International Journal of Mental Health & PsychiatryISSN: 2471-4372

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Review Article, Int J Ment Health Psychiatry Vol: 1 Issue: 1

Music Therapy as a Treatment for Patients with Post-Traumatic Stress Disorder

Chanel Miller and Masaru Teramoto*
College of Nursing and Health Professions, Department of Health Sciences, Drexel University, Cherry Street, Philadelphia, USA
Corresponding author : Masaru Teramoto, PhD
MPH, 1601 Cherry Street, MS 9503 Philadelphia, PA 19102, USA
Tel: +1-267-359-5718; Fax: +1-267-359-5722
E-mail: [email protected]
Received: April 15, 2015 Accepted: May 12, 2015 Published: May 15, 2015
Citation: Miller C, Teramoto M (2015) Music Therapy as a Treatment for Patients with Post-Traumatic Stress Disorder. Int J Ment Health Psychiatry 1:1. doi:10.4172/2471-4372.1000103

Abstract

This paper summarizes literature to explore the ways in which music therapy is able to act as a treatment for patients suffering from post-traumatic stress disorder (PTSD). In many countries, PTSD is treated with many different modalities. One of the most common forms of treatment currently includes the use of selective serotonin reuptake inhibitors. However, these medications are associated with adverse side effects and can create addictive habits for patients. Consequently, it is important to consider complementary and alternative medicine (CAM) as a potential treatment for PTSD. With the use of music therapy, a form of CAM, each session and program can be tailored to the specific patient depending on how severe their cases of PTSD are. Music therapy could be used for such a variety of populations, including those living in countries with limited medical resources. Music can be made from various, readily available resources, such as stones, wood, and clapping motions. The act of drumming on nearby objects can promote emotional expression by certain patients. Limited evidence indicates that music therapy is potentially effective in improving PTSD symptoms. Through better language comprehension, music therapy allows the patient to express their emotions as it may relate to a past traumatic event.

Keywords: Post-traumatic stress disorder; Music therapy; Drumming; Psychotherapeutic interventions

Keywords
Post-traumatic stress disorder; Music therapy; Drumming; Psychotherapeutic interventions
Introduction
Post-traumatic stress disorder (PTSD) is a condition that has lasting effects, including evoking strong emotions in patients who have experienced traumatic events [1]. As the condition progresses, side effects manifest, such as adverse emotional reactions to the events even years later [1]. The most common types of treatment for PTSD are the use of pharmaceutical drugs and psychotherapeutic interventions [1]. These include, but are not limited to, serotonin reuptake inhibitors (SSRIs), debriefing methods, and cognitive behavioral therapy [1].
Music therapy is a form of complementary and alternative medicine (CAM) which has been gaining popularityin the United States [2]. For example, the use of drums has become a stress relieving therapy when in time of war [3]. CAM could be used for soldiers and other populations who have found themselves dealing with PTSD. When used as CAM, music therapy can incorporate groups to come together with simple instruments, such as drums [3]. Whether it is for soldiers or refugees, music therapy could allow them to feel connected to society once again [3]. Therefore, it is of particular interest to understand whether and how music therapy could be used to treat people with PTSD. The purpose of this literature review is to summarize the findings of music therapy as a potential treatment modality for patients suffering from PTSD compared with traditional pharmaceutical treatments.
Literature Review
PTSD is a condition that affects millions of people each year, regardless of age, gender, race and ethnic background [4]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PTSD is categorized as “trauma- and stressorrelated disorders” with exposure to a traumatic event as part of diagnostic criteria [5]. When discussing PTSD, one of the most common groups of affected individuals are military personnel. This is simply because they are involved in an occupation in which they are constantly exposed to traumatic events. Though some events are more severe than others, when taken out of the environment in which trauma occurred, the lasting effects of an incident tend to follow and haunt the individual involved [1]. Children and adults of all ages can also be affected by traumatic events that may result in PTSD. Currently, the most frequently studied treatment for PTSD is perhaps the use of selective serotonin reuptake inhibitors (SSRIs) [6]. SSRIs were originally used for the treatment of depression, panic disorder, and obsessive compulsive disorder [7]. Multiple clinical trials have been conducted to test the effects of the combination of SSRIs along with other drugs, but it was found that SSRIs were shown to be most effective in the pharmaceutical market [7]. A particular benefit of using SSRIs is that in randomized controlled trials they were found to decrease alcohol consumption and feelings of emotional numbness among patients with PTSD [7]. This is one of the many examples that makes SSRIs stand out from the rest of the pharmaceutical drugs, and the drug of choice over the years when health care providers were dealing with patients suffering from PTSD.
Meanwhile, similar to all pharmaceutical drugs, there are side effects and risks associated with SSRIs [8]. It is important to take into account that everyone responds to a medication in different ways [8]. In one study, after examining patients who were on long term SSRI treatments, up to 75% of individuals were found to have acquired adverse effects from the drugs, including sexual dysfunction [6]. Other side effects of long term use of SSRIs are nausea, weight gain and sleep disturbance [6]. It’s interesting to see sleep disturbance as a side effect, when this is also one of the common symptoms of patients suffering from PTSD [6].
Researchers now look to CAM for the treatment of psychological disorders. Some common CAM treatments that have been found to be effective include spirituality, yoga, chiropractic, music therapy, and aromatherapy [2]. CAM tends to focus more on the mind, body, and soul of the individual with the disorder as opposed to placing them in a category with thousands of others who are experiencing similar symptoms [2].
Music therapy has been a therapeutic counseling treatment for hundreds of years, mainly starting in tribal villages [3]. Playing music allows individuals to express themselves when it comes to their emotions, at times when words are not able to be formed [3]. In Bensimon’s study regarding the art of drumming, it was shown how the act of drumming gave patients with PTSD an idea of togetherness and a sense of belonging [3]. A great aspect found in this treatment was its ability to access memories from traumatic events in a nonintimidating fashion [3]. It also acted as an outlet to release emotions, such as anger and rage, when those memories did come to surface [3]. CAM has a great variety of modalities that use this focus in incorporating many methods to ensure wellness. When using the concept of music therapy, health care professionals can include group exercises and use various resources depending on a given environment [9]. More specifically, focusing on music therapy, it is a way of breaking past the barriers that traumatized patients tend to put up without even knowing [10].
Aside from the fact that pharmaceutical drugs have adverse and variable side effects, music therapy has been shown to be a more versatile and cost-effective treatment option with limited side effects for hospital patients [11,12]. Researchers have noted that CAM is already incorporated in most other cultures [2]. Longrace explained that CAM, such as music therapy, is already seen as primary care in foreign-born populations [2]. Research suggests that music therapy is effective in treating people with psychotic, as well as non-psychotic, mental disorders by improving symptoms and functions associated with conditions [13]. Many individuals suffering from PTSD tend to repeatedly recall past experiences that may remind them of traumatic events they are coping with [11]. Music therapy can be used to cope with this reoccurring fear [9]. Music therapy can also be used in a variety of environments, regardless of age or native language of the patient [3]. Hundreds of years ago, the act of drumming was used in war not only as a signaling method but also surprisingly to calm the troops and even refugees [3]. The idea of music therapy for PTSD is important for health care professions, because more individuals are diagnosed with PTSD, and these people include both military personnel and civilians [4]. Health care professionals need to be aware of the most effective treatments available for PTSD, and which options are effective with fewer side effects for patients.
Music therapy has commonly been used in war trauma healing programs, for both military and civilians, as it promotes healing and reconstruction, and allows people to get back to their everyday lives [9]. Although music therapy has been used for physical healing as well as psychological treatments, experts state that one of the main reasons it has been shown effective is for its direct relationship with emotions [11]. Studies have found that listening to music, and more specifically, engaging in music therapy has a way of affecting an individual’s limbic and paralimbic structures inside the brain [11]. CAM focuses on catering each treatment to the individual’s needs, and this is another aspect that sets music therapy apart from traditional western medicine, such as pharmaceutical interventions. Music is something that can be both played and created by the individual. When creating music, people can cater it to their specific emotion at that given point of time [10]. When the traumatic experiences are not dealt with, patients suffering from PTSD have repetitions of the traumatic event that can be triggered by sounds, smells, or symbols/images [10]. This form of therapy can make the patient feel as if he/she has some control over their treatment, and also allows them to become engaged in the recovery process [10]. Music therapy as a treatment for PTSD can be used as a combination with other treatments, and is not exclusive to any certain populations [4]. This alternative treatment can be used on site when dealing with populations that may not have the time or resources for certain medical facilities. This is especially true of military personnel who are the biggest population suffering from PTSD [4]. In refugee camps, music therapist can be stationed with limited resources and still be able to influence people.
Regarding research focusing specifically on music therapy and PTSD, as Carr and colleagues pointed out [14], there were only a few existing studies. Bensimon and associates [3] explored the therapeutic effects of music therapy group work for six young soldiers diagnosed with PTSD. The treatment used was group drumming with instruments, such as Darbuka, Tabla, Indian Drum, Floor Drum, and Djembe. Each treatment session was 90 mins long, and the entire experiment lasted for four months. The study observed that there were some signs of improvements in PTSD symptoms among the patients, such as increased feelings of openness, togetherness, and intimacy, as well as achieving non-intimidating access to traumatic memories [3]. Furthermore, drumming served as an outlet for rage and promoted relieve and helped to regain self-control for the patients [3]. Carr et al. [14] conducted a randomized controlled trial to examine the effectiveness of music therapy on PTSD. Patients recruited in UK were those suffering from PTSD who had not previously responded to cognitive behavioral therapy. Seventeen patients were randomly assigned to either treatment group (n=9) or control group (n=8). The treatment group received music therapy that consisted of playing a wide range of musical instruments, such as those from Africa, India, Asia, and small percussion. These instruments required no/little prior knowledge or technique to produce a sound, while more complex instruments were also provided to the patients. The intervention was an hour of music therapy per week for a total of 10 weeks, which was provided by music therapists. It was found that after 10 weeks of the treatment, music therapy reduced the severity of PTSD symptoms measured by the Impact of Events Scale-Revised and Beck Depression Inventory II (24.50 reduction) among the patients in the treatment group, which was significantly greater than that of the control group (4.32 reduction). Furthermore, the qualitative data analysis revealed that music therapy was perceived helpful socially and psychologically by the patients.
As with most treatments, there are some challenges in terms of examining the effects of different forms of therapy as it is encountered with various patients. One of the issues faced with treating PTSD victims is the idea that psychological disorders are simply based off of observation [4]. These observations need to be made from a variety of sources, and researchers must remove as much bias as possible [4]. One way to accomplish this is by having consistent self-reports of the patients, but also to gather data from their family and friends with whom they interact in a daily basis [7]. Scientists and researchers explain that one of the difficulties in determining the best pharmaceutical drug was the fact that patients with psychological disorders respond to medications in various ways [7]. The neurological aspect of music therapy shows that it increases language comprehension, making connections in the brain that previously patients were not able to decipher when encountered by a flashback of the traumatic event [11]. Incorporation of different genres of music was found to trigger a response in the amygdala of the brain [11]. The amygdala acts as the headquarters for how the body tends to encounter and carry out various emotions [11]. A combination of different musical methods is able to trigger and evoke responses from many parts of the brain simultaneously [11]. Music therapy allows each patient to have a personalized treatment to cater to their individual situations and diagnoses [3,14]. For instance, playing music can be spontaneous, and music therapy can incorporate various types of instruments based on an individual’s preference and skill level [3,14]. Music therapy allows individuals to perform multitasking while dealing with their traumatic situations [3]. Most people may not regard CAM as a legitimate treatment option for most disorders, and that view is simply because of the lack of research. By incorporating music therapy into treatment options for PTSD, health care professionals can expand this new discovery to other countries, as it is more affordable and takes other factors into account, such as resources and language barriers.
Discussion
Current literature suggests that music therapy could be a viable treatment option for patients suffering from PTSD. This is an important indication, as music therapy could be delivered relatively easily with the lack of harmful side effects [12], as opposed to using pharmaceutical drugs. Also, this form of therapy can be catered to the individual [3,14], as symptoms of PTSD may vary with each patient. Music therapy has potential to be used for various populations, especially for those living in countries where medical resources may be scarce. A limited number of studies have reported the effects of music therapy on reducing symptoms associated with PTSD. Specifically, drumming and playing percussion instruments appear to be beneficial for patients with PTSD. Further research should be conducted to examine the efficacy of which music therapy, along with other conventional/alternative treatments, has on improving symptoms of PTSD. In addition, future studies need to explore how music therapy influences comorbid disorders associated with PTSD, such as depression and anxiety. By following these patients over a longer period of time (=longitudinal studies), the decision of whether or not music therapy needs to be an ongoing treatment for PTSD can be determined.

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