Professional Documents
Culture Documents
Short communication
a r t i c l e i n f o a b s t r a c t
Article history: Objectives: To compare the effects of 1) active group music therapy and 2) receptive group music therapy
Received 9 March 2015 to group counseling in treatment of major depressive disorder (MDD).
Received in revised form 18 March 2016 Design & setting: On top of standard care, 14 MDD outpatients were randomly assigned to receive 1) active
Accepted 21 March 2016
group music therapy (n = 5), 2) receptive group music therapy (n = 5), or 3) group counseling (n = 4). There
Available online 26 March 2016
were 12 one-hour weekly group sessions in each arm.
Main outcome measures: Participants were assessed at baseline, 1 month (after 4 sessions), 3 months (end
Keywords:
of interventions), and 6 months. Primary outcomes were depressive scores measured by Montgomery-
Active group music therapy
Receptive group music therapy
Åsberg Depression Rating Scale (MADRS) Thai version. Secondary outcomes were self-rated depression
Major depressive disorder score and quality of life.
Results: At 1 month, 3 months, and 6 months, both therapy groups showed statistically non-significant
reduction in MADRS Thai scores when compared with the control group (group counseling). The reduction
was slightly greater in the active group than the receptive group. Although there were trend toward better
outcomes on self-report depression and quality of life, the differences were not statistically significant.
Conclusion: Group music therapy, either active or receptive, is an interesting adjunctive treatment option
for outpatients with MDD. The receptive group may reach peak therapeutic effect faster, but the active
group may have higher peak effect. Group music therapy deserves further comprehensive studies.
© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
http://dx.doi.org/10.1016/j.ctim.2016.03.015
0965-2299/© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.
0/).
142 P. Atiwannapat et al. / Complementary Therapies in Medicine 26 (2016) 141–145
2.1. Subjects the music. Sessions ended with music and relaxation. Active music
making behaviors were not actively reinforced.
Outpatients, age 18–65, with ICD-10 diagnosis of MDD were
eligible. A score of ≥7 on the Montgomery-Åsberg Depression
Rating Scale (MADRS) Thai version15 was required. Eligibility did 2.5. Control (counseling) group
not include medication status and music skills. Participants were
allowed to continue taking psychiatric medications and seeing Control group was designed to reduce the confounding effect of
psychiatrists during the study. Exclusion criteria included severe group therapy. Individuals participated in a weekly 1-hour group
depression with repeated suicidal behavior/psychotic symptoms counseling for 12 sessions facilitated by senior psychiatry resident
or need hospitalization, substance abuse/dependence, hearing or (PA). Group interventions focused on problem-solving and improve
communication problems and treatment with psychotherapy or coping skills.
electroconvulsive therapy. Participants were randomly assigned to
active group, receptive group, and counseling group using drawing
lots 1:1:1 randomization.
2.6. Outcome assessment
Table 1
Baseline characteristics of 14 patients randomized to active group music therapy, receptive group music therapy, or standard care alone (control group).
Age: years, mean (SD) 41.6 (11.15) 54.4 (6.73) 55.25 (10.21) 0.09
Female, n (%) 4 (80) 3 (60) 4 (100) 0.73
Married, n (%) 1 (20) 3 (60) 2 (50) 0.53
Employed, n (%) 5 (100) 2 (40) 2 (50) 0.15
Diagnosisb , n (%) 1.00
Mild depressive episode 1 (20) 3 (60) 3 (75)
Moderate depressive episode 2 (40) 1 (20) 0 (0)
Severe depressive episode 2 (40) 1 (20) 1 (25)
Duration of depression: years, mean (s.d.) 9.48 (12.56) 8.95 (11.59) 8.77 (13.09) 0.90
Age of onset of depression: years, mean (s.d.) 32.12 (13.65) 45.45 (13.95) 46.48 (11.54) 0.22
Medical comorbidity, n (%) 2 (40) 3 (60) 3 (75) 0.80
Musical background (self-reported), n (%) 1.00
Sings 1 (20) 2 (40) 1 (25)
Plays an instrument 1 (20) 0 (0) 0 (0)
Both 1 (20) 0 (0) 0 (0)
Current medication (self-reported), n (%)
SSRIs 5 (100) 2 (40) 1 (33.33) 0.15
SNRIs 0 (0) 2 (40) 0 (0) 0.30
Any other antidepressant medication 0 (0) 3 (60) 2 (66.67) 0.15
Psychiatric test scores, mean (s.d.)
MADRS Thai 27.2 (11.90) 20.6 (11.19) 16.25 (13.20) 0.33
Thai Depression Inventory 31.2 (11.61) 24.8 (10.80) 19.5 (12.37) 0.35
SF-36 Thai
All 8 dimensions 40.81 (20.80) 46.42 (20.79) 53.59 (28.64) 0.70
Physical functioning 71.0 (29.03) 67.0 (19.87) 55.0 (38.30) 0.68
Role-physical 35.0 (41.83) 30.0 (41.08) 68.75 (47.32) 0.49
Role-emotional 33.34 (33.35) 13.32 (18.24) 58.33 (50.01) 0.28
Vitality 25.0 (17.68) 46.0 (19.17) 51.25 (13.15) 0.08
Mental health 29.6 (18.46) 46.0 (24.58) 51.0 (13.22) 0.24
Social functioning 45.0 (42.02) 57.5 (32.60) 46.88 (18.75) 0.79
Bodily pain 57.5 (32.60) 62.5 (25.00) 50.0 (39.53) 0.87
General health 30.0 (27.39) 49.0 (23.83) 47.5 (32.27) 0.59
Note: a ANOVA test/Kruskal-Wallis test for continuous outcomes, Fisher’s exact test for dichotomous outcomes. b Based on Montgomery-Åsberg Depression Rating Scale
(MADRS) cut-off scores (up to 19, mild; 20–29, moderate; 30 or greater, severe).
Abbreviations: SSRIsselective serotonin reuptake inhibitors; SNRIsserotonin and norepinephrine reuptake inhibitors; MADRS ThaiMontgomery-Åsberg Depression Rating
Scale Thai version; SF-36 ThaiThai version of Short Form (36) Health-related Quality of Life Survey.
Table 2
Changes in primary and secondary outcomes in the active music therapy group, receptive music therapy group, and control group from baseline to 1, 3, and 6 months.
Mean (s.d.) Change from P value Mean (s.d.) Change from P value Mean (s.d.) Change from
baseline, meanc baseline, meand baseline, meane
Note: a active group n = 4; receptive group n = 4; control group n = 2. b active group n = 5; receptive group n = 4; control group n = 2. c Mean difference of each patient’s psychiatric
test scores that change from baseline to 1 month. d Mean difference of each patient’s psychiatric test scores that change from baseline to 3 months. e Mean difference of each
patient’s psychiatric test scores that change from baseline to 6 months.
Abbreviations: MADRS Thai, Montgomery-Åsberg Depression Rating Scale Thai version; SF-36 Thai, Thai version of Short Form (36) Health-related Quality of Life Survey.
after the active treatment group. This may help keeping partici-
pants in the control condition interested in the study and reduce
the drop-outs.
4.1. Limitations
Our study had many limitations. First, our sample size was small
(n = 14) which limited the study statistical power. A few drop-outs,
occurred early before the first assessment, precluded any outcome
measurements for those cases. Second, participants and therapist
could not be blinded due to the nature of interventions. Third, most
participants were women (79%). Although depression is more com-
mon among women22 we cannot generalize our findings to predict
the same result for men. Fourth, we allowed participants to inde-
pendently continue their medications during the study to simulate
real clinical practice. As a consequence, medications effect could
be another confounder. Finally, non-modifiable confounders, such
as spontaneous remission, stress relief, or positive life events, can
also affect outcomes. A large sample size and effective randomiza-
tion should reduce the differences of these confounders between
groups.
5. Conclusion
References 12. Gold C, Solli HP, Krüger V, Lie SA. Dose-response relationship in music
therapy for people with serious mental disorders: systematic review and
1. Fava M, Davidson KG. Definition and epidemiology of treatment-resistant meta-analysis. Clin. Psychol. Rev. 2009;29(3):193–207.
depression. Psychiatr. Clin. North Am. 1996;19(2):179–200. 13. Grocke D, Bloch S, Castle D, et al. Group music therapy for severe mental
2. Nemeroff CB. Prevalence and management of treatment-resistant depression. illness: a randomized embedded-experimental mixed method study. Acta
J. Clin. Psychiatry. 2007;68(Suppl. 8):17–25. Psychiatr. Scand. 2014;130(2):144–153.
3. Rush AJ, Warden D, Wisniewski SR, et al. STAR*D: revising conventional 14. Maratos AS, Gold C, Wang X, Crawford MJ. Music therapy for depression.
wisdom. CNS Drugs. 2009;23(8):627–647. Cochrane Database Syst. Rev. 2008;(1):CD004517.
4. Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn. Sci. 15. Kongsakon R, Zartrungpak S, Rotjananirunkit A, Buranapichet U. The
2013;17(4):179–193. reliability and validity of montgomery asberg depression rating scale
5. American Music Therapy Association [Internet]. What is music therapy? (MADRS) thai version. J. Psychiatr. Assoc. Thai. 2003;48(4):211–219.
Available from: http://www.musictherapy.org/about/musictherapy/. 16. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to
6. Bruscia KE. Defining Music Therapy. 2nd ed. Gilsum, NH: Barcelona Publishers; change. Br. J. Psychiatry. 1979;134:382–389.
1998. 17. Lotrakul M, Sukanich P. Development of the thai depression inventory. J. Med.
7. Choi AN, Lee MS, Lim HJ. Effects of group music intervention on depression, Assoc. Thai. 1999;82(12):1200–1207.
anxiety, and relationships in psychiatric patients: a pilot study. J. Altern. 18. Kongsakon R, Silpakit C. Thai version of the medical outcome study 36 items
Complement. Med. 2008;14(5):567–570. short form health survey (SF-36): an instrument for measuring clinical results
8. Castelino A, Fisher M, Hoskyns S, Zeng I, Waite A. The effect of group music in mental disorder patients. Rama Med. J. 2000;23(1):8–19.
therapy on anxiety, depression and quality of life in older adults with 19. Ware JE. The short-form-36 health survey. In: McDowell I, ed. Measuring
psychiatric disorders. Australas. Psychiatry. 2013;21(5):506–507. Health: A Guide to Rating Scales and Questionnaires. 3rd ed. New York (NY):
9. Lu SF, Lo CH, Sung HC, Hsieh TC, Yu SC, Chang SC. Effects of group music Oxford University Press; 2006:446–456.
intervention on psychiatric symptoms and depression in patient with 20. Erkkilä J, Punkanen M, Fachner J, et al. Individual music therapy for
schizophrenia. Complement. Ther. Med. 2013;21(6):682–688. depression: randomised controlled trial. Br. J. Psychiatry.
10. Han P, Kwan M, Chen D, et al. A controlled naturalistic study on a weekly 2011;199(2):132–139.
music therapy and activity program on disruptive and depressive behaviors 21. Maratos A, Crawford MJ, Procter S. Music therapy for depression: it seems to
in dementia. Dement. Geriatr. Cogn. Disord. 2010;30(6):540–546. work, but how? Br. J. Psychiatry. 2011;199(2):92–93.
11. Chu H, Yang CY, Lin Y, et al. The impact of group music therapy on depression 22. Piccinelli M, Wilkinson G. Gender differences in depression. Critical review.
and cognition in elderly persons with dementia: a randomized controlled Br. J. Psychiatry. 2000;177:486–492.
study. Biol. Res. Nurs. 2014;16(2):209–217.