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Meta-Analysis
. 2017 May 29;5(5):CD004025.
doi: 10.1002/14651858.CD004025.pub4.

Music therapy for people with schizophrenia and schizophrenia-like disorders

Monika Geretsegger  1 , Karin A Mössler  1 , Łucja Bieleninik  1 , Xi-Jing Chen  2 , Tor Olav Heldal  3 , Christian Gold  1
Affiliations
Meta-Analysis

Music therapy for people with schizophrenia and schizophrenia-like disorders

Monika Geretsegger et al. Cochrane Database Syst Rev. .

Abstract

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.

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Conflict of interest statement

Monika Geretsegger ‐ clinically trained music therapist.

Karin Mössler ‐ clinically trained music therapist and author of an included trial.

Łucja Bieleninik ‐ none.

XiJing Chen ‐ clinically trained music therapist.

Tor Olav Heldal ‐ clinically trained music therapist.

Christian Gold ‐ clinically trained music therapist and author of an included trial.

Figures

1
1
Study flow diagram (all searches)
2
2
3
3
1.1
1.1. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 1 Global state: No clinically important overall improvement (as rated by trialists).
1.2
1.2. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 2 Mental state: General ‐ 1a. Average endpoint score (PANSS, high score = poor).
1.3
1.3. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 3 Mental state: General ‐ 1b. Average endpoint score (BPRS, high score = poor).
1.4
1.4. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 4 Mental state: Specific ‐ 2. Negative symptoms ‐ average endpoint score (SANS, high score = poor).
1.5
1.5. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 5 Mental state: Specific ‐ 3. Positive symptoms ‐ average endpoint score (SAPS, high score = poor).
1.6
1.6. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 6 Mental state: Specific ‐ 4a. Depression ‐ average endpoint score (SDS, high score = poor).
1.7
1.7. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 7 Mental state: Specific ‐ 4b. Depression ‐ average endpoint score (Ham‐D, high score = poor).
1.8
1.8. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 8 Mental state: Specific ‐ 4c. Depression ‐ average endpoint score (CDSS, high score = poor)).
1.9
1.9. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 9 Mental state: Specific ‐ 5. Anxiety ‐ average endpoint score (SAS, high score = poor).
1.10
1.10. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 10 Leaving the study early.
1.11
1.11. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 11 Functioning: General ‐ 1a. Average endpoint score (GAF, high score = good).
1.12
1.12. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 12 Functioning: General ‐1b. Average endpoint score (IADL, high score = poor).
1.13
1.13. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 13 Functioning: Social 2a. Average endpoint score (SDSS, high score = poor).
1.14
1.14. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 14 Functioning: Cognitive ‐ 3a. Attention ‐ average endpoint score (PASAT, high score = good).
1.15
1.15. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 15 Functioning: Cognitive ‐ 3b. Vigilance and attention ‐ average endpoint score (CCPT, high score = good).
1.16
1.16. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 16 Functioning: Cognitive ‐ 3c. Memory ‐ average endpoint score (WMS, high score = good).
1.17
1.17. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 17 Functioning: Cognitive ‐ 3d. Memory ‐ average endpoint score (CMT, high score = good).
1.18
1.18. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 18 Functioning: Cognitve ‐ 3e. Abstract thinking ‐ average endpoint score (BCST, high score = good).
1.19
1.19. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 19 Functioning: Cognitive ‐ 3f. Abstract thinking ‐ average endpoint score (WCST‐Cc, high score = good).
1.20
1.20. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 20 Behaviour: 1. Average endpoint general behaviour score (NOSIE, high score = good).
1.21
1.21. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 21 Behaviour: 2. Average change in general behaviour score (NOSIE, high score = good)).
1.22
1.22. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 22 Recipient of care satisfaction: Average endpoint score (CSQ, high score = good).
1.23
1.23. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 23 Quality of life: General ‐ average endpoint score (GWB, high score = good).
1.24
1.24. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 24 Quality of life: Specific 1. Mental health ‐ average endpoint score (SPG, high score = good).
1.25
1.25. Analysis
Comparison 1 Music therapy + standard care versus standard care alone, Outcome 25 Quality of life: Specific 2. Perceived social support ‐ average endpoint score (SSQ, high score = good).
See this image and copyright information in PMC

Update of

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Moe 2000 {published data only}
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Morgan 2011 {published data only}
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Murow 1997 {published data only}
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Na 2009 {published data only}
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Ni 2002 {published data only}
    1. Ni JZ, Liu YR. Analysis of music therapy effect on patient with chronic schizophrenia [yin yue liao fa zhi liao jing shen fen lie zheng liao xiao fen xi]. Health Psychology Journal 2002;10(2):145‐6. [CBM: (Chinese Biomedical Literature); CAJ]
Offer 1960 {published data only}
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Olbrich 1990 {published data only}
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Pavlicevic 1994 {published data only}
    1. Pavlicevic M, Trevarthen C, Duncan J. Improvisational music therapy and the rehabilitation of persons suffering from chronic schizophrenia. Journal of Music Therapy 1994;31(2):88‐104.
Pfeiffer 1987 {published data only (unpublished sought but not used)}
    1. Pfeiffer H, Wunderlich S, Bender W, Elz U, Horn B. Music improvisation with schizophrenic patients ‐ a controlled study in the assessment of therapeutic effects [Freie Musikimprovisation mit schizophrenen Patienten ‐ kontrollierte Studie zur Untersuchung der therapeutischen Wirkung]. Die Rehabilitation 1987;26(4):184‐92. - PubMed
Pierce 2004 {published data only}
    1. Pierce JW. The effect of music therapy and psychoeducation versus psychoeducation for mainstreaming mental health patients into society [Thesis]. Florida: University of Florida, 2004.
Reker 1991 {published data only}
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Schmuttermayer 1983 {published data only}
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Silverman 2003a {published data only}
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Silverman 2009 {published data only}
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Silverman 2013 {published data only}
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    1. Silverman, MJ. Effects of family‐based educational music therapy on acute care psychiatric patients and their family members: an exploratory mixed‐methods study. Nordic Journal of Music Therapy 2014;23(2):99‐122.
Silverman 2016 {published data only}
    1. Silverman MJ. Effects of educational music therapy on illness management knowledge and mood state in acute psychiatric inpatients: a randomized three group effectiveness study. Nordic Journal of Music Therapy 2016;25(1):57‐75. [DOI: 10.1080/08098131.2015.1008559] - DOI
Skelly 1952 {published data only}
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Song 1994 {published data only}
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Steinberg 1991 {published data only}
    1. Steinberg R, Kimming V, Raith L, Gunther W, Bogner J, Timmermann T. Music psychopathology: the course of musical expression during music therapy with psychiatric inpatients. Psychopathology 1991;24:121‐9. - PubMed
Su 1999 {published data only}
    1. Su L, Fan Z, Qu Y. The effect of dance therapy for chronic schizophrenic patient [dui man xing jing shen bing huan zhe fu yi wu dao zhi liao de liao xiao guan cha]. Chinese Journal of Psychiatry 1999;32(3):167‐9.
Su 2005 {published data only}
    1. Su H, Zhang HD, Du XS. The synergistic effects of comprehensive rehabilitation on the negative symptoms of patients with schizophrenia [zong he xing kang fu zhi liao dui man xing fen lie zheng yin xing zheng zhuang de zeng xiao zuo yong]. Sichuan Mental Health 2005;18(3):172‐3. [CAJ]
Tan 2009 {published data only}
    1. Tan S, Yizhuang Z. Computerized cognitive remediation therapy for patients with schizophrenia, a multicenter randomized controlled study. ChiCTR‐TRC‐00000249.
Tang 2002 {published data only}
    1. Tang HYi, Zhang XY, Wu LM. The comparison study of brain function curer as a adjuvant therapy for schizophrenia patients [nao gong neng bao jian yi fu zhu zhi liao jing shen fen lie zheng de dui zhao yan jiu]. Chinese Journal of Nervous and Mental Diseases 2002;28(1):53‐4.
Thaut 1989 {published data only}
    1. Thaut MH. The influence of music therapy interventions on self‐rated changes in relaxation, affect, and thought in psychiatric prisoner‐patients. Journal of Music Therapy 1989;26:155‐66.
Troice 2003 {published data only}
    1. Troice EM, Sosa JJS. The musical experience as a curative factor in music therapy with patients with chronic schizophrenia. Salud Mental 2003;26(4):47‐58.
Vadas 2012 {published data only}
    1. Vadas L, Bloch B, Reshef A, Kremer I, Haimov I. The effects of acupuncture on sleep quality and emotional measures among psychiatric ward inpatients. Journal of Molecular Neuroscience 2012; Vol. 48:S119.
Valencia 2006 {published data only}
    1. Valencia M, Murow E, Rascón ML. Comparison of three methods of intervention in schizophrenia: psychosocial therapy, music therapy, and multiple therapies. [Comparación de tres modalidades de intervención en esquizofrenia: terapi psicosocial, musicoterapia y terapias múltiples]. Revista Latinoamericana de Psicologia 2006;38(3):535‐49.
Wahass 1997 {published data only}
    1. Wahass S, Kent G. The modification of psychological interventions for persistent auditory hallucinations to an Islamic culture. Behavioural and Cognitive Psychotherapy 1997;25:351‐64.
Wang 2002a {published data only}
    1. Wang H, Wang D, Zhou XH. The observation of the effect of music therapy on 50 chronic schizophrenia patients. [yin yue zhi liao dui 50 li man xing jing shen fen lie zheng de kang fu xiao guo guan cha]. Harbin Medical Journal 2002;22(1):33‐4.
Wang 2002b {published data only}
    1. Wang Aw, Shi F, Dong X. Influence of traditional pentatonic music on brain electrical activity mapping of schizophrenics [wu yin yue qu dui jing shen fen lie zheng nao dian huo dong de ying xiang]. Chinese Mental Health Journal 2002;16(7):494‐5.
Wang 2005 {published data only}
    1. Wang Yi‐Yun, Wang Qiu‐Yan, Cheng Ai‐Ping, Li Shui‐Xiang. The effects of music therapy on the rehabilitation of patients with chronic schizophrenia [yin yue liao fa zai man xing jing shen fen lie zheng kang fu zhi liao zhong de zuo yong]. Journal of Qiqihar Medical 2005;26(9):1011‐2. [CAJ]
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Wang 2006 {published data only}
    1. Wang HM, Zhang DM. The influence of music therapy on patients' social function with chronic schizophrenia [yin yue liao fa dui man xing jing shen fen lie huan zhe de she hui gong neng de ying xiang]. Practice Nursing Care and Study Journal 2006;3(1):7‐8.
Wang 2007 {published data only}
    1. Wang Z, Li X. Comparative study of the music therapy on the negative symptoms of schizophrenia with native risperidone [yin yue zhi liao he bing guo chan li pei tong zhi liao jing shen fen lie zheng yin xing zheng zhuang dui zhao yan jiu]. Chinese Journal of Health Psychology 2007;15(2):155‐6. [CHINESE: Academic Journals]
Warren 1980 {published data only}
    1. Warren J. Paried‐associate learning in chronic institutionalised subjects using synthesized sounds, nonsense syllables, and rhythmic sounds. Journal of Music Therapy 1980;17(1):16‐25.
Wu 2000 {published data only}
    1. Wu LR. The effect of musical therapy on chronic schizophrenics rehabilitation [yin yue liao fa zai man xing jing shen fen lie zheng kang fu zhi liao zhong de zuo yong]. Modern Rehabilitation 2000;4(4):550‐1.
Wu 2003 {published data only}
    1. Wu Y, Zhao F. Effect of music and dance on recovery of schizophrenia [yin yue wu dao dui jing shen fen lie zheng kang fu de ying xiang]. Health Psychology Journal 2003;11(3):207‐8.
Xiao 2005 {published data only}
    1. Xiao LR, Pei XY, Wang CY. The effect factors of rehabilitation measures on the self‐managing ability and social ability of patients with schizophrenia. [yin xing jing shen fen lie huan zhe zi li he she hui neng li hui fu cuo shi ji ying xiang yin su]. Chinese Journal of Clinical Rehabilitation 2005;9(20):225. [CAJ]
Yang 2005 {published data only}
    1. Yang RL, Lv HX, Lou F. The effect of group psychotherapy on the recovery of patients with chronic schizophrenia [xin li xiao zu zhi liao de man xing jing shen fen lie zheng huan zhe de kang fu zuo yong]. Occupation and Health 2005;21(6):936. [CAJ]
Zhang 2003a {published data only}
    1. Zhang ML. The effect of active and receptive music therapy on patients with chronic schizophrenia [zhu bei dong yin yue zhi liao dui man xing jing shen fen lie zheng liao xiao fen xi]. Health Psychology Journal 2003;11(5):370‐1.
Zhang 2003b {published data only}
    1. Zhang Y. Effect of music therapy and behavioral therapy on schizophrenia patients. China Clinical Rehabilitation 2003;7(5):857.
Zhang 2005 {published data only}
    1. Zhang HJ. The effects of music therapy and physiotherapy on the negative symptoms of schizophrenia [yin ti liao fa dui jing shen fen lie yin xing zheng zhuang huan zhe de ying xiang]. Practical Journal of Medicine and Pharmacy 2005;22(9):832. [CAJ]
Zhang 2010 {published data only}
    1. Zhang HQ, Ma XJ, Zhao LL, Feng B, Tang ZS. The effects of music therapy in combination with electric convulsive treatment for patients with refractory schizophrenia [yin yue zhi liao lian he wu chou chu dian xiu ke zhi liao nan zhi xing jing shen fen lie zheng liao xiao fen xi]. China Practical Medicine 2010; Vol. 5, issue 32:212‐3.
Zhang 2013 {published data only}
    1. Zhang GP. The effects of behavioral modification training and music therapy on improving symptoms and social life function in patients with chronic schizophrenia [xing wei jiao zhi xun lian lian he yin yue zhi liao dui man xing jing shen fen lie huan zhe ji she hui sheng huo gong neng de gai shan zuo yong]. Practical Cardio‐Cerebral Pulmonary Vascular Disease 2013; Vol. 21, issue 9:85‐6.
Zhao 2013 {published data only}
    1. Zhao SQ, Wang JY, Li YF, L R, Liu J. The application of music appreciation for patients with schizoprenia in early rehabilitation [yin yue shang xi zai jing shen fen lie zheng zao qi kang fu zhi liao zhong de ying yong]. China Practical Medicine 2013; Vol. 8, issue 10:201‐2.
Zhou 2003 {published data only}
    1. Zhou B, Xu XB, Yang GZ. The effect of music therapy on the negative symptoms of patients with schizophrenia [yin yue liao fa dui jing shen fen lie zheng yin xing zheng zhuang de liao xiao fen xi]. Ningxia Medical Journal 2003;25(4):247‐8.
Zhou 2006 {published data only}
    1. Zhou YP, Shou YQ, Tang WZ. Comparative study of the rehabilitative effect of different types of receptive music therapy on patients with schizophrenia [bu tong gan shou shi yin yue liao fa dui jing shen fen lie zheng huan zhe de kang fu zuo yong]. Shanghai Nursing Journal 2006;6(6):12‐4.
Zhu 2002 {published data only}
    1. Zhu Y, Jin X. Effect of music treatment on memory decrease of patients with schizophrenia caused by clozapine [yin yue zhi liao mu dan ping suo zhi ji yi li xia jiang de dui zhao yan jiu]. Chinese Journal of Rehabilitation Theory and Practice 2002;8(11):684‐6. [CAJ; CBM]
Zincir 2011 {published data only}
    1. Zincir SB, Semiz UB, Yenel A, Basotlu E, Bilici M, Tulay C. Effects of group musical therapy on inpatients with schizophrenia: a preliminary study. Klinik Psikofarmakoloji Bulteni 2011:S191.

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