Effectiveness of Music Therapy in Mental Health: A Systematic Review

This article presents a systematic review on the effectiveness of music therapy in mental health. The review includes a PICO framework, search strategy, literature review, and conclusion. The article suggests that music therapy can be considered as an effective therapeutic modality for persons with mental disorder.

Running head: ESSAY
Topic Identification & Searching Research Evidence
Name of the Student
Name of the University
Author Note

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Introduction- Mental health refers to the cognitive, emotional and behavioural
wellbeing of individuals and also governs the way by which people think, behave and feel. In
other words, this state of psychological wellbeing is characterized by an absence of mental
disorders and also includes the ability of an individual to enjoy life, whilst maintaining a
balance between psychological resilience and life activities (Clement et al. 2015). According
to the WHO (2014) a person’s wellbeing is encompassed in relation to the realization of the
capability of the person to cope with stressful events of life.
However, there are a range of risk factors that increases the potential of an individual
to suffer from poor mental health. Some of the most common mental disorders are anxiety
disorders, mood disorders, and schizophrenia. Mental health nurses are entitled with the
responsibility of working in specialized fields and have the duty of providing care to people
suffering from a plethora of mental disorder and/or illness. The primary focus of a mental
health nurse is to work in collaboration with people and carers for overcoming the illness
symptoms and continuing personal recovery (Hunter et al. 2015). Thus, implementation of an
evidence based practice in mental health would prove imperative in enhancing the optimal
wellbeing of the affected people.
EBP and mental health nursing- Mental health has been identified as a national
practice priority in Australia. The National safety priorities in mental health plan provides a
direction in recognising, evading and decreasing harm to the affected people, residing across
different environments that has the provision of providing care to those with mental health
disorders. Mental health has also been identified as the topic of interest owing to the fact that
the nation considers safety of mentally ill people to be of utmost importance. Safety has been
recognised as an essential component of the quality of national plan. The National Mental
Health Working Group also works towards implementing the priority plan, with the aim of
providing leadership in the four priority areas (Commonwealth of Australia 2016). These

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areas are characterised by a collective effort of the stakeholders in preventing adverse events,
doing less harm, and increasing the safety of mental health services. Evidence based practice
(EBP) refers to a multidisciplinary approach of clinical practice that involves the
conscientious usage of best available evidences that would help in making essential decisions
related to patient care. This problem solving approach is imperative to mental health practice
owing to the fact that EBP will facilitate a systemic search of relevant literature that are most
relevant to a clinical question (Baker and Tickle-Degnen 2014).
The process will also help in making decision about particular mental health programs
and/or intervention that is based in best available evidences. These would be informed by
experiential evidences related to the domain of mental health. In other words, the three stages
of EBP that will guide the process of clinical decision making encompass (1) gathering
evidences, (2) interpreting evidences, and (3) applying the learnings in practice (Brownson
2017). The primary benefit of EBP in mental health is that it would provide assistance to the
healthcare professionals to remain updated with the clinical relevant and best interventions
that can be implemented upon patients. The fundamental principle of EBP can be associated
with the fact that specific design in study help in providing unbiased answers to a range of
clinical questions. Thus, in relation to a clinical question that concerns treatment, high quality
randomised have been found most effective in producing valid estimates regarding the
effectiveness of the treatment being investigated (Farrelly et al. 2016).
Clinical question- Clinical questions are required to be relevant to the problem or the
group of patients who shall be treated in a way that facilitates the easy search for an answer.
The clinical questions are either foreground or background. A foreground question was
formulated during the research that unravelled answers for specific knowledge related to
depression, a mental illness, in order to inform clinical decisions. A PICO framework was
adopted for the process. This mnemonic is made up of four components that helped in

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formulation of the search strategy via the identification of key concepts related to the clinical
question (Considine et al. 2017). The research question in relation to mental health was as
follows:
Does the administration of music therapy prove effective in reducing symptoms of
mental disorders?
The three components for the aforementioned clinical question is given below.
P (Population/Problem) Individuals with mental disorders
I (Intervention) Music Therapy
C (Comparison) Treatment as usual
O (Outcomes) Reduced symptoms
Table 1- PICO framework
The search strategy involved creating an organised structures of essential search terms or
key phrases that were fed into three electronic databases. The CINAHL Complete, EBSCO
Health, and PsycInfo international database were selected for retrieval of the articles. The
search terms that were fed into the databases were ‘mental’, ‘health’, ‘depression’, ‘anxiety’,
‘illness’, ‘disorder’, ‘mood’, ‘schizophrenia’, ‘obsessive compulsive disorder’, ‘symptoms’,
‘music’, ‘therapy’, ‘intervention’, and ‘management’.
The relationship between the search terms was established with the use of Boolean
operators. ‘AND’ was used for narrowing down the search results. ‘OR’ helped in broadening
the search hits by connecting between the synonyms. Truncations (*) and wildcards were
used for obtaining search results with different endings of the terms or multiple spellings
(McGowan et al. 2016). Search filters that were used for restricting the search to specific
articles were as follows:

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 English published articles
 Publication year 2013-2018
 Peer reviewed articles
This resulted in extraction of seven relevant articles that are discussed below.
Literature review- Verrusio et al. (2014) conducted a randomised controlled trial where
participants with depression were allotted to two groups namely, music and exercise therapy,
and pharmacotherapy. Upon assessing the differences that the music therapy intervention
brought in the state of mood, it was found that patients subjected to exercise and music
demonstrated a noteworthy reduction in the depression and associated anxiety symptoms, at
3-months and 6-months (p<0.05). Average reduction was also observed in the TNF-α from
57.67 to 35.80 pg/ml. The findings of the study established music therapy as a potential
candidate for mental health nursing of depression patients. Similar findings were presented in
another pilot study that recruited 36 male participants in music therapy sessions conducted
over a period of 30 minutes, for six weeks (Hwang and Oh 2013). The sessions comprised of
music listening, singing, and instrument playing. The results suggested absence of any
significant difference in the impacts of the three types of therapies. However, the patients
manifested momentous lessening in their scores related to the presence of depression (3.92-
3.03), anger, anxiety (3.46-2.71), and stress disorder (4.10-2.91). The largest diminution in
scores with respect to music therapy was as follows: stress and anger following music
listening sessions and depression following singing sessions. Thus, it was quite evident from
the article that conducting musical activities are an effective intervention in the
accomplishment of therapeutic goals among mentally ill patients.
Im and Lee (2014) also conducted a trial, the primary aim of which was to investigate the
impacts of music and art therapy on the cognitive function and depression symptoms among

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older adults. The study based on a pre-test and post-test design and was conducted from
January-March 2013, among 94 elderly people who resided in metropolitan areas. Upon
conducting a statistical analysis it was found that the depression scores among the older
adults diminished after implementation of the music therapy. The therapy was effective in
releasing their oppressed feelings, bringing out their emotions and providing them
psychological comfort. Although music therapy failed to bring about any cognitive
improvement, it was highly effective in reducing presenting complaints of depression.
Effectiveness of music therapy in mental health setting has also been established in another
randomised trial where 80 schizophrenic patients having depression and psychiatric
symptoms were randomised to usual care and music therapy groups. Those in the latter group
were subjected to 60 minute long music therapy sessions, held twice a week and
demonstrated statistically significant variations in their depression status (p<0.05) and
psychiatric symptoms (p<0.05). UCG PANSS and MIG scores were 80.80 ± 22.73 and 65.77
± 19.18, respectively. Hence, this formed an essential component of EBP in mental health
(Lu et al. 2013).
Chung and Woods-Giscombe (2016) conducted a systematic review on the effects of the
type, format and dosage of music therapy on individuals diagnosed with schizophrenia. Upon
searching six electronic databases, they retrieved articles that elaborated on the fact that
music therapy was operative in enhancing management of depression, psychotic symptoms,
and anxiety, social behaviour, cognitive functioning, and quality of life among the
participants. Furthermore, the articles also suggested that combination of receptive and active
music therapy demonstrated an increased likelihood to bring about significant improvements
in the mental health outcomes. Music therapy has also been identified as a major form of
non-pharmacological therapy for treating anxiety disorder. A quality improvement (QI)
project appraised the effects of music therapy on anxiety levels, with the use of a visual

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analog scale (VAS) and reported that the intervention was responsible for a significant
lowering in the VAS scores from 3.1 during pre-intervention, to .897 immediately following
the intervention (p= 0.008). Greater score reduction was observed among African Americans,
compared to their Caucasian counterparts (Pavlov et al. 2017).
Bidabadi and Mehryar (2015) also opined that music therapy can be considered as an
adjunct to standard care services among OCD patients. Upon conducting a randomised
controlled trial that allocated patients to two groups namely standard treatment and individual
music therapy, those in the second group demonstrated a greater reduction in the total
obsessive scores (12.4±1.9 versus 15.1±1.7) (p<0.001). Furthermore, noteworthy differences
between the groups were observed in relation to slowness (p=0.019) and checking (p=0.004).
Music therapy also proved effective in lowering rates of anxiety (16.9±7.4 vs 22.9±4.6) and
depressive symptoms (10.8±3.8 vs 17.1±3.7).
Conclusion- Thus, it can be concluded that the systematic review was of the highest
evidence, followed by the individual studies, and the pre-test and post-test trials. The findings
presented above will greatly benefit evidence-based practice in mental health. Hence, the use
of music therapy as a non-pharmacological intervention can be implemented across mental
health settings, to reduce the severity of different mental disorders such as, depression, mood
disorder, anxiety, and schizophrenia. The above evidences were helpful in establishing the
fact that music not only acts in the form of a medium that facilitates the processing of trauma,
emotions, and grief, but can also be exploited as a changeable or comforting instrument for
mental dysregulation. To conclude, patients diagnosed with mental disorders are able to
recognise the soulfulness of music in a similar way, when compared to people without any
mental illness. The evidences support that music therapy can be considered as an effective
therapeutic modality for persons with mental disorder.

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