Osmano Oasi

Effects of music therapy on psychological symptoms and heart rate variability in patients with dementia. A pilot study

We assessed the effects of music therapy (MT) on behavioral and psychological symptoms (BPSD) in dementia associated with changes in physiological parameters, as heart rate (HR) and heart rate variability (HRV). Twenty subjects were randomly assigned to MT treatment or standard care; all patients underwent neuropsychological assessment and ECG Holter recordings before and after the 15-week treatment. The treatment included 30 MT sessions. Depression significantly decreased (p=0.021) in the MT group. PNN50 improved in 50% patients of the MT group, but in none of the control group (p=0.013). MT may improve symptoms of depression and increase HRV in demented patients.

The use of the defence style questionnaire in major depressive and panic disorders: A comprehensive meta-analysis

PURPOSE The issue of defence mechanisms is of great importance in clinical practice. The aim of this meta-analysis is to compare different defence styles (Mature, Neurotic, and Immature), assessed using the three-factor defence style questionnaire (DSQ), in major depressive disorder (MDD), and panic disorder (PD) in order to evaluate potential differences in defence profiles among these disorders. METHODS We assessed all publications listed in PubMed, PsycINFO, ISI, and Lilacs databases focusing on DSQ defence styles in MDD and PD. To be included studies had to be published in English, to include psychiatric patients, to provide defence style mean scores, and to employ the three-factor DSQ versions. Data were entered into the Cochrane Collaboration Review Manager Software and analysed by RevMan version 4.2. RESULTS MDD patients reported significantly lower scores in Mature style and both MDD and PD patients reported significantly higher scores in Neurotic and Immature styles. CONCLUSIONS A dissimilarity between depressive and anxious profiles emerged, since the former profile was characterized by low Mature and high Neurotic and Immature scores while the latter by high Neurotic and Immature scores only. These results could indicate the use of specific strategies in clinical and psychotherapeutic management of patients with these diagnoses. Nevertheless, present results should be considered with caution because of the high heterogeneity of the studies and some weaknesses in the psychometric properties of the DSQ.

A coding scheme for the evaluation of the relationship in music therapy sessions

This study presents a coding system for observation and monitoring of changes in the interactive behaviour between patient and therapist during music therapy sessions. The coding scheme was developed from a psychodynamic framework and mainly consists of four behavioural classes: Verbal Communication, Nonverbal Communication, Countenance, and Sonorous Musical Communication. The 15 minutes in the middle of each videotape concerning the first active music therapy session—based on the sonorous musical improvisation—were coded. Subjects were children (4 boys; 3 girls) ages 3 to 10 years (M age = 6.3), diagnosed with Pervasive Developmental Disorder, and seven therapists. The method for data collection was continuous recording, applied through The Observer Video-Pro 5.0. For the reliability indexes there was a substantial agreement between assessments by video raters.

Autism and music therapy. Intersubjective approach and music therapy assessment

Autism is a pathology in which the communicative and relational deficit is quite clear. After giving an up-to-date general view to the nosographic aspects and to the interpretative models of the Autistic Disorder, the authors focus on an improvisational music therapy approach in an intersubjective theoretical perspective. Coherently, with the theoretical frame and the clinical evidence, important process indicators were extrapolated into the analysed session. By using an appropriate coding scheme made to evaluate the music therapeutic process, the authors present an example analysis about the coding of some music therapys sessions of a clinical case of infantile autism. Such analysis highlighted the occurred changes within the sessions and it can be considered a useful tool for a longitudinal evaluation of the music therapeutic treatments.

Comparison of the music therapy coding scheme with the music therapy checklist

The Music Therapy Checklist is useful for music therapists to monitor and evaluate the music therapeutic process. A list of different types of behaviors were selected based on results derived from applying the Music Therapy Coding Scheme. The use of a checklist to code the events with a recording method based on 1-min. intervals allows observation without data-processing systems and drastically reduces coding time. At the same time, the checklist tags the main factors in musical interaction.

Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory.Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome.For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome.However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation.Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies.

Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial

Aim of the study: The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasics Communicative Effectiveness) in stroke patients with chronic aphasia. Materials and methods: The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. Results: The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohens d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). Conclusions: The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.

Personality Factors and Depressive Configurations. An Exploratory Study in an Italian Clinical Sample

Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results. Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200). Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression. Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.

Observing the determinants of the psychotherapeutic process in depressive disorders. A clinical case study within a psychodynamic approach.

This paper focuses on the relationship between depressive disorders, personality configurations, and mental functioning. A one-year treatment of a young man with the diagnosis of Depression is presented: the clinical and empirical points of view are described in depth through an assessment at the beginning and at one year after of an oriented psychodynamic psychotherapy. SCID I and II and HAMRS were administered to the patient in assessment phase. In the same phase he filled in BDI-II, and DEQ; the psychotherapist completed SWAP-200. These clinician instruments were used again after 1 year of the treatment. The PDM point of view is also presented. All sessions are audiotaped: 12 verbatim transcripts were coded with the Defense Mechanisms Rating Scale and CCRT. The results show a decrease in depressive symptoms, a change in some personality configurations, but a substantial invariance of the introjective profile, and a modification in mental functioning.

Music and health: what interventions for what results?

For several decades, music has been used more and more frequently and consciously as a mean of care to reduce or stabilize symptoms and/or complications arising therefrom. This has been the case with several diseases, including chronic and degenerative ones (in psychiatry, child neuropsychiatry, neurology, oncology, palliative care, etc.) (Gold et al., 2004; Sarkamo et al., 2008; Bradt et al., 2011; Erkkila et al., 2011; Mossler et al., 2011; Raglio et al., 2012; Bradt and Dileo, 2014) and in contexts in which the symptoms are just momentary (e.g., in hospitals before surgical interventions in order to reduce anxiety and stress, or to reduce the perception of pain during invasive medical procedures) (Bradt et al., 2013; Cepeda et al., 2013). Indeed, music also gives pleasure, promotes well-being, facilitates the expression and regulation of emotions and improves communication and relationships between individuals (Hillecke et al., 2005). Numerous systematic reviews of the literature (including many Cochrane Reviews), randomized controlled or controlled clinical trials and qualitative studies, all show the significant results that come with the therapeutic use of music. The basis underlying the therapeutic potential of music are to be considered in relation to the extensive action which music itself exerts on the brain at the cortical level but also at the limbic and paralimbic ones (Koelsch, 2009; Levitin and Tirovolas, 2009). Music and sound also affect vital signs and neurochemical systems (such as those of dopamine, opioid, serotonin, cortisol, oxytocin, etc.) which are related to the perception of pleasure, reward and motivation, but also to stress and arousal level, to the immune system and even to ones social attitude (Chanda and Levitin, 2013). The purposes of this article are to define the basic characteristics that therapeutic interventions with music have in common and to categorize the types of intervention based on the use of music. This is of paramount importance to identify therapeutic interventions with music as distinguished from a general practice or fruition of it (Raglio, 2011). The latter, while producing beneficial effects on the individual, it does not possess the characteristics that define a therapeutic intervention. In many contexts in which the therapeutic use of music is put into practice, we can observe a considerable heterogeneity of interventions (Gold, 2009), a low level of definition of the therapeutic proposals and some methodological weaknesses in the evaluation of the effectiveness of such interventions. There are some basic conditions that characterize a therapeutic intervention such as the presence of a qualified professional, a reference model that defines the theoretical and practical details which support the intervention (the therapy rationale), the presence of a therapeutic setting, and also the ability to define targets and therapeutic strategies of intervention with adequate awareness and the possibility to verify the therapeutic results achieved. From a careful analysis of the scientific literature different applications that make use of music can be identified: music therapy interventions (following relational or rehabilitative models), music listening (individualized music listening or listening to music based on “music medicine” approach) and general music-based interventions. Music therapy interventions in the scientific culture of the discipline are characterized by a relational component, which is considered essential, and by the presence of a qualified music therapist. In these cases, the treatment is therefore mediated by the presence of a therapist that uses applicative models based on psychological and/or neuroscientific theories. In the first case the reference is to the active techniques (which are based on a direct interactions with the patient/client using chiefly musical improvisation) and receptive ones (which involve listening to music in order to verbally elaborate the emotional content emerging from it) that aim at reducing psychological symptoms or complications arising therefrom, and at increasing relational and communication skills (Gold et al., 2009). Neuroscientific models are mainly based on the use of active techniques, such as music exercises (with a frequent use of rhythm), that constitute an effective motor, cognitive and sensory rehabilitation tool (the most common example in the literature is given by Neurologic Music Therapy) (Thaut, 2005). Applications that involve listening to music can be divided into those where the patient listens to his favorite music (individualized music listening) (Sarkamo et al., 2008; Gerdner, 2012), and those that go under the name of “music medicine” approach (in relation to the possibility of acting on specific symptoms or diseases) (Haas and Brandes, 2009). Listening to music is different from music therapy techniques mainly in that it does not imply a relational component between the patient/client and the therapist. A therapeutic value is therefore attributed to the mere action of music. In this case, the role of the music therapist is to lay down a program of music listening. This task can be carried out either according to the choices made by the patient/client, or according to the structural characteristics of music and its parameters in relation to the objective of the treatment. In the case of individualized music listening, a trained music therapist prepares a play-list containing pieces that are emotionally relevant for the patient/client, or pieces that meet his taste. Thus, the tracks are selected on the basis of indications given by the patient/client himself and through an anamnestic work involving formal or informal caregivers. Music listening based on the selection of favorite music, as documented in the literature, is aimed at people with a disease, often chronic or degenerative, in order to stimulate the patient/client cognitively and to reduce psychological or behavioral disturbances. In the case of music listening based on the “music medicine” approach, pieces are identified on the basis of the structural characteristics of music and their parameters, depending on the objective of the treatment. Tracks are then proposed that, because of their nature, can act on the patient/client by adjusting its physiological and psychological parameters passing from one phase of resonance to one of gradual change and adaptation that goes in the opposite direction to that of the pathology. Sometimes “music medicine” approach is aimed at reducing symptoms, sometimes momentarily, and therefore at having an immediate impact on the person. Frequently listening to music is used when the condition of the patient/client does not allow a direct interaction, or when logistical issues do not allow to set up a proper music therapy setting in the place where the treatment is performed (e.g., in hospitals). The generic music-based interventions can be considered a non-specific use of music. In these, a professional with music skills organizes activities aimed at increasing the persons well-being. In particular, the objective is to improve the persons mood and motivation, promote socialization and stimulate sensory, motor and cognitive aspects in general. These are activities that lack a therapeutic rationale, they are usually performed in groups, where there is neither a real therapeutic setting nor intervention strategies aimed at achieving specific targets. The proposed activities are generally structured and consist of musical interaction (e.g., rhythmic accompaniment of a song, singing, movements associated with music, etc.), but can also be listening experiences in which the music turns out to be an excuse to stimulate verbalization, memories or to encourage of relaxation. In Table ​Table11 the identification of application areas in relation to the characteristics of the interventions is proposed. Table 1 Types of intervention with music in clinical settings and their characteristics. From the literature analysis some key points and recommendations emerge that can promote the development of music therapy: first of all the need to use appropriate research methodologies to assess the effectiveness of interventions, focusing on randomized controlled trials and controlled clinical trials; moreover the need to define the interventions (Robb et al., 2011) and their application methods more adequately and finally the need to implement evidence-based approaches and research programs that would endorse the therapeutic results arising from the use of music in different clinical settings. This may facilitate the integration of music interventions in hospitals and institutions (even in the many countries in which music therapy is not yet formally recognized) by promoting the use and spread of these effective non-pharmacological approaches, which are indeed applicable in several areas of health care, at low cost and without side effects.