Application of Music Therapy in the Treatment of Common Mental Disorders
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Index date: 12 March 2024
Application of Music Therapy in the Treatment of Common Mental Disorders abstract
Application of Music Therapy in the Treatment of Common Mental Disorders Keywords:
Application of Music Therapy in the Treatment of Common Mental Disorders authors
دانشجوی پزشکی، دانشگاه علوم پزشکی زاهدان
مقدمه/پیشینه تحقیق
Introduction All humans can cope with sorrow at some point in their lives. Still, when we talk about common mental disorders, we refer to depression and anxiety disorders, which are very different from the experience of grief. 1 Depression is a widespread chronic medical condition that can influence mood, thoughts, and physical health. It is characterized by insomnia, inability to enjoy life, sadness, low mood, and lack of energy. 2 Generalized anxiety disorder (GAD) is one of the most common mental disorders, and it is characterized by producing fear, worry, and a constant feeling of being overwhelmed. 3 There are multiple and different therapeutic approaches for treating depression in the acute phase, including pharmacotherapy, psychotherapy, or a combination of both, and somatic therapies such as electroconvulsive therapy. 4 The story is not very different for generalized anxiety disorder. Cognitive-behavioral therapy and pharmacotherapy are the two main treatment approaches for this disorder. Of course, combining these two treatment methods can be helpful for patients. 5 However, we are not here to just talk about the old methods; we are supposed to describe something new, like music therapy. Music therapy is an evidence-based and artistic health profession that uses music experiences within a therapeutic relationship to address clients' physical, emotional, cognitive, and social needs. 6 Our ancestors believed that music could have a healing effect on mind and body 7 . Moreover, today, we have concluded that music therapy can significantly enhance the mental health of patients suffering from depression and anxiety disorders. 8 There are two types of music therapy approach for children and adolescents: active methods, such as improvisation (playing pre-composed songs or writing a new song), and receptive methods (listening to the pre-composed songs)6 . In this narrative review, we will study the application of music therapy for treating common mental disorders, namely depression and generalized anxiety disorders, and compare this therapeutic approach with other treatment methods, highlighting its advantages and disadvantages.
روش ها
Methods To synthesize the information, we first used specific keywords to search the scientific databases. The keywords are as follows: Music Therapy, Common Mental Disorders, Depression, and Generalized Anxiety Disorders. The phrases that were used for searching in the databases are music therapy in depression, music therapy in anxiety, music therapy in generalized anxiety disorder, and music therapy in common mental disorders. The scientific databases used for this paper are Pubmed, Google Scholar, and Science Direct. Regarding to advanced search and filtration, the language of articles must be English. The publication date range is from 2011 to 2023. However, there are six exceptions: Creative music therapy : individualized treatment for the handicapped child9 , Defining Music Therapy10 , The Art and Science of Music Therapy: A Handbook11 , Why Provide Music Therapy in the Community for Adults with Mental Health Problems?12 , Treating generalized anxiety disorder13, and The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial14 , which were published in order 1977, 1991, 1991, 1995, 2003, and 2008. The selection criteria were: being a meta-analysis or systematic review because of the comprehensiveness of these articles, being the newer reference for including the updated information, having more citation and scientific value, and having the most negligible bias in selection and information. Being the more recent reference was our priority, but for some data, we had no choice but to use the older references because of their novelty and originality.
نتایج
Results Overall, music therapy is effective in reducing anxiety levels and enhancing the functioning of depressed individuals.15 The music therapy action mechanism in depression treatment is clearly described in both passive and active approaches. However, regarding the action mechanism of music therapy in GAD, a considerable scientific gap is demonstrated in the mechanism of music therapy action in GAD treatment, which is why more studies in this field are required.
بحث ها
Discussion Depression As mentioned, common methods for treating depression include psychotherapy, pharmacotherapy, or a combination of both. In the pharmacotherapy approach, selective serotonin reuptake inhibitors (SSRIs) are generally considered as first-line antidepressants because of their adverse effects and safety profile. However, there are alternative options such as tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.16 Nevertheless, some side effects, such as headache, nausea, anxiety, and diarrhea, are widely known, so patients are enthusiastic about finding alternative ways.14 From a psychotherapy perspective, there are three common types of psychotherapy in the therapeutic approach: cognitive behavioral therapy (CBT), interpersonal therapy, and supportive therapy.17 One of the therapeutic tools that has been increasingly used in recent years is music.18 Music therapy is the clinical and art-based employment of music interventions a certified specialist performs to achieve personalized aims.19 Regarding the efficacy of music therapy on depression, according to a meta-analysis conducted in 2020, which examined 55 randomized clinical trials (RCT) on the effect of music therapy on depression, music therapy has a significant impact on reducing depressive symptoms in individuals compared with the control group.20 One of the most critical questions is what music therapy offers compared with common therapeutic methods. Based on a meta-analysis conducted in 2017 on the impact of music therapy on depression compared with treatment as usual (TAU), examining nine randomized clinical trials and controlled clinical trials with a total of 421 participants, the findings showed that music therapy has short-term beneficial effects on individuals with depression. Music therapy, when added to TAU, improves depressive symptoms compared with TAU alone. Additionally, music therapy added to TAU does not have significantly greater or lesser adverse events than TAU alone. Finally, music therapy has also been found to be functional in reducing anxiety levels and improving the functioning of depressed individuals.15 Generalized Anxiety Disorders Generalized Anxiety Disorder (GAD) is a situation in which a person feels excessive and unequal worry and anxiety about issues that do not bother the majority of people.21 We mentioned two main approaches for GAD treatment: pharmacotherapy, cognitive-behavioral therapy, and sometimes a combination of these approaches could be valuable. The most frequent options in pharmacotherapy include selective norepinephrine and selective serotonin reuptake inhibitors (SNRIs and SSRIs), benzodiazepines, anti-adrenergic medications, tricyclics, second-generation antipsychotics, antihistamines, melatonin analogues, azapirones, monoamine oxidase inhibitors, and trazodone.22 In the psychotherapy approach, based on Borkovec and Whisman’s studies, cognitive-behavioral therapy (CBT) is clinically and statically beneficial, and the benefits remain for 6 to 12 months. They also found that the combination of cognitive therapy and relaxation therapy could reduce the need for medication and be beneficial compared with other psychotherapy approaches.13 Music therapy is a novel and acceptable therapeutic approach for most patients.23 Regarding the efficacy of music therapy in GAD treatment, based on a meta-analysis carried out in 2021 on 32 randomized control trials with a total number of 1,924 patients, music therapy was effective for anxiety relief compared with the control group. One possible reason was that music plays a role in patient distraction, redirecting their attention from negative stimuli to more pleasant subjects, ultimately ameliorating anxiety.24 The Action Mechanism of Music Therapy in Depression and Generalized Anxiety Disorder Treatment As we mentioned earlier, there are two main therapeutic approaches in music therapy: active and receptive. Based on a systematic review which has been carried out in 2017 on all randomized control trials (RCTs) and controlled clinical trials (CCTs) comparing music therapy versus treatment as usual (TAU) with a total number of 421 participants15, the presumed mechanism of action in active music therapy, used for depression, is that the established musical rapport between the therapist and the patient or the patient group facilitates the patient’s understanding of relational and emotional issues through discussions centered around musical dialogue.9 12 The musical connection further empowers the patient to organize thoughts, problem-solve, assume responsibility, enhance communication skills, augment attention, cultivate feelings of self-worth and accomplishment, meet a spectrum of emotional and physical needs, and convey emotions by creating sounds and musical structures.25 10 26 Musical expression can also assists patients with reducing stress and anxiety levels, akin to the observed effects through synchronization and attuned musical expression. 27 On the other hand, the other approach in music therapy for depression is the receptive method. The hypothesized mechanism in receptive music therapy suggests diverse stimuli initially induce shifts in consciousness, stimulate sensory and imaginative responses, evoke emotional states, impact the body, modulate physical or mental energy levels, motivate or deter physical engagement, foster interpersonal interaction, and encourage introspective contemplation, reflection, discernment.10 It has been posited that utilization of receptive music therapy may potentially reduce stress, soothe pain, and energize the body.10 11 Now, let us talk about the other disorder. First, we should consider that there are several types of anxiety disorders: generalized anxiety disorder, panic disorder, agoraphobia, separation anxiety disorder, specific phobias, and selective mutism.28 As we described, music therapy could be effective in GAD treatment, although there is a considerable gap in the mechanism of music therapy used for generalized anxiety disorder treatment. Numerous scientific papers have investigated the application of music therapy in other types of anxiety, for example, in critically ill patients’ anxiety 29, in cancer patients’ anxiety 30 , and in surgical anxiety 31. when it comes to the music therapy mechanisms used for generalized anxiety disorder treatment specifically, more studies are required
نتیجه گیری
Conclusion The main purpose of this narrative review was to determine the application of music therapy in the treatment of common mental disorders which were depression and generalized anxiety disorder (GAD). The application of music therapy in the treatment of depression and GAD was investigated separately before. However, the main feature that enhances the novelty of this review is that this article explores depression and GAD simultaneously and describes the action mechanisms in both depression and GAD; it also compares this approach with the treatments as usual, which makes it unique in its own way. Assessment of the relevant studies shows that the application of music therapy can significantly improve symptoms of both depression and GAD. The findings showed that music therapy has short-term beneficial effects on individuals with depression. Music therapy, when added to TAU, improves depressive symptoms compared with TAU alone. Additionally, music therapy added to TAU does not have significantly greater or lesser adverse events than TAU alone. Regarding the application of music therapy in the treatment of GAD, music therapy was effective for anxiety relief compared with the control group. Although one possible reason was that music plays a role in patient distraction, redirecting their attention from negative stimuli to more pleasant subjects, ultimately ameliorating anxiety. The action mechanism of music therapy in the treatment of depression is clarified. The primary presumed mechanism of action in active music therapy, used for depression, is that the established musical rapport between the therapist and the patient or the patient group facilitates the patient’s understanding of relational and emotional issues through discussions centered around musical dialogue. On the other hand, the hypothesized mechanism in receptive music therapy suggests diverse stimuli initially induce shifts in consciousness, stimulate sensory and imaginative responses, evoke emotional states, impact the body, modulate physical or mental energy levels, motivate or deter physical engagement, foster interpersonal interaction, and encourage introspective contemplation, reflection, discernment. Tons of scientific papers investigate the action mechanism and application of music therapy in the treatment of other types of anxiety, yet the action mechanism of music therapy in the treatment of GAD is not very clear. As mentioned earlier, the studies suggest that music therapy can be efficient for anxiety relief. However, they also stated that this effect could be the result of patient distraction and redirecting their attention from negative stimuli to more pleasant subjects, ultimately ameliorating anxiety. More studies are required on music therapy action mechanisms in GAD treatment.
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