Enhancing the efficacy of integrative improvisational music therapy in the treatment of depression: study protocol for a randomised controlled trial
Enhancing the efficacy of integrative improvisational music therapy in the treatment of depression: study protocol for a randomised controlled trial
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DOI：
10.1186/s13063-019-3323-6
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发表时间：
2019-04-29
期刊：
影响因子：
2.5
通讯作者：
Gold, Christian
中科院分区：
文献类型：
--
作者：
Erkkila, Jaakko;Brabant, Olivier;Gold, Christian
抑郁症是全世界致残的主要原因之一。并不是所有的抑郁症患者对标准治疗都有充分的反应。在对照试验中显示出良好效果的创新疗法是音乐疗法。先前的一项试验表明，综合即兴音乐疗法（IIMT）对中短期抑郁症状以及焦虑和功能有有益的影响，本试验旨在通过检查IIMT的具体变化来确定其效果的潜在机制和改善。方法/设计将在芬兰的一个单中心进行一项2x2因子随机对照试验，涉及68名诊断为抑郁症的成年人（国际疾病和相关健康问题统计分类第10版F32或F33）。所有参与者都将接受为期6周的双周IIMT，在那里他们被邀请即兴创作音乐，并在一对一的音乐治疗师的指导下反思这些即兴创作。对IIMT的潜在改进将包括：在家听IIMT会议录制的即兴演奏（LH），以促进治疗过程融入日常生活；共振频率呼吸（RFB），在每次治疗开始时进行呼吸练习，以促进情绪的表达和处理。参与者将按1:1:1:1的比例随机分配到每种组合中（单独使用IIMT或同时使用一种或两种增强疗法）。主要结果是在6周时用Montgomery-angstrom - sberg抑郁评定量表（MADRS）测量抑郁症状。次要结局是6个月时出现抑郁症状；6周和6个月时的焦虑、生活质量和功能；以及不良事件。次要的潜在机制/过程变量是每次IIMT前自评的短暂抑郁水平；IIMT + LH作业依从性。统计分析包括意向治疗方法，使用线性混合效应模型检查主要效应（LH vs无LH； RFB vs无RFB）和相互作用效应（LH x RFB）。本试验将有助于理解IIMT的机制，并可能进一步提高干预的有效性，该干预先前被证明优于单独治疗成人抑郁症的标准治疗。
BackgroundDepression is among the leading causes of disability worldwide. Not all people with depression respond adequately to standard treatments. An innovative therapy that has shown promising results in controlled trials is music therapy. Based on a previous trial that suggested beneficial effects of integrative improvisational music therapy (IIMT) on short and medium-term depression symptoms as well as anxiety and functioning, this trial aims to determine potential mechanisms of and improvements in its effects by examining specific variations of IIMT.Methods/designA 2x2 factorial randomised controlled trial will be carried out at a single centre in Finland involving 68 adults with a diagnosis of depression (F32 or F33 in International Statistical Classification of Diseases and Related Health Problems 10th revision). All participants will receive 6weeks of bi-weekly IIMT, where they are invited to improvise music and reflect on those improvisations with a music therapist in a one-to-one setting. Potential enhancements to IIMT will include: home-based listening to recorded improvisations (LH) from IIMT sessions to facilitate integration of therapeutic processing into daily life; and resonance frequency breathing (RFB), a breathing exercise at the beginning of each session to facilitate emotional expression and processing. Participants will be randomised in a 1:1:1:1 ratio into each combination (IIMT alone or with one or both enhancements). The primary outcome is depressive symptoms measured by the Montgomery-angstrom sberg Depression Rating Scale (MADRS) at 6weeks. Secondary outcomes are depressive symptoms at 6months; anxiety, quality of life, and functioning at 6weeks and 6months; and adverse events. Secondary underlying mechanisms/process variables are self-rated momentary depression level before every IIMT session; and homework compliance in IIMT + LH. Statistical analyses involve an intention-to-treat approach, using a linear mixed-effects model examining the main effects (LH vs no LH; RFB vs no RFB) and interaction effects (LH x RFB).DiscussionThis trial will contribute to understanding the mechanisms of IIMT and may further enhance the effectiveness of an intervention that was previously shown to be superior to standard care alone for adults with depression.