A Pilot Study Investigating Research Design Feasibility Using Pre-post Measures to Test the Effect of Music Therapy in Psychiatry with People Diagnosed with Personality Disorders

Authors

  • Niels Hannibal Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark
  • Inge Nygaard Pedersen Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark
  • Lars Ole Bonde Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark
  • Lars Rye Bertelsen Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark 2 Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark

DOI:

https://doi.org/10.15845/voices.v19i1.2731

Keywords:

pilot study, personality disorder, process oriented music therapy, mentalization-based treatment

Abstract

Introduction: The objectives of the pilot study were (a) to investigate the feasibility of the research design (referral procedure, data collection procedure, measurement tools, and treatment doses/frequency); (b) to develop and evaluate the PROMT treatment manual; and (c) to test the use of flexible and or multiple interventions as part of the treatment options. Findings from this investigation aim to prepare for a future outcome study of music therapy treatments for patients with personality disorders, that are inspired by analytically oriented music psychotherapy and mentalization-based treatment.

Methods: Four participants assessed and diagnosed with personality disorder received 40 sessions of individual music therapy. Pre and post measures of outcome variables looking at attachment style, helping alliance, symptom severity, interpersonal problems, and quality of life were evaluated for inclusion in the design. Interviews with clinicians were used to further evaluate the manual.

Results: All participants completed treatment. Outcome measurement provided usable information and also showed some positive changes in the four cases. The research design was found to be usable for a larger study. The treatment manual was evaluated as usable, but specification on how to use mentalization-based treatment in music-based interventions is required in a future manual.

Discussion: In light of the current findings, we discuss several factors relevant to a possible future outcome study, including the research design, theoretical model, and specific elements of the treatment manual. We also discuss the potential of using flexible and/or multiple interventions as part of the treatment options. We conclude that integration of mentalization-based treatment into music therapy seems promising, but further development of the treatment manual is needed.

Author Biographies

Niels Hannibal, Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark

Niels Hannibal MT, PhD, Associate Professor at the Music Therapy Education at Aalborg University, clinical music therapist and researcher at the Music Therapy Clinic at Aalborg University Hospital – Psychiatry. NH has over twenty years of clinical experience as a music therapist in psychiatry. He has been researching clinical music therapy since 1995, currently focusing on music therapy and mentalization, patients with personality disorder issues, and alliance building.

Inge Nygaard Pedersen, Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark

Inge Nygaard Pedersen, Associate Professor, PhD at the Department of Communication and Psychology, Aalborg University (DK). She is the Head of The Music Therapy Research Clinic at Aalborg University Hospital, Psychiatry, a certified music therapist, and a GIM therapist and clinical supervisor. Current research projects include an RCT, blinded, multi-site study on music therapy towards negative symptoms for people diagnosed with schizophrenia. Research areas include: music therapy in psychiatry, supervision, experiential, and resonant learning processes for music and other psychotherapists.

Lars Ole Bonde, Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark and Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark

Lars Ole Bonde, PhD, FAMI, is emeritus professor in music therapy at Aalborg University and emeritus professor II at Center for Research in Music and Health (CREMAH) at the Norwegian Academy of Music. He is a certified music therapist and clinical supervisor. In the 1980s and 1990s, he worked as music and concert producer. He served as associate editor of the Nordic Journal of Music Therapy until 2017. His current research projects include music and public health, music therapy for people suffering from schizophrenia, and monographs on the Danish composers Bent Lorentzen and John Høybye. He has published numerous books, book chapters, and articles on the theory and practice of music therapy, music psychology, music education, music theatre, and music and health.

Lars Rye Bertelsen, Department of Communication and Psychology, the Music Therapy Education, Aalborg University, Aalborg, Denmark 2 Music Therapy Clinic, Aalborg University Hospital, Psychiatry. Aalborg, Denmark

Lars Rye Bertelsen MT, PhD student. trained at the Music Therapy Masters Programme at Aalborg University. Currently he is a part-time Ph.D. student researching music medicine in ECT treatment, in ambulances,  and “Culture Vitamines.” He is also co-inventor of “The Music Star” with a deep interest in developing playlists. LRB has been private music therapist clinician since 1988, currently holding a part-time MT position at the University Hospital of Aalborg, Psychiatry.

References

Antonovsky, A. (1987). Unraveling the mystery of health. How people manage stress and stay well. San Fransisco, CA: Jossey-Bass Publishers.

Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorders: Mentalisation-based treatment. Oxford, GBR: Oxford University Press. https://doi.org/10.1093/med:psych/9780198527664.001.0001.

Bateman, A., & Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorder: A practical guide. Oxford, GBR: Oxford University Press. https://doi.org/10.1093/med/9780198570905.001.0001.

Boston Process Change Study Group. (2010). Change in psychotherapy: A unifying paradigm. York, NY: Norton Professional Books.

Bruscia, K. E. (2006). Dynamics of music psychotherapy. Gilsum: Barcelona publishers.

Daubney, M., & Bateman, A. (2015). Mentalization-based therapy (MBT): an overview. Australasian Psychiatry, 23(2), 132-135, https://doi.org/10.1177/1039856214566830.

de Backer, J. (2016). The future of music therapy clinical improvisation. In C. Dileo (Ed.), Envisioning the future of music therapy (pp. 112-122). Philadelphia, PA: Temple University.

Collins, N. L. (1996). Working models of attachment: Implications for explanation, emotion and behavior. Journal of Personality and Social Psychology, 71, 810-832, https://doi.org/10.1037/0022-3514.71.4.810.

Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). Psychological measurements in psychopharmacology. Basel, Switzerland: Karger Publishers. pp. 79-110, https://doi.org/10.1159/000395070.

Derogatis, L. R. (1994). Symptom checklist-90-Revised: Administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems.

Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., & Vanhala…Gold, C. (2011). Individual music therapy for depression: Randomised controlled trial. The British Journal of Psychiatry, 199(2), 132-139, https://doi.org/10.1192/bjp.bp.110.085431.

Eriksson, M., & Lindström, B. (2005). Validity of Antonovsky’s sense of coherence scale: a systematic review. Journal of Epidemiology & Community Health, 59(6), 460-466.

Hannibal, N. (1999). The client's potential for therapeutic insight assessed through the ability to reflect verbally and musically. Nordisk Tidsskrift for Musikkterapi, 8(1), 36-46, https://doi.org/10.1080/08098139909477952.

Hannibal, N. (2001). Præverbal Overføring i Musikterapi: kvalitativ undersøgelse af overføringsprocesser i den musikalske interaktion [Preverbal transference in music therapy: A qualitative investigation of transference process in the musical interaction] (Doctoral dissertation). Aalborg, Denmark: Aalborg University.

Hannibal, N. (2002). Henvisning. assessment og egnethed til musikterapi i psykiatrisk regi. [Refferal, assessment and suitability to music therapy in psychiatry]. Musikterapi i Psykiatrien Online, 3(1), 56-73.

Hannibal, N. (2003). A woman’s change from being nobody to somebody: Music therapy with a middle aged, speechless, and self-destructive woman. In S. Hadley (Ed.), Psychodynamic music therapy: Case Studies (pp. 403-413). Gilsum, NH: Barcelona Publishers.

Hannibal, N. (2005). Beskrivelse af patientpopulationen i klinisk musikterapi på fem psykiatriske institutioner i Danmark i perioden august 2003-juli 2004. [Description of the patientpopulation in clinical music therapy on five psychiatric institutions in Denmark in the period from August 2003-July 2004]. Musikterapi i Psykiatrien Online, 4(1), 65-75.

Hannibal, N. (2008). Gruppemusikterapi med patienter med borderline-personlighedsforstyrrelse i dagbehandlingsregi. [Group music therapy with patients with borderline-personality disorder in day care treatment]. Musikterapi i psykiatrien: årsskrift, 5(1), 76-101.

Hannibal, N., Petersen, B., Windfelt, M., & Skadhede, S. (2008). Gruppemusikterapi i Dagbehandlingsregi: Opsamling på perioden 2003 til 2010. [Group Music Therapy in Day care treatment: Summary form the period 2003 to 2010]. Musikterapi i psykiatrien: årsskrift, 6(1), 27-37.

Hannibal, N. (2013). Mentaliseringsbaseret behandling og musikterapi. [Mentalization based treatment and music therapy]. Musikterapi i Psykiatrien Online, 8(1), 4-16.

Hannibal, N. (2014). Implicit and explicit mentalization in music therapy in the psychiatric treatment of people with borderline personality disorder. In J. De Backer & J. Sutton (Eds.), The music in music therapy: Psychodynamic music therapy in Europe: Clinical, theoretical and research approaches (pp. 211-223). London, GBR: Jessica Kingsley Publishers.

Hannibal, N. (2017). Mentalisering i aktiv musikterapi set i forhold til neuroaffektiv teori. Mentalizing in active music therapy seen in relation to neuroaffective theory. In C. Lindvang & B. D. Beck (Eds.), Musik, krop og følelser. Neuroaffektive processer i musikterapi (pp. 269-284). Frederiksberg, Denmark: Frydenlund Academic.

Hannibal, N., & Pedersen, I. N. (2000). Opgørelse af fremmøde-stabilitet for patienter i musikterapi 1997. [Description of the attendance stability for patients in music therapy in 1997]. . Musikterapi i Psykiatrien Online, 2(1), 141-143.

Hannibal, N., Petersen, B., & Windfeld, M. (2011). Gruppemusikterapi i Dagbehandlingsregi: Opsamling på perioden 2003 til 2010. [Group music therapy in day care treatment]. Musikterapi i Psykiatrien Online, 6(1), 26-37.

Hannibal, N., Pedersen, I. N., Hestbæk, T., Sørensen, T. E., & Munk-Jørgensen, P. (2012a). Schizophrenia and personality disorder patients' adherence to music therapy. Nordic Journal of Psychiatry, 66, 376-379, https://doi.org/10.3109/08039488.2012.655775.

Hannibal, N., Pedersen, I. N., Bonde, L. O., Bertelsen, L. R., Dammeyer, C., & Lund, H. N. (2012b). Manual for procesorienteret musikterapi med personer med bpd. [Manual for process oriented music therapy with people with bpd]. Musikterapi i psykiatrien Online, 7(2), 64-80.

Hannibal, N., & Schwantes, M. (2017). What does music therapy have to offer mentalization based treatment (MBT)? A mentalization-based view on music therapy clinical practice in psychiatry. Voices, 17(2), https://doi.org/10.15845/voices.v17i2.897.

Hawe, P., Shiell, A., & Riley, T. (2004). Complex interventions: How out of control. British Medical Journal, 328, 1561-1563, https://doi.org/10.1136/bmj.328.7455.1561.

Horowitz, L. M., Rosenberg, S. E., & Bartholomew, K. (1993). Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy. Journal of Consulting Clinical Psychology, 61(4), 549-560, https://doi.org/10.1037/0022-006X.61.4.549.

Johansson, H., & Eklund, M. (2006). Helping alliance and early dropout from psychiatric out-patient care. Social Psychiatry and Psychiatric Epidemiology, 41(2), 140-147, https://doi.org/10.1007/s00127-005-0009-z.

Luborsky, L., Barber, J. P., Siqueland, L., Johnson, S., Najavits, L. M., Frank, A., & Daley, D. (1996). The revised Helping Alliance questionnaire (HAq-II): Psychometric properties. The Journal Of Psychotherapy Practice and Research, 5, 260-271.

Lund, H. N., & Fønsbo, C. D. (2012). Musiklyttegrupper – en empirisk undersøgelse af anvendte metoder i psykiatrien. [Music listening groups – an empirical investigation of used methodes in psychiatry]. Musikterapi i psykiatrien, 6(1), 87-101.

Odell-Miller, H. (2007). The practice of music therapy for adults with mental health problems: The relationship between diagnosis and clinical method (Doctoral dissertation). Aalborg, Denmark: Aalborg University. Retrieved from http://vbn.aau.dk/files/41635432/odell_miller.pdf.

Odell-Miller, H. (2016). Music therapy for people with a diagnosis of personality disorder: Considerations of thinking and feeling. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 313-334). Oxford, GBR: Oxford University Press.

Pedersen, I. N. (2002). Music therapy with psychiatric clients. In T. T. Wigram., I. N. Pedersen, & L. O. Bonde (Eds.), A comprehensive guide to music therapy: Theory, clinical practice, research and training (pp. 153-168). London, GBR: Jessica Kingsley Publishers.

Pedersen, I. N. (2003). The revival of the frozen sea urchin: Music therapy with a psychiatric patient. In S. Hadley (Ed.), Psychodynamic music therapy: Case studies (pp. 375-387). Gilsum,NH: Barcelona Publishers. https://doi.org/10.1080/08039480801984271.

Pedersen, I. N. (2014). Analytisk Orienteret Musikterapi (AOM). [Analytic oriented music therapy]. In L. O. Bonde (Ed.), Musikterapi.Teori.Uddannelse.Praksis.Forskning.En håndbog om musikterapi i Danmark. Aarhus, Denmark: Klim Forlaget. [[Music therapy. Theory. Education. Practice. Research. A handbook about music therapy in Denmark]].

Petersen, B., Toft, J., Christensen, N. B., Foldager, L., Munk-Jörgensen, P., Lien, K., & Valbak, K. (2008). Outcome of a psychotherapeutic programme for patients with severe personality disorders. Nordic Journal of Psychiatry, 62(6), 450-456.

Paivio, S., & Bahr, L. (1998). Interpersonal problems, working alliance, and outcome in short-term experiential therapy. Psychotherapy Research, 8(4), 392-407, https://doi.org/10.1080/10503309812331332487.

Rolvsjord, R., Gold, C., & Stige, B. (2005). Research rigour and therapeutic flexibility: Rationale for a therapy manual developed for a randomised controlled trial. Nordic Journal of Music Therapy, 14, 15-32, https://doi.org/10.1080/08098130509478122.

Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47(4), 637-645, https://doi.org/10.1037/a0021175.

Stern, D. (1991). Barnets Interpersonelle Univers [The interpersonal world of the infant: A view from psychoanalysis and developmental psychology]. København, Denmark: Hans Reitzels Forlag.

Stern, D. (2010). Vitalitetsformer - dynamiske oplevelser i psykologi, kunst, psykoterapi og udvikling [Forms of vitality: Exploring dynamic experience in psychology, the arts, psychotherapy, and development]. København, Denmark: Hans Reitzels Forlag.

Strehlow, G. (2009). The use of music therapy in treating sexually abused children. Nordic Journal of Music Therapy, 18(2), 167-183, https://doi.org/10.1080/08098130903062397.

Strehlow, G., & Lindner, R. (2016). Music therapy interaction patterns in relation to borderline personality disorder (BPD) patients. Nordic Journal of Music Therapy, 25(2), 134-158, https://doi.org/10.1080/08098131.2015.1011207.

Strehlow, G., & Hannibal, N. Mentalization in improvisational music therapy. Nordic Journal of Music Therapy, https://doi.org/10.1080/08098131.2019.1574877.

Sundhedsstyrelsen. (2015). National klinisk retningslinje for behandling af emotionel ustabil personlighedsstruktur, borderline type [National clinical guidelins for treatment of emotional unstable personality structure, Borderline type]. Retrieved from https://sundhedsstyrelsen.dk/da/nyheder/2015/~/media/80113F052C3A4097B7772B225256895B.ashx.

Trondalen, G. (2016). Relational music therapy: An intersubjective perspective. Dallas, TX: Barcelona Publishers.

Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620-630, https://doi.org/10.1037/0022-006X.61.4.620.

WHOQoL Group. (1993). Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research, 2, 153-159, https://doi.org/10.1007/BF00435734.

WHOQoL GROUP. (1998). The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. Social science & Medicine, 46(12), 1569-1585, https://doi.org/10.1016/S0277-9536(98)00009-4.

Wigram, T., Pedersen, I. N., & Bonde, L. O. (2002). A comprehensive guide to music therapy: Theory, clinical practice, research and training. London, GBR: Jessica Kingsley Publishers.

World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines (Vol. 1). World Health Organization.

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

Niels hannibal, Inge Nygaard Pedersen, Lars Ole Bonde, Lars Rye Bertelsen

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2019-02-11

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Hannibal, N., Nygaard Pedersen, I., Bonde, L. O., & Bertelsen, L. R. (2019). A Pilot Study Investigating Research Design Feasibility Using Pre-post Measures to Test the Effect of Music Therapy in Psychiatry with People Diagnosed with Personality Disorders. Voices: A World Forum for Music Therapy, 19(1). https://doi.org/10.15845/voices.v19i1.2731

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Vol. 19 No. 1 (2019)

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Research

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