The parallel between modern medicine and avenues of complementary and alternative medicine has created a paradigm shift that incorporates music therapy as a therapeutic alternative to combat depression experienced by patients living with schizophrenia. The Cochrane Collaboration identifies complementary medicine as the “diagnosis, treatment and/or prevention which complement mainstream medicine by contributing to a common whole by satisfying a demand not met by orthodox medicine or by diversifying the conceptual framework of medicine” (De Sousa & De Sousa, 2010, p. 13). During this time music therapy has been used as an alternative psychotherapeutic approach toward the treatment of many psychiatric conditions, primarily schizophrenia. Studies involving music therapy as psychotherapy have shown a dramatic reduction in depression-related symptoms. Depressive symptoms of schizophrenic patients are measured using the positive and negative syndrome scale (PANSS) (De Sousa & De Sousa, 2010, p. 13). Due to the psychiatric management and rehabilitation of patients with schizophrenia, the provision of music therapy as an adjunct to the routine therapy, pharmacotherapy, and psychosocial treatment has recently undergone a transformation.
A meta-analysis is a quantitative approach used to examine and measure the impact of music, musical elements, and musical techniques on the psychotic symptoms patients living with schizophrenia often experience. A meta-analysis performed on 19 different studies revealed that when music is used as a psychotherapeutic agent the symptoms associated with schizophrenic patients including depression are significantly inhibited and suppressed thereafter (Silverman, 2003, p. 27).
According to a Cochrane review based on the interventional approach of music therapy for patients living with schizophrenia, studies have been performed which support the utilization of music therapy. Scientific research revealed that the application of music therapy helps by adding to the standard of care schizophrenic patients receive in hopes of improving their mental state (Juslin & Sloboda, 2010, p. 33). Furthermore, patients with schizophrenia who undergo an adequate amount of music therapy sessions demonstrate drastic enhancements in their mental capability and functioning.
Based on mood induction as a musical technique, music has been evaluated as “a stimulus to elicit affective responses and influence therapeutically relevant behaviours” (Juslin & Sloboda, 2010, p. 33). Varying music including music classified as being happy or sad denotes a multitude of mood enhanced states which help to induce depressive and euphoric symptoms. Albersnagel and colleagues proclaimed that mood induction based on a music technique results in more intense mood ratings in comparison to the use of verbal methods used by patients living with schizophrenia (Juslin & Sloboda, 2010, p. 33). Report of the “superiority of music to induce mood without strong demand characteristics and gender differences associated with verbal induction” exemplified the application of music therapy for schizophrenic patients from a clinical perspective (Juslin & Sloboda, 2010, p. 33). Due to the power underlying the facilitation of music from a theoretical standpoint, schizophrenic patients use music therapy to help build, develop, and maintain the depressive symptoms linked to schizophrenia. The positive correlation between music therapy and the musical effect on the patients’ mood helps patients experience first-hand, from a practical standpoint, the actual effects of music as compared to simply discussing the effects of music therapy as an interventional approach using a verbal method.
A study conducted in 4 London hospitals involved 81 patients diagnosed with schizophrenia who were 18 years of age and older (Gold, 2007, p. 77). The study revealed that music therapy in addition to standard care encouraged schizophrenic patients to express themselves as compared to standard care by itself. In the study, standard care referred to patients’ access to nursing care, occupational, and social-based activities (Gold, 2007, p. 77). The data collected and the results that were derived from the research study have shown that patients diagnosed with schizophrenia that were selected to adhere to the overall concept of music therapy as an alternative treatment to standard care. Results were obtained for a timeframe of 12 weeks, which led to significant improvements in the quality of life and in symptoms associated with standard care alone.
A careful assessment of the effects of four different kinds of emotionally distinctive pieces of music was examined with 14 patients with schizophrenia who have experienced major depression. Emotionally distinctive music was separated into four varying music categories including anger, fear, happiness, and sadness (Amir et al. 2007, p. 142). Schizophrenic patients who chose to listen to sad music could “circumvent the verbal barrier they typically experience when asked to express their emotions” (Amir et al., 2007, p. 142). Based on several random control trials, music therapy in conjunction with standard care were assessed as the data was recorded for four studies. The effects of music therapy for patients living with schizophrenia were measured anywhere from 1-3 months (Dahle et al., 2005, p. 3). The results displayed outcomes that signified that standard care plus music therapy is much more superior compared to standard care alone.
Rehabilitation efforts have proven that music therapy is quite useful when applied to individuals diagnosed with schizophrenia. In a month-long random yet controlled trial performed in Shanghai, 76 inpatients with schizophrenia were randomly allocated to either a control or treatment group (Tang et al., 1994, p. 33). During the study, both the control group as well as the treatment group continued to receive their standard medication as prescribed by their physician. However, the treatment group was also provided music therapy which included passively listening to music and actively singing with fellow schizophrenic patients for a period of one month (Tang et al., 1994, p. 33). Four nurses assessed the outcome of all 76 patients and stated that music therapy reduced depression and other negative symptoms associated with schizophrenia, which correlated to a decline in social isolation. Schizophrenic patients who used music therapy in conjunction with standard medication prescribed by a physician also exhibited an increase in social interaction through improved communication and an intensification of the interest level in external events (Tang et al., 1994, p. 33). The positive effects associated with music therapy as a psychotherapeutic intervention will enhance the schizophrenic patients’ ability to adapt to a new social setting.
As music therapists begin to understand the theoretical framework both supporting and refuting the use of music therapy in individuals living with schizophrenia in addition to the underlying characteristics associated with schizophrenic individuals, music therapists will be able to construct an appropriate plan to combat depression in these individuals. Schizophrenia is comprised of a set of emotional symptoms that tend to affect feelings including depression, a typical comorbid condition linked to patients with schizophrenia (Christodoulou et al., 2000, p. 275). The hopelessness experienced by schizophrenic individuals would ultimately lead to depression and eventual suicide. Suicide is considered the leading cause of death amongst the schizophrenic population as 10-13% of patients with schizophrenia actually commit suicide (Girardi et al., 2004, p. 476). Depression in patients with schizophrenia is assessed and measured in accordance with the “Calgary Depression Scale for Schizophrenia” (Girardi et al., 2004, p. 476).
Although there is no known cure for schizophrenia, early diagnosis in conjunction with proper medication and other interventions will minimize the symptoms associated with schizophrenia. Based on the severity of schizophrenia, antidepressants, anxiolytics, in addition to mood stabilizers are administered by physicians to prevent relapse and potential hospitalization in patients with schizophrenia (West et al., 2005, p. 283). Recent studies have fostered the amalgamation of “pharmacological and psychosocial interventions” for treating patients with schizophrenia. Alternative treatment should directly accompany the consumption of medication prescribed by a physician in hopes of successfully managing the symptoms associated with depression in schizophrenic patients (Foulds, 2006, p. 3). People diagnosed with schizophrenia who follow the standard of care as prescribed by their physician are typically administered medication.
Music therapy incorporates the use of music by a certified music therapist to help patients with schizophrenia reach psychotherapeutic goals. Since the fundamental goal of psychosocial treatment-based interventions is to rebuild the patient to “the best level of functioning socially, vocationally, recreationally, and personally, while minimizing clinical dependence,” music therapy plays a quintessential role in managing depression in schizophrenic patients (Kopelowics & Liberman, 2003, p. 1495). Results based on a music therapy survey indicated that 57% of patients with schizophrenia deemed music therapy as more advantageous than other forms of therapeutic techniques in combating psychiatric symptoms such as depression (Silverman, 2006, p. 111).
The theoretical framework underlying the clinical use of music therapy has revolutionized from a model based on a social science to an approach founded on the premise of neuroscience (Thaut, 2005, p. 306). Research has shown “the reciprocal relationship between the neurobiological foundations of music in the brain and how musical learning and experiences change brain and behavior functions,” therefore music therapy has the capability to transform from “an adjunct or complimentary treatment option to a central treatment modality in therapy and rehabilitation” (Thaut, 2005, p. 306). The application of music therapy to neuroscience has led to discoveries involving stimulated changes to the brain to help patients with schizophrenia facilitate a state of emotional processing by identifying, understand, controlling, and synthesizing emotion (Thaut, 2005, p. 307). By actively listening to music through headphones, patients with schizophrenia will be able to stimulate thoughts and feelings that promote a healthier mental state thereby, minimizing symptoms of depression.
Although some theories involving the application of music therapy as a psychotherapeutic approach has proven to be successful in patients diagnosed with schizophrenia, other studies oppose the use of music therapy as a theoretical framework to improve depression in schizophrenic patients. The original study performed in a psychiatric setting revealed that music had very little effect on schizophrenic patients (Podolsky, 1954, p. 39). Since music has demonstrated to be beneficial in people without schizophrenia and other psychological disorders, researchers initially believed that music will be advantageous in people diagnosed with schizophrenia. However, music therapy is being used in schizophrenic patients based on the discoveries, information, and knowledge which have been acquired after careful assessment of normal functioning people (Podolsky, 1954, p. 44). A research study pertaining to the examination of happy music as opposed to sad music in people with schizophrenia established that a normal individuals’ assessment of happy music is perceived as sad music in individuals diagnosed with schizophrenia (Podolsky, 1954, p. 51). Yet, patients diagnosed with schizophrenia are unable to strike a balance by being able to differentiate between happy music and sad music.
Amir, D., Bodner, E., Gilboa, A., Iancu, J., Mazor, A., Sarel, A. (2007). Finding words for emotions: The reactions of patients with major depressive disorder towards various musical excerpts. Arts in Psychotherapy, 32(2), 142-150.
Christodoulou, G. N., Collias, C. T., Havaki-Kontaxaki, B. J, Kontzxakis, V. P., Margariti, M. M., & Stamouli, S. S. (2000). Comparison of four scales measuring depression in schizophrenic inpatients. European Psychiatry, 15, 274-277.
Dahle, T., Gold, C., Heldal, T. O., & Wigram, T. (2005). Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database of Systematic Reviews, 3.
De Sousa, A., & De Sousa, J. (2010). Music therapy in chronic schizophrenia. Journal of Pakistan Psychiatric Society, 7(1), 13. Retrieved from http://www.jpps.com.pk/display_ articles.asp?d=240&p=art
Foulds, M. (2006). Contemporary psychosocial treatment of psychosis. Australian Family Physician, 35, 3.
Gold, C. (2007). Music therapy improves symptoms in adults hospitalized with schizophrenia. Evidence-Based Mental Health, 10(3), 77.
Juslin, P. N., & Sloboda, J. (2010). Handbook of music and emotion: Theory, research, applications. New York, NY: Oxford University Press.
Kopelowicz, A. & Liberman, R. (2003). Integrating treatment with rehabilitation for persons with major mental illness. Psychiatric Services, 54, 11, 1491-1498.
Podolsky, E. (1954). Music therapy. Philosophical Library. New York, NY.
Silverman, M. J. (2003). The influence of music on the symptoms of psychosis: A meta-analysis. Journal of Music Therapy, 40(1), 27-40.
Silverman, M. (2006). Psychiatric patients’ perception of music therapy and other psychoeducational programming. Journal of Music Therapy, 63, 111-122.
Thaut, M. (2005). The future of music in therapy and medicine. Annals of the New York Academy of Sciences, 1060, 303-308.
Tang, W., Yao, X., & Zheng, Z. (1994). Rehabilitative effect of music therapy for residual schizophrenia: A one-month randomized controlled trial in shanghai. British Journal of Psychiatry, 165 (Suppl. 24), 38-44.
West, J., Wilk, J., Olfson, M., Rae, D., Marcus, S., Narrow, et al. (2005). Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services, 56, 3, 283-291.