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Music therapy for depression (Review)

Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A, Crawford M, Chen XJ,
Gold C

Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A, Crawford M, Chen XJ, Gold C.
Music therapy for depression.
Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004517.
DOI: 10.1002/14651858.CD004517.pub3.

www.cochranelibrary.com

Music therapy for depression (Review)

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 Cochrane Trusted evidence.
Informed decisions.
Library Better health.
BACKGROUND
Description of the condition
Depression is a mood disorder and a common mental illness that
affects more than 300 million people worldwide. Depression is
projected to become the leading cause of disability by the year
2020. At its worst, depression can lead to suicide, and it has been
linked to approximately 800,000 cases of suicide per year (WHO
2017).
Depression is characterised by core symptoms of persistent low
mood, diminished interest, loss of pleasure, and lack of energy,
along with other symptoms such as sleep disturbance, appetite and
weight disturbance, poor concentration, psychomotor changes,
and feelings of guilt, worthlessness, and low self-esteem (WHO
1992). Affective disturbance is at the core of depression (Gotlib
2014).
As with most psychiatric disorders, the aetiology of depression
appears to be multi-factorial, involving both genetic and
environmental factors, and current evidence points towards a
complex interaction between neurotransmitter availability and
receptor regulation within the brain (Palazidou 2012).
A major depressive disorder (MDD) can be diagnosed on the basis
of one of two widely used classification systems: the World Health
Organization’s International Classification of Disease, Tenth Revision
(ICD-10) (WHO 1992), and the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders, 5th edition
(DSM-5) (APA 2013). In both systems, diagnosis requires the
presence of at least one core symptom for most of the day, almost
every day for at least two weeks. Severity of depression - mild,
moderate, or severe - is determined by the number and severity
of symptoms and the degree of functional impairment. Depressive
disorders are comorbid with a vast array of other psychiatric
disorders, health problems, and diseases, and with many types of
severely dysfunctional relationships (Richards 2014).
Depressive symptoms can become chronic and recurrent and can
lead to substantial impairment in an individual’s ability to function
in everyday life (WHO 2012). It is important to recognise that
individuals experiencing persistent depressive symptoms below
the threshold for a diagnosis of MDD, previously categorised as
having a ‘minor depressive disorder’, may find their symptoms
equally as distressing and disabling (Fils 2010).
Description of the intervention
Music therapy can be defined as “the professional use of music
and its elements as an intervention in medical, educational,
and everyday environment with individuals, groups, families, or
communities, who seek to optimise their quality of life and improve
their physical, social, communicative, emotional, intellectual and
spiritual health and well-being. Research, practice, education,
and clinical training in music therapy are based on professional
standards according to cultural, social, and political contexts
(WFMT 2011)".
Music therapy is delivered in a variety of contexts (e.g. mental
health, medical, community, developmental, and educational
contexts) (Edwards 2016). Music therapy can be delivered to groups
or individually, and participants may drop into an open group (e.g.
in a psychiatric ward setting) or may be referred and assessed by
Music therapy for depression (Review)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews
the music therapist before placement in individual treatment or
closed group therapy.
Music therapy approaches across the world have emerged
from diverse traditions such as behavioural, psychoanalytical,
educational, or humanistic models of therapy. Music therapy
methods can be active and/or receptive and include verbal
processing of feelings and experiences. In active methods
(improvisational, re-creative, compositional), participants are
‘making music’, and in receptive music therapy, participants are
‘receiving’ (e.g. listening to) music (Bruscia 2014; Wheeler 2015).
Improvisation might be the active method most commonly used
in adult mental health (Gold 2009). Often, different methods and
techniques are combined in the same therapy. In recent years,
specialisations have evolved (e.g. neurologic music therapy (NMT)),
to improve cognitive, sensory, and motor functioning (Thaut 1999;
Thaut 2014).
The aim of music therapy is to improve health via therapeutic
change agents such as music, relationships, and reflections. In both
active and receptive methods, the music therapist and participants
are actively involved and musical interaction takes place between
therapist and patient, or between therapist and group. Sessions are
carried out within a structured therapeutic framework that serves
as the basis for the music therapy intervention. Music therapy
training is delivered at the Master's level, at the Bachelor's level, or
at completion of extended undergraduate degree programmes.
Evidence-based practice (EBP) is receiving increased attention
in music therapy (Edwards 2016; Silverman 2015; Wigram 2014).
This work involves integration of the best available research
evidence, the therapist’s clinical expertise, and the patient’s unique
values and circumstances (Hoffmann 2013; Straus 2011). Cochrane
reviews are an important source of information on EBP of music
therapy and have been conducted to provide a guide for music
therapy treatment, music therapy education, and development of
meaningful guidelines (Edwards 2016).
How the intervention might work
Music is a powerful stimulus that evokes and modulates moods
and emotions (Baumgartner 2006; Baumgartner 2006a; Koelsch
2015); music is often used intentionally to regulate moods and
emotions in daily life (Juslin 2010). Juslin reports that music may
influence motivation, self-image, and coping mechanisms around
difficult feeling states; in some forms of music therapy, the therapist
explicitly helps individuals process feelings that have been aroused
by music (Juslin 2010). Other possible mechanisms of action have
been described by Maratos and colleagues (Maratos 2011), who
suggest that high levels of engagement are seen in music therapy
trials because music-making is largely a social, pleasurable, and
meaningful activity, and that therapists use these affordances in a
variety of ways to help people.
In active music therapy, the music therapist uses improvisational,
re-creative, or compositional methods. Improvisational methods in
music therapy include any experience by which the patient actively
participates in spontaneous music-making with the music therapist
or with other individuals while playing instruments, vocalising,
or sounding their bodies or other objects. Re-creative methods
involve reproduction of pre-composed musical material vocally
or instrumentally. With compositional methods, the process of
composition helps patients generate and refine personal opinions,
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