music therapist could use this information to create activities working on switching attention from one task to another or one item to another. Flashlights may be useful in directing attention to different musical stations set up around the room. Musical games may be used to help clients learn to switch attention from one topic to another.

Wolfgram, Bonnie J. “Music Therapy for Retarded Adults with Psychotic Overlay: A Day Treatment Approach.” Journal of Music Therapy. Vol. 15, No. 4 (1978): 199-207.

This day treatment approach in Milwaukee County (Wisconsin) is trying to develop work skills, academic skills, and social skills so the patients can return to appropriate functioning in the community. Each patient has five daily sessions including music therapy, occupational therapy, activities of daily living, a service project, and coed recreation. Here are five advantages of day treatment:

1. family and community ties stay intact
2. less shame and social isolation are experienced
3. day hospital status implies trust that the client will be able to utilize his positive ego assets and functions
4. family and community roles are more likely to stay open during day treatment and
5. it gives the opportunity for gradual reintegration into the community. The most common diagnoses of these patients are schizo-paranoid, adult adjustment reactions, and depression. Music therapy is non-threatening and its goal is to make behaviour changes so the patient can adapt and have the ability to function normally in the community. The therapist needs to have a warm and accepting approach and has to provide a structure and goal-oriented community. This article gives good ideas of activities to do with these types of patients.

Music Therapy in the Treatment of Adults with Mental Disorders, edited by Robert F. Unkefer, 1990.

Summary: The book details a theoretical position of Music Therapy. It describes factors impacting on levels of Music Therapy interventions and gives a taxonomy of Music Therapy techniques with detailed descriptions of specific techniques and interventions. Adult mental disorders are outlined. The main idea of the book is that both language and music are forms of communication processed by the auditory system. They have structural similarities in terms of pitch, duration, stress, and listener expectations. The book describes how music communicates human needs and values when words no longer suffice.

W. Tang, X. Yao, and Z. Zheng, “Rehabilitative effect of music therapy for residual schizophrenia. A one-month randomised controlled trial in Shanghai,” British Journal of Psychiatry, Supplemental, no. 24, pp. 38-44, 1994.

Abstract: Seventy-six in-patients who had the residual subtype of schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also received a one-month course of music therapy that included both passive listening to music and active participation in the singing of popular songs with other patients. Outcome was evaluated by four nurses using Chinese versions of the Scale for Assessment of Negative Symptoms and the in-patient version of the World Health Organization’s Disability Assessment Scale. Music therapy significantly diminished patients’ negative symptoms, increased their ability to converse with others, reduced their social isolation, and increased their level of interest in external events. As music therapy has no side-effects and is relatively inexpensive, it merits further evaluation and wider application. Music therapy goals for Schizophrenia symptoms may include:

1. Re-establish client with reality
2. Draw client away from delusions and hallucinations
3. Open communication with people around client
4. Identify and express emotions
5. Reduce stress and anxiety
6. Control aggressive and destructive impulses
7. Learn adaptive behaviour patterns, which allow client to function normally in society

Music therapy activities for treatment of symptomatic problems:

1. Lyric analysis
2. Song writing: individually or in a group setting

3. Folk dance or structured dance
4. Improvisational instrumental music
5. Music and relaxation
6. Singing or doing jazz style `scat’ vocalizing
7. Group guitar lessons

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