Songwriting Group Music Therapy to promote psychological adjustment in informal caregivers of elderly people with dependency: a mixed methods study.

Introduction: Informal caregivers of elderly people with dependency (EPD) provide intensive care that can affect their quality of life (QoL). Psychosocial interventions such as music therapy are important to work on their self-care. The aim of this study is to analyze, with a mixed method approach, the experience of participating in a Songwriting Group Music Therapy (SGMT) intervention on informal caregivers of EPD. Methods: A total of 11 groups, with a convenience sample of 61 caregivers, received 10 SGMT sessions. Quantitative information related to QoL variables (anxiety, depression, spirituality, burden, and coping) was collected before and after the intervention and at 3 months of follow-up. Regarding qualitative data, an open-ended question about the experience of participating was asked. Results: Significant changes were shown, sustained over time, in trait anxiety and depression and subscales including inner peace, social functioning, and mental health. Three themes were generated from the thematic analysis, including that SGMT participation can enhance personal growth, bring out and enable work on emotions, and promote helpful interpersonal dynamics. Discussion: The findings indicate that SGMT is a useful intervention for informal caregivers of EPD, promoting psychological adjustment, enhanced coping, emotional regulation, and social support. This study reinforces the findings with caregivers of other populations, providing new results and highlighting the benefits of SGMT for caregivers of EPD.

The experiences of people living with dementia and their care partners participating in an online therapeutic songwriting program.

BACKGROUND AND AIM: Despite the impact of dementia on close care relationships, accessible therapeutic services for people living with dementia and their care partners remain scarce. Further, there is an increasing demand for online services, highlighting the need for ongoing telehealth research. This study aimed to explore the experiences of people living with dementia and their informal and formal care partners following participation in a 10-week online therapeutic songwriting program. METHODS: The songwriting program included four duo and six group sessions facilitated by a music therapist. Post-program semi-structured interviews were analysed using thematic analysis. FINDINGS: Nine people with dementia and six care partners (nine duos) participated in the program. Five duos were in spousal relationships and four people with dementia participated with a formal care partner. Participants attended an average of four duo sessions and three group sessions. Six people with dementia and five care partners participated in post-program interviews. Four themes were developed: (1) No one else does this; (2) It's all about us as people; (3) After the sessions we'd come out buzzing; and (4) The journey was as important as the product. CONCLUSIONS: Participants highlighted songwriting as a unique opportunity to connect with music, experience welcomed challenges, and spend 'real time' together. The program drew on participants' lived experience and promoted connection with others, resulting in feelings of enjoyment, enhanced mood, and achievement. Participants valued both the songwriting process and song product, emphasising the importance of sensitive and skilful facilitation. Our findings suggest that these distinct benefits were not available through other support services. Further, online songwriting is a viable option for people living with dementia and their care partners where in-person sessions are not available or accessible.

A Cluster-Randomized Comparison of Music Therapy Interventions as Measured by Craving and Commitment in Adults on a Detoxification Unit.

Background: Music therapy can positively impact craving, treatment readiness, and motivation in adults with substance use disorder (SUD) on a detoxification unit. However, the existing research is primarily comprised of studies with a single pre- or posttest and there is a need for randomized controlled studies that compare within-session changes resultant of various music therapy interventions to determine best practice. Objective: The purpose of this single-session study was to compare within-session changes between group motivational and educational songwriting (MESW) and group recreational music therapy (RMT) on craving and commitment to sobriety in adults with SUD on a detoxification unit. Method: Participants (N = 100) were cluster-randomized to group MESW or group RMT conditions and completed established psychometric instruments measuring craving and commitment to sobriety at pre- and posttest. Results: Within-group changes were significant in all measures, indicating that music therapy was effective within the temporal parameters of a single session. Although between-group differences were not significant, mean within-session improvements in expectancy, compulsivity, emotionality, total craving, and commitment to sobriety were larger in the MESW condition than the RMT condition. Additionally, the MESW group tended to have slightly more favorable posttest scores than the RMT group in all measures. Conclusion: Despite the temporal limitations of single-session therapy common on detoxification units, both MESW and RMT protocols resulted in significant within-session changes in measures of craving and commitment to sobriety. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

Group music therapy with songwriting for adult patients with long-term depression (SYNCHRONY study): a feasibility and acceptability study of the intervention and parallel randomised controlled trial design with wait-list control and nested process evaluation.

BACKGROUND: Despite effective treatments, one fifth of patients develop chronic depression. Music therapy may offer a different approach. This study aimed to assess feasibility and acceptability of a music therapy intervention and trial methodology. METHODS: A parallel two-arm randomised controlled trial with wait-list control, mixed feasibility/acceptability measures and nested process evaluation. Adults with long-term depression (symptom duration > 1 year) were recruited from community mental health services and computer randomised to 42 sessions of group music therapy with songwriting three times per week or wait-list control. Depression, social functioning, distress, quality of life, satisfaction and service use were assessed by blinded researchers at enrolment, 1 week and 3 and 6 months post-therapy. Outcomes were analysed descriptively, controlling for baseline covariates. Recruitment (number eligible, participation and retention rates) and intervention (fidelity, adherence) feasibility were assessed using pre-defined stop-go criteria. Attendance, adverse events, mood, relationship satisfaction and semi-structured interviews were analysed in a nested process evaluation. RESULTS: Recruitment processes were feasible with 421 eligible, 12.7% participation and 60% (18/30) retention. Thirty participants were randomised to intervention (N = 20) and control (N = 10). Session attendance was low (mean 10.5) with four withdrawals. Music therapist adherence was good but changes to session frequency were suggested. Outcomes were available for 10/20 treatment and 9/10 wait-list participants. Depression increased in both arms post-therapy. Treatment depression scores fell below baseline 3 and 6 months post-therapy indicating improvement. Wait-list depression scores increased from baseline 3 and 6 months post-therapy. At 3 months, the treatment arm improved from baseline on all measures except satisfaction and functioning. At 6 months, quality of life, distress and functioning improved with reduction in health service contacts. High-attending participants improved more than low-attending. Seven adverse events (one serious) were reported. LIMITATIONS: As this was a feasibility study, clinical outcomes should be interpreted cautiously. CONCLUSION: A randomised controlled trial of group music therapy using songwriting is feasible with inclusion criteria and session frequency modifications, but further intervention development is required. TRIAL REGISTRATION: ISRCTN18164037 on 26.09.2016.

Indicators of Self-Determination in Therapeutic Songwriting Lyrics Created by Adults with High LDL Cholesterol.

Individuals with low-density lipoprotein cholesterol ≥190 mg/dL are at high risk for atherosclerotic cardiovascular disease events. Our goal was to determine if adults with this condition would express important psychological, health, and motivation themes when generating lyrics during music therapy. Thirty-one participants each created their own original song with the help of a music therapist. The lyrics were analyzed using a deductive approach guided by Self-Determination Theory (specifically the satisfaction or frustration of basic psychological needs): (1) for each entire song (macro-analysis) and (2) line-by-line (micro-analysis). Song lyrics generated during music therapy sessions by patients with a low-density lipoprotein cholesterol ≥190 mg/dL revealed the presence of the three basic needs (autonomy, competence, and relatedness) of Self-Determination Theory. The most prevalent theme identified in the macro-analysis of songs was autonomy satisfaction, coded in 25 songs (27.17% of all macro codes), and followed by competence satisfaction in 17 songs (18.48%) and relatedness satisfaction in 15 songs (16.3%). Line-by-line micro-analysis of lyrics revealed that at least one basic need of Self-Determination Theory was present in 277 of the unique lyric lines (50%); 107 (19%) for relatedness, 101 (18%) for autonomy, and 69 (13%) for competence. Need satisfaction occurred more frequently than need frustration in both analyses. However, depending on the level of analysis (macro or micro), results differed as to which themes were most prevalent. These results indicate that therapeutic songwriting may be a unique way to identify the basic psychological needs that, when satisfied, indicate self-determination.

The 'becomings': singing and songwriting with mothers and midwives at South-East Queensland.

: How can songwriting show us the meaning of music and language for health and wellbeing in culturally and linguistically diverse mothers? This article examines the artistic processes in music-cum-health workshops involving new and expectant mothers and their midwives. The voices of the mothers of colour have been silenced historically and systemically. To give them social justice in a health context, singing is a powerful tool and songwriting links this tool to useful health messages. Through this article, the formation of a song on the placenta, a key part of the womb in childbearing, is traced through the stories of a music facilitator, a mother and a midwife. The storying highlights the importance of artistic processes for understanding the person within and their cultural identity. The article argues that cultural understanding of the participants in such arts-in-health programmes is important for socially just models of health care for those at the margins. SUMMARY: From being instrumentalized as interventions that are 'administered' with an aim to garner health outcomes, art-based participatory approaches are now recognized as capable of activating culturally founded wellbeing in individuals. Through this article, I propose that as the focus shifts from what art does for health to what art means for a healthy life, the cultural vitality inherent in individuals and societies can be better championed in arts-in-health discourses. I discuss the artistic processes in singing and songwriting in a perinatal context involving mothers from culturally and linguistically diverse backgrounds and their midwives. I argue for lenses to better understand the role of cultural practices in health research involving migrant and refugee communities. Using narrative inquiry, I trace intersecting trajectories wherein the storied life of a coloured mother is intercepted by that of a midwife, and of myself, a coloured female mother-researcher and facilitator. At the intersection emerges a song, as a process and product. This article advances that it is when artmaking processes are centred that the voices from the margins become heard, and it is when their voices are amplified that health research design becomes equitable and ethically sound.

A Cluster-Randomized Trial Comparing Songwriting and Recreational Music Therapy via Craving and Withdrawal in Adults on a Detoxification Unit.

BACKGROUND: Craving and withdrawal can contribute to the development and maintenance of substance use disorder (SUD), relapse, and overdose. Although music therapy can positively impact craving and withdrawal in adults with SUD on a detoxification unit, there is a lack of randomized research comparing different music therapy interventions as well as studies measuring within-session changes in these critical constructs. OBJECTIVE: The purpose of this effectiveness study was to compare motivational-educational songwriting (MESW) and recreational music therapy (RMT) via measures of craving and withdrawal in adults with SUD on a detoxification unit using a two-group pre- and posttest design. METHOD: Participants (N = 134) were cluster-randomized to a single group MESW or RMT condition. Established craving and withdrawal psychometric instruments were used as pre- and posttests to determine potential within- and between-group differences. RESULTS: There were significant within-group differences in craving subscales of urges and coping as well as withdrawal, all p < .001. Within-group effect sizes ranged from .244 to .456 with favorable changes from pre- to posttest. There was no between-group difference among the MESW and RMT conditions, all p > .05. CONCLUSIONS: Although the specific music therapy intervention did not impact craving or withdrawal, a single MESW or RMT session can have an immediate and significant positive impact on craving and withdrawal in adults with SUD on a detoxification unit. As the MESW condition also addressed motivational and educational aspects of recovery, perhaps MESW interventions are ideal in detoxification settings.

The Therapeutic Approach to Military Culture: A Music Therapist's Perspective.

Culture can broadly be defined as "the values, norms, and assumptions that guide human action" (Wilson 2008, 14). In contrast with the broader civilian society, the experiences and environments within the military community create a unique cultural subset. The United States armed forces are unified by their primary mission to provide external defense, security, and protection, and each branch (Army, Navy, Marine Corp, Air Force, Coast Guard and National Guard) shares a unique core set of values and norms. Because this culture is so complex and unique, it can sometimes be a challenge for many civilian professionals to work with this community, so having a strong competency in understanding military culture, as well as knowledge of specific conflicts and wars, one is not only able to begin to understand the lives and personalities of our soldiers but also able to recognize that this culture aids in survival. This paper will demonstrate and discuss the importance of competency in military culture when practicing music therapy or other interdisciplinary approaches within the process of group therapy with veterans. Other topics covered will include: issues of social transmission as it relates to transitioning into civilian society; the importance of being a witness to veterans' stories; and facilitators' ethical responsibilities when working with this population.

Quantitative comparison of group-based music therapy experiences in adults with substance use disorder on a detoxification unit: a three-group cluster-randomized study.

Background: Service users' values and preferences are components of evidence-based practice and recovery. Methods: Adults (N = 113) with substance use disorder (SUD) on a detoxification unit were cluster-randomized to one of three group-based single-session conditions: Recreational music therapy (RMT), educational lyric analysis for illness management and recovery (ELA-IMR) or educational songwriting for illness management and recovery (ESW-IMR). Participants completed the Ferrara Group Experiences Scale after their session. Results: There were significant differences in the sharing of emotions and experiences subscale between the RMT and both the ELA-IMR and ESW-IMR conditions, with the educational conditions having higher scores. There was a significant difference in the total group experience between the RMT and ELA-IMR conditions, with the ELA-IMR condition having a higher score. Conclusions: Merging the results of previous literature with the current study, educational music therapy interventions can positively impact recovery-based objectives and the group-based experience in adults with SUD.

Collaborative Songwriting Intervention for Veterans with Post-Traumatic Stress Disorder.

Objectives: Given that veterans are significantly more likely to suffer from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and anxiety than civilians, yet current gold-standard treatments for PTSD are not effective for all patients, the present study sought to examine the feasibility and acceptability of a collaborative songwriting intervention (CSI) while exploring its potential effectiveness in improving physical and mental health outcomes for veterans with PTSD. Design: Ten veterans took part in the CSI. A variety of pre- and postintervention measures were administered, including the Measurement of Current Status (MOCS), the Coping Expectancies Scale (CES), the Post-traumatic Stress Disorder Checklist-Military (PCL-M), and the Patient Health Questionnaire-9 (PHQ-9). Participants also wore a Fitbit to track average heart rate, sleep, and step count. Intervention: The CSI consisted of each veteran meeting with a professional songwriter, trained specifically for co-writing original material with the veteran population. There were three phases of songwriting that took about an hour and 15 min total. Veterans were instructed to listen to their song daily for 5 weeks. Results: Participants reported that the intervention was helpful and relevant to them, and most participants (95%) would refer others to this treatment. We found that the CSI reduced participant's PTSD symptoms (d = 0.869), specifically the Numbing (d = 0.853) and Hyperarousal (d = 1.077) subscales. Depressive symptoms (d = 0.72) and stress reactivity (d = 0.785) also marginally decreased. There was no significant change in physiological data (i.e., sleep, no. of steps) from pre- to postintervention. Conclusion: These data suggest that a CSI is an acceptable intervention for veterans with PTSD that may also improve their PTSD symptoms.

Therapeutic Songwriting for Perceived Stigma and Perceived Social Support in Adults with Substance Use Disorder: A Cluster-Randomized Effectiveness Study.

Background: Due to negative societal stereotypes associated with substance use disorder (SUD), many people with addictions experience perceived stigma and lack perceived social support. Perceived stigma can prevent people with SUD from seeking treatment while perceived social support can facilitate recovery. Objective: The purpose of this study was to determine the effects of a single music therapy songwriting intervention on perceived stigma and perceived social support in adults with SUD on a detoxification unit. Method: Participants (N = 132) were cluster-randomized to a therapeutic songwriting or control condition in a single-session design. The experimental condition received a highly structured group-based blues songwriting intervention wherein participants composed lyrics describing stigma against addiction as an inappropriate and false social construct in the first verse and coping with stigma by using social supports in the second verse. Results: Analyses of variance indicated no significant between-group difference in perceived stigma or perceived social support. Conclusions: Due to its non-threatening medium, therapeutic songwriting concerning perceived stigma and perceived social support may be clinically relevant way to target these sensitive yet essential topics. Implications for clinical practice, limitations, and suggestions for future research are included.

Essential Elements of Song for Grieving Young Adults.

Complications experienced by grieving young adults have developmental, mental, and behavioral components. Music offers opportunities to promote healthy grieving. While song writing has been widely used as an informal therapy for centuries, current researchers are beginning to explore its benefits. There is a noticeable lack of literature regarding the role of music in the grieving process. The aims of this study were to explore the grieving experiences of young adults who had lost a family member or friend, to identify song elements most helpful in promoting healthy grieving, and then to use these findings to compose a piece of music. Fifteen 20- to 23-year-old participants were interviewed about the death of a close friend or family member using a structured interview guide that included questions about their experience with the death and their grief, as well as questions about what song elements might help in grief. These questions included specifics about the song tempo (speed), dynamic (volume), and whether the song should contain lyrics (words). Thematic analysis was used to analyze interviews. Themes derived from the interview that should be relayed in a song included: Grief can include joy and pain together; It will get better; There is value in community; and, It is ok not to be ok For song elements, participants elected a slow tempo, a mixed or soft dynamic, and inclusion of lyrical content. All findings were integrated into a song composition that may help promote healthy grieving.

The Resilience Songwriting Program for Adolescent Bereavement: A Mixed Methods Exploratory Study.

Music therapy research with youth who are grieving often reports on a combination of interventions, such as lyric analysis, improvisation, and/or songwriting. Unfortunately, the lack of theoretical transparency in how and why these interventions affect targeted outcomes limits interpretation and application of this important research. In this exploratory study, the authors evaluated the impact of an 8-session, theory-driven group songwriting program on protective factors in adolescent bereavement, and also sought to better understand adolescents' experiences of the program. Using a single-group, pretest-posttest convergent mixed methods design, participants were enrolled from three study sites and included 10 adolescents (five girls and five boys), ages 11-17 years, who self-identified as grieving a loss. Outcomes measured included grief, coping, emotional expression, self-esteem, and meaning making. Qualitative data were captured through in-session journaling and semi-structured interviews. There were no statistically significant improvements for grief, self-esteem, coping, and meaning making. Individual score trends suggested improvements in grief. The majority of the participants reported greater inhibition of emotional expression, and this was statistically significant. Thematic findings revealed that the program offered adolescents a sense of togetherness, a way to safely express grief-related emotions and experiences verbally and nonverbally, and opportunities for strengthening music and coping skills. These findings suggest that engaging in collaborative therapeutic songwriting with grieving peers may decrease levels of grief, enhance creative expression, and provide social support. More research is needed on measuring self-esteem, emotional expression, coping, and meaning making outcomes in ways that are meaningful to adolescents.

Comparing Educational Music Therapy Interventions via Stages of Recovery with Adults in an Acute Care Mental Health Setting: A Cluster-Randomized Pilot Effectiveness Study.

The purpose of this cluster-randomized pilot effectiveness study was to compare two different group-based educational music therapy interventions with a control condition as measured by the stage model of recovery in adults on an acute care mental health unit. Participants (N = 69) were cluster-randomized to one of three single-session conditions: educational lyric analysis (ELA), educational songwriting (ESW), or control. ELA and ESW conditions targeted motivations for and factors contributing to recovery. Results indicated no significant between-group difference. However, ELA and ESW conditions tended to have slightly more favorable stage of recovery mean scores than the control condition. Generally, educational music therapy may be clinically relevant for impacting stage of recovery within the temporal parameters of a single session. As ELA and ESW conditions had similar results, the specific educational music therapy intervention did not affect results. Implications for clinical practice, limitations, and suggestions for future research are provided.

Music Therapy for Coping Self-Efficacy in an Acute Mental Health Setting: A Randomized Pilot Study.

For adults with mental illness, coping skills represent an integral component of illness management and recovery (IMR) programs. Music therapy can be used to target IMR but empirical research specific to coping is needed. The purpose of this study was to determine if educational music therapy can influence coping self-efficacy in acute care mental health inpatients. Adults on an acute care mental health unit (N = 92) were cluster-randomized to one of three single-session conditions over 24 group-based sessions: educational lyric analysis, educational songwriting, or control. Although results were not significant, both educational music therapy conditions tended to have more favorable coping self-efficacy subscale means than the control condition but there were negligible differences between lyric analysis and songwriting conditions. Results can be considered clinically relevant within the temporal parameters of single-session therapy typical in acute care settings. Limitations, implications for practice, and suggestions for future research are included.

Exploring the Self through Songwriting: An Analysis of Songs Composed by People with Acquired Neurodisability in an Inpatient Rehabilitation Program.

BACKGROUND: Neurological trauma is associated with significant damage to people's pre-injury self-concept. Therapeutic songwriting has been linked with changes in self-concept and improved psychological well-being. OBJECTIVE: This study analyzed the lyrics of songs composed by inpatients with neurological injuries who participated in a targeted songwriting program. The aim of this study was to understand which of the subdomains of the self-concept were the most frequently expressed in songs. METHODS: An independent, deductive content analysis of 36 songs composed by 12 adults with spinal cord injury or brain injury (11 males, mean age 41 years +/- 13) were undertaken by authors 1 and 2. RESULTS: Deductive analysis indicated that when writing about the past self, people created songs that reflected a strong focus on family and descriptions of their personality. In contrast, there is a clear preoccupation with the physical self, on the personal self, and a tendency for spiritual and moral reflections to emerge during the active phase of rehabilitation (song about the present self). Statistical analyses confirmed a significant self-concept subdomain by song interaction, F(10, 110) = 5.98, p < .001, ηp2 = .35), which was primarily due to an increased focus on physical self-concept and a reduced focus on family self-concept in the present song, more than in either past or future songs. CONCLUSIONS: The analysis process confirmed that songwriting is a vehicle that allows for exploration of self-concept in individuals with neurological impairments. Songwriting may serve as a therapeutic tool to target the most prevalent areas of self-concept challenges for clients undergoing inpatient neurological rehabilitation programs.

Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial.

BACKGROUND: Depression is of significant global concern. Despite a range of effective treatment options it is estimated that around one in five diagnosed with an acute depressive episode continue to experience enduring symptoms for more than 2 years. There is evidence for effectiveness of individual music therapy for depression. However, no studies have as yet looked at a group intervention within an NHS context. This study aims to assess the feasibility of conducting a randomised controlled trial of group music therapy for patients with long-term depression (symptom durations of 1 year or longer) within the community. METHODS: This is a single-centre randomised controlled feasibility trial of group music therapy versus wait-list control with a nested process evaluation. Thirty participants will be randomised with unbalanced allocation (20 to receive the intervention immediately, 10 as wait-list controls). Group music therapy will be offered three times per week in a community centre with a focus on songwriting. Data will be collected post-intervention, 3 and 6 months after the intervention finishes. We will examine the feasibility of recruitment processes including identifying the number of eligible participants, participation and retention rates and the intervention in terms of testing components, measuring adherence and estimation of the likely intervention effect. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of process measures and end-of-participation interviews with participants and referring staff. DISCUSSION: Whilst group music therapy is an option in some community mental health settings, this will be the first study to examine group music therapy for this particular patient group. We will assess symptoms of depression, acceptability of the intervention and quality of life. We anticipate potential challenges in the recruitment and retention of participants. It is unclear whether offering the intervention three times per week will be acceptable to participants, particularly given participants' enduring symptoms and impact upon motivation. This study will provide data to inform both development of the intervention and to assess and inform the design of a full trial. TRIAL REGISTRATION: ISRCTN.com, ISRCTN18164037 . Registered on 26 September 2016.

Group music therapy for severe mental illness: a randomized embedded-experimental mixed methods study.

OBJECTIVE: Music therapy is an innovative approach to support people with severe mental illness (SMI). The aim of the study was to determine whether group music therapy (GMT) positively impacted on quality of life (QoL), social enrichment, self-esteem, spirituality and psychiatric symptoms of participants with SMI and how they experienced the intervention. METHOD: The primary outcome was QoL; secondary measures assessed social enrichment, self-esteem, spirituality and psychiatric symptoms. The 13-week intervention comprised singing familiar songs and composing original songs recorded in a professional studio. Qualitative data were generated from focus group interviews and song lyric analysis. RESULTS: Ninety-nine adults (57 female) were recruited, with an initial cohort (n = 75) randomized to either: weekly GMT followed by standard care (SC) or SC followed by GMT. Crossover occurred after 13 weeks. Measures were conducted at baseline, 13, 26 and 39 weeks. A second cohort (n = 24) could not be randomized and were assigned to GMT followed by SC. Intention-to-treat analysis showed a significant difference between GMT and SC on QoL and spirituality. This was robust to different assumptions about missing data (listwise deletion, last observation carried forward or multiple imputation). Per-protocol analysis suggested greater benefit for those receiving more sessions. Focus group interview and song lyric analyses suggested that GMT was enjoyable; self-esteem was enhanced; participants appreciated therapists and peers; and although challenges were experienced, the programme was recommended to others. CONCLUSION: Group music therapy may enhance QoL and spirituality of persons with SMI.