正式的音乐治疗显然可以改善忧郁情绪

摘要：根据一项回顾5项小型随机分派研究的文献，音乐疗法相较于忧郁症标准照护，改善忧郁情绪的幅度显然较大。来自英国伦敦NHS信托中央与西北伦敦基金会的主要作者Anna Moratos向Medscape精神医学表示，这4项研究都显示音乐疗法具有正面的效果，她观察到，相较于没有提供正式治疗方法的标准照护，该研究报导音乐治疗并没有显著......

　　根据回顾5项小型随机分派研究的文献，音乐疗法相较于忧郁症标准照护，改善忧郁情绪的幅度显然较大；篇文献线上发表于2008年1月23日的科卡兰系统性回顾资料库。
　　
　　来自英国伦敦NHS信托中央与西北伦敦基金会的主要作者Anna Moratos向Medscape精神医学表示，这4项研究都显示音乐疗法具有正面的效果，她观察到，相较于没有提供正式治疗方法的标准照护，该研究报导音乐治疗并没有显著改善精神状态。
　　
　　然而，该团队表示，因为研究数目过少且品质不佳，这些有潜力的发现需要在未来以严谨的研究方法证实。
　　
　　【接受性与主动性音乐治疗比较】
　　音乐治疗已经被定义为治疗者使用音乐及其所有面向来协助病患改善、回复或是维持健康的人与人之间的过程。
　　
　　Moratos女士解释，音乐疗法有两种，分别是接受性与主动性；接受性的音乐治疗是病患与治疗者一起聆听音乐，该音乐可以被用于放松与激励，且作为情绪、认知功能、人发展与自我抒发。
　　
　　在主动音乐治疗中，病患与治疗者一起即兴演奏音乐；病患并不需要是个有技巧的音乐家；逐渐地你可以从病患得到一些且一起谱成一段音乐，这可以是讨论的基础或是本身作为治疗；我们经常与对口服认知行为疗法没有反应的病患一起工作。
　　
　　她指出，正式的专业大约发源自1950年代，且越来越广为周知，英国已经有等同于硕士学位的专业训练。
　　
　　音乐疗法对苦于忧郁症的人们来说显然是有益的，但其影响力仍然未知；研究者进行了一项系统性回顾，针对确认音乐疗法是否可以有效降低临床忧郁症状的随机分派研究。
　　
　　她们的研究找出了5篇符合收纳条件的试验，这些试验是在1992年至1999年之间进行的、样本数目并不大，收纳的对象也有差异（包括老年人与年轻人），且使用不同的音乐治疗；在试验开始时，大部分的受试者罹患中重度忧郁症。
　　
　　【音乐治疗试验特质】

试验	受试者，人数	年龄，岁	音乐疗法种类	治疗频率，每周几次	治疗时间，周
1 a	68	60 – 77	主动的	6	8
2	30	> 60	接受性的 b	1	8
3	19	14 – 15	接受性的 b	1	—
4 a	60	21 – 62	接受性的 b	2	6
5	60	70 – 82	接受性的 b	2	10

　　a住院病患
　　b与治疗者一起聆听预先录制好的音乐，每组6~8人或单独进行。
　　c每次进行时间从20到90分钟
　　
　　相较于仅接受标准治疗，5项研究中有4项，音乐治疗加上标准治疗可以改善预后，预后是以不同的记分方法评量忧郁症症状；第5项试验，以主动式治疗的音乐疗法，相较于标准照护，对于精神状态的改变并没有显著差异。
　　
　　这些数据并不适合印行综合分析，因为介入之间、研究病患族群、以及量测的预后差异很大。
　　
　　所有试验接受音乐治疗的退出率都很低。
　　
　　Maratos女士表示，这是有些令人惊奇的，音乐疗法似乎对于那些不是在精神治疗雷达上的病患最有效益，这些人包括老年人与年轻人；她附带表示，加上由受过训练的音乐治疗家所提供的音乐治疗，可能可以用于激励那些不愿进行认知行为治疗的年轻人、或是用于对于不擅长诉说自我感受，但习惯于歌唱或是聆听歌曲的老年病患。
　　
　　在最近的一项有关精神分裂症的回顾性文章中，他们发现音乐疗法对于精神分裂症患者也有好的预后。
　　
　　【希望的注解】
　　该团队的结论是，这些小型的试验显示，音乐疗法与至少是短期的情绪改善有关，且超出仅接受标准照护所能提供的多；由退出试验的比率很低来看，这显然是一项耐受性良好的治疗；然而，她们提出警告，试验数目仍然太少、且方法学并不严谨；因此，针对音乐疗法是否可以治疗忧郁症进行大规模高品质的研究，是有必要的，以提供对于其疗效的信心。
　　
　　Anna Maratos是一位州注册音乐治疗家。

Formal Music Therapy Appears to Improve Mood in Depression

By Marlene Busko
Medscape Medical News

Music therapy appears to result in greater mood improvement than standard care alone for depression, according to a review of 5 small controlled trials, published online January 23, 2008 in the Cochrane Database of Systematic Reviews.

"All [4] studies that had formal music therapy approaches showed positive results," lead author Anna Moratos, from the Central and Northwest London Foundation NHS Trust, in London, United Kingdom, told Medscape Psychiatry. The study that did not report a significant improvement in mental state with music therapy compared with standard care did not appear to offer a formal therapy approach, she observed.

The group notes, however, that due to the small number of studies and the poor quality of the reporting, these promising findings need to be studied more rigorously in future trials.

Receptive vs Active Music Therapy

Music therapy has been defined as "an interpersonal process in which the therapist uses music and all of its facets to help patients to improve, restore, or maintain health," the group writes.

Ms. Moratos explained that there are 2 kinds of music therapy: receptive or active. In receptive music therapy, a person listens to music with a therapist, and the music can be used for relaxation and motivation and as a bridge to emotions, cognitive work, personal development, and self-reflection.

In active music therapy, the patient and therapist play improvisational music together. The patient does not need to be a skilled musician. "Gradually you draw out from the patient something musical and build a piece of music together that can be used as the basis for a discussion, or it can be the therapeutic agent in itself," she said. "We often work with people who do not [respond to] verbal cognitive behavioral therapies," who cannot articulate difficult feelings, she added.

The formal profession has been around since about the 1950s, she said, noting that it is becoming more recognized now, and in the United Kingdom training is available at the master's level.

Music therapy appears to be beneficial for people who suffer from depression, but its impact is unclear. The researchers conducted a systematic review of randomized controlled trials to determine whether musical therapy is effective in reducing the symptoms of clinical depression.

Their search identified 5 studies that met the selection criteria. The studies, done from 1992 to 1999, were small, had diverse patient populations (older patients, adolescents), and used different types of music therapy. At study start, most participants had moderate to severe depression.

Music Therapy Study Characteristics

Study	Participants, n	Age, y	Music Therapy Type	Session Frequency, time(s)/wk^c	Duration, wk
1^a	68	60 – 77	Active	6	8
2	30	> 60	Receptive^b	1	8
3	19	14 – 15	Receptive^b	1	—
4^a	60	21 – 62	Receptive^b	2	6
5	60	70 – 82	Receptive^b	2	10

a. In-patients.
b. Listening to prerecorded music with a therapist, either in a group of 6 to 8 or individually.
c. Sessions ranged from 20 to 90 minutes.

In 4 of 5 of the studies, music therapy plus standard therapy led to better outcomes compared with standard care alone, as determined using various scales to measure depression symptoms. The fifth study, in which music therapy was used as an active treatment, reported no significant change in mental state with music therapy compared with standard care.

The data were not suitable for a meta-analysis, due to marked variations in the interventions, populations studied, and outcome measures used.

The dropout rate for music therapy was low for all studies.

"Somewhat surprisingly, music therapy seems to be best targeted to people who are not in the usual 'psychotherapy radar' — adolescents and older adults," Ms. Maratos said, adding that music therapy given by a trained therapist might be used to engage a teenager who does not want to do cognitive behavior therapy homework or an older adult who may be unfamiliar with talking about feelings but used to singing or listening to songs.

They also found good outcomes with music therapy in schizophrenia, in a recent review of that illness, she observed.

A Note of Hope

"These small-scale studies suggest that music therapy is associated, at least in the short term, with improvements in mood that go beyond those found with standard care alone and, based on low dropout rates, appears to be a well-tolerated treatment," the group summarizes. They caution, however, that the number of studies was small and the quality of the methodology was low; therefore, large-scale, high-quality trials looking at music therapy for depression are needed to provide confidence about its effectiveness.

Anna Maratos is a state registered music therapist.

Cochrane Database Syst Rev.2008; Issue 1:CD004517.

发布日期：2008-3-26

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