Recent studies have been designed to investigate the non-pharmalogical treatments in the world of mental disorders. A variety of mental disorders are set to have a (possible) psychotic component: schizophrenia, psychosis, schizoaffective disorder and bipolar disorder. Non-pharmalogical treatments exist of exercise therapy, cognitive therapy, art therapy, relaxation and music therapy. Zooming in on the music therapy gives us reason to think that there could be a beneficial aspect for using it to reduce psychotic problems. Thus, we can question whether musical therapy would clinically relevant reduce psychotic symptoms [positive, negative and general wellbeing].
Oude studie van muziek positief effect op mental zieken
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In a cross-national survey of 1124 choral singers, the benefits of group singing have been shown. These benefits included improved mode a enhancement of the quality of life, a rise in happiness, reduction of stress and improved wellbeing. In another qualitative study, where a choir consisting of 89% members with a mental illness, membership in the choir and singing had a personal impact, social impact (better social functioning and connection with others) and improved physical health.
Psychose Uitleg
Psychosis is a group of symptoms and is currently defined by hallucinating and delusions dividing the conscious mind from reality. Delusions are strong beliefs that are false. They are based on false inferences about reality and maintained despite evidence that undeniably contradicts the belief. Hallucinations are sensory perceptions in the absence of corresponding external stimulus. In other words, sensations that are not real. Delusions are strong beliefs that are false. They are based on false inferences about reality and maintained despite evidence that undeniably contradicts the belief Hallucinations can be experiences with any sense: hearing, sight, smell, taste, or touch. There should be added that the person in question doesn’t have insight into a hallucination. Meaning that the person in unaware of it being unreal, therefore preserved insight like the visual hallucination of migraine aura will not be defined as symptoms of a psychosis. psychotic disorders are defined by abnormalities of one, or more, of five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behaviour (including catatonia), and negative symptoms. Psychosis can be seen in multiple psychiatric disorders presented in the DSM-5. It is the defining feature of the schizophrenia spectrum disorders. Psychosis can also occur in bipolar disorders (during a manic or depressive episode) and during a major depressive episode associated with major depressive disorders. In those conditions, the psychotic symptoms (usually delusions) may increase or decrease in correlation with the change in mood.
Severe mental Ilness uitleg + Dat therapy niet helpt music therapy well?
Starting off with the term severe mental disorders also called severe mental illness: we can define these types of mental disorders by a severe global impression, low level of functioning or by chronicity and treatment resistance. Specific states that are considered as severe, such as psychosis or suicidal behaviour, meet these criteria.
Consequences for people with these types of illnesses include difficulties in maintaining employment, isolation from others and having and having unstable future where the family relationships can be difficult due to separation from family support.
Treatment options for these people include psychopharmacological and psychotherapeutic approaches. These are efficient in patients, but it must be stressed that it’s not efficient in all patients and the effect has its limits. The remaining patients show substantial symptom levels and impaired functioning. This is where other forms of therapy came in place. Several studies have described how participants, that not improved through other therapies, benefitted from music therapy.
Geschiedenis
It was in North and South America, 1940, that music therapy was first recognized as a profession. In Europe this was more than a decade later (Austria and England 1958).
In 1962, it was noted that the influence of music may not only have effects on physiological human functioning, but also the quality of life and psychological well-being. Applications of music for treatment of various diseases have been recognizable and musicians practiced musical therapy for patients in mental hospitals in the early years of the last century.
After that we see innovative efforts to broaden the use of musical therapy. This caused increased use of various kinds of musical therapy that have been performed in clinical practice for patients with psychosis. Therapists in Japan, influenced by the beginnings and accomplishments made in America and Europe, started systematized efforts of musical therapy practice for psychiatric patients. Most of these patients having schizophrenia. These events resulted in the establishment of the Japanese Federation of Musical Therapy (1995). This unification of musical therapy organizations provided a base for the specialized training while it spread over other areas of psychiatric practice.
Music Therapy Now And Goal
Music therapy as we know it today is a form of psychotherapy that uses musical interaction and communication alongside verbal communication to address intra- and intrapsychic as well as social processes. It is hypothesized to diminish severe emotional disturbances. This is done by increasing communication skills, social interactions, and quality of life. Bruscia defines music therapy as “a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships developing through them as dynamic forces of change”. It addresses social isolation and stimulates the evolvement of new relationships. Social interaction is enhanced through singing familiar songs, instrumental improvisation, writing original songs and receptive listening to music. This could all be done in group form or individually. The aim is to help people suffering from a severe mental illness to develop relationships and open up or address issues they aren’t able to with words alone. Music is used as an outlet for self-expression and creativity. Going beyond words, it “can be uplifting to the spirit and can be a source of inspiration and hope for positive change”.
Individueel Specifiek Niet Diagnose En Actief Vs Passief
Generally, music therapy is more focused on the individual than the clinical diagnosis. The diagnose does not demand a specific technique. It does however play a role in the therapist’s choices, attitudes and behaviours during the therapy. Meaning the diagnoses of the clients can be different but they follow the same form of music therapy.
This brings us to the different forms of music therapy. Which we divide in active and passive. The active component in active music therapy is creating the music, being through instruments or vocally. This is done by the therapist and patient together. In passive music therapy the therapist is the one that plays music while the patient rests or recorded music may be selected by either therapist or client. The therapists invite the patients to visualize peaceful images, hereby producing a state of mental rehabilitation. A study of Gold found that active and passive music therapy can correct psychosis and depression, even within treatment resistant cases.
Improvisatie structuur/vrij, hoezo werkt het, niet alleen muziek
Except from the form being active or passive, the predefined structuring may vary. By either using more structured forms of music making or having already selected the activities beforehand, as opposed letting these be decided during the session. The level of structuring may vary depending on the clients need, but they also differ between different music therapy models. We see these differences between American and European approaches.
Improvisation might be the most prominent form of interaction in music therapy, being free or structured. The central role of it can be seen in many of the music therapy models. Clients and therapists play together on self-chosen instruments with a musical or non-musical theme. The therapists are trained to imply the therapeutic intervention within the medium. E.g. this could be done by providing the base rhythm, to clarify or confront the client’s expression in the music.
Songs can be used to express feelings in a safe and socially acceptable way. Feelings that normally would be too overwhelming for them to express. Music listening may be helpful to find therapeutically relevant issues and make them come to the surface. Issues like emotions, associations, memories and identity issues.
One of the main focusses in music therapy is the stimulation of social interaction and learning the process of coping with difficulties in the social setting. Musical techniques emphasize the playing of instruments, and it is this mechanism that demonstrates that one is responsible for his or her own actions. There is no sound if no-one plays the instrument, if the client stops the music stops. Therapists try to motivate clients to write or sing own songs and there is a place for reflection in the group discussions.
These different angles of approach in music become therapeutic when used in the context of a therapeutic relationship. Discussions, reflections or interpretations connected to the music play a role in the clients meaning of this experience and help to relate the new experiences in the therapy to situations to its own life. It is still unsure how much the music itself is the active and effective factor as to the verbal reflection. The degree in which it’s one or the other may vary between different models of music therapy, as well as between individuals.
However, if the effect of music alone would be tested we wouldn’t call this music therapy. Music therapy is more than the direct effect of music alone and involves a therapeutic setting where there is a process of intervention between client and therapist and this form of music therapy could be given individually or in small group settings over an extended period.
Veel Studie Schizophrenie – Paar Feiten
Most studies in this thesis tend to focus on schizophrenia in regard to psychotic disorders. Schizophrenia is one of the most serious mental disorders. The prevalence is over 1.1 percent (for the people above 18). The Who states that over 21 million people in the world suffer from schizophrenia. People with schizophrenia have a disruption in their thinking pattern this influences language perception and sense of self. As stated before psychotic experiences are included in schizophrenia. The illness has a grip of the patient’s personal life sometimes in such a way that they are incapable of earning a living. Antipsychotics are the main therapeutic intervention for schizophrenia, but these are not without side effects. Schizophrenia has a high risk of chronicity. Treatments until now are aimed at the positive symptoms and the effect on the negative symptoms is less.
Negative symptoms
An important predictor of the quality of life for people with a psychotic disorder are negative symptoms. This aspect of psychotic disorders is described as the reduction or even absence of affective, social and behavioural expression. Negative symptoms may also be side effects from antipsychotic medication or may be secondary to depression. Persistent negative symptoms however are often labelled as primary to the underlying disease. 25% of the patients with a first episode psychoses show persistent negative symptoms this is even more for people with chronic schizophrenia. Biological treatments have a modest impact on negative symptoms. Currently the use of psychological an psychosocial interventions in addition to the medication is suggested. Music helps as a medium for emotional expression and diminish the negative symptoms (affective flattening). Also, the music therapy helps the clients in the social aspect and thus helping them with problems in this area. Another wat in which music therapy helps is by motivating the participants, especially for those who show little to no motivation, this motivation may then have effect in other situations.
Depressive symptoms
Expect from positive and negative symptoms in schizophrenia depressive symptoms also play a role in the wellbeing of the person suffering from schizophrenia. Depressive symptoms partly remit when the positive symptoms decrease. 40% of the people show depressive symptoms a year after remission. In psychosis depressive symptoms are associated with poorer adherence, substance abuse (alcoholism) and poorer outcome in symptoms and daily functioning. Depressive symptoms during a psychosis is also linked to an increased risk of suicides. Therefore, it is important to treat this side of the psychoses also. There isn’t a unanimous decision in the guidelines whether antidepressant should be prescribed in adjunct to antipsychotics or not. Music therapy, as well as other nonverbal therapies, have positive results on depressive symptoms. This will be further investigated in this thesis.
EINDE
All in all, this thesis gives an update on the effect on music therapy for people with a psychotic disorder, mainly focussing on schizophrenia but not only. Studies for the additional effect of music therapy will be systematically reviewed and results for quality of life, positive symptoms, negative symptoms and depressive symptoms will be given in a table to compare (with music therapy and without).
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