Music Therapy is Effective for Depression Treatment

With origins believed to date back as early as Aristotle and Plato, music therapy has become an alternative to traditional cognitive and behavioral therapies.  Michigan State University developed the first college curriculum in 1944 in response to a positive impact music therapy had on veterans of WWI and WWII. Music therapy successes are based on the utilization of creative lyrics, in addition to harmony, to stimulate the senses of a patient. In doing so, music therapy provides an impact to the physical, cognitive, emotion and social well-being. More recently, music therapy has begun to incorporate into the treatment of eating disorders, ADHD and depression with a benefit exhibited to both genders and across various age groups.

In the treatment of depression, music therapy provides spoken words in addition to harmony in an effort to provide inspiration and promote wellness.  Music therapy alleviates pain and promotes calmness by slowing the heart rate and other bodily functions. It is through the therapy that a patient will feel more adept to expressing emotion and begin to feel a motivation to fight against the disease. 

Recent Studies

Music therapy might help ease the symptoms of depression, though its effectiveness as a stand-alone intervention is not certain, according to a recent review of five small studies.

Four of the studies found reduced depression symptoms in participants receiving music therapy compared to those who did not. The fifth study did not find any difference.

The benefits of music appeared greatest when providers used theory-based therapeutic techniques rather than “winging it.”

“In the four studies where there was an impact, there was a very coherent theoretical framework, a very coherent explanation of what went on in the session and obvious reasons why the therapists were there,” said lead author Anna Maratos. “In the study that showed no effect, there didn’t seem to be any theoretical underpinning to the intervention. We have no idea why the therapist was there, really.”

Therapeutic interventions included listening to music in groups, body movement and painting to music, and improvised singing.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Maratos, head of profession for Arts Therapies at the Central and Northwest London NHS Foundation Trust, and colleagues looked for randomized controlled trials that compared music therapy with other, more traditional interventions for depression. They found a dearth of rigorous research.

Because there was little or no uniformity in study approaches, study populations or therapeutic techniques, the researchers did not pool the results for meta-analysis.

Maratos said that although the fifth study did not meet reviewers’ eligibility criteria, it was included because it was the only study with a certified professional coordinating the sessions.

The reviewers defined music therapy as an intervention designed to improve health status that included musical interaction between therapist and patient within a structured theoretical framework and in which outcomes were born of music, talk inspired by music or therapeutic relationships.

Each study author determined his or her own definition of standard care, on the other hand, which included pharmacological, routine hospital and cognitive therapeutic treatment.

Three studies focused on adults aged 60 and older; one study looked at adults between ages 21 and 65; and one focused on 14- and 15-year-old adolescents.

Although the studies did not show a definitive cause-and-effect relationship between music therapy and clinical improvement in depression, the authors found a positive correlation. They attributed the unevenness of the studies’ results to the varied uses of music by therapists in the studies and the relative weakness of some researchers’ methods.

The researchers found unusually high levels of participation and compliance among patients receiving the interventions.

Shara Sand, Psy.D., clinical assistant professor of psychology at Yeshiva University in New York City, agreed with researchers’ conclusion that meta-analysis was not possible in the review, but said that the evidence of music’s influence on mood makes the research question interesting.

“It does make me wonder: What is standardized treatment [in music therapy]? There’s really a whole avenue of research that should be done,” Sand said.

She adding that music therapy broadens the range of interventions available to people who might shy away from traditional approaches: “There’s often an isolation and alienation; a difficulty connecting and with relatedness” for people with depression, and the music therapy might offer a less threatening option.

Maratos said that her own status as a licensed music therapist spurred her interest in doing the review and added that music therapy is a state-sanctioned mental health treatment in the United Kingdom.

The Graduate School of Art Therapy Study

Researchers from the Graduate School of Art Therapy, Daejeon University, Daejeon, South Korea, tested whether group music therapy is effective for improving depression, anxiety and relationships in 26 patients allocated to either a music intervention group or a routine care group.

The music intervention group received 60 minutes of music intervention for 15 sessions (one or two times weekly).

The study found that after 15 sessions, the music intervention group showed significant improvements in depression, anxiety and relationships compared with the control group.

The authors concluded that despite the positive results, objective and replicable measures are required from a randomized controlled trial with a larger sample size and an active comparable control.

There is evidence that music that reflects the listener's personal preference is more likely to have desired effects. It is possible that music through headphones during medical procedures could interfere with the patient's cooperation with the procedures. Further research is needed in this area.

Entrainment List for Depression

For successful music therapy, the entrainment list for depression should be made based on an individual's musical tastes. Classical and pop music tend to be the easiest styles to use when producing a progression from depression to neutral/happy. Sometimes country or rock will work as well, but heavy metal music is not usually a good choice.

The following factors are important to consider when trying music as an anti-depressant:
  • The most important factor is the meaning of each song to the person listening.
  • Ten to 14 songs make up the ideal list.
  • The first three songs are increasingly depressing and the fourth is the most depressing.
  • The fifth song is slightly brighter – hope has been introduced.
  • Subsequent songs become happier until a neutral or slightly happy mood is reached by the tenth song.
  • If desired, a few more songs may be added to reinforce the desired mood (relaxed, happy, carefree, inspired, etc.).
The person experiencing the depressed mood should find a comfortable position either sitting or lying down. Then he or she should listen to the playlist from start to finish.

During the depressing songs, it is important to thoroughly feel and experience the sadness or hopelessness, rather than attempting to fight it off. Continuing with the rest of the list should naturally improve the mood; it is unlikely that the person will get "stuck" in a very depressed state (unless the entrainment list is not completed). The natural anti-depressant effect of the music will bring the person out of the undesired mood and into a neutral or happy state.

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