Music therapy in mental health care

Transcription

1 Music therapy in mental health care An introduction to practice and current research Dr Catherine Carr HEE/NIHR Clinical Lecturer Music Therapist, East London Foundation NHS Trust Research Fellow, Queen Mary University @catherinecarrmt

2 What is music therapy? This? This? How about this?

3 What is music therapy? Everyone has the ability to respond to music, and music therapy uses this connection to facilitate positive changes in emotional wellbeing and communication through the engagement in live musical interaction between client and therapist. It can help develop and facilitate communication skills, improve selfconfidence and independence, enhance self-awareness and awareness of others, improve concentration and attention skills. British Association for Music Therapy,

4 Music Therapy Music usually active and improvisatory Therapeutic relationship Verbal reflection Individual, groups or community Nonverbal expression Building relationships Creativity

5 Music Therapy Music usually active and improvisatory Therapeutic relationship Verbal reflection Individual, groups or community Nonverbal expression Building relationships Creativity Flexibility Adaptability Context Sensitivity

6 Music Therapists Allied Health Profession Protected title Health and Care Professions Council MA Training Usually from music or psychology backgrounds High level of musical skill fluency in 2+ instruments Psychological and Psychotherapy theory often psychodynamic Clinical Improvisation

7 What happens? (and what can we learn from dogs?)

8 What happens? (and what can we learn from mothers & infants?) Dr Edward Tronick- still face experiment:

9 Moving into music therapy

10 What does music therapy offer in mental health? Motivation Emotional regulation and containment Connection to and transformation of feeling states Organising thoughts and feelings A new experience of being together with others Relating in the here and now Opportunities to experience different ways of relating to others (Re)connecting to healthy parts of self Creativity and play

11 Music therapy in acute in-patient settings

12 Evidence for music therapy in acute inpatient care Music therapy in mental health NICE Guidelines for schizophrenia, Cochrane review (Mössler et al., 2014) Effective for patients with low therapy motivation (Gold et al., 2013) Dose effect response across diagnoses (Gold et al., 2009) One UK study: Individual music therapy for schizophrenia (Talwar et al., 2007) No evidence for UK NHS clinical practice with acute inpatients Group provision Mixed diagnoses Complex Intervention: requires detailed examination of processes to build a theory of how the intervention works for a specific context (Medical Research Council, 2008)

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14 Phases of complex intervention development, MRC, 2008 p.8

15 Intensive group music therapy Acceptability of 3 x per week groups Modelling of processes and outcomes (Carr, 2014) Focus groups to describe adaptations, best practice Feasibility study for randomised controlled trial

16 Vignette 1: On-ward group, male ward Adam- Guitar Eric- Maracas Brian- First to sing Kevin- Gathering drum Charles- Djembe Therapist- Keyboard castanet and voice Therapist sings matching intensity of singing bowl (Brian) and gathering drum (Kevin) Group come to a close. Kevin continues on drum. Therapist enters with keyboard- too soft Therapist takes castanet Brian whoops - therapist mirrors then offers melody Dialogue between Brian and therapist Kevin and Charles join Ending- Eric stands up and says Happy birthday to everybody

17 Responses to session Discussion afterwards music as pain relief, pain in the singing, rejoicing Post-session: got lost in the rhythm improved mood Being with people and feeling wanted The vocals were about our pain Voices were drowned out a little Therapist singing took session to a next level

18 Describes attending for relaxation and fun- to forget problems you d just play, you d laugh, you d joke and- and that s about it, you know talking about your innermost feelings and err this and that it doesn t come up, because you know that door s shut. But then..the last session we played drums for a very long time, it was really, really good. So she stopped it for a little bit because we were going for a long time and then we just started talking and, you know? One thing led to another and we started expressing our issues and erm, I expressed myself you know, all the bad things that we re doing and how I should correct it and then she was listening to me and she was giving me her thoughts as well. And that other person was saying the same thing...so, in a way it really helped...it helps you figure out who you are. So within the group session, when everybody started expressing themselves I was thinking, ok, I can handle it when he suffers the same as me or he did, or he did, so basically everyone is in the same boat, so in a way you don t feel isolated...you just think oh, that s good...i thought I was the only one. Hearing sort of like intimate details...were discussed. So that- in a way erm, can do you good.

19 Vignette 2: MHCOP acute ward Service provision: Open on ward group, 60mins, weekly Therapeutic engagement and individual sessions Psychosis quick engagement with instruments risk factors Consistent group attendance Non-compliance 1:1 Individual sessions Return to group

20 Vignette 3: Individual music therapy with a client with dementia Expressive dysphasia Lack of confidence- quiet volume Unable to communicate needs Distress, high anxiety on ward Use of known song structure Supporting to hold vocal line independently Singing- breath work, volume, confidence in vocal production

21 Group music therapy for Post-traumatic Stress Disorder Re-experiencing Dissociation Avoidance Hyperarousal Carr, d Ardenne, Sloboda, Scott, Wang & Priebe, 2011

22 Group music therapy for Post-traumatic Stress Disorder Pilot randomised controlled trial- wait-list control 10 sessions, weekly group music therapy Non-response or engagement with trauma-focused CBT Wide range of index trauma multiple traumas N=17 Carr, d Ardenne, Sloboda, Scott, Wang & Priebe, 2011

23 Participant verbal reflection: The music helps to be yourself again. You feel like you re you and not just somebody else walking around as if you re up there watching down on you When I m in this room and I m playing, I feel me again...like I was before...before everything that happened. When I go out that door- out there- I feel as if I m up there again in a cloud watching me Carr, d Ardenne, Sloboda, Scott, Wang & Priebe, 2011

24 PTSD symptom scores* Results Music therapy group (n=9) Waiting list group (n=8) 10 4 participants re-engaged with CBT 0 Baseline 10 weeks follow-up * Impact of Events Scale- Revised Carr, d Ardenne, Sloboda, Scott, Wang & Priebe, 2011

25 Music therapy for chronic depression Development of approach Songwriting Focus groups Feasibility study for a randomised controlled trial Carr, O Kelly, Sandford & Priebe, 2017

26 Future areas of enquiry Unpicking the knot Mechanisms and understanding of processes Not for all - factors associated with engagement Effectiveness of diagnostically heterogeneous groups Context sensitivity adaptations to different environments Developing the interface: music therapy community music

27 References British Association for Music Therapy: Carr, C. (2014). Modelling of intensive group music therapy for acute adult psychiatric inpatients. Submitted May Queen Mary University of London. Carr, C, d Ardenne P, Sloboda A, Scott C, Wang D, Priebe S. (2011). Group music therapy for patients with persistent post-traumatic stress disorder an exploratory randomized controlled trial with mixed methods evaluation. Psychology and Psychotherapy: Theory, Research and Practice, doi: /j x Carr, CE, O Kelly, J, Sandford, S, Priebe, S. (2017). 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. Trials 18:149. doi: /s Geretsegger M, Mössler KA, Bieleninik Ł, Chen X, Heldal T, Gold C. Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic Reviews 2017, Issue 5. Art. No.: CD DOI: / CD pub4 MCCAFFREY, Tríona et al. Music Therapy and Recovery in Mental Health: Seeking a Way Forward. Voices: A World Forum for Music Therapy, [S.l.], v. 18, n. 1, jan ISSN Available at: Date accessed: 01 Mar doi: /voices.v18i Stern, D.N. (2010). Forms of vitality: Exploring Dynamic Experience in Psychology, the Arts, Psychotherapy, and Development. Oxford: Oxford University Press.

28 Thank you! Dr Catherine Carr HEE/NIHR Clinical Lecturer Music Therapist, East London Foundation NHS Trust Research Fellow, Queen Mary University @catherinecarrmt