Music therapy improves negative symptoms of schizophrenia, such as lack of motivation, reclusiveness, and isolation, a new review of the literature suggests.
Dr Amy Agrawal
Although the study had conflicting results regarding the effects of music therapy on positive symptoms of schizophrenia, such as hallucinations, delusions, and disordered thoughts, it consistently shows that music therapy improves negative symptoms, poster presenter Amy Agrawal, MD, VA Boston Healthcare System and instructor of psychiatry at Harvard Medical School, told Medscape Medical News.
Current antipsychotic drugs aren’t very effective in addressing negative symptoms of schizophrenia, and many patients are noncompliant with these drug regimens because of side effects.
“We need to target the negative symptoms of schizophrenia better,” said Agrawal. “The antipsychotic medications we have are not enough, so why don’t we start incorporating music therapy groups into the inpatient psychiatry setting as a standard of care?”
The findings were presented at the American Psychiatric Association (APA) 2023 Annual Meeting.
Agrawal has long been interested in music. As a child, she was a member of a state choir, but she hadn’t sung for years. After receiving several medals for her clarinet playing during her youth, she stopped playing while in medical school.
During the pandemic, though, she turned back to music and started singing regularly. “I noticed an instant boost in my mood and wondered why I stopped making music for so long, as it made me feel so much happier and calmer.”
She also noticed how music affected her sister, who has paranoid schizophrenia. She described an incident in which her sibling became so loud and paranoid at a restaurant that Agrawal thought they would be asked to leave.
Then her sister started singing a song she’d sung during a beauty contest years before. “With the music, she calmed right down; she was smiling; she was happy,” said Agrawal.
That incident made Agrawal feel, “I had my sister back.” She decided to bring music therapy to her inpatient psychiatry unit and soon noted the benefits for individual patients.
For this new study, Agrawal and her mentor carried out a literature search. “I was surprised at how many articles popped up, because the field of psychiatry can be very heavily medication based, but people are now getting very interested in this topic,” said Agrawal.
The review included seven articles, most of which were published within the past 3 years. Some articles specified that the therapy was conducted on an inpatient psychiatric unit, but others didn’t indicate the setting. Studies also didn’t specify whether the therapy was delivered by a trained music therapist.
There was an overall lack of clear measures, graphs, or statistics quantifying the benefits of music therapy on schizophrenia, noted Agrawal. “But from general statements in the articles, music therapy helped treat sleep disturbances and improved negative symptoms.”
Gets Patients Socializing
The music, she said, led patients to start socializing, talking about their emotions, and opening up to their clinicians about their mental health symptoms. “Some patients just did not engage at all, and then when the music came on, they would actively participate with the clinician.”
Dancing to music also tended to motivate patients to participate in their treatment, she added. Different forms of movement, such as rhythmic movements and creative exercises, can be added during music therapy.
In addition to improving negative schizophrenia symptoms, music therapy helps with sleep disturbances, depression, and regulating emotional behavior, the research shows. “When patients were agitated or upset, certain music would help them regulate their own affect,” said Agrawal.
However, it’s not clear from these studies what type of music — classical, rock, country, etc — was most effective for people.
One article discussed the positive impact of music on patients with schizophrenia while at work. “They seem to have improved work performance,” Agrawal said.
The length of exposure to music therapy did not seem to make a difference in terms of whether the therapy had a positive effect, she added.
Key Research Wave
A “key next wave” of research should be to determine whether music therapy decreases the hospital readmission rate, said Agrawal.
There are several barriers to implementing music therapy programs in hospitals, including cost, the availability of trained therapists, and time constraints, she said.
“Regardless of the barriers, hospital administrators and psychiatrists need to know about this research so they will invest more efforts in recruiting music therapists and incorporating music group therapy into standard clinical practice for psychiatric patients so there are better clinical outcomes.”
Commenting for Medscape Medical News, Michelle B. Riba, MD, professor, Department of Psychiatry, University of Michigan, Ann Arbor, said the study adds to the literature “and helps us think about adjunctive treatments in a very difficult population.”
She added, “It’s good to see physicians get interested in this topic.”
Difficult Topic to Study
Although she found the review “very limited,” she recognizes the difficulty of studying music therapy on in-patient psychiatry units.
“Patients are there for short stays, most are getting other treatments, and it’s hard to segment people into negative vs positive. Also, the ages and genders are different, and their previous treatments are different.”
While it’s sometimes difficult to conduct major research on a topic, “that doesn’t mean we can’t help people,” said Riba.
She noted that music therapy is not only beneficial for patients with schizophrenia but also is “soothing and relaxing” for those with other conditions. She runs a psychiatric oncology program at her institution’s cancer center, which offers music therapy along with art therapy.
Kevin M. Malone, MD, from University College Dublin, also has firsthand experience with music therapy. “We had a terrific music therapist as part of our clinical psychosis team,” he told Medscape Medical News.
The music therapist is no longer there, but, he said, “as far as I’m concerned, every clinical psychosis team should have a music therapist as an essential team member.”
American Psychiatric Association (APA) 2023 Annual Meeting: Presented May 22, 2023.
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