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Table of Contents
REVIEW ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 43-50

Effectiveness of music therapy on aggression as an adjunct therapy


1 Department of nursing, NIMHANS, Bangalore-29, Karnataka, India
2 Department of Child and adolescent Psychiatry, NIMHANS, Bangalore-29, Karnataka, India

Date of Web Publication17-Jun-2019

Correspondence Address:
C A Jesna
Department of nursing, NIMHANS, Bangalore-29, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.260550

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  Abstract 


Knowledge on the effect of music therapy in person with mental illness is very important. The aim of the review is to discuss the articles pertaining to music therapy on aggression among person with mental illness. The review was based on studies conducted globally. Systematic search was conducted on a range of databases, citations were sought from relevant reviews and several websites were also included in the search, including those of MIND and Mental Health Foundation. MEDline, EMBASE and Psyc INFO were searched for studies published from 2000 January to 2015. Quantitative method and Descriptive approach were used for this reviewing 14 articles. Majority of the studies (11 out of 14, 78.57%) showed positive effects of music therapy on aggression, were as remaining 3 studies (21.42 %) not shown any effect on aggression. The present review also reveals that Group Active Music Therapy model (75%) was more effective than Group Receptive Music Therapy Model (66.66%). Group music therapy model enhances the group interactions and communications. Music intervention being one form of non-pharmacological approaches has several advantages in that it addresses the psychosocial as well as environmental aspects for managing behavioural problems. Music intervention, therefore, may have provided an avenue for appropriate expression of negative emotions.


How to cite this article:
Jesna C A, Radhakrishnan, Lalitha K, Ramachandra, Gandhi S, Nattala P, Vijaysagar J. Effectiveness of music therapy on aggression as an adjunct therapy. Indian J Psy Nsg 2016;12:43-50

How to cite this URL:
Jesna C A, Radhakrishnan, Lalitha K, Ramachandra, Gandhi S, Nattala P, Vijaysagar J. Effectiveness of music therapy on aggression as an adjunct therapy. Indian J Psy Nsg [serial online] 2016 [cited 2022 Aug 7];12:43-50. Available from: https://www.ijpn.in/text.asp?2016/12/1/43/260550




  Introduction Top


Mentally ill patients show an elevated rate of aggressive behavior.

The prevalence of aggression in mentally ill is about 19.5%. (DC Chukwujekwu, PC Stanley,2011)[1]. Aggressive behavior is often associated with developmental transitions and a range of medical and psychiatric diagnoses across the lifespan. As healthcare professionals involved in the medical and psychosocial care of patients from birth through death, nurses frequently encounter and may serve as—both victims and perpetrators of aggressive behavior in the workplace. Management of aggression in person with mental illness is a challenging problem among health professionals[3].

Music therapy has numerous applications within a psychiatric setting. The benefits of the music in a therapeutic environment such as making positive alteration in mood and emotional states, improving concentration and attention span, developing coping and relaxation skills, exploring self-esteem and personal insight, enhancing awareness of the self and the environment and improving social interaction[2]. Listening to Music engages and stimulates multiple areas of the brain, both subcortical and cortical. Thus helps in emotional processing and controlling of the brain areas[4]. It can play a role in managing mood, influencing choices and changing attitudes; behaviors strongly influence social interactions. In fact, research indicates that music can be actively used to manage mood states or manage levels of arousal[2].

In some hospitals, even in India, mellow music is played to divert and relax patients. Behavioral disorders like schizophrenia, anxiety and autism suit music therapy. There is also what is called ‘Melodic Intonation Therapy’ that corrects speech disorders. (From ; The Hindu newspaper; Friday Review April 5, 2012)[5]

Recently Music Maestro Ilayaraja who was presented with the Centenary Award, asked the government to make music “compulsory” in schools which, he felt, would go a long way in curbing violence. (http://www.wikinewsindia.com/english- news/thehindu-news/entertainment-news/music-maestro- ilayaraja-honoured-at-iffi/)

An advantage of music therapy as an adjunct therapy is that it is an inherently nonthreatening and inviting medium. Moreover, singing, playing musical instruments and listening to music are all non-invasive methods that incur little to no cost. They’re also non-controversial and hardly have any ethical, legal or cultural stigmas attached. Also, with such clear evidence available on the beneficial impact of music on mind, there needs to be still greater international focus on studying and demonstrating the effects of music on other mental and neurological ailments as well. This will further strengthen the idea of mainstreaming music therapy in the world of medicine[2]. Music makes the ward environment socially more interactive. Music therapy benefits to be acknowledged in every Mental Health Institutions. In India awareness about the music therapy need to be intensified on a larger scale. Lack of evidence is the one of the reason for the slow development of music as a therapy. So, more research works and systematic reviews on music therapy will be helpful in mainstreaming musical interventions in psychiatric unit.


  Title of the Review Top


Effectiveness of music therapy on aggression among person with mental illness - A Systematic Review


  Aim of the Review Top


Aim of the review was to identify the evidence on the effectiveness of music therapy on aggression among persons with mental illness.


  Objectives of the Review Top


  • To review the related studies and other articles regarding the effectiveness of music therapy on aggression among persons with mental illness.
  • To understand the evidence of effectiveness of music therapy on aggression among person with mental illness.



  Method Top


Quantitative method and Descriptive approach were used for this review.

After identifying the need for the particular review, eligibility criteria for the papers to be reviewed were prepared, according to which the review was carried out by using different search strategies by adopting the interfaces and databases. The collected papers were checked for clarity and then used for the review.


  Eligibility Criteria Top


The review was done to identify the articles that explicitly describe the effectiveness of music therapy on aggression among person with mentally illness.


  Inclusion Criteria Top


  • Studies related to the effectiveness of music therapy on aggression among person with mental illness.
  • Literature published in English language
  • Literature published from the year 2000-2014



  Exclusion Criteria Top


  • Studies with insufficient data such as inadequate information on the research methodology
  • Studies related to the effectiveness of music therapy on other than aggression and mental illness.



  Literature Search Strategies and Data Source Top


The literature was obtained from the databases were searched-Proquest, MEDLINE, Pubmed , EBSCO Host, PsycINFO, Ovid, Cochrane Library, SAGE Journals, Psychiatric Online, Springer, Science Direct, Wiley Online Library,CINAHL,Web of Science, Taylor & Francis.

The review was restricted to 2000-2014. Reviews were mainly collected with the help of Boolean/ phrase search by using the following terms identified from the title, abstract or key words;

  • Music therapy and aggression
  • Music and mentally ill
  • Music and aggression
  • Classical music and aggression
  • Raga and aggression
  • Music and anger management



  Data Extraction and Quality Assessment Top


The extracted data were assessed based on eligibility criteria. The experimental studies were evaluated on the basis of relevance, appropriateness, clarity and methodology.
Figure 1: Process of selection of the articles

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  Data Analysis Top


The data analysis consisted of three stages;

  • Developing a preliminary synthesis of studies.
  • Exploring the studies based on the various objectives.
  • Summarizing the findings


Stage1; Preliminary synthesis of studies.

A Gesalt approach of getting cognitive cluster of studies was used. A preliminary analysis was done by tabulating and translating data. For each included paper, the following data were extracted and tabulated;

• Author, year of publication, country, methodology, instruments/techniques, sample size and major findings.

Stage 2; Exploring the studies based on the various objectives The studies were explored to gather data based on the objectives. The collected data were categorized under each objective.

Stage 3; Summarizing the findings

The frequency and percentage of each category of data was calculated and the significant areas were identified.


  Results of the review Top


Baseline data

All the studies included in the review were published in the time period 2002-2013, and were experimental studies (one was quasi experimental and others were randomized control studies).The articles included in the review are listed in the [Table 1], classified as author, year of publication, country, method, sample size, tools and technique used and major findings.
Table 1: showing the studies classified as author, year of publication, country, method, sample size, tools and technique used and major findings.

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Participants were recruited from a range of settings, including hospitals, special schools, clinics, nursing homes, half way homes, old age homes etc. Subjects of the studies included person with mental illness and aggression. Majority of the subjects were diagnosed as Dementia (through DSM IVTR ). Studies were done in various countries across the world with maximum number of studies were done in Australia(n= 3) followed by Taiwan (n= 2). Sample size in all studies varied from 16-210. Mean sample size of all the studies was59.66.Most of the study was conducted by nurse (7 studies). In four studies music intervention were given by music therapist and in three studies music interventions were given by psychologist.


  Major Findings of the Review Top


EFFECTIVENESS OF MUSIC THERAPY ON AGGRESSION

Majority of the studies (11 Out of 14, 78.57%) showed positive effects of music therapy on aggression, were as remaining 3 studies (21.42 %) not shown any effect on aggression.
Figure 2: Showing the effectiveness of music therapy on aggression among person with mental illness

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  Types of Music THERAPY Used in Various Studies Top


There are mainly 5 different types of music therapy. Out of 14 studies reviewed, group receptive music therapy was used in 7 studies(50%) and among that 4 studies were found to be effective (66.6%).Individual Receptive Music Therapy was used in 2 studies and found to be effective (100%). One study with live music demonstration has shown no effect on aggression. None of the studies were used the Individual Active Music Therapy.
Table 2: showing types of music therapy used in various studies and its effectiveness N=14

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  Age Group and Effectiveness of Music Therapy on Aggression Top


Out of 14 studies 10 studies (71.42%) were done among the elderly population, among these 7studies were found to be effective (70%).Three studies were done among the pediatric population out of these, 2studies were found to be effective.
Table 3: showing the age group and effectiveness of music therapy on aggression N=14

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  Treatment Duration (Number of Sessions) and Effectiveness of Music Therapy Top


Out of 14 studies, 8studies (57.14%) were done with less than 20 sessions, among these 6 (75%) studies were found to be effective. Four studies (28.5 %) had 20-40 session, out of that 3 studies had positive effect (75%). The 2 Studies that was conducted with more than 40 sessions (100%) were found to be effective for reducing aggression. Even though all the studies were not mentioned the duration of sessions, we can conclude that percentage of effectiveness of music therapy increases as the number of the session increases.
Figure 3: showing treatment duration and effectiveness of music therapy on aggression; x axis number of sessions and y axis number of studies

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  Different Control Group Interventions Top


Out of 14 studies three studies were having different control group interventions. Study results showed, no additional benefits for music groups compared to different control group interventions.
Table 4: showing different control group intervention and effectiveness of music therapy on aggression n=14

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  Summary of the Findings Top


  • Major findings of this review reveals that majority of the studies (78.57%) have shown a positive effect of music therapy on reducing aggression.
  • In the present review, 10 studies (71.42%) were done on elderly, out of that 7 studies (70%) were found to be effective.
  • Most of the studies used group receptive type music therapy model (50%) among these 66.6% found to be effective. Although the Individual receptive music therapy model was found to be effective (100%) than group receptive type music therapy.
  • Administering Music therapy more than 40 sessions was found to be effective (100%).
  • Among 14 studies, 3 studies were done with different control group interventions. Study results showed, no additional benefits for music groups compared to different control group interventions.



  Discussion Top


Discussion with major findings

The systematic review was intended to understand the effectiveness of music therapy on aggression among persons with mental illness. The review of 14 studies revealed the importance of music therapy in managing aggression among person with mentally illness.

In Current review, 78.54% of the studies suggest that music therapy helps to reduce aggression. The findings suggest that music therapy plays a substantial role in reducing aggression among person with mentally illness and aids in decreasing the need for pharmacological management of aggression.

Music therapy is found to be more effective in population with verbal inhibition; especially vulnerable populations like elderly and pediatric populations with mental illness. So music therapy can be used more for the elderly and children.

For music therapy a model based approach is found evolving.

In this present review, it was seen that Individual Receptive Music Therapy Model is effective (100%), but in clinical settings scope for the Individual Receptive Music Therapy Model is limited. The present review also reveals that Group Active Music Therapy model (75%) was more effective than Group Receptive Music Therapy Model (66.66%). Group music therapy model enhances the group interactions and communications.

The current review suggests the positive relation between the number of the sessions and effect of the music on aggression among mentally ill. The exact dose response studies are not conducted in this area. Although the review of 14 studies revealed the dose response relation between number of the session and effects of the music to be as 40 sessions

Alison J. Ledger& Felicity A. Baker (2006) study revealed that music therapy has only immediate effects on agitated behaviors displayed by people with Alzheimer’s disease. No other study results were found to support this finding. So furthermore studies needs to be conducted to evaluate the long term effect of the music therapy.

Kattryn, Garland, Edwin Beeret al,(2007)mentioned that placebo group ( reading horticulture text) has also shown some amount of reduction in the agitated behavior than expected. He concluded that any activities that engage their brain helps to reduce the aggression in mentally ill. On a more positive note, the finding suggests that even simple technologies can enrich patient’s lives and alleviate the distress.

One of the benefits suggested by most of the researchers is that music is easy to administer and is acceptable to most of the patients with apparently no side effects and burden to the patients. Music intervention being one form of non-pharmacological approaches has several advantages in that it addresses the psychosocial as well as environmental aspects for managing behavioural problems. Music intervention, therefore, may have provided an avenue for appropriate expression of negative emotions. Participation in group music also provides those with mental illness a channel for communication and social interaction. This helps the patient to get rid of stigmas and reduce the burden of the hospitalization.

Limitations

  • Most of the studies were from foreign countries.
  • Broad range of population with mental illness included in the study
  • Dose- response calculation was not done



  Conclusion Top


Music no doubt plays a pivotal role in the lives of human beings. Music therapy has been used effectively in psychiatric disorders. It has been used to modify the behavior of children with mental illness with moderate success. It has been used to reduce agitation in patients with dementia by soothing them and eliminating the social isolation of these patients. Incorporating music therapy into regular therapy programs for psychiatric disorders can help speed recovery and also make therapy a more positive experience. Music therapy is a valuable but relatively unexplored asset in the field of psychiatry and psychotherapy.



 
  References Top

1.
Chukwujekwu DC, Stanley PC. Prevalence and correlates of aggression among psychiatric in-patients at Jos University Teaching Hospital. Nigerian journal of clinical practice. [online] 2011[accessed on July 2015];14(2):163  Back to cited text no. 1
    
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Nizamie SH, Goyal N, Haq MZ, Akhtar S. Central Institute of Psychiatry: A tradition in excellence.Indian J Psychiatry. 2008;50:144-8. [PMC free article] [PubMed]  Back to cited text no. 2
    
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Shamala.A, K. Lalitha, et al an experimental study to assess the effectiveness of anger control programe on the level of anger in children with emotional and behavioural disorder dissertation masters of psychiatric nursing NIMHANS April 2010  Back to cited text no. 3
    
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5.
Srihari.G. Healing with music, The Hindu newspaper; 2012 Apr 5, Friday Review (http://www.thehindu.com/features/friday- review/music/healing-with music/article3283502.ece)  Back to cited text no. 5
    
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Barbara Jennings GSW, MW & David Vance, The Short-Term Effects of Music Therapy on Different Types of Agitation in Adults withAlzheimer’sActivities, Adaptation& Aging, 26:4, 2002, 27-33, DOI: 10.1300/J016v26n04_03  Back to cited text no. 6
    
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Rickson, Daphne J, &Watkins, William G. Music Therapy to Promote Prosocial Behaviors in Aggressive Adolescent Boys-A Pilot Study, Journal of Music Therapy 40.4 (Winter 2003): 283301  Back to cited text no. 7
    
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Huei-chuan Sung, Shu-min Chang et al The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan, Complementary Therapies in Medicine, Volume 14, Issue 2, June 2006, Pages 113-119  Back to cited text no. 8
    
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Alison J. Ledger & Felicity A. Baker,An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s Disease, Aging & Mental Health, Volume 11, Issue 3, 2007, pages 330-338  Back to cited text no. 9
    
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Kathryn Garland, D.Psych, Edwina Beer, M.A,et al. A Comparison of Two Treatments of Agitated Behavior in Nursing Home Residents With Dementia: Simulated Family Presence and Preferred Music, The American Journal of Geriatric PsychiatryVolume 15, Issue 6, June 2007, Pages 514-521  Back to cited text no. 10
    
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Lars-Olov Lundqvist,Gunilla Andersson, Jane Viding, et al Effects of vibroacoustic music on challenging behaviors in individuals with autism and developmental disabilities, Research in Autism Spectrum Disorders 3 (2009) 390-400  Back to cited text no. 11
    
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Fang-Yu Chang, Hui-Chi Huang et alThe effect of a music programme during lunchtime on the problem behaviour of the older residents with dementia at an institution in TaiwanJournal of Clinical Nursing, Volume 19, Issue 7-8, pages 939-948, April 2010.  Back to cited text no. 13
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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  In this article
Abstract
Introduction
Title of the Review
Aim of the Review
Objectives of th...
Method
Eligibility Criteria
Inclusion Criteria
Exclusion Criteria
Literature Searc...
Data Extraction ...
Data Analysis
Results of the r...
Major Findings o...
Types of Music T...
Age Group and Ef...
Treatment Durati...
Different Contro...
Summary of the F...
Discussion
Conclusion
References
Article Figures
Article Tables

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