Music Therapy with PTSD

This week I’m reviewing the study “Music Therapy to Regulate Arousal and Attention in Patients with Substance Use Disorder and Posttraumatic Stress Disorder: A Feasibility Study” from the Journal of Music Therapy Fall 2020. This study focused on using specific music therapy interventions to treat patients with Substance Use Disorders (SUD) and Post-Traumatic Stress Disorder (PTSD). Data indicates that patients with these co-existing disorders are harder to treat and more likely to relapse. There has been previous music therapy research on SUD but they focused on outcomes other than the severity of substance dependence and the reduction of substance use. Neurological research indicates that Prefrontal-cortex (PFC) function influences both SUD and PTSD. However, there are few treatments that specifically address hyper-arousal and sustained attention. There was a previous study examining the use of the short-term music therapy arousal and attention treatment (SMAART) intervention with patients with PTSD. This research builds on the previous study to see if the SMAART protocol is effective with people with the dual diagnosis of SUD and PTSD.

Sessions were one hour per week for six weeks. Pre- and post-testing were part of every session. Assessment tools focused on PTSD, sustained attention, and aspects related to substance use. The Bourdon-Wiersma (BW) test was used in order to replicate an earlier study on the use of the SMAART protocol with persons with PTSD. The assessments before and after the treatment period were conducted by a psychologist and the music therapists were not given the results of the testing before treatment. Music therapist conducted a shortened assessment as part of each session. Music therapy interventions used in the session included breathwork and singing, body percussion, and attention control training. They recruited 12 participants. Of those 12, six completed the study.

At least three of the participants showed improvement in PTSD symptoms. The third treatment session showed slight increases in symptoms for nearly all participants but symptoms decreased for the rest of the sessions. Two of the patients who dropped out did so due to experiencing craving or withdrawal. However, the rest of the participants did not experience significant changes in their substance use so the main focus was on controlling PTSD. Some of the fluctuations in symptoms were attributed to the stressors of establishing a therapeutic relationship and a deeper exploration of their PTSD. Dropout rate tends to be high for patients with SUD in general but several patients reported expectations for music therapy not matching the experience.

I found this study to be interesting as much for the things that didn’t work as for whether or not the intervention was effective. In fact, because of the small sample size, the researchers caution against generalizing the data. It doesn’t say what patients were expecting from music therapy, just that their expectations differed. Educating patients on what we do is important in any health care setting, no matter what the discipline is. Recruiting patients was difficult due to the very precise criteria for inclusion and due to scheduling around patients’ other treatments. In addition, one of the assessments, although accurate, was perceived as confrontational by most of the patients.