music therapy in the management of acute psychosis

285 Pages·2013·2.66 MB·English

MUSIC THERAPY IN THE
MANAGEMENT OF
ACUTE PSYCHOSIS

BY

KYLIE ANNE MORGAN

BCAP (Music), G.Dip.M.T., RMT

A thesis submitted in fulfilment
of the requirements for the degree of
Doctor of Philosophy

The University of Western Sydney
College of Arts
Sydney, Australia
2007

i
DECLARATION
I declare that the thesis presented by me for the degree of Doctor of Philosophy is my
own work unless otherwise referenced or acknowledged. I declare that this work has
not been submitted for qualification at any other academic institution.

ii
ABSTRACT
The management of acute psychosis is a constant challenge to the health care system,
with only a limited amount of research providing data for allied health care
practitioners. Despite anecdotal data indicating that music therapy may be an
effective intervention, there have been few studies to date which provide any
rigorous empirical evidence. This project aimed to test the following hypotheses:

1. That music therapy has the potential to help (a) improve severe emotional
disturbance including angry feelings, pathological anxiety, depressed mood,
and behavioural changes in an individual suffering from acute psychosis, as
exemplified by agitation and restlessness, and (b) increase communication
and social interaction.

2. That music therapy may lessen some of the emotional colouring of the
delusional thought processes and perceptual disorder which are hallmarks of
a person suffering from acute psychosis.

3. That music therapy is a concomitant factor in faster recovery time, thus
reducing the length of stay in hospital.

4. That listening to music may decrease the high levels of slow brain wave
activity as seen in individuals undergoing electroencephalographic (EEG)
testing whilst experiencing an acute psychotic episode.

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Since this study is the first of its kind, it was necessary to determine if the
methodology chosen would be acceptable and efficacious on an acute psychiatric
admissions unit. Therefore, a pilot study was conducted during 2002. Thirteen
participants, with a DSM IV diagnosis of schizophrenia, schizoaffective disorder or
bipolar I disorder were randomly assigned to either group a (music therapy sessions
comprising of either improvisation or song-writing); group b (control group –
listening to a pre-recorded relaxation CD); or group c (standard care available on the
ward). One participant was excluded from the pilot study on requesting to
discontinue their participation. The successful completion of the pilot study and the
resulting decrease in the Brief Psychiatric Rating Scale (BPRS) scores in the
treatment group indicated that the methodology chosen was suitable.

A full scale study was conducted between 2003 - 2006. Sixty participants took part
in a randomised control trial (RCT) and were allocated to either the treatment or
control group. The treatment group received four individual music therapy sessions
over two weeks while the control group received an equal amount of time listening in
the presence of the music therapist to a CD playing relaxing nature sounds.
Standardised psychological assessments (BPRS, Calgary, NOSIE, DASS21, SR1 and
SR2) were conducted both before and after the sessions to determine if there was any
significant change in outcome measures when comparing treatment to control
groups.

Results from this study showed that music therapy significantly reduced psychiatric
symptomatology as rated by the BPRS and the Calgary. Trends toward
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improvements in communication and social interaction skills as well as self-rated
symptoms were seen in the results of the NOSIE, DASS21 and SR1 & SR2.

To further explore the impact of music therapy on social interaction and
communication skills a qualitative review of clinical notes written by both
occupational therapist and music therapist was conducted. The results of this review
indicate that the relationship between the therapist and the participant was important
in helping people to further develop these skills.

As this was the first trial of its kind post hoc analyses were run for the treatment and
control groups to ascertain if there were any relationships between the significant
changes in BPRS and Calgary results from pre to post therapy with the demographic
data. The results showed that for the treatment group, level of education, shorter
duration of illness prior to admission, living alone prior to admission and being
without employment were associated with significant changes in the BPRS and
Calgary scores when compared to the control group.

In addition to the main study, a sub-group of 15 participants had music of their own
choosing played during their routinely administered electroencephalography (EEG)
to assess if there were any changes to brain wave activity when listening to music of
their own choice. One participant was excluded from the study due to abnormally
fast beta activity.

The EEG results showed that subjects listening to music of their own choosing
experienced significantly reduced dysfunctional brain wave activity in the delta,
v
alpha and beta waves when compared to a resting condition. These results were
affected to a significant degree by age, duration of illness, level of musical training
and psychiatric symptomatology.

This study has shown that music therapy is a valuable therapeutic adjunct to standard
ward programs for the management of an acute psychotic episode resulting in shorter
hospital stays, considerable cost savings and significant improvement in
symptomatology as judged by the standardized measures employed. In addition,
EEG testing while listening to self-chosen music demonstrated a reduction in
dysfunctional brain wave activity.

This project has highlighted the importance of music therapy in allied mental health
care and opens up the need for further research into the management of such a large
disease burden in Australia.

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ACKNOWLEDGEMENTS

Firstly, I would like to thank both J.Albert & Son and Nordoff-Robbins Australia
who worked in conjunction with the University of Western Sydney to provide a
scholarship and candidature support necessary to complete this research.

Secondly, I would like to thank my supervisory panel Clinical Associate Professor
Roger Bartrop and Professor Christopher Tennant (University of Sydney) as well as
Professor Michael Atherton (Principal) and Robin Howat (University of Western
Sydney). However, special thanks must go to Clinical Associate Professor Roger
Bartrop and his wife Sue who were there through every step of the process and never
let me lose hope in either myself or the benefits of music therapy.

Thanks also to the staff of the Cummins Unit and in the Department of Psychological
Medicine at Royal North Shore Hospital who continued their support throughout the
past few years. Dr. Telfer, thank-you for all your hard work on this research and
your willingness to work with our team to help complete this research. Lucia
Clements (RN), you were amazing, both in your effort on this research and your
continual sense of humour.

My appreciation also goes to Clinical Associate Professor Geoff Herkes, Karen
Prince, Professor Ashley Craig, Dr. Yvonne Tran and Dr Anthony Harris. You were
all so willing to participate in this research and impart your knowledge of
neurophysiology.

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Dr. Georgina Luscombe, your patience in guiding me through the statistical analyses
was outstanding.

Lastly, I would like to thank John for coping with me throughout the Ph.D. and all
the turmoil it brought to our life. Words cannot describe the gratitude I feel for your
continued support and the willingness just to walk beside me through this journey.

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DEDICATION

This thesis is dedicated to the memory of my parents

Margaret Helen Morgan
(6.5.1944 – 3.6.1989)

and

Bruce Ronald Morgan
(21.12.1941 – 10.12.2006)

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TABLE OF CONTENTS

Title of thesis…….……………………………………………………………………i

Declaration………......………………………………………………………………...ii

Abstract………………………………..……………………………………….……..iii

Acknowledgements..……………………………………………………………....…vii

Dedication.....................................................................................................................ix

Table of Contents………………..…………………………………………………x

List of Tables……………………………..……………………………………….xxiii

List of Figures...…………………………………..………………………………xxvii

Appendix List…………………………………………………………………….xxix

List of Abbreviations…………………………..………………………………...xxx

Conference Paper Presentations..............................................................................xxxi

Chapter 1: INTRODUCTION

1.1 Introduction……………………………………………………….……….….1
1.2 Schizophrenia
1.2.1 Definition and diagnosis………………………………………….....1
1.2.2 Aetiology – Biological………………………………………………3
1.2.3 Aetiology – Environmental………………………………………….6
1.2.4 Prognosis……………………………………………..……………….7
1.2.5 Current Interventions……………………………………………..…..8
1.3 Schizoaffective Disorder
1.3.1 Definition and diagnosis…………………………………………….9
1.3.2 Aetiology – Biological………………………………………………9
1.3.3 Aetiology – Environmental………………………………………….10
1.3.4 Prognosis………………………………………………………..…...10
x