Improving Quality of Life of Schizophrenic Patients Utilizing a Music Therapy Project

Abstract

Individuals diagnosed with schizophrenia typically exhibit psychological symptoms, which adversely impact their overall quality of life (QoL). The negative connotation associated with schizophrenia leads most individuals affected by schizophrenia to live in extreme social isolation. Since social isolation increases the probability of developing psychotic symptoms, a therapeutic methodology must focus on ways to diminish the level of social anxiety individuals diagnosed with schizophrenia tend to experience.

Music therapy entails a psychotherapeutic approach that utilizes musical interaction to improve methods of interpersonal communication. Once individuals diagnosed with schizophrenia are able to communicate effectively they will feel less social anxiety and be able to actively engage in social settings. Twenty individuals between the ages of 21-50 who have already been diagnosed with schizophrenia will partake in a music therapy project conducted within a mental health facility clinic. All participants will listen to the music of their choice via headphones for a 30 minute period lasting 60 days. Assessment and evaluations of outcomes will be measured using WHOQoL-BREF, SIAS, and BIS methods.

Statement of the Problem

The feasibility of music therapy interventions for patients diagnosed with schizophrenia will be explored more extensively. Music therapy is a form of treatment, which utilizes a psychotherapeutic approach to improve the quality of life of schizophrenic patients within a mental health facility clinic. The etiology associated with schizophrenia include a genetic predisposition to mental illness, psychological factors, as well as social elements. Schizophrenia is linked to a number of psychological symptoms; however, the most common symptoms include anxiety, depression, and delusions or hallucinations (Hadsell, 1974, p. 113). These symptoms range from mild to extreme, which causes schizophrenic patients to feel alone as they are typically withdrawn from social interactions. Therefore, individuals diagnosed with schizophrenia often have severely strained relationships with their friends and family members.

Once schizophrenia and other mental illnesses are diagnosed, a combination of several medications and other forms of therapy are generally part of the recommended treatment plan. As a result, therapeutic methods now implement the use of music therapy as a form of intervention for individuals diagnosed with schizophrenia. Music therapy as an alternative therapy may improve the duration and frequency of the psychological symptoms associated with schizophrenia as well as reduce the number of psychiatric symptoms present. Improved symptoms help to provide an environment, which is conducive for developing and maintaining social interaction. According to Choi and his colleagues, music therapy allows individuals with schizophrenia to express their true emotions while maintaining an utter sense of relaxation from their mental state (Choi et al., 2008, p. 568). Music therapy has been proven to be beneficial and presumably advantageous in diminishing the prevalence of psychological symptoms in a dire effort to improve the quality of life of schizophrenic patients within a mental health facility clinic. The question for this project: does listening to self-chosen music using headphones for 30 minutes a day as an adjunct treatment to schizophrenia affect individuals thereby improving patient’s quality of life during the 60 day period?

Background and Significance

Schizophrenia is categorized as a severe and enduring illness (SEMI). People living with schizophrenia often live in isolation due to their inability to secure regular employment as well as their inability to develop and maintain relationships with their family members and friends (Bloch et al., 2009, p. 90). Based on a recent schizophrenia research study of adults living with SEMI, studies reveal that approximately 58% were socially withdrawn. Of those who were categorized as being socially withdrawn, 39% reported not having a close friend and 45% wished they had people they could call friends (Bloch et al., 2009, p. 90). Since social isolation inhibits clinical recovery for people living with schizophrenia, the music therapy project will focus on sessions that entail listening to music to reduce the reported symptoms associated with schizophrenia patients in the project.

Music therapy is a psychotherapeutic intervention used to help individuals diagnosed with schizophrenia better cope with their mental health and the implications which may arise as a result. The utilization of music therapy as a methodology in conjunction with the use of medication as prescribed by the patients’ physician will minimize anxiety disorders and depression thereby improving and maintaining positive interpersonal social interactions. The purpose of the study is to implement a music therapy project in a group of schizophrenic individuals in an effort to determine whether music therapy has an effect on the presence of psychological symptoms.

According to an article entitled “A Sociological Theory and Approach to Music Therapy with Adult Psychiatric Patients,” music therapy is recognized as “the use of the unique properties and potential of music in a therapeutic situation for the purpose of changing human behavior so that the individual affected will be more able to function as a worthwhile member of today’s as well as tomorrow’s society’ (Hadsell, 1974, p. 114). A music therapy project has been constructed based on studies conducted utilizing meta-analysis and meta-synthesis. Such meta-studies have previously served as proof, which helps to highlight the potential benefits correlated with evidence-based practice and research findings associated with music therapy as an interventional approach. Evidence-based practice has been utilized to formulate a music therapy approach, which will create an environment conducive for reducing the presence of psychiatric symptoms and minimizing social withdrawal thereby improving and strengthening interpersonal communication in schizophrenic patients.

The intended outcome of a successful music therapy project will not only help reduce the level of anxiety and depression but will also alleviate some of the other psychological symptoms present in patients with schizophrenia who live in a mental health facility clinic. Hence, reducing the psychotic symptoms associated with schizophrenia will increase their ability to communicate with other people and reduce their level of social interaction when placed in different social environments. Furthermore, the seven therapeutic goals of music as an intervention will “(1) re-establish client with reality, (2) draw client away from delusions and hallucinations, (3) open communication with people around client, (4) identify and express emotions, (5) reduce stress and anxiety, (6) control aggressive and destructive impulses, (7) learn adaptive behavior patterns, which allow client to function normally in society” (Tang et al., 1994, p. 38). These advantages are deemed quite beneficial as they will also help individuals diagnosed with schizophrenia develop and maintain better relationships with their family members and friends as well as engage in communication when placed within varying social settings.

Systems Context

The organizational system within which the music therapy project will be conducted involves a number of stakeholder groups at varying organizational levels. The stakeholders involved in this project include individuals, groups, and organizations that either affect or are affected by the actions taken when utilizing a music therapy approach to improve the quality of life for individuals diagnosed with schizophrenia. The major stakeholders in this project include the patients, providers, as well as the state and federal government. Patients include those individuals diagnosed with schizophrenia who will serve as participants in the music therapy project. All patients selected for the project must give informed written consent accompanied by a cosigner they rightfully know and trust to sign as a witness. The providers will include a team consisting of three physicians and two nurses who have extensive experience working with people diagnosed with schizophrenia in addition to a highly qualified and skilled music therapist. The music therapist has a master’s degree with a specialization in psychopathology (Behrens & Cohren, 2002, p. 197). Lastly, the primary role of the state and federal government is to implement policies and legislation to increase funding for music therapy projects for people with schizophrenia.

The provision of funding by the state and federal government will enable all other stakeholder groups involved to take on active roles within the music therapy project. Therefore, all major stakeholders must acknowledge schizophrenia as a severe and enduring illness (SEMI) (Bloch et al., 2009, p. 90). Stakeholders will ultimately recognize the significance of music therapy toward improving the quality of life of individuals diagnosed with schizophrenia (Dahle et al., 2005, p. 3). This is ultimately achieved by identifying and understanding the importance and benefits associated with utilizing a music therapy project for patients with schizophrenia. The project is geared toward ameliorating some of the psychological symptoms associated with schizophrenia as well as increasing their ability to actively engage in a social setting.

Feedback loops depicted in Diagram 1: Music Therapy Project within Mental Health Facility Clinic will be used to sustain stakeholder involvement and support. Providers will assess and evaluate patients with schizophrenia and monitor their progress. This information will be recorded and will eventually be used as a basis to generate more funding from the state and federal government for similar music therapy projects on schizophrenia patients in the near future. The data and results obtained will ultimately serve as an evidence-based practice for subsequent music therapy projects on patients diagnosed with schizophrenia. Clinical, satisfaction, and cost outcomes are outlined in Table 1: Data Structure Table.

Definition of Clinical Satisfaction, and Cost Outcomes

(Diagram 1 omitted for preview. Available via download)

(Table 1 omitted for preview. Available via download)

The clinical, satisfaction, and cost outcomes demonstrated in Table 1 will be used to appraise the success of the music therapy project involving individuals diagnosed with schizophrenia within a mental health facility clinic. The music therapy project consists of three clinical outcomes all of which will be measured utilizing a different approach. First and foremost, the clinical outcome will test the variable referred to as personal relations and enjoyment of life. Music therapy and its clinical practice are used as a structured therapeutic intervention geared toward improving both the mood and personal interactions of individuals diagnosed with schizophrenia (Choi et al., 2008, p. 568). Since a number of people with schizophrenia often lack support from family members and friends, music therapy helps people form and maintain relationships and friendships with others thereby improving both their personal relationships and bringing enjoyment to their life.

Secondly, the next clinical outcome will measure the success of the variable involving anxiety. According to Spielberger and his colleagues, anxiety is described as an overwhelming feeling of restlessness, which is an attribute to constant worrying (Gorsuch, 1983, p. 14). Due to the stigmatization associated with mental illness, people with schizophrenia are often isolated and remain socially withdrawn due to high levels of anxiety. Research has shown that approximately 58% of schizophrenics are socially withdrawn (Bloch et al., 2009, p. 90). As a result, more and more research is being conducted on alternative treatments for people diagnosed with schizophrenia. Music therapy has proven to reduce anxiety in people diagnosed with schizophrenia while helping to improve their social interactions. Music therapy has created an entirely new platform and is currently used to bridge the gap between social isolation and participation.

The last clinical outcome involved in the music therapy project measures the success of the psychiatric symptoms as a set of variables. The influence of music therapy on individuals diagnosed with schizophrenia help in reducing the duration and occurrence of psychological symptoms associated with schizophrenia. Music therapy offers a holistic approach to treat psychiatric symptoms linked to schizophrenia. Research studies have revealed that the psychiatric symptoms associated with schizophrenia are diminished the most when patients seek a combination of treatment, which generally includes continuous consumption of the medication prescribed by their physician along with the use of music therapy as an alternative treatment option.

The satisfaction outcome will measure satisfaction during the group interview session conducted at the end of the music therapy project. The exit interview will focus on what it’s like for individuals diagnosed with schizophrenia within a mental health facility center to be actively involved in the music therapy program, how the program could be improved, and whether they would recommend this music therapy project to other people diagnosed with schizophrenia. Information about their overall experience listening to the music of their choice for 30-minute sessions will be transcribed verbatim and recorded accordingly. The same questionnaire given in the first session will be completed on Day 60 and used to assess the level of satisfaction of schizophrenic people involved in the study.

The cost outcome will measure the complete training of schizophrenic participants involved in the music therapy project. Music therapy has grave advantages for those who actively partake in the study. Therefore, individuals involved in the study who regularly attend the weekly music therapy sessions will ultimately experience the most significant changes. It is imperative that all individuals with schizophrenia who are involved in the music therapy project attend all sessions until the end of the study on Day 60.

Methods of Measuring Clinical, Satisfaction, and Cost Outcomes

Critical variables are displayed in Table 1 and defined using 3 assessment scales. WHOQoL-BREF is a 16-item questionnaire that has been utilized as an assessment tool to evaluate the quality of life of individuals diagnosed with schizophrenia. The following domains help to measure the quality of life (QoL) of schizophrenic individuals including the environment, physical and psychological health, as well as social relationships (Bloch et al., 2009, p. 90). The questions will be measured using a Likert scale (5-point) and will essentially reflect the QoL of participants (Evert et al., 2000, p. 28). WHOQoL-BREF is a “psychometrically valid and reliable instrument” that assesses the quality of life of individuals diagnosed with schizophrenia in the music therapy project conducted within a mental health facility clinic (Evert et al., 2000, p. 30). Improvements in personal relations and enjoyment of life would be measured accordingly.

SIAS is a 20-item questionnaire. SIAS, also known as the “Social Interaction Anxiety Scale,” is primarily focused around questions surrounding the apprehensiveness that people with schizophrenia have about being around others (Clark & Mattick, 1998, p. 256). Since SIAS is rated using a scale from 0-4. The score of 0 is indicative that the question posed is not at all characteristic of the schizophrenic patient, 2 means it is moderately characteristic of the patient, while a 4 refers to the fact that the question is extremely characteristic of the schizophrenic patient (Clark & Mattick, 1998, p. 257). Since a higher score is an indication of greater social anxiety, the goal after the music therapy project is to reduce each participants’ previous score as much as possible (< 3). Psychometric elements are based on “good convergent and discriminant validity” as SIAS is a closely linked assessment involving the measure of social interaction anxiety as opposed to performance anxiety (Clark & Mattick, 1998, p. 257). However, SIAS serves as a mere representation of good reliability and validity measures to evaluate aspects pertaining to the level of social anxiety in individuals diagnosed with schizophrenia.

In addition, to the use of WHOQoL-BREF and SIAS as instrumental tools in measuring varying aspects of individuals diagnosed with schizophrenia, BSI is another method used in the evaluation process for patients involved in the music therapy project. BSI also is known as “Brief Symptom Inventory” is a 53 item self-reported instrument that detects mental health symptoms (Bloch et al., 2009, p. 90). BSI consist of several clusters of psychiatric symptoms from 9 different dimensions including “Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid ideation, and Psychoticism” (Castle et al., 2000, p. 810). Individuals diagnosed with schizophrenia who are involved in the music therapy project take this BSI self-assessment at the beginning of the first session on Day 1 and following the last session on Day 60. All participants must rate their responses based on a scale that spans from 0 (not characteristic of me) to 4 (extremely characteristic of me). BSI as a psychopathological assessment tool has been recognized for both validity and reliability (Bloch et al., 2009, p. 90). During the final assessment, the presence of psychiatric symptoms based on the 9 dimensions of the BSI instrument should be reduced from 9 to 6.

The satisfaction outcome is measured and defined during a group interview session. Exit interviews help stakeholders involved in the music therapy project to acquire information that will assist major stakeholders in identifying any problem areas (Dahle et al., 2005, p. 3). Upon identification of such concerns, the information obtained will be utilized to improve certain aspects of the music therapy project prior to implementation in the future. The main area of focus is whether those individuals with schizophrenia involved in the music therapy project will recommend music therapy as a therapeutic intervention to other people diagnosed with schizophrenia. Stakeholders are hopeful that at least 85% of patients will recommend this music therapy project to others with schizophrenia based on the face validity of the project. Face validity is a form of measurement that tests whether the target variable initially intended to be measured is actually measured (Dahle et al., 2005, p. 3). The reliability and validity of the group interview session are based on face validity.

The cost outcome involving the variable complete training is defined by records of the number of weekly music therapy project sessions attended by schizophrenic individuals involved in the study. The face validity of complete training records is based on a form of content validity that measures whether the number of weekly sessions attended utilize criteria that are expected (Dahle et al., 2005, p. 3). Stakeholders involved in the music therapy project expect that approximately 90% of schizophrenic participants involved in the project will complete training. The face validity of the complete training is a way to evaluate the weekly attendance of individuals diagnosed with schizophrenia who actively participate in weekly music therapy sessions.

Implications of Outcomes for Quality Management

Clinical, satisfaction, and cost outcomes are based on clinical practice guidelines. Hence, clinical practice guidelines include “systematically developed statements that assist clinicians and patients in making decisions about appropriate treatment for specific conditions (National Institute for Health & Clinical Excellence, 2010, p. 10). The quality management initiative of clinical practice guidelines is based upon research evidence, which aids in identifying and evaluating the evidence from music therapy projects conducted on individuals diagnosed with schizophrenia. Relevant quality management initiatives entails that clinical practice guidelines will “be used as the basis to set standards to assess the practice of healthcare professionals,” “form the basis for education and training of healthcare professional,” as well as “improve communication between healthcare professionals, service users and their carers” (National Institute for Health & Clinical Excellence, 2010, p. 11). Clinical practice guidelines will, therefore, improve both the process and outcomes associated with the implementation of music as a therapeutic intervention among schizophrenic patients in a mental health facility clinic.

The quality management initiatives set forth by clinical guidelines must take into account situations in which clinical guidelines are not applicable. It is therefore imperative to know that clinical guidelines do not under any circumstances overrule the responsibility of providers in the music therapy project to make appropriate decisions for each schizophrenic patient (National Institute for Health & Clinical Excellence, 2010, p. 11). National guidelines are focused on the clinical outcomes associated with music therapy as well as the cost-effectiveness of applying a psychotherapeutic intervention within a mental health facility clinic as costs will be regulated by the National Health Service (National Institute for Health & Clinical Excellence, 2010, p.11). Moreover, when a national guideline is published local stakeholder groups are required to construct a plan for identifying all resources needed to successfully implement the music therapy project.

Ethical Balance

Since all studies generally encounter potential ethical implications, certain ethical decisions must be addressed in the music therapy project design involving individuals diagnosed with schizophrenia. Ethical policies and guidelines were followed as all stakeholders involved in the study ensured that the identity of all participants would be protected at all times. Providers who were part of the music therapy project “hereby recognize and publicly accept the preposition that the fundamental purposes of the profession are the progressive development of the use of music to accomplish therapeutic aims and the advancement of training, education, and research in music therapy” (AMTA, 2013, p. 1). All participants involved in the music therapy project had to give informed written consent and also had to be accompanied by someone they knowingly trusted to serve as their co-signer. Shortly after providing informed written consent, all participants were made aware of the purpose of the music therapy project to eliminate any form of possible deception on behalf of the major stakeholder groups.

According to Dileo, surveyors must meet the terms of all ethical codes involved in music therapy as a psychopathological intervention by implementing “a variety of procedures to protect the confidentiality of subject” (Dileo, 2005, p. 331). Schizophrenic patients were given a set of three questionnaires to fill out on Day 1 of their music therapy sessions. The questionnaires measure personal relations and the overall quality of life experienced by individuals diagnosed with schizophrenia (WHOQoL-BREF), anxiety (SIAS), in addition to psychiatric symptoms as exemplified by the 9 dimensions (BSI). For confidentiality purposes, all questionnaires completed by individuals diagnosed with schizophrenia were returned in a sealed envelope so that the stakeholders involved in the study will not be able to trace each completed questionnaire back to its owner. This helped to maintain a certain level of anonymity for schizophrenic patients involved in the music therapy project. All completed questionnaires will be contained within a locked drawer to protect the identity of those patients involved in the music therapy project.

Sustainability Plan for Translating Evidence Into Practice

A successful music therapy project involving individuals diagnosed with schizophrenia helps to demonstrate a certain level of feasibility, which would eventually be translated into a sustainable change in practice for the mental health community. Music therapy as a therapeutic interventional approach will generate a set of data-based results, which will serve as a significant parameter for future studies involving music therapy for individuals with schizophrenia. The qualitative data collected from the validity and reliability of the three questionnaires used in the study (WHOQoL-BREF, SIAS, and BSI) will be used to obtain statistical data as well based on a 5-point Likert scale. Statistical results will, therefore, be gathered and recorded accordingly so that the feedback will be in the form of both qualitative and quantitative data.

Once an adequate number of music therapy projects are conducted for individuals with schizophrenia, the effects of music therapy in a mental health facility clinic will be more appropriately addressed. Research study findings from this music therapy project will “provide sufficient evidence to justify a larger explanatory trial of music therapy for people with schizophrenia” (Crawford et al., 2005, p. 18). This type of research will determine whether the research methodology used in the music therapy project and its impact on individuals diagnosed with schizophrenia are sustained in practice. Upon examination of the qualitative and quantitative data collection, a definitive relationship will be identified between the process and the clinical, satisfaction, and cost outcomes of the music therapy project. Since research findings involving music therapy as an interventional approach for individuals diagnosed with schizophrenia reveal a reduction in the number of psychiatric symptoms present, a reduction in anxiety, and improvement in personal relations and quality of life, this will serve as an evidence-based practice for successive music therapy projects. So, music therapy will ultimately become more and more popular and readily used by more individuals diagnosed with schizophrenia. This shift is evident that the implementation of a music therapy project within a mental health facility clinic serves as a sustainable change in practice within the mental health community.

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