Music therapy was noninferior to verbal standard treatment of traumatized refugees in mental health care: Results from a randomized clinical trial

Abstract

Background: Many people with refugee backgrounds suffer from trauma-related complex social and psychological problems, and compliance with standard psychological treatment tends to be low. More culturally adaptable treatment options seem to be needed. Objective: We aimed to investigate whether the music therapy method: 'trauma-focused music and imagery' (tr-MI), characterized by a particular focus on arousal and affect regulation, would be equally effective as the standard psychological talk therapies for ameliorating trauma symptoms in Danish refugees. Methods: A pragmatic, noninferiority, parallel, randomized controlled trial with six-month follow-up was carried out at three clinics for refugees in the public mental health services of the Psychiatry (DK). Seventy-four adults diagnosed with posttraumatic stress disorder (PTSD) were allocated to either music therapy sessions (tr-MI, N = 39) or psychological treatment as usual (TAU, N = 35). Western classical music, new age music, and music from the participants' own national culture were used to generate inner imagery, following a phased treatment protocol. Homework entailed listening to music. The primary outcome was the measurement of trauma symptoms by the Harvard Trauma Questionnaire, section IV (HTQ-IV); secondary measures were somatoform and psychoform dissociation (DSS-20), SDQ-20), attachment (RAAS), and well-being (WHO-5). Treatment effects reflected by primary and secondary measures were estimated using linear mixed models. Results: Tr-MI was noninferior to TAU (mean difference at follow-up HTQ-IV: 0.14, CI (−0.10; 0.38), with a − 0.3 noninferiority margin). A high dropout rate of 40% occurred in the TAU group, compared to 5% in the music therapy group. Secondary measures generated small to medium effect sizes in both groups, with significant medium effect sizes for well-being and psychoform dissociation at follow-up in tr-MI. Conclusions: Tr-MI is an innovative form of psychological treatment in refugee mental health services. Trials comparing music therapy to standardized therapy are needed to substantiate the evidence base for tr-MI therapy. Músicoterapia no fue inferior al tratamiento estándar de refugiados en atención de salud mental: Resultados de un ensayo clínico aleatorizadoAntecedentes: Muchas personas con antecedente de condición de refugiadas sufren complejos problemas psicológicos y sociales relacionados con el trauma, y el cumplimiento con el tratamiento psicológico estándar tiende a ser bajo. Parecen ser necesarias opciones de tratamiento más culturalmente adaptadas. Objetivo: Apuntamos a investigar si el método de músico-terapia: 'música e imaginería focalizada en el trauma' (tr-MI), caracterizado por un enfoque particular en el nivel de alerta y regulación emocional, podría ser igualmente efectivo como las terapias psicológicas de conversación para aliviar síntomas de trauma en refugiados daneses. Métodos: Se llevó a cabo un ensayo clínico aleatorizado controlado, pragmático, de no inferioridad, paralelo, con seis meses de seguimiento e...

A Neurobiological Framework for the Therapeutic Potential of Music and Sound Interventions for Post-Traumatic Stress Symptoms in Critical Illness Survivors

“…After sixteen GIM sessions, adult refugees showed positive improvements in PTSD symptoms, sleep quality, well-being, and social functioning [ 98 ]. A recent randomized control trial with 74 refugees with PTSD, employing western classical music, New Age music, and music from the participants’ own national culture showed improvements in quality of life and fewer symptoms of psychological dissociation after music therapy [ 99 ]. In addition, unlike the standard treatment, the positive effects of music and imagery were manifested even at the 6 month follow-up.…”

“…A systematic review on music interventions for mechanically ventilated patients reported participant dropout rates to be higher in researcher-selected music compared to patient-selected [ 125 ]. Instead, studies involving a music therapist to assess patient music preferences have reported no dropouts and a high degree of participant satisfaction [ 70 , 98 , 99 ]. Therefore, self-selected music appears to be associated with both the effectiveness of music interventions and participant retention.…”

“…The tempo of 60-80 beats per minutes can help induce a state of relaxation and regulate emotions [127]. A study by Beck et al, 2021, used predictable slow-tempo music to decrease arousal and induce relaxation in PTSD patients [99]. In addition, the harmonic complexity of relaxing music should be consonant and remain within the diatonic key with a clear tonal center [126,127].…”

Ventral tegmental area dopaminergic action in music therapy for post-traumatic stress disorder: A literature review

“…Different modalities of music therapies exert different effects on PTSD phenotypes aside from the cardinal symptoms. Guided imagery and music (GIM) significantly decreases the symptoms of dissociation (Maack, 2012 ; Story and Beck, 2017 ); GIM in the trauma-focused group of patients enhanced PTSD patients' quality of life and wellbeing (Rudstam et al, 2017 ; Beck et al, 2021 ); songwriting treatment reduced the numbing and depressive symptoms of PTSD patients (Coulter, 2000 ; Precin, 2011 ; Hirschberg et al, 2020 ), and playing musical instruments, such as drums or guitars, increased the sense of openness and togetherness, and facilitated non-intimidating access to traumatic memories in PTSD patients (Bensimon et al, 2008 ; Pezzin et al, 2018 ).…”

“…Notably, music therapy has been shown to exhibit significant effects on trauma symptoms (e.g., it improves wellbeing and sleep quality) in traumatized refugees (Jespersen and Vuust, 2012 ; Beck et al, 2018a , 2021 ). There is abundant theoretical and empirical evidence concerning the beneficial effects of music therapy on PTSD patients ( Table 3 ).…”