Psychiatry, 81:218–227, 2018 218

Ó Washington School of Psychiatry

ISSN: 0033-2747 print / 1943-281X online
DOI: https://doi.org/10.1080/00332747.2018.1502559

Acute Effects of Music Therapy in Subjects With

Psychosis During Inpatient Treatment
Umberto Volpe, Carlo Gianoglio, Luca Autiero, Maria Luisa Marino,
Diana Facchini, Armida Mucci, and Silvana Galderisi

Objective: Previous studies have proposed music therapy (MT) as a useful rehabilita-
tion approach for patients with psychosis, but few studies have focused on acute
settings. The aim of the study was to evaluate the effects of a structured MT program
on clinical and social functioning indices of patients with psychosis while hospitalized
in an emergency psychiatric ward. Method: The intervention followed a modified
approach to Benenzon’s MT model and was delivered biweekly to 61 patients with
psychosis consecutively admitted to our ward. Before and after the MT program, all
subjects were administered the Brief Psychiatric Rating Scale (BPRS) for assessment of
general psychopathology, the Hospital Anxiety and Depression Scale (HADS) for
affective symptomatology, the Clinical Global Impression (CGI) scale for severity of
symptoms, and the Global Assessment of Functioning (GAF) scale for psychosocial
functioning. Results: A repeated-measures analysis of variance revealed that patients
who underwent the MT intervention had a statistically significant reduction of BPRS
and CGI scores, compared to the control group; furthermore, the BPRS anxiety/
depression factor and the HADS scores for affective symptomatology significantly
decreased after the observation period compared to controls. Conclusion: Our results
are in line with previous studies showing favorable effects of MT in patients with
psychosis, in particular on affective symptomatology, but extend this observation to
an emergency setting with short periods of hospital stay.

Music therapy (MT) can be defined as client or a group, in a process designed to

the controlled “use of music and/or musical facilitate and promote communication, rela-
elements (sound, rhythm, melody and har- tionships, learning, mobilization, expres-
mony) by a qualified music therapist with a sion, organization and other relevant

Umberto Volpe, MD, PhD, is Assistant Professor of Psychiatry, at the University of Campania “L. Vanvitelli”, Napoli,
Italy. Carlo Gianoglio, MD, is psychiatric trainee at the University of Campania “L. Vanvitelli”, Napoli, Italy. Luca
Autiero, is a psychiatric rehabilitation student at the University of Campania “L. Vanvitelli”, Napoli, Italy. Maria Luisa
Marino, licensed music therapist at the Istituto di Formazione in Musicoterapia, ISFOM, Naples, Italy. Diana Facchini,
licensed music therapist and Director at the Istituto di Formazione in Musicoterapia, ISFOM, Naples, Italy. Armida
Mucci, MD, PhD, is Associate Professor of Psychiatry at the University of Campania “L. Vanvitelli”, Napoli, Italy.
Silvana Galderisi, MD, PhD, is Full Professor of Psychiatry at the University of Campania “L. Vanvitelli”, Napoli, Italy.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/upsy.
Address correspondence to Umberto Volpe, Department of Psychiatry, University of Naples SUN, Largo Madonna
delle Grazie, Naples 80138, Italy. E-mail: umberto.volpe@unina2.it
Volpe et al.
therapeutic objectives, in order to meet phy-
sical, emotional, mental, social and cognitive
needs” (World Federation of Music Ther-
apy, 2005). Generally speaking, MT aims
to develop potential and/or restore psycho-
logical functions of the individual, so it may
have a crucial role in achieving better inter-
personal, physical, and psychological func-
tioning to induce a deeper emotional
integration, as well as to enhance quality of
life of psychiatric patients (Gold, Solli, Kru-
ger, & Lie, 2009; Silverman, 2003, 2011).
MT is usually delivered through two
main approaches (Solanki, Zafar, & Ras-
togi, 2013). In active MT models, therapist
and patient actively create music, using
musical instruments and their voices. In pas-
sive or receptive MT, the patient rests and
the therapist plays music, inviting the patient
to produce specific mental states. In medi-
cine, MT has been often regarded as an
adjunctive treatment to standard care, most
often in its active form (Wigram, 2002).
Previous studies suggested that MT can
be effective in a number of psychiatric disor-
ders, including psychosomatic, affective, and
psychotic syndromes (Avram, 2014; Gold
et al., 2011; Iamandescu, 2014; Lu et al.,
2013). MT has been classically conceptualized
as a means to increase group cohesion, accep-
tance, and interpersonal relationships in psy-
chiatric settings (McCaffrey, Edwards, &
Fannon, 2011); more recently, MT has been
regarded as an adjunctive treatment for psy-
choses, and it is thought to be more effective
than standard therapy alone because it
improves the patient’s global state, mental
state, negative symptoms, and social function-
ing (Cassity, 1976). According to recent evi-
dence, art therapies (including MT) can be a
valid adjunctive treatment for schizophrenia to
induce an amelioration of negative symptoms,
especially in the short or medium term (Möss-
ler, Chen, Heldal, & Gold, 2011).
It has been reported that MT reduces
positive symptoms in subjects with schizophre-
nia (Gold et al., 2011; NICE, 2014; Zhang &
Curie, 1997). According to Suzuki (1998), a
219
structured MT program was effective in redu-
cing the level of negative and affective symp-
toms after three and six months. Several
subsequent studies confirmed this evidence
(Erkkilä et al., 2008; Hyun & Yang, 2009;
Peng, Koo, & Kuo, 2010; Ulrich, Houtmans,
& Gold, 2007).
Previous studies have reported on the
effects of MT in people with schizophrenia
during their hospital stay. Hayashi, Tanabe,
Nakagawa, and Noguchi (1999) reported an
advantage for patients attending a MT
group over those on a waiting list, but they
also warned that the observed effect might
not be durable over time. An exploratory
controlled randomized trial on MT (Talwar
et al., 2006) confirmed that structured MT
programs can induce both clinical and func-
tional improvement in patients with schizo-
phrenia, compared to patients who did not
attend such programs. A study by Silverman
(2003) described the effects of an assertive-
ness MT for 133 psychiatric inpatients:
Although participants tended to have higher
overall quality-of-life scores, no significant
difference on posttest quality-of-life mea-
sures was found. A recent study (Yang
et al., 2012) reported that MT was effective
in reducing anxiety in half of 24 hospitalized
patients enrolled in the trial.
The available evidence concerning the
use of MT for the treatment of mental disorders
in inpatient settings is still relatively scarce and
controversial, and further studies are needed to
assess its effectiveness. The present study aimed
to explore the effectiveness of a structured MT
program on psychopathology indices and mea-
sures of psychosocial functioning in patients
with functional psychoses (e.g., schizophrenia,
schizoaffective disorder, or bipolar disorder)
during hospitalization.
MATERIALS AND METHODS
Sample
Subjects were recruited among
patients consecutively admitted to the
220
women’s acute inpatient ward of the Depart-
ment of Mental Health of the University of
Naples SUN. The clinical diagnosis of schi-
zophrenia, schizoaffective disorder, or bipo-
lar disorder was based on the Diagnostic
and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision (DSM-IV-TR)
criteria (American Psychiatric Association
[APA], 2004) and confirmed by the Struc-
tured Clinical Interview for DSM-IV, Patient
Version. Patients had to fulfill the following
inclusion criteria: (a) standardized diagnosis
of schizophrenia, schizoaffective disorder, or
bipolar disorder; (b) right-handedness, veri-
fied using the Oldfield Questionnaire (Old-
field, 1971); (c) negative history of head
trauma with loss of consciousness, epilepsy,
or substance abuse or dependence in the
year preceding recruitment; (d) age range of
18 to 65 years; (e) educational level not
under five years; (f) a Mini-Mental State
Examination (Folstein, Folstein, & to patients’ proposals (concerning music
McHugh, 1975) total score of ≥ 18 to
exclude severe cognitive impairment; and
(g) written informed consent to participate
in the experimental procedures. Patients
were randomly assigned either to the MT
or to the control group. Patients in the con-
trol group fulfilled inclusion criteria (a)
through (f) and received standard care only
(i.e., pharmacological treatment and a stan-
dard daily rehabilitation program, which
provided a self-care individualized program
and group relaxation training, which was
also provided to the MT group).
The Department Review Board
approved the experimental procedures, which
conformed to the ethical principles for medical
research endorsed in the Declaration of Hel-
sinki.
Music Therapy Protocol
Group sessions of MT were per-
formed biweekly, according to Benenzon’s
MT model (Benenzon, De Gainza, &
Wagner, 1997). This model of music ther-
apy has strong psychoanalytical roots and
Music Therapy for Acute Psychosis
is focused on music/sound interaction
within a nonverbal frame. The main aim
of the activity is to improve interpersonal
communication and facilitate emotional
expression, which in turn should improve
quality of life and well-being (Solanki
et al., 2013).
The MT group included no more
than 10 subjects, and each session lasted
about 60 minutes.The sessions included
singing songs, writing songs, and impro-
visation. All sessions were recorded. Dur-
ing the session, participants sat in a circle
with an Orff instrument set (always keep-
ing the same instrument set to favor the
creation of a reassuring musical setting;
Orff, 1990) in a dedicated room; two
trained music therapists ran the group
activity, assisted by two rehabilitation
technicians who also served as facilitators.
The session usually started with listening
themes and/or other issues related to the
session), progressed through a passive and
gentle involvement of patients, and then
gradually moved toward more lively and
active music performances. Nondirective-
ness and interactivity were a key element
of the sessions, with emphasis on several
musical techniques such as improvising
(“recreating”), imitating and mirroring,
composing songs, sound dialogue, and
“musical maternage” (Benenzon et al.,
1997). After each session, music thera-
pists used an ad hoc schedule (available
from the authors on request) to monitor
the characteristics of sound production
and the communicative dynamics within
the group.
Psychopathological Evaluations
At the time of admission, sociodemo-
graphic and clinical basic parameters (i.e.,
standardized diagnosis, age of onset, dura-
tion of illness, number of previous hospita-
lizations, duration of last hospitalization,
drug status) were collected by means of an
Volpe et al.
ad hoc form from each subject. For all
patients included in the study, the following
psychopathological measures were obtained,
both at the time of admission and at the end
of the hospitalization period:
1. General psychopathology, assessed by the
Brief Psychiatric Rating Scale (BPRS; Luk-
off, Liberman, Nuechterlein, & Ventura,
1986), consisting of 24 items, exploring
both psychopathological symptoms and
signs. The scale provides a rating from 1
(Symptom absent) to 7 (Extremely severe)
for each item.
2. Affective and anxiety symptoms, evalu-
ated by means of the Hospital Anxiety
and Depression Scale (HADS; Herrmann,
1997; Zigmond & Snaith, 1983). HADS
contains 14 items and provides a total
score and separate subscores for anxiety
and depression, respectively; the scale is
specific and sensitive for inpatient settings
(Herrmann, 1997).
3. Severity of symptoms, with the Clinical
Global Impression (CGI) scale (Guy,
1976). The CGI takes into account the
patient’s history, psychosocial circum-
stances, symptoms, behavior, and the
impact of symptoms on the patient’s
functioning. The assessment consists
of a 7-point scale (1 = Normal;
7 = Among the very sick patients).
Psychosocial Functioning
Social, occupational, and psychological
functioning was explored by means of the
Global Assessment of Functioning (GAF)
scale (APA, 2004), providing a score ranging
from 0 to 100 such that higher scores are
associated with higher functioning.
Subjective Perception of MT
Patients within the MT group were
also asked to complete three 7-point
Likert scales designed to explore the
221
following items: degree of cooperation
within the MT session, degree of relaxa-
tion after each MT session, and interac-
tion with the group and department staff
within the MT session. Such evaluations
were repeated after each session.
Statistical Analysis
Data on the main sociodemographic
characteristics were submitted to multivariate
analyses of variance (MANOVAs) to deter-
mine the presence of any statistically signifi-
cant difference between the two experimental
subgroups with respect to these variables.
Because antipsychotic drugs often
induce an impairment of attention, con-
centration, and memory (Culpepper,
2007), we assessed the dose of antipsy-
chotic medication for each patient after
conversion in haloperidol equivalents, in
agreement with the indications of Andrea-
sen et al (2010). The individual antipsy-
chotic doses were subjected to anaylses of
variance (ANOVAs) to exclude significant
differences in antipsychotic doses between
the two groups.
Psychopathological indices were sub-
jected to a repeated-measures ANOVA (in
which the between factor was the MT/con-
trol group and the within-group factor was
the time elapsed between admission to and
discharge from the hospital) to assess even-
tual differences between the two groups at
the end of the intervention.
The measures of subjective perception
of MT (i.e., the total scores of the Likert
scales on cooperation, relaxation, and
group interaction within MT sessions) were
also subjected to a repeated-measures
ANOVA, in which the time elapsed between
the first and the last session was the main
categorical factor.
All statistical analyses were per-
formed using STATISTICA software (Ver-
sion 10, StatSoft Inc., 2012). The level of
statistical significance was set at p ≤ 0.05,
two-tailed, for all comparisons.
222 Music Therapy for Acute Psychosis

RESULTS patients were affected mainly by a schizo-

phrenia spectrum disorder (45%) or bipolar
disorder (45%), with a minority of patients
We recruited 106 female patients. In
having borderline personality disorders with
the control group, 15 patients did not pro-
psychotic symptoms (10%); in the control
vide consent to the study procedures and
group, 51% of the patients had a diagnosis
had to be excluded. The majority of patients
within the schizophrenia spectrum, while
attended the MT group (N = 61), while
49% suffered from bipolar disorder.
those who did not attend it were considered
as belonging to the control group (N = 45).
The main sociodemographic and clin- Sociodemographic and Basic Clinical
ical characteristics of the study groups are Characteristics
summarized in Table 1. In the MT group,
Although the control group had a
slightly higher number of previous hospital
TABLE 1. Clinical and Sociodemographic Character- admissions and a longer duration of illness,
istics of the Sample. no significant difference between the two
Control groups was observed for any sociodemo-
Music Therapy Group graphic characteristic.
Sociodemographics Group (N = 61) (N = 45)
Patients from both groups were on
Age (years) 41.5 ± 12.4 47.0 ± 13.0 antipsychotic drugs. Patients in the MT
Education (years) 10.0 ± 4.0 8.8 ± 2.0 group received, on average, a significantly
Age at onset (years) 23.1 ± 10.8 28.0 ± 13.3 higher dose of antipsychotic drugs (MT:
Duration of illness 18.28 ± 10.3 20.3 ± 11.6 859 ±225 Eq/day; Control: 640 ±270 Eq/
(years)
day; F1,55 = 10.19; p ≤ 0.002) than the control
Number of previous 6.8 ± 5.7 7.1 ± 5.0
admissions group; therefore, in all subsequent group
Duration of current 25.3 ± 13.3 23.0 ± 10.2 comparisons, the mean dose of antipsychotic
hospitalization (days) medication was introduced as a covariate.
Note. Values are shown as M ±SD.

Psychopathology
TABLE 2. Clinical Variables Among the Two Experi-
mental Groups. Patients who attended the MT group
sessions showed a greater reduction of the
Variables CG MT
mean BPRS global score (i.e., from 32.4 ±17.4
BPRS TOT, T0 30.4 ± 17.9 32.4 ± 17.4 to 15.8 ±7.8) than the control group (from
BPRS TOT, T1 24.4 ± 16.3 15.8 ± 7.8 30.4 ±17.9 to 24.4 ±16.3), after the interven-
BPRS anx/dep, T0 6.12 ± 5.8 5.69 ± 4.6 tion (F1,54 = 13.69; p ≤ 0.0005) (Figure 1); the
BPRS anx/dep, T1 5.04 ± 4.3 4.27 ± 4.2 MT group also had a lower score for the BPRS
HADS, T0 21,13 ± 10,3 25,22 ± 9,55 item anxiety/depression (4.27 ±4.2) compared
HADS, T1 19,31 ± 8,32 20,78 ± 8,72 to the control subjects (5.04 ±4.3) at discharge
CGI, T0 4,64 ± 1,06 5,45 ± 1,03 (F1,103 = 8.55; p ≤ 0.004).
CGI, T1 4,76 ± 0,93 5,13 ± 1,06 A reduction of the affective sympto-
GAF, T0 39,9 ± 10,9 36,93 ± 11,70 matology in the MT group at discharge was
GAF, T1 55,18 ± 8,10 53,28 ± 12,68
also confirmed by the HADS scores, while
Note. CG = control group; MT = music therapy group; no significant improvement was observed in
BPRS = Brief Psychiatric Rating Scale; TOT = total score; the control group (see Figure 2)
anx/dep = anxiety/depression item of BPRS; HADS = Hospital
Anxiety Depression Scale; CGI = Clinical Global Impression (F1,103 = 5.15; p ≤ 0.02). A statistically sig-
scale; GAF: Global Assessment of Functioning; T0 = at time of nificant improvement of both HADS anxiety
admission; T1 = at time of discharge.
(F1,103 = 5.36; p ≤ 0.02) and depression
Volpe et al.
FIGURE 1. General psychopathology score before and
after music therapy.
BPRS= Brief Psychiatric Rating Scale; T0= admission;
T1= discharge; *p<0.0005.
FIGURE 2. Affective symptomatology, before and after
music therapy.
HADS= Hospital Anxiety and Depression Scale; T0=
admission; T1= discharge; *p<0.0005.
(F1,103 = 14.59; p ≤ 0.0002) subscores was
found in the MT group but not in the con-
trol group.
The clinical improvement observed in
subjects attending the MT group was also
confirmed by the evaluation of CGI scores:
With respect to the control group, MT sub-
jects showed a significantly greater reduction
in the final overall severity of symptoms
(F1,54 = 5.03; p ≤ 0.0001), which was not
observed in the control group (Figure 3; see
also Table 2 for further details).
Psychosocial Functioning
Psychosocial functioning followed a
pattern similar to the one observed for
223
FIGURE 3. Clinical global severity, before and after
music therapy.
CGI= Clinical Global Impression Scale; T0= admission;
T1= discharge; *p<0.0001.
psychopathology measures: Both experimen-
tal groups were found to have better psycho-
social functioning at the time of discharge
from the hospital, but the MT group had sig-
nificantly higher GAF scores (F1,103 = 15.77;
p ≤ 0.0001); the control group did not show
such final improvement (Figure 4).
Attendance to and Subjective
Perception of the MT Sessions
On average, patients in the MT group
attended three (SD = 1.7) sessions during their
hospital stay; patients in the control group
attended one session or no sessions (aver-
age = 0.60; SD = 0.49). Patients in the MT
group showed an improvement of the degree
of cooperation and of relaxation, as well as
the interaction with the group and department
staff, after the completion of the MT sessions,
FIGURE 4. Psychosocial functioning, before and after
music therapy.
GAF= Global Assessment of Functioning; T0= admis-
sion; T1= discharge; *p<0.0001.
224
as witnessed by a statistically significant
(F1,59 = 53.36; p ≤ 0.00001) difference
between the groups on Likert scale measures.
Observations on Music Production
Recurring elements of musical produc-
tion were the use of local (Neapolitan) sounds
and rhythms, the creation of new songs con-
cerning mental illnesses and hospital stays, the
transformation of known songs (to convey per-
sonal experiences, with high subjective cathar-
tic value), and the use of instruments with
“feminine” musical characteristics (such as the
metallophone and the “ocean drum”). The use
of voice was also of particular interest, since
most of the participants used vocal production
to convey personal messages, related to an
introspective dimension.
DISCUSSION
Even after a short time period (in our
case, hospitalization lasted on average less
than four weeks), and independently from
drug treatment, we observed that inpatients
with severe mental disorders attending a struc-
tured MT group reported greater clinical and
psychosocial improvements compared to
those who did not attend such a group.
Our results seem to be in line with those
from previous studies (Zhang & Curie, 1997;
Hayashi et al., 1999; Talwar et al., 2006;
Grocke et al., 2013; Morgan, Bartrop, Telfer,
& Tennant, 2011; Erkkilä et al., 2011; Avram,
2014) reporting that MT has a positive impact
on general and affective symptomatology of
patients with severe mental disorders. In addi-
tion, in our study, we demonstrated that MT
exerts its effects on both clinical symptoms and
psychosocial functioning even with a relatively
low number of MT sessions and in an acute
inpatient setting.
A possible interpretation of our results
lies in the reported effects that music has on
brain areas related to emotional processing
Music Therapy for Acute Psychosis
(Koelsch, 2010). Music perception and perfor-
mance represent complex phenomena that
involve different subcortical and interhemi-
spheric brain pathways (Wigram, 2002). In
particular, activation of limbic system regions
has previously been demonstrated during music
playing (Peretz & Zatorre, 2005; Peretz et al.,
2009). Such changes, together with the
reported preferential activation of the right cer-
ebral hemisphere and the prevailing activity of
the parasympathetic system (Lee, Chung,
Chan, & Chan, 2005) and the cascade of cog-
nitive and emotional events elicited by music
perception/production (Solanki, Zafar, & Ras-
togi, 2013), may represent the neural substrate
for the increase of social functioning and reduc-
tion of affective symptomatology which we
observed in our inpatients with severe mental
illnesses.
Some limitations may hinder the gener-
alization of our results. First, we performed
our study in a patient population of female
subjects only, as our ward admitted only
women; thus, our results should be replicated
in a larger sample, including patients of both
sexes. Second, it was not possible to follow up
all patients after discharge and thus, in order
to evaluate if the reported improvements are
sustained over a longer period of time, studies
with a longitudinal design should be con-
ducted in the future. Finally, we have
explained the observed effects of MT in light
of the most recent evidence from neurobiolo-
gical studies of the effects of music production
on the brain. While some recent evidence
tends to confirm that musical activities may
stimulate neuronal plasticity in motor, audi-
tory, and limbic areas, with cross-modal
effects on further brain regions (Wan &
Schlaug, 2010), this interpretation remains
speculative in nature and further studies
exploring this hypothesis with brain-imaging
techniques are still needed.
Aside from these mentioned limitations,
our study highlights that music therapy may
represent a useful rehabilitative technique for
patients with severe mental illnesses, even
Volpe et al.
during short-term hospitalization, and that it
well complements pharmacological treatment
and other psychosocial rehabilitation activities.
ACKOWLEDGMENTS
The authors wish to thank Drs. P.
Punzo, A. Suraci, O. Petrillo, M. Reale, T.
Tallerico, D. De Lisi, A. De Novellis, and S.
De Simone for their constant support for
REFERENCES
American Psychiatric Association (APA). (2004).
Diagnostic and statistical manual of mental dis-
orders, text revision (DSM-IV-TR). Washington,
DC: American Psychiatric Association.
Andreasen, N. C., Pressler, M., Nopoulos, P.,
Miller, D., & Ho, B. C. (2010). Antipsychotic
dose equivalents and dose-years: A standardized
method for comparing exposure to different
drugs. Biological Psychiatry, 67(3), 255–262.
Avram, C. L. (2014). Psycho-somatic virtues of
singing together. Journal of Psychosomatic
Research, 76(6), 495–496.
Benenzon, R. O., De Gainza, H., & Wagner, G.
(1997). La nuova musicoterapia. Phoenix: Roma,
Italy.
Cassity, M. (1976). The influence of a music
therapy activity upon peer acceptance, group
cohesiveness, and interpersonal relationships of
adult psychiatric patients. Journal of Music Ther-
apy, 13, 66–76.
Culpepper, L. A. (2007). Roadmap to key phar-
macologic principles in using antipsychotics. Pri-
mary Care Companion – Journal of Clinical
Psychiatry, 9, 444–454.
Erkkilä, J., Gold, C., Fachner, J., Ala-Ruona, E.,
Punkanen, M., & Vanhala, M. (2008). The effect
of improvisational music therapy on the treat-
ment of depression: Protocol for a randomised
controlled trial. BMC Psychiatry, 8, 50.
Erkkilä, J., Punkanen, M., Fachner, J., Ala-
Ruona, E., Pöntiö, I., Tervaniemi, M., . . . Gold,
225
music therapy activities, and music thera-
pists F. Molfini, G. Catuogno, P. Ferrucci,
G. Ascione, G. Barone, R. Volpe, and L.
Catapano for their active collaboration in
conducting the music therapy sessions.
DISCLOSURE STATEMENT
None of the authors had any financial
or nonfinancial conflicts of interest to declare.
C. (2011). Individual music therapy for depres-
sion: Randomised controlled trial. British Journal
of Psychiatry, 199(2), 132–139.
Folstein, M. F., Folstein, S. E., & McHugh, P. R.
(1975). “Mini-mental state”. A practical method
for grading the cognitive state of patients for the
clinician. Journal of Psychiatric Research, 12(3),
189–198.
Gold, C., Erkkilä, J., Bonde, L. O., Trondalen,
G., Maratos, A., & Crawford, M. J. (2011).
Music therapy or music medicine? Psychotherapy
and Psychosomatics, 80(5), 304.
Gold, C., Solli, H. P., Krüger, V., & Lie, S. A.
(2009). Dose-response relationship in music
therapy for people with serious mental disor-
ders: Systematic review and metanalysis. Clin-
ical Psychological Review, 29(3), 193–207.
Grocke, D., Bloch, S., Castle, D., Thompson,
G., Newton, R., Stewart, S., & Gold, C.
(2013). Group music therapy for severe mental
illness: A randomized embedded experimental
mixed methods study. Acta Psychiatrica Scan-
dinavica, 130, 1–10.
Guy, W. (1976). The clinical global impression
scale. In ECDEU assessment manual for psy-
chopharmacology-revised (pp. 218–222).
Rockville, MD: US Dept. of Health, Education
and Welfare, NIMH Psychopharmacology
Research Branch.
Hayashi, N., Tanabe, Y., Nakagawa, S., &
Noguchi, M. (1999). Effectiveness of group musi-
cal therapy on chronic schizophrenic patients: A
226
comparative study. Acta Psychiatrica Scandina-
vica, 96, 35–36.
Herrmann, C. (1997). International experiences
with the hospital anxiety and depression scale: A
review of validation data and clinical results.
Journal of Psychosomatic Research, 42, 17–41.
Hyun, J. N., & Yang, S. (2009). Effects of listen-
ing to music on auditory hallucination and psy-
chiatric symptoms in people with schizophrenia.
Journal of Korean Academy of Nursing, 39(1),
62–71.
Iamandescu, I. B. (2014). Music-diagnosis — A
useful new method for psychotherapy in psycho-
somatic patients. Journal of Psychosomatic
Research, 76(6), 505–506.
Koelsch, S. (2010). Towards a neural basis of
music-evoked emotions. Trends in Cognitive
Sciences, 14, 131–137.
Lee, O. K., Chung, Y. F., Chan, M. F., &
Chan, W. M. (2005). Music and its effect on
the physiological responses and anxiety levels
of patients receiving mechanical ventilation: A
pilot study. Journal of Clinical Nursing, 14,
609–620.
Lu, S. F., Lo, C. H., Sung, H. C., Hsieh, T. C., Yu,
S. C., & Chang, S. C. (2013). Effects of group
music intervention on psychiatric symptoms and
depression inpatient with schizophrenia. Comple-
mentary Therapies in Medicine, 21, 682–688.
Lukoff, D., Liberman, R. P., Nuechterlein, K. H.,
& Ventura, J. (1986). Manual for expanded brief
psychiatric rating scale. Schizophrenia Bullettin,
12, 594–602.
McCaffrey, T., Edwards, J., & Fannon, D.
(2011). Is there a role for music therapy in the
recovery approach in mental health? Art Psy-
chotherapy, 38, 185–189.
Morgan, K., Bartrop, R., Telfer, J., & Tennant,
C. (2011). A controlled trial investigating the
effect of music therapy during an acute psychotic
episode. Acta Psychiatrica Scandinavica, 124,
363–371.
Mössler, K., Chen, X., Heldal, T. O., & Gold, C.
(2011). Music therapy for people with schizo-
phrenia and schizophrenia-like disorders.
Music Therapy for Acute Psychosis
Cochrane Database Systematic Reviews, 7(12),
CD004025.
National Institute for Clinical Excellence (NICE).
(2014). Psychosis and schizophrenia in adults the
NICE guideline on treatment and management –
Updated edition. London, UK: NHS.
Oldfield, R. C. (1971). The assessment and ana-
lysis of handedness: The Edinburgh inventory.
Neuropsychologia, 9(1), 97–113.
Orff, G. (1990). Key concepts in the orff music
therapy: Definitions and examples. London, UK:
Schott Music Ltd.
Peng, S. M., Koo, M., & Kuo, J. C. (2010). Effect
of group music activity as an adjunctive therapy
on psychotic symptoms in patients with acute
schizophrenia. Archives of Psychiatric Nursing,
24(6), 429–434.
Peretz, I., & Zatorre, RJ. (2005). Brain organiza-
tion for music processing. Annual Review of Psy-
chology, 56, 89–114.
Peretz, I., Gosselin, N., Belin, P., Zatorre, R. J.,
Plailly, J., & Tillmann, B. (2009). Music lexical
networks: The cortical organization of music
recognition. Annals of the New York Academy
of Sciences, 1169, 256–265.
Silverman, M. J. (2003). The influence of music
on the symptoms of psychosis: A meta-analysis.
Journal of Music Therapy, 40(1), 27–40.
Silverman, M. J. (2011). Effects of a single-ses-
sion assertiveness music therapy role playing pro-
tocol for psychiatric inpatients. Journal of Music
Therapy, 48, 370–394.
Solanki, M. S., Zafar, M., & Rastogi, R. (2013).
Music as a therapy: Role in psychiatry. Asian
Journal of Psychiatry, 6, 193–199.
Suzuki, A. (1998). The effects of music therapy
on mood ad congruent memory of elderly adults
with depressive symptoms. Music Therapy Per-
spectives, 16(2), 75–80.
Talwar, N., Crawford, M. J., Maratos, A., Nur,
U., McDermott, O., & Procter, S. (2006). Music
therapy for in-patients with schizophrenia:
Exploratory randomised controlled trial. British
Journal of Psychiatry, 189, 405–409.
Volpe et al.
Ulrich, G., Houtmans, T., & Gold, C. (2007). The
additional therapeutic effect of group music therapy
for schizophrenic patients: A randomized study.
Acta Psychiatrica Scandinavica, 116, 362–370.
Wan, C. Y., & Schlaug, G. (2010). Music making
as a tool for promoting brain plasticity across the
life span. The Neuroscientist, 16(5), 566–577.
Wigram, T. (2002). Indications in music therapy:
Evidence from assessment that can identify the
expectations of music therapy as a treatment for
autistic spectrum disorder (ASD): Meeting the
challenge of evidence based practice. British Jour-
nal of Music Therapy, 16, 11–28.
World Federation of Music Therapy. (2005).
Retrieved September 10, 2005, from http://
227
www.musictherapyworld.net/. University of Wit-
ten/ Herdecke,Witten (Germany).
Yang, C. Y., Chen, C. H., Chu, H., Chen, W. C.,
Lee, T. Y., Chen, S. G., & Chou, K. R. (2012).
The effect of music therapy on hospitalized psy-
chiatric patients’ anxiety, finger temperature, and
electroencephalography: A randomized clinical
trial. Biological Research for Nursing, 14(2),
197–206.
Zhang, X., & Curie, K. (1997). Effects of music
therapy on chronic schizophrenia. Chinese Jour-
nal of Clinical Psychololgy, 5, 48–49.
Zigmond, A. S., & Snaith, P. R. (1983). The
hospital anxiety and depression scale. Acta Psy-
chiatrica Scandinavica, 67, 361–370.
Copyright of Psychiatry: Interpersonal & Biological Processes is the property of Routledge
and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder's express written permission. However, users may print, download, or
email articles for individual use.