Jaakko Erkkilä

Individual music therapy for depression: randomised controlled trial

BACKGROUND Music therapy has previously been found to be effective in the treatment of depression but the studies have been methodologically insufficient and lacking in clarity about the clinical model employed. Aims To determine the efficacy of music therapy added to standard care compared with standard care only in the treatment of depression among working-age people. METHOD Participants (n = 79) with an ICD-10 diagnosis of depression were randomised to receive individual music therapy plus standard care (20 bi-weekly sessions) or standard care only, and followed up at baseline, at 3 months (after intervention) and at 6 months. Clinical measures included depression, anxiety, general functioning, quality of life and alexithymia. TRIAL REGISTRATION ISRCTN84185937. RESULTS Participants receiving music therapy plus standard care showed greater improvement than those receiving standard care only in depression symptoms (mean difference 4.65, 95% CI 0.59 to 8.70), anxiety symptoms (1.82, 95% CI 0.09 to 3.55) and general functioning (-4.58, 95% CI -8.93 to -0.24) at 3-month follow-up. The response rate was significantly higher for the music therapy plus standard care group than for the standard care only group (odds ratio 2.96, 95% CI 1.01 to 9.02). CONCLUSIONS Individual music therapy combined with standard care is effective for depression among working-age people with depression. The results of this study along with the previous research indicate that music therapy with its specific qualities is a valuable enhancement to established treatment practices.

Music and speech listening enhance the recovery of early sensory processing after stroke

Our surrounding auditory environment has a dramatic influence on the development of basic auditory and cognitive skills, but little is known about how it influences the recovery of these skills after neural damage. Here, we studied the long-term effects of daily music and speech listening on auditory sensory memory after middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 patients who had middle cerebral artery stroke were randomly assigned to a music listening group, an audio book listening group, or a control group. Auditory sensory memory, as indexed by the magnetic MMN (MMNm) response to changes in sound frequency and duration, was measured 1 week (baseline), 3 months, and 6 months after the stroke with whole-head magnetoencephalography recordings. Fifty-four patients completed the study. Results showed that the amplitude of the frequency MMNm increased significantly more in both music and audio book groups than in the control group during the 6-month poststroke period. In contrast, the duration MMNm amplitude increased more in the audio book group than in the other groups. Moreover, changes in the frequency MMNm amplitude correlated significantly with the behavioral improvement of verbal memory and focused attention induced by music listening. These findings demonstrate that merely listening to music and speech after neural damage can induce long-term plastic changes in early sensory processing, which, in turn, may facilitate the recovery of higher cognitive functions. The neural mechanisms potentially underlying this effect are discussed.

Validity and reliability of electroencephalographic frontal alpha asymmetry and frontal midline theta as biomarkers for depression

Electroencephalographic (EEG) frontal alpha asymmetry (FAA) and frontal midline (FM) theta have been suggested as biomarkers for depression and anxiety, but have mostly been assessed in small and non-clinical studies. In a clinical sample of 79 adults with depression (ICD-10: F32), resting EEG and scales of depression (MADRS) and anxiety (HADS-A) were measured at intake and after 3 months. FAA and FM theta values were referenced to a normative population database. Internal consistency, test-retest reliability, and correlations with psychiatric tests were examined. Reliability was sufficient. However, FAA and FM theta values were close to the general population, and correlations with psychiatric tests were mostly small and non-significant, with the exception of FAA on F7-F8 z-scores and HADS-A. We conclude that the validity of FAA and FM theta and therefore their potential as biomarkers for depression and anxiety remain unclear.

The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial

BackgroundMusic therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression.Methods85 adults (18–50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months.DiscussionThis study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive clients improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research.Trial registrationISRCTN84185937

Music therapy or music medicine

pression; that review provided a clear definition of MT and excluded studies where music listening alone was used as the intervention. Music listening may be used as a part of MT, but without a therapist and a therapeutic relationship, music listening in itself is not MT. The study by Brandes et al. [1] would have been excluded from that review; yet the authors use the review to claim that their study overcomes some of the methodological shortcomings of earlier MT studies. Their claim that their study is ‘the largest to date’ cannot be substantiated when comparing it to the studies that were included in that review – at a minimum, one would need to examine the table of excluded studies from the Cochrane review. In the next update of the Cochrane review, their study will be added to that list. More research is clearly needed on both types of intervention [3] . However, we sincerely hope that future researchers will distinguish between them with the necessary care and sensitivity. In a recent study, Brandes et al. [1] report the results of a randomised trial of music listening as an adjunct treatment for depression. Their results are interesting – but are they really about music therapy (MT)? MT is most commonly defined as an intervention where ‘the therapist helps the client to promote health, using music experiences and the relationships developing through them’ [2] . Also other definitions of MT agree that a therapeutic relationship is important for a music intervention to be considered MT. Other programmes that ‘use music for health-related goals, but in ways that do not qualify as music therapy’ [3] may be described as music medicine, or in the case of this study, simply as music listening. Other music listening studies have successfully avoided this confusion [4] . Of course, the fact that an academic field has developed a consensus does not necessarily imply that all authors and journals in the world are aware of it. Sometimes unknowing editors may send manuscripts from unknowing authors to unknowing reviewers. However, lack of knowledge does not seem to be the explanation in this case. We know that the authors have presented their study at several conferences where the distinction between MT and music (medicine) was discussed. Also the reference list of the paper allows the conclusion that the authors were probably aware of the distinction. They have cited a Cochrane review [5] of MT for deReceived: November 23, 2010 Accepted: November 26, 2010 Published online: June 30, 2011

Biased Emotional Preferences in Depression: Decreased Liking of Angry and Energetic Music by Depressed Patients

Depression is a highly prevalent mood disorder, which has been associated with low levels of energetic arousal, delays in approach and avoidance processes, and problems expressing and regulating negative emotions such as anger. We designed a novel experiment to test the hypothesis that depressed patients’ preferences for emotional stimuli also demonstrate this tendency. To investigate how depressed patients differ in their preferences for music excerpts, both healthy (n 1⁄4 30) and depressed (n 1⁄4 79) participants were presented with 2 sets of 30 musical excerpts that represented the basic emotions (anger, sadness, and happiness), as well as different points on the 2-dimensional model of emotions (valence and energetic arousal). Depressed patients were found to dislike music that was highly energetic, arousing, or angry, which is assumed to be related to their problems with emotion regulation. The present study has practical implications for the use of music and music therapy in the treatment of depression. Keywords depression, approach and avoidance motivation, liking and preference, music, emotion

Shifting effects in randomised controlled trials of complex interventions: a new kind of performance bias?

Gold C, Erkkilä J, Crawford MJ. Shifting effects in randomised controlled trials of complex interventions: a new kind of performance bias?

Favouring emotional processing in improvisational music therapy through resonance frequency breathing: a single-case experimental study with a healthy client

ABSTRACT Resonance frequency breathing (RFB) is a form of slow breathing at around six breaths/min, whose immediate effects are to substantially increase heart rate variability (HRV) and to reduce stress levels. Since RFB has already been successfully used on its own to treat various emotional disorders, we wanted to evaluate its effect on emotional processing when used as a preparatory intervention in improvisational music therapy. To do so, we performed a single-subject experimental study with a healthy participant. We hypothesised that RFB would serve both as an emotional catalyst and emotional regulator, the actual outcome depending on the client’s current issues and needs. The study consisted of 10 music therapy sessions, with the breathing intervention used at the beginning of every other session, in alternation with a control intervention. The data collection focussed on HRV during talking and music-making, emotion and abstraction levels in verbal content, body language, and a set of music features extracted from the client’s improvisations. Our results show that the sessions starting with RFB were characterised by higher stress levels and the expression of more negative emotions, without it leading to hyperarousal and integration problems.

Clinical improvisation in music therapy: theory, practice, research and training

Clinical improvisation is widely used in music therapeutic settings. This roundtable will reflect the use and innovated research of clinical improvisation in music therapy practice from an international, multi-theoretical perspective.Six music therapists from three different countries will provide a comprehensive presentation about innovated theoretical perspectives, clinical uses of improvisation with various classifications of psychiatric and medical populations, as well as provide relevant information on improvisational analysis (manual and computational), on how to assess the emotional impact of improvisations through heart rate variability measurements, on conducting various types of research in improvisation and also on advanced training in improvisation.

Predicting Music Therapy Clients' Type of Mental Disorder Using Computational Feature Extraction and Statistical Modelling Techniques

Background. Previous work has shown that improvisations produced by clients during clinical music therapy sessions are amenable to computational analysis. For example, it has been shown that the perception of emotion in such improvisations is related to certain musical features, such as note density, tonal clarity, and note velocity. Other work has identified relationships between an individual’s level of mental retardation and features such as amount of silence, integration of tempo with the therapist, and amount of dissonance. The present study further develops this work by attempting to predict music therapy clients’ type of mental disorder, as clinically diagnosed, from their improvisatory material.