Professional Documents
Culture Documents
Example of Final Research Paper
Example of Final Research Paper
Student A
Student B
Student C
Andrews University
MUSIC AND SCHIZOPHRENIA 2
Schizophrenia is one of the most disabling mental and physical illnesses that exist among
the world today. Although it only affects 1% of the adult population in the United States, it has a
devastating effect on the life of a person, the person’s family, as well as society. Many people
who suffer with schizophrenia have a difficult time caring for themselves, holding a job, and
maintaining healthy relationships. In addition, the stigma associated with mental illness prevents
some from seeking proper treatment, which only quickens the progression of the disease.
Schizophrenic symptoms include, but are not limited to, hallucinations, thought derailment, flat
affect, social withdrawal and trouble paying attention. The onset of schizophrenia typically
occurs between ages 16-30 (National Institute of Mental Health, 2016). According to the World
Health Organization, adolescent is described roughly as the period from 10-19 years old. The
the years when they search for a sense of personal identity and independence by exploring
personal values, developing a belief system and setting goals. The occurrence of such a
deteriorating disease at such a pivotal transition in life demands research in using complementary
medicine to assist patients in improving overall health and wellbeing which may not be afforded
The purpose of this literature review was to gather relevant information and draw
conclusions regarding the use of the group music therapy to improve the overall health and
wellbeing of adolescents who suffer from schizophrenia. In this project, health and wellbeing is
defined as “a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity” and are the categories observed for improvement (World Health
MUSIC AND SCHIZOPHRENIA 3
Organization, 1946). Thus, the question to be answered is: In schizophrenic patients, aged 10-19
years old (P), what is the effect of group music therapy in addition to standard facility care (I) as
compared to schizophrenics receiving only standard facility care (C) on the physical (reduction
in symptoms), mental (improved self-esteem) and social (positive interactions) (O) wellbeing of
the patients?
Background
psychosocial treatments. Some side effects of the medication disappear after a few days, but
others may persist, which cause patients to be noncompliant with the medication regimen. It is
imperative that doctors and individuals work together to choose the appropriate treatment plan.
Psychosocial treatments help patients deal with issues that medication can’t solve such as coping
skills, work, maintaining relationships and communication. When these are used collectively,
schizophrenics are less likely to experience relapse and hospitalizations (National Institute of
Mental Health, 2016). Holistic care is vital to the health of these individuals and thus,
Literature Review
The literature review was conducted using the EBSCO and Google scholar online
databases. Key words used when searching the database were schizophrenia, schizophrenic,
music therapy, adolescents, mental illness, psychosis and hallucinations. The time frame for the
literature search ranged from 1999-2016. The literature review focused on music therapy and
schizophrenia and adolescents and music. The inclusion criteria consisted of (1) patients
clinically diagnosed with schizophrenia or any psychotic disorder and the use of music therapy in
treating those individuals and (2) the effect of music on adolescents. Some articles were
MUSIC AND SCHIZOPHRENIA 4
excluded from this literature review because (1) access to the full article could not be retrieved
(2) not enough methodological information and (3) language barriers as some articles were not
translated to English. The two themes that emerged from the research was exploring the effect of
music on severe mental illness and exploring the effect of music on adolescents.
Three research articles addressed the effect of music on patients with severe mental
illness. In the first, A. De Sousa and J. De Sousa (2010) conducted a single blind randomized
controlled trial with 272 patients to explore the effect of music therapy in improving the
symptomatology of chronic schizophrenia. The subjects were between the ages of 18-60 years
with a diagnosis of schizophrenia at least three years prior to the start of the study. Music therapy
was given in daily sessions every day for 30 minutes for one month using a CD player with
speakers. Indian classical music was played with instruments such as the santoor, tabla, shehnai,
flute, sitar and violin. Following the music session, there was a reflection on the type of music.
There were two data collection methods. The first was a structured interview to obtain
demographic and clinical data. The second was the Positive and Negative Symptom Scale for
Schizophrenia, which provides scores in nine clinical domains: positive syndrome, negative
general psychopathology. At the end of 1 month, there were significant differences in certain
areas of the PANSS scores. Scores on the anergia, activation, and depression subscales showed
significant differences with a p<0.0001, while scores on the positive and negative syndromes
differed significantly with a p<0.005. The researchers found that after one month of group music
therapy, there were improvements in the areas of anergia, activation, depression, and positive
and negative syndromes. These results show that music therapy can be used as an adjunct to
MUSIC AND SCHIZOPHRENIA 5
standard care in the management of chronic schizophrenia. The authors recommended that
further studies address the role of long term therapy, as well as the role of various types of music
Sugita, Horiuchi, Sasaki, and & Koike (2010) focused on the effect of group music therapy on
inpatients with chronic psychoses. There were a total of 66 patients, taken from two wards in the
hospital. The music therapy consisted of 15 1-hr per week sessions. The objective of the therapy
communications through musical activities. The measurements used for data collection was the
Positive and Negative Syndrome Scale (PANSS) and the Quality of Life (QLS) scale. To inquire
about the subject’s subjective musical experience in ward life, the authors devised a self-report
scale for assessing musical experiences: one for music listening experience and the other for
ward chorus activity which was carried out independently of the studied musical therapy. The
ward nursing staff also rated the therapy group using a 5-point, 10-item scale for assessing the
Repeated measures ANOVA for the PANSS subscales revealed a significant advantage
of the musical therapy sessions for the symptoms. Individual PANSS items that showed
significant advantage of the musical sessions were emotional withdrawal, poor rapport and
passive apathetic social withdrawal (p<0.05). For the QLS total score, the repeated measures
ANOVA gave a significant finding of an interaction of group and time for the QLS total score
(p<0.05). Individual items that showed a significant interaction of group and time were less
socially withdrawal (p<0.01) and empathy toward other people (p<0.05). All the PANSS and
QLS items that gave positive finding appeared to be related to interpersonal activities. A
MUSIC AND SCHIZOPHRENIA 6
significant finding of the repeated measures ANOVA for music experience scales was an
interaction of group and time for the chorus activity scale (p<0.05), which also suggested an
advantage of the therapy. Overall, the authors found that the music therapy sessions showed a
significant advantage in terms of improvement of the negative symptoms and a QOL measure:
some signs of activation of personal relations, and increased subjective sense of participation in
chorus activity. Authors’ recommendations to this study include having a blind, random
assignment of subjects to each group. Second, the assessors should be blind to the treatment
condition of the subjects. Thirdly, there was no dummy treatment for the waiting group and a
result, the effect of simply having meetings could not be distinguished from the advantage of the
therapy group found in the study. Lastly, the subjects of the study should be more representative
of the population.
The third study completed by Grocke, Bloch, Castle, Thompson, Newton, Stewart, &
Gold (2014) focused on the effect of group music therapy for severe mental illness. There were a
total of 99 participants divided into two cohorts-one randomized and one non-randomized. This
mixed methods approach. Participants were randomized to either: 1) group music therapy (GMT)
and standard care, followed by SC alone or to 2) SC alone, followed by GMT and SC. Group
music therapy was conducted over 13 weeks with 1 hr weekly sessions. It consisted of singing
familiar songs, writing original songs and preparation for recording the original songs in a
professional studio. The quantitative methods included self-reported surveys that measured
quality of life, social support, self-esteem, spirituality and global severity of illness. The
qualitative measures were focus group interviews and song lyrics. The authors found that GMT
had a positive impact on quality of life (p=0.019) as well as spirituality (p=0.026). There was
MUSIC AND SCHIZOPHRENIA 7
also moderate effects of GMT for self-esteem and global severity of illness. Qualitative results
found five themes from the focus group, one of which support the current research question. It
opportunities for creative self-expression, inspired learning and growth, and motivation to attend
the weekly group (p. 150).” Authors found that music therapy could be beneficial to those who
struggle with mental illness. The improvement in the quality of life after GMT showed that
music can provide an avenue for socialization, motivation to attend the group sessions,
appreciation of others, all of which can lead to a reduction in social isolation. It was also
concluded that GMT may enhance the quality of life and spirituality of persons with severe
mental illness. Authors’ recommendations to this study include group music therapy where songs
can be written and then immediately provided for the group members to listen to in the future
weeks and months. In addition, trying to reduce as many factors as possible that would prevent
the phenomenon of mood regulation and music in eight adolescents. The participants listened to
music in their natural setting and data was then collected through interviews and analyzing of
follow-up forms. Each participant was asked to fill out a follow-up form each time they engaged
in a musical activity. Music had an effect both subjectively and physiologically. Musical
activities seemed to regulate three elements of subjective experiences: valence, intensity and
clarity. It affected valence by strengthening positive feelings and helping to move away from
negative feelings. Music also affected the intensity of the current mood that they were in. It
typically increased the intensity. Music also helped to give clarity to their feelings, giving them
the ability to understand their feelings. As it pertains to physiological processes, music increased
MUSIC AND SCHIZOPHRENIA 8
energy levels and uplifted their spirits. Overall, music offered the adolescents a medium in which
to increase and restore well-being and it made their emotional lives more varied and colorful. For
further studies, the authors recommended observing another age group, as well as adolescents
beyond Finland in order to strengthen and refine the developed theory. In addition, this theory
development lays the foundation for further empirical testing. For example, a clinical,
randomized trial involving the effect of preferred music on adolescent behavior should be
Schwartz (2003) performed a non-experimental study and studied 175 adolescents from
Junior and Senior High School, ages ranging from 12-19, to explore the relationship between
music preferences and a variety of emotional, social, and developmental needs in adolescents.
The main purpose of performing this study was to identify and contrast personality
(a) those who preferred light music, (b) those who preferred heavy music, and (c) those who had
no strong preference for either heavy or light music, also known as being “eclectic”. To
commence this study, no intervention was given, however, questionnaires were administered to
adolescents in groups of 15 to 24 during their regularly scheduled class times for the duration of
approximately 40 minutes. The questionnaire measured music preference, how much they
enjoyed music, developmental issues and behaviors that correlated. The Million Adolescent
Personality Inventory (MAPI), which consisted of twenty scales showed that adolescents who
preferred heavy music were: tough- minded, assertive, and impulsive (Forceful scale p <.01,
Impulse Control Scale p < .01). Adolescents who preferred light music were: overly responsible,
rule-conscious, and concerned of being accepted with peers (Respectful scale p < .01, Peer
Security scale < .05). Interestingly enough, adolescents who were more eclectic in their music
MUSIC AND SCHIZOPHRENIA 9
were appeared to be better adjusted with no significant issues with regards to self or others.
Authors concluded each of these three categories has a unique and distinct profile of personality
dimensions and developmental issues which in turn can help in getting to know the background
of music preferences, and using more than one posttest in the case of effects occurring later on
adolescents recruited from outpatient care and special education centers to compare changes over
time in clients receiving music therapy versus those on waiting lists. The purpose of this study
effective treatment for adolescents with psychopathology, as well as examining its effects. For
the duration of 25 weeks, one 45-min session per week was given to the experimental group
consisting of the music intervention, while the control group was put on the waiting list. To
assess levels of capabilities, or competencies, from social competence even to achievement, the
German version of the Child Behavior checklist (CBCL) scale was used, while quality of life
was measured with the Munich Health-Related Quality of Life Questionnaire for children
(KINDL). Medical conditions were present in 73 of the 136 participants, with associated
psychosocial conditions in 88. There were four outcome variables being tested for both groups:
symptoms, competencies, quality of life (parent), and quality of life (self). Results found that the
intervention group showed a medium effect significant improvement on two outcomes: the
CBCL parent rating of symptoms with p <.001, as well as the KINDL parent ratings of quality
life with showed a p-value of .09. Authors concluded that although music therapy was shown to
be a good treatment for children and adolescent with mental disorders, its overall effect to be
MUSIC AND SCHIZOPHRENIA 10
implemented into clinical practice is still uncertain. The study was only able to conclude an
effect in just a fraction of the clients, namely those who didn’t present with any comorbidities.
Researchers recommended using clients with lesser comorbidities or further research on the
Rucsanda (2015) performed an experimental study with fifty adolescent students from High
School to determine if listening to various music genres influence positive or negative emotions
in adolescents. Adolescents in the control group received a questionnaire with a focus on music
preferences in young people, the amount of time spent listening to it, why they listen to the genre
they do and what their emotion is at the time they are listening to it. Over the course of 4 days,
the adolescents in the experimental sample group received the music intervention and listened to
4 different genres of music, one per day as was scheduled. On completion, they would then
indicate their emotional state before and after on a piece of paper, categorized into two
categories: positive emotions and negative emotions. During the listening activity, the
adolescents were then asked to write down any feelings that might have been triggered by the
When it came to reaching a correlation between music and emotional state, authors
noticed: when adolescents felt cheerful 37% listen to pop music, when adolescents feel
enthusiastic 41% listen to pop music, when adolescents feel sad 33% listen to rock music, when
adolescents feel melancholic 34% listen to pop music, and when adolescents feel angry 42%
listen to heavy metal. Authors concluded that the modern music helps to create a foundation for
their lives, and has the capability of influencing their development when it comes to self-concept
and socialization amongst their peers. Authors recommended expanding the repertoire of music
MUSIC AND SCHIZOPHRENIA 11
some from more foreign areas, and performing a randomized controlled trial to help prevent
biases in students.
Hendricks, Robinson, Bradley, and Davis (1999) performed an experimental study where
19 adolescents from Junior High School where studied to determine the efficacy of music
techniques were measured with a pretest and posttest of the Beck Depression Scale. Participants
were first randomly assigned to either the experimental group with the music techniques over 8
weeks, or the control group with no music techniques, but cognitive behavioral group activities
dealing with self-concept. It was discovered that the treatment group’s score was more
significant on the posttest. The t test including the variance of the group means was found to be
significant at the .05 level with p= .0195. Not only did depression decrease in the treatment
group, there was also a 6-month follow-up showing a great decrease in depression with
Because the finding was so significant, authors concluded with an emphasis on paying
attention to the environment of adolescents and their context. It is important to understand some
of their beliefs and values in hopes of fostering a relationship of trust. Authors then mentioned
the necessity of counselors and employees actively listening to youth in order for their needs to
be met. At times this may require going against the tide of tradition, but is necessary to reshape
our approach towards adolescents. Though music techniques have been found to be of help in
adolescents with depression, it is not the “gold standard” for all and counselors must always
consider what will be best for the adolescent. Authors recommended that there should be a larger
MUSIC AND SCHIZOPHRENIA 12
sample size, a more structured curriculum, and a variety of techniques used instead of only music
Summary of Findings
The findings from this literature review support the use of music therapy in the treatment
improve physical, mental and social well-being. As it pertains to physical health, group music
therapy gave an improvement in the both the positive and negative syndromes and energy levels.
The reduction of symptoms can help individuals in having a better quality of life as they attempt
to live a normal life. The mental health of schizophrenics also saw an improvement with the use
of group music therapy. There was an increase in self-esteem as they explored personal
creativity and learned new songs as a group, which also assisted with building social
connections. As a matter of fact, the findings of the study completed by Hayashi et.al (2005),
revealed that the positive findings in the scales used were all related to interpersonal activities.
There is a therapeutic benefit in being with a group who understands the challenges of living
Music also tends to have an influence on adolescents. It was found that music had an
outstandingly strong effect on mood improvement as long as the musical activity was self-
selected. It made the adolescents feel better and change their mood in a positive direction. The
reflective mental work caused by some songs and lyrics provided the adolescents with a deeper
understanding of their unsettling thoughts and improved their knowledge. To determine how
music effected the mood regulation in adolescents, various experimental designs were used and
showed that music acts as an outlet to release feelings such as frustration, happiness, and
sadness. Listening to peaceful or cheerful music when feelings of anger or sadness were present
MUSIC AND SCHIZOPHRENIA 13
for instance, aided in the manifestation of a peaceful and tranquil atmosphere among the youth.
This intervention was also found to aid in building a foundation in socialization amongst peers,
communication, and self-reflection. Of the three music categories in one of our studies, the one
found to be the most emotionally beneficial was light music. Authors noted that light music was
especially helpful in transitioning to being more independent and expressive adults. Overall,
those who responded better towards the music intervention were generally adolescents with
lesser comorbidities.
Conclusion
The use of music therapy in the treatment of mental illness is not unfamiliar to the realm
of research. According to Nizamie and Tikka (2014), there are benefits in using music as part of
the therapeutic environment such as “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 self and environment and improving social
interactions (“Music Therapy, para. 8).” In addition, studies have noted a connection between
music preferences and emotional development in adolescents. Adolescents have used music
effectively and successfully in diverting themselves from stress, worries and disturbances
(Saarikallio & Erkkila, 2007). Overall, an intervention such as this would be best performed in
adolescents presenting with little to no comorbidities, and should consist of a wider realm of
music for participants to choose from. Further research should be explored in a more systematic
way to expand knowledge before implementation should occur, as well as planning effectively to
minimize controllable barriers. The use of music therapy in schizophrenic adolescents is an area
of research that holds much light and promise in improving the physical, mental and social
References
De Sousa, A., & De Sousa, J. (2010). Music therapy in chronic schizophrenia. Journal of
Gold, C., Wigram, T., Voracek, M. (2007). Effectiveness of music therapy for children and
Grocke, D., Bloch, S., Castle, D., Thompson, G., Newton, R., Stewart S., & Gold, C. (2014).
Hayashi, N., Tanabe, Y., Nakagawa, S., Noguchi, M., Iwata C., Koubuchi, Y.,…Koike I. (2002).
Hendricks, B., Robinson, B., Bradley L., Davis K. (1999). Using music techniques to treat
38(1), 39-46.
https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Nizamie, S.H., & Tikka S.K. (2014). Psychiatry and music. Indian Journal of Psychiatry, 56(2),
128-140.
Ruscanda, M. (2015). The effect of various music genres on the adolescents’ emotional state.
Saarikallio, S., & Erkkila, J. (2007). The role of music in adolescents’ mood regulation.
http://www.who.int/about/mission/en/
http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/