The religion of Evidence Based Practice: Helpful or harmful to music therapy? Prof. Tony Wigram Aalborg University Prof. T...
Evidence Based Practice and a Clinical situation <ul><li>Responses to music therapy compared with other interventions, con...
Evidence Based Practice in music therapy <ul><li>“ ....challenges are being presented to music therapists to demonstrate t...
What are clinicians really supposed to do about this? <ul><li>“ ...Most music therapists are, after all, employed to treat...
USA American Music Therapy Association (AMTA) INITIATIVE IN RESEARCH <ul><li>AMTA have prepared important documentation th...
EFFECTIVENESS or EFFICACY? <ul><li>Efficacy:  Using a well-controlled experiment, can we show that the treatment affects t...
Relevant studies, articles and books in the literature <ul><li>The Hierarchy of EBP </li></ul><ul><li>High Quality meta an...
John Eisenberg, former head of  Agency for Healthcare Research  and Quality ( AHRQ), observed that  there is  “sufficient ...
A broader understanding of Evidence Based Practice <ul><li>An Approach to health care that promotes the collection, interp...
What does the literature show? <ul><li>Analysis of 4 journals for the last two years: 2008-2009 </li></ul><ul><li>Categori...
Prof. Tony Wigram CADIZ EU Conference  2010 Copyright  2008 - 2009 Total Number of Articles EBP: Case reports EBP: Control...
Prof. Tony Wigram CADIZ EU Conference  2010 Copyright  2008 - 2009 Total Number of Articles EBP: Controlled studies Percen...
Music Therapy in Autism Spectrum Disorder and Developmental Disability Type of Evidence Edgerton 1994 Evidence based Clini...
Edgerton 1994 - Mean Scores for group <ul><ul><li>change from first to last session significant (p < .01) </li></ul></ul>P...
Impact on a Meta Review <ul><li>Gold, C., Voracek, M., &  Wigram, T . (2002). Effects of music therapy with mentally ill c...
Oldfield 2005: Music Therapy Diagnostic Assessment (MTDA)  and Autism Diagnostic Observation Schedule (ADOS) study: Design...
RESULTS <ul><li>There was a 72 % level of agreement when the findings from each assessment identified a diagnosis. The MTD...
Cochrane reviews <ul><li>The Cochrane Library </li></ul><ul><li>Dementia .  2003  ( Vink AC, Birks JS, Bruinsma MS, Scholt...
Music Therapy for Autistic Spectrum Disorder: A Cochrane Review Christian Gold , PhD Bergen University, Norway Tony Wigram...
Outcomes Prof. Tony Wigram CADIZ EU Conference  2010 Copyright
Findings <ul><li>MT  may  help children with ASD to improve communicative skills both gestural (p= .0006) and verbal (p=.0...
Kim, J;  Wigram, T  & Gold, C (2008) The effects of improvisational music therapy on joint attention behaviors in autistic...
Early Social Communication Scale (Mundy et al) – joint attention and social interaction   Prof. Tony Wigram CADIZ EU Confe...
Inter-observer reliability  <ul><li>Dependent variable Agreement  ICC   </li></ul><ul><li>Eye contact frequency  0.96 </li...
Selected session analysis findings; music therapy vs. free play  Eye contact Duration  a significant effect (p <.0001)  wa...
Initiation of engagement by child with autism   condition (p <.0001) , session (p= .0010) and session part (p= .0292).   P...
Therapeutic interventions <ul><li>Highest ‘success’ rate for  any  intervention: about 50% </li></ul><ul><ul><ul><li>no si...
Research Autism UK Website <ul><li>Music Therapy submission by Tony Wigram, Christian Gold & Amelia Oldfield </li></ul><ul...
1, 2 & 3 tick interventions <ul><li>1 Tick: TEACCH; Social Stories, Gluton free Casein free diet, Milieu training, Visual ...
Relevant texts for EBP: 1 Research and Clinical <ul><li>Effectiveness of Music Therapy Procedures, Third Edition: AMTA Pub...
Relevant texts for EBP: 2 Research <ul><li>Ansdell, G; Pavlicevic M & Proctor, S (2001) Presenting the Evidence: A Guide f...
Relevant texts for EBP: 3 Research <ul><li>Dileo, C and Bradt, J (2005) Medical Music Therapy: A Meta-Analysis & Agenda fo...
Quantitative Research Studies 1994-2012 <ul><li>Cochavit Elefant (Israel) 1998-2002  </li></ul><ul><li>COMMUNICATION IN RE...
Mixed design – quantitative and qualitative Research Studies 1994-2007 <ul><li>Hanne Mette Ochsner Ridder (Denmark) 1999–2...
Qualitative Research Studies 1993-2007 <ul><li>Wolfgang Mahns (Tyskland) 1993-1997  </li></ul><ul><li>INTELLECTUAL DISABIL...
Qualitative Research Studies 1993-2007 <ul><li>Torben Moe (Danmark) 1995 - 2000  </li></ul><ul><li>ADULT PSYCHIATRY/SCHIZO...
Relevant texts for EBP: 4 Clinician Observed <ul><li>Bruscia, K (Ed.)(1991) Case Studies in Music Therapy. Barcelona Publi...
Relevant texts for EBP: 5 Client reported <ul><li>Hibben, J (1999) Inside Music Therapy: Client Experiences. Barcelona Pub...
Relevant texts for EBP: 6 Client reported <ul><li>Hibben, J (1999) Inside Music Therapy: Client Experiences. Barcelona Pub...
SHORT SUMMARIES OF ARTICLES: ESSENTIAL INFORMATION <ul><li>Authors </li></ul><ul><li>Title </li></ul><ul><li>Subjects </li...
EXAMPLE <ul><li>Hammer, Susan E. (1996) The Effects of Guided Imagery Through Music on State and Trait Anxiety,  Journal o...
EVIDENCE BASED PRACTICE Music Therapy in Psychiatry Prof. Tony Wigram CADIZ EU Conference  2010 Copyright  Type of Evidenc...
Previous research <ul><li>Cochrane Review: Music Therapy for people with psychotic disorders </li></ul><ul><ul><li>rigorou...
Important review including both psychotic and non-psychotic patients(Gold 2007):  Included studies <ul><li>15 studies incl...
Findings on symptoms <ul><li>Effect on anxiety : Overall effect significant  </li></ul><ul><li>p < .01  </li></ul><ul><li>...
Findings <ul><li>the effects of MT increase with the no. of sessions and negative symptoms respond more quickly than gener...
CONCLUSION: WHAT DOES IT ALL MEAN!!! <ul><li>Research is vital to: </li></ul><ul><li>Establish the value of music therapy ...
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Prof. Tony Wigram, keynote, Cadiz 2010

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Keynote held at the 8th European Music Therapy Congress in Cadiz, Spain, 2010.

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  • IN 2004 AND 2005 I HELD SEMINARS IN DENMARK AS PART OF THE PHD COURSES CALLED: MUSIC THERAPY ACADEMICS IN IVORY TOWERS: THE RELEVANCE OF RESEARCH TO CLINICAL PRACTICE. TODAY I WANT TO LOOK AT THIS AGAIN. WE ARE FACING AN INCREASING CHALLENGE TO PROVIDE EVIDENCE IN SOME COUNTRIES. THERE IS SIMPLY NOT ENOUGH MONEY TO FUND ALL THE POTENTIALLY GOOD INTERVENTIONS IN HEALTH, EDUCATION OR THE SOCIAL SYSTEM WHAT IS IT LIKE IN COUNTRIES I HAVE VISITED OR WORKED IN: UK, USA, BELGIUM, SPAIN, DENMARK, NORWAY, AUSTRALIA, FINLAND, EBP NEEDS THREE THINGS – RESEARCH, GOOD CLINICAL PRACTICE, AND CLIENTS WHO FIND A THERAPY EFFECTIVE. WE ARE RATHER GOOD AT REPORTING THE MIDDLE OF THESE THREE, BUT NOT SO GOOD AT THE OTHER TWO. I HAVE SPENT THE LAST 15 YEARS BUILDING A RESEARCH PROGRAMME IN EUROPE AT AALBORG UNIVERSITY, WHERE THE DANISH GOVERNMENT HAVE INVESTED SUBSTANTIALLY IN TRAINING MUSIC THERAPY RESEARCHERS AT DOCTORAL LEVEL. I WANT TO DRAW ON MY EXPERIENCES OF BUILDING UP A RESEARCH SCHOOL IN A UNIVERSITY WHERE I CURRENTLY HAVE 13 REGISTERED PHD’S. I ALSO WORKED FOR 33 YEARS IN CLINICAL PRACTICE FOR AT LEAST THE FIRST 15 YEARS, I DID NOT THINK ABOUT EBP, OR RELY ON ARTICLES AND RESEARCH STUDIES TO SUPPORT MY POSITION. I IMAGINE MANY OF YOU ARE ALSO CLINICIANS IN PRACTICE, AND ARE NOT EXPECTING YOUR SELVES TO START DOING RESEARCH.
  • WHERE DID EVIDENCE BASED PRACTICE COME FROMIN 2002, I WROTE “ ....CHALLENGES ARE BEING PRESENTED TO MUSIC THERAPISTS TO DEMONSTRATE THAT THEY ARE PROVIDING TREATMENT AND INTERVENTIONS THAT ARE SUPPORTED BY STUDIES, ARTICLES AND EXPERT OPINION WITHIN THE HIERARCHY OF EBP. MANY THERAPISTS MAY BE UNPREPARED TO RESPOND TO DEMANDS FOR EVIDENCE, AND MAY NOT HAVE THE RESOURCES AT THEIR DISPOSAL TO COLLECT, ANALYSE AND ACCUMULATE EVIDENCE.....” WIGRAM, T (2002) INDICATIONS IN MUSIC THERAPY. BRITISH JOURNAL OF MUSIC THERAPY 16,(1)
  • IN THE 2002 ARTICLE I ALSO ASKED WHAT ARE CLINICIANS REALLY SUPPOSED TO DO ABOUT THIS? “ ...MOST MUSIC THERAPISTS ARE, AFTER ALL, EMPLOYED TO TREAT PATIENTS, WRITE REPORTS, AND ATTEND MEETINGS CLOSELY CONNECTED TO THEIR CLINICAL CASELOAD.......THEY ARE CERTAINLY NOT PAID TO BE RESEARCHERS...”
  • AMTA have prepared important documentation that ALL music therapists must attend to – clinicians, educators, managers and researchers Explaining the heirarchy of EBM/EBP Explaining differences between efficacy and effectiveness Explaining Research Utilisation – drawing on many types of research to support clinical practice AMTA propose more… Research based music therapy education
  • Efficacy: Using a well-controlled experiment, can we show that the treatment affects the outcome? (Presumes outcomes are operationalized and can be measured via valid and reliable technology) Effectiveness: Does the treatment affect the outcome in the real world? Effectiveness studies usually follow efficacy trials. Traditional medical research looks at questions of efficacy first. However, in the MT research literature, the opposite occurs for several reasons including, economy, client/patient access, and measurement. Efficacy research strives for high internal validity but at the expense of generalizability. Early drug trials are studies of efficacy without respect to the ‘real world’ situations of patients and health access and delivery. Effectiveness seeks high external validity but at the expense of careful controls. The conventional and traditional medical research community tends to regard efficacy studies over effectiveness studies while the practice community prefers effectiveness studies. Both have their place and are appropriate in the research continuum and process.
  • THE HEIRARCHY OF EVIDENCE FROM THE OXFORD CENTRE FOR EVIDENCE BASED PRACTICE IS VERY COMPLEX WE CAN SIMPLIFY THIS HEIRARCHY TO BE MORE USER FRIENDLY FOR MUSIC THERAPY, WITHOUT LOSING THE ESSENTIAL ELEMENTS. THIS INCLUDES THREE ESSENTIAL FORMS OF EVIDENCE I WILL EXPLAIN IN A MOMENT. THE HIERARCHY OF EBP HIGH QUALITY META ANALYSES RANDOMISED CONTROLLED TRIALS (RCT’S) REVIEWS OF CASE-CONTROL/COHORT STUDIES CASE CONTROLLED TRIALS CASE REPORTS/ CASE STUDIES QUALITATIVE STUDIES EXPERT OPINION
  • WE ALSO NEED TO UPDATE OUR KNOWLEDGE AND SKILLS THROUGH CONTINUING MUSIC THERAPY EDUCATION, PUBLICATIONS AND PROFESSIONAL DEVELOPMENT. JOHN EISENBERG, FORMER HEAD OF AGENCY FOR HEALTHCARE RESEARCH AND QUALITY ( AHRQ), OBSERVED THAT THERE IS “SUFFICIENT EVIDENCE TO SUGGEST THAT MOST CLINICIANS&apos; PRACTICES DO NOT REFLECT THE PRINCIPLES OF EVIDENCE-BASED MEDICINE BUT RATHER ARE BASED UPON:… - TRADITION - THEIR MOST RECENT EXPERIENCE - WHAT THEY LEARNED YEARS AGO IN (MEDICAL) SCHOOL OR - WHAT THEY HAVE HEARD FROM THEIR FRIENDS.” AND HE WAS TALKING TO DOCTORS!
  • ITS VERY IMPORTANT TO REMEMBER …AND TO ARGUE THAT EVIDENCE BASED PRACTICE RELIES ON MORE THAN JUST RESEARCH RESULTS. IN THE UK, THE WELSH OFFICE DEFINED EBP AS: AN APPROACH TO HEALTH CARE THAT PROMOTES THE COLLECTION, INTERPRETATION AND INTEGRATION OF VALID, IMPORTANT AND APPLICABLE PATIENT-REPORTED, CLINICIAN-OBSERVED AND RESEARCH-DERIVED EVIDENCE HOWEVER, TOTAL RELIANCE ON ANY ONE OF THESE ELEMENTS MAY, IN ALL LIKELIHOOD, INTRODUCE BIAS, RESULT IN INEFFECTIVE AND/OR UNSATISFACTORY CARE, AND INFLUENCE OUTCOME – ONE WAY OR ANOTHER. .
  • I have made an Analysis of 4 journals for the last two years: 2008-2009 I Categorized published articles into those that would meet criteria for Evidence Based Practice: Controlled studies Case reports We have to consider how much can be found in music therapy publications to support the profession in demonstrating EBP
  • Here is a table showing the TOTAL number of articles published in these four journals during 2008 and 2009. In the 3 rd and 4 th column you can see how many of these articles were Case reports and how many were controlled studies. In the final column I have calculated the percentage of article that are therefore usable for EBP
  • However – many do now acknowledge case reports as evidence – so when I took those articles away, we can see a much smaller percentage of usable article (Overall 10.3% or 10 articles out of 97) that are usable for EBP.
  • I AM GOING TO LOOK BRIEFLY AT THE RESULTS FROM THREE STUDIES. THERE IS HERE A LIST OF STUDIES, SOME OF WHICH ARE INCLUDED IN THE COCHRANE REVIEW ON AUTISM I DID WITH CHRISTIAN GOLD AND COCHAVIT ELEPHANT. THERE ARE MANY MORE – MY APOLOGIES FOR THOSE I HAVE NOT LISTED HERE – THEY ARE LISTED IN THE COCHRANE REVIEW.
  • CINDY EDGERTON‘S STUDY GAVE US AN IMPORTANT FINDING AS IT DEMONSTRATES IMPROVEMENT OVER TIME IN COMMUNICATIVE ABILITY – A PRIMARY CORE IMPAIRMENT IT ALSO DEMONSTRATES SOMETHING ELSE – THE 6 TH SESSION USED DIRECTED, MORE PEDAGOGICAL TECHNIQUES. THIS INFERS THAT THESE CHILDREN RESPONDED BETTER WITH IMPROVISATION, AND IT ALLOWED THEM MORE CONTROL
  • In the article we published in 2002, there were 11 studies in the meta review, including the Edgerton study. Edgerton study: ES - d = 4.56 (Small effect = .20, Medium effect = .50 and large effect = .80 +) This skewed the results of the meta review to suggest a large mean effect of music therapy when including all 11 studies in the analysis (d = .99) When the Edgerton study was excluded as an outlier, the mean effect of music therapy for the remaining 10 studies fell to a more conservative medium to large effect (d =.61)
  • IN THE UK OLDFIELD DEVELOPED AN ASSESSMENT TOOL THAT IS CORRELATED WITH A STANDARDISED PSYCHOLOGY TOOL – THE AUTISTIC DIAGNOSTIC OBSERVATION SCHEDULE (ADOS). Over a period of two years 30 children attending the Croft children’s Unit and receiving the ADOS and the MTDA were investigated A scoring system for the MTDA, similar to the already existing ADOS scoring system was devised
  • The two assessments showed that there was a 72 % agreement when the findings from each assessment identified a diagnosis. The MTDA provided comparable information to the ADOS. Both are play based assessments, and therefore explore the nature of behaviour by a similar method
  • A REVIEW FOR THE COCHRANE LIBRARY, BEGUN BY DR ARCHIE COCHRANE WHO I MENTIONED EARLIER, IS ACTUALLY THE HIGHEST AND MOST RIGOROUS LEVEL OF REVIEW The Cochrane Library Dementia . 2003 ( Vink AC, Birks JS, Bruinsma MS, Scholten RJPM) Schizophrenia or schizophrenia-like illnesses 2005 ( Gold C, Heldal TO, Dahle T, Wigram T) Autism spectrum disorder 2006 ( Gold C, Wigram T, Elefant C.) 2006 Coronary Heart Disease 2007 (Bradt &amp; Dileo) Depression . 2008 (Maratos AS, Gold C, Wang X, Crawford MJ.) Dr. John Lumley, professor of Vascular Surgury and President of the Music Therapy Charity said that even Dr. Archie Cochrane would have been astonished, and disapproving of the way his dream of a library of quality research reviews are now being used to exclude all other evidence in funding priorities.
  • . Music Therapy for Autistic Spectrum Disorder: A Cochrane Review
  • OUT OF AN ORIGINAL 52 STUDIES (DRAWN FROM A POOL OF 312 STUDIES), THREE STUDIES COULD BE INCLUDED UNDER THE COCHRANE COLLABORATION’S STRICT CRITERIA. PEOPLE (INCLUDING ME) GET QUITE ANGRY AND FRUSTRATED THAT SO MANY STUDIES ARE EXCLUDED HERE – BUT IF YOU DO NOT STICK TO THEIR LIMITS, THE REVIEW WILL NOT BE PUBLISHED. LET ME SAY AGAIN, THAT A COCHRANE REVIEW IS ONE PART OF THE EVIDENCE – NOT ALL OF IT.
  • THE FINDINGS SHOWED THAT MT MAY HELP CHILDREN WITH ASD TO IMPROVE COMMUNICATIVE SKILLS BOTH GESTURAL (P= .0006) AND VERBAL (P=.0009) WHETHER THESE EFFECTS ARE PERSISTENT REMAINS TO BE SHOWN LIMITATIONS: ARTIFICIAL EXPERIMENTAL SETTING: HIGH LEVEL OF STRUCTURE WITHIN MT INTENSIVE, EXTREMELY SHORT-TERM MT FOR CLINICAL PRACTICE: MT IS A PROMISING OPTION TO HELP CHILDREN WITH ASD IMPROVE SOME OF THEIR CORE PROBLEMS
  • I WANT TO ILLUSTRATE IN MORE DETAIL THE VALUE OF MUSIC THERAPY WITH ASD USING A RECENT STUDY FROM AALBORG. THIS STUDY MEASURED JOINT ATTENTION AND SOCIAL BEHAVIOUR – TWO CORE IMPAIRMENTS IN AUTISM. IT WAS A REPEATED MEASURES DESIGN WITH SUBJECTS RANDOMLY ASSIGNED TO THE ORDER OF EXPERIMENTAL AND CONTROL CONDITIONS. 10 subjects: Half the group had music therapy first and free play second, the other half had free play first and music therapy second
  • THESE GRAPHS HOW THE RESULTS OF A STANDARDISED ASSESSMENT WITH THE EARLY SOCIAL AND COMMUNICATION SCALE. AS YOU CAN SEE, THE RESPONSES OF THE CHILDREN WHO HAD MUSC THERAPY FIRST (DOTTED LINE) IMPROVED FROM BASELINE TO MEASUREMENT POINT TWO, WHILE THE RESPONSES OF THOSE RECEIVING FREE PLAY FIRST (CONTINUOUS LINE) IMPROVED MORE IN MUSIC THERAPY, FROM MEASUREMENT POINT 2 TO 3.
  • THE STANDARDISED MEASURES OVER TIME AS PRE, IN BETWEEN AND POST SCORES WERE COMPLIMENTED BY VIDEO ANALYSIS. WE ALL KNOW HOW MUCH VIDEO FOOTAGE SHOWS, BUT ANALYSING THIS DATA REQUIRES VERY DETAILED ATTENTION, AND OBSERVER RELIBILITY. WE GOT A HIGH LEVEL OF INTER OBSERVER RELIABILITY ON ALL CHOSEN VARIABLES, EXECPT PERHAPS IMITATION.
  • THE BOX PLOTS HERE ARE GOOD AT ILLUSTRATING THE DIFFERENCES, AS IN THE EVIDENCE HERE FOR EYE CONTACT DURATION, WHICH FOUND A HIGHLY SIGNIFICANT DIFFERENCE BETWEEN MUSIC THERAPY AND FREE PLAY
  • THIS SHOWS THE SAME RESULTS AS THE LAST BOX, THIS TME FOR HOW MUCH A CHILD WOULD INITIATE ENGAGEMENTS WITH THE THERAPIST. I THNK THIS IS VERY IMPORTANT, AS IT DEMONSTRATES THAT THE CHILDREN SOUGHT ENGAGEMENT WITH THE THERAPIST IN MUSIC THERAPY, BUT DID NOT IN PLAY. THIS IS ONE OF OUR GREAT STRENGTHS, AND THIS DATA STRENGTHENS THIS ARGUMENT.
  • Highest ‘success’ rate for any intervention: about 50% no single therapy helps everyone no single therapy helps everything hard to know who will benefit from what What helps? early intervention intense intervention structure and predictability increasing ‘attention’ to others building up motivation
  • Research Autism UK Website Music Therapy submission by Tony Wigram, Christian Gold &amp; Amelia Oldfield Evaluations by Prof. Tony Charman (UCL); Prof. Patricia Howlin (St. George’s Medical School &amp; Prof. Dido Green (Guy’s Hospital) Music Therapy graded with two ticks based on the research evidence: 2 ticks represents Strong Positive Evidence of effect.
  • 1 Tick: TEACCH; Social Stories, Gluton free Casein free diet, Milieu training, Visual Schedule 2 Ticks: Cognitive Behaviour Therapy; Music Therapy, Anti Depressents (also 3 Hazards); Melatonin 3 Ticks: Early Intensive Behavioural Intervention (LOVAAS); Olonzapine; PECS; Risperidone (also 3 Hazards
  • WHERE ARE THE BEST PLACES TO LOOK FOR MATERIAL AND EVIDENCE: THIS IS ONE BOOK I STRONGLY RECOMMEND
  • Ansdell, G; Pavlicevic M &amp; Proctor, S (2001) Presenting the Evidence: A Guide for Music Therapists Responding to the Demands of Clinical Effectiveness and Evidence-Based Practice. London: Nordoff Robbins Music Therapy Centre This is also an excellent resource that helps students or more early career clinicians to find their way through the jargon, arguments forms of evidence and ways in which to develop EBP. The text also provides resources, helpn and references. Again this is 9 years old, but still very relevant.
  • Dileo, C and Bradt, J (2005) Medical Music Therapy: A Meta-Analysis &amp; Agenda for Future Research This text represents an extraordinary range of research studies involving music therapy and music interventions. The content is exclusively meta reviews that give statistically significant results or music and music therapy interventions. Compared to the Standley reviews(1196,2000), these meta reviews give substantially more and comprehensive information, and demonstrates where music or music therapy is an indicated treatment This text is a very substantial contribution to Evidence Based Practice.
  • Bruscia, K (Ed.)(1991) Case Studies in Music Therapy. Barcelona Publishers. Penn. USA. Wigram, T and de Backer, J (1999) Clinical Applications of Music Therapy in Developmental Disability, Paediatrics and Neurology . Jessica Kingsley Publishers: London Wigram, T and De Backer, J. (1999 ) Clinical Applications of Music Therapy in Psychiatry (1999) Jessica Kingsley Publishers: London Hadley, S (2003) Psychodynamic Music Therapy: Case Studies Ed.Susan Hadley. Barcelona Publishers. Penn. USA. These texts (and many more besides) address the second arm of Evidence Based Practice with well documented case examples of the effect of music therapy, from case reports by experienced clinicians
  • Dileo, C and Bradt, J (2005) Medical Music Therapy: A Meta-Analysis &amp; Agenda for Future Research This text represents an extraordinary range of research studies involving music therapy and music interventions. The content is exclusively meta reviews that give statistically significant results or music and music therapy interventions. Compared to the Standley reviews(1196,2000), these meta reviews give substantially more and comprehensive information, and demonstrates where music or music therapy is an indicated treatment This text is a very substantial contribution to Evidence Based Practice.
  • Hibben, J (1999) Inside Music Therapy: Client Experiences. Barcelona Publishers Denise Grocke: The stories from Denize Grocke’s study on Pivotal Moments in GIM (narrative 33), reported more comprehensively in her doctoral study. In her interview of her pivotal GIM session, Bernadette talks about finding her voice, and subsequently being able to make decisions in her life. Inge Nygaard Pedersen: (in Wigram, T., Nygaard Pedersen, I., &amp; Bonde, L.O. (2002) A Comprehensive Guide to Music Therapy. Theory Clinical Practice, Research and Training. London: Jessica Kingsley Publications.) Reporting a case of a 41 year old man with personality disorder, the thoughts of the client three years after the therapy finished are written down by the client:
  • Hammer, Susan E. (1996) The Effects of Guided Imagery Through Music on State and Trait Anxiety, Journal of Music Therapy, 33 (1), 47-70. A study investigating the effects of Guided Imagery through Music (GIM) and relaxation techniques on stress and anxiety levels. 16 subjects involved in alcohol and chemical dependency rehabilitation participated - consisting of an experimental group receiving 10 treatment sessions and a control group receiving no treatment. Stress levels were measured through the State-Trait Anxiety Inventory (STAI) and individual self-reports and evaluations. Test results showed that the experimental group experienced a decrease in perceived situational stress that was statistically significant. Verbal reports and observations corroborated this. Results indicate that GIM may be of benefit to persons with chronic stress and anxiety.
  • THE OTHER CLINICAL AREA I WOULD LIKE TO PAY SPECIFIC ATTENTION TO IS THE FIELD OF MENTAL HEALTH. HERE AGAIN, I WOULD LIKE TO REFER TO JUST TWO STUDIES, A META REVIEW IN PROGRESS BY CHRISTIAN GOLD IN NORWAY, AND A SURVEY STUDY BY ODELL-MILLER WHICH HAS JUST BEEN COMPLETED IN AALBORG. AS WITH AUTISM, THERE ARE MANY VERY WORTHY STUDIES, FROM THE US, EUROPE, ASIA AND AUSTRALIA THAT CAN BE LISTED HERE. I WILL SHOW YOU SOME OF THE AALBORG STUDIES, AND WE HAVE HAD THREE PHD DEFENCES THIS YEAR IN AALBORG – ALL IN THE FIELD OF PSYCHIATRY – ODELL-MILLER, NYGAARD PEDERSEN AND ROLVSJORD
  • THE COCHRANE REVIEW THAT I UNDERTOOK WITH THE NORWEGIAN TEAM CONCENTRATED ONLY ON PSYCHOTIC DISORDERS. IT INCLUDED 4 RCTS TO DATE (2 CHINESE, 2 EUROPEAN) COMPARING MT VS. STANDARD CARE, 1-3 MONTHS THE RESULTS SHOWED POSITIVE EFFECTS ON SYMPTOMS OF SCHIZOPHRENIA (DEPENDING ON NUMBER OF THERAPY SESSIONS) NEGATIVE SYMPTOMS GENERAL SYMPTOMS AND (SOCIAL) FUNCTIONING
  • GOLD HAS NOW COMPLETED A NEW REVIEW. 15 STUDIES ARE INCLUDED OUT OF A POOOL OF 166 8 RCTS, 3 CCTS, 4 UNCONTROLLED STUDIES THEY ARE FROM ALL PARTS OF THE WORLD (FROM NETHERLANDS TO CHINA) MOST COMPARED MT VS. STANDARD CARE INCLUDED 689 PATIENTS TOTAL 456 PSYCHOTIC, 233 NON-PSYCHOTIC (MOSTLY DEPRESSION) THERE WERE 10 STUDIES EXCLUSIVE TO PSYCHOTIC DISORDER AND 3 EXCLUSIVE TO NON-PSYCHOTIC DISORDERS (ALL DEPRESSION) MIXED SAMPLE: 4 STUDIES (BUT OFTEN NOT VERY MIXED)
  • RATHER THAN SHOW SEVERAL MORE GRAPHS, THE RESULTS OF THIS META REVIEW CAN BE SUMMARISED AS FOLLOWS: EFFECT ON ANXIETY : OVERALL EFFECT SIGNIFICANT P &lt; .01 EFFECT ON GENERAL SYMPTOMS: SESSIONS SIGNIFICANT P &lt; .01 EFFECT ON FUNCTIONING: SESSIONS SIGNIFICANT P &lt; .01 EFFECT ON DEPRESSIVE SYMPTOMS: SESSIONS SIGNIFICANT P &lt; .001
  • SO THIS REVIEW SHOWED THAT THE EFFECTS OF MT INCREASE WITH THE NO. OF SESSIONS NEGATIVE SYMPTOMS RESPOND MORE QUICKLY THAN GENERAL SYMPTOMS CONFIRMED AND EXTENDED FINDINGS FROM A PREVIOUS REVIEW CONFIRMED THE ”DOSE-RESPONSE” RELATIONSHIP (AND QUANTIFIED IT) EXTENDED THE FINDINGS TO NON-PSYCHOTIC DISORDERS
  • Research is vital to: Establish the value of music therapy Create jobs Guide clinicians in the best and most effective approaches Research for evidence: we have many studies that provide research evidence and clinician observation but.... We need MORE research results We need to use the research we have to argue our value We need to find out more from our clients – what really does help them?
  • Prof. Tony Wigram, keynote, Cadiz 2010

    1. 1. The religion of Evidence Based Practice: Helpful or harmful to music therapy? Prof. Tony Wigram Aalborg University Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    2. 2. Evidence Based Practice and a Clinical situation <ul><li>Responses to music therapy compared with other interventions, controls or situations </li></ul><ul><li>Kate: Shows almost every aspect of her pathology in the clinical meeting with the family </li></ul><ul><li>Kate: Music therapy shows hand use, turn-taking, developing communicative engagement and reciprocal affective attunement </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    3. 3. Evidence Based Practice in music therapy <ul><li>“ ....challenges are being presented to music therapists to demonstrate that they are providing treatment and interventions that are supported by studies, articles and expert opinion within the hierarchy of EBP. Many therapists may be unprepared to respond to demands for evidence, and may not have the resources at their disposal to collect, analyse and accumulate evidence.....” </li></ul><ul><li>Wigram, T (2002) Indications in Music Therapy. British Journal of Music Therapy 16,(1) </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    4. 4. What are clinicians really supposed to do about this? <ul><li>“ ...Most music therapists are, after all, employed to treat patients, write reports, and attend meetings closely connected to their clinical caseload.......they are certainly not paid to be researchers...” </li></ul><ul><li>Wigram, T (2002) Indications in Music Therapy. British Journal of Music Therapy 16,(1) </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    5. 5. USA American Music Therapy Association (AMTA) INITIATIVE IN RESEARCH <ul><li>AMTA have prepared important documentation that ALL </li></ul><ul><li>music therapists must attend to – clinicians, educators, </li></ul><ul><li>managers and researchers </li></ul><ul><li>Explaining the hierarchy of EBM/EBP </li></ul><ul><li>Explaining differences between efficacy and effectiveness </li></ul><ul><li>Explaining Research Utilisation – drawing on many types of research to support clinical practice </li></ul><ul><li>AMTA propose more… </li></ul><ul><li>Research based music therapy education </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    6. 6. EFFECTIVENESS or EFFICACY? <ul><li>Efficacy: Using a well-controlled experiment, can we show that the treatment affects the outcome? (Presumes outcomes are operationalized and can be measured via valid and reliable technology) </li></ul><ul><li>Effectiveness: Does the treatment affect the outcome in the real world? Effectiveness studies usually follow efficacy trials. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    7. 7. Relevant studies, articles and books in the literature <ul><li>The Hierarchy of EBP </li></ul><ul><li>High Quality meta analyses </li></ul><ul><li>Randomised Controlled Trials (RCT’s) </li></ul><ul><li>Reviews of case-control/cohort studies </li></ul><ul><li>Case controlled trials </li></ul><ul><li>Case reports/ case studies </li></ul><ul><li>Qualitative studies (still not included in the Oxford Centre list) </li></ul><ul><li>Expert Opinion </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    8. 8. John Eisenberg, former head of Agency for Healthcare Research and Quality ( AHRQ), observed that there is “sufficient evidence to suggest that most clinicians' practices do not reflect the principles of evidence-based medicine but rather are based upon:… - tradition - their most recent experience - what they learned years ago in (medical) school or - what they have heard from their friends.” Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    9. 9. A broader understanding of Evidence Based Practice <ul><li>An Approach to health care that promotes the collection, interpretation and integration of valid, important and applicable a) patient-reported , b) clinician-observed and c) research-derived evidence </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    10. 10. What does the literature show? <ul><li>Analysis of 4 journals for the last two years: 2008-2009 </li></ul><ul><li>Categorized published articles into those that would meet criteria for Evidence Based Practice: </li></ul><ul><li>Controlled studies </li></ul><ul><li>Case reports </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    11. 11. Prof. Tony Wigram CADIZ EU Conference 2010 Copyright 2008 - 2009 Total Number of Articles EBP: Case reports EBP: Controlled studies Percentage of articles usable for EBP Journal of Music Therapy 41 6 8 34% Nordic Journal of Music Therapy 18 6 1 38% Music Therapy Perspectives 24 4 1 20% British Journal of Music Therapy 14 4 0 28% TOTALS 97 17 10 27.8%
    12. 12. Prof. Tony Wigram CADIZ EU Conference 2010 Copyright 2008 - 2009 Total Number of Articles EBP: Controlled studies Percentage of articles usable for EBP Journal of Music Therapy 41 8 20% Nordic Journal of Music Therapy 18 1 5.5% Music Therapy Perspectives 24 1 4.2% British Journal of Music Therapy 14 0 0% TOTALS 97 10 10.3%
    13. 13. Music Therapy in Autism Spectrum Disorder and Developmental Disability Type of Evidence Edgerton 1994 Evidence based Clinician Observed Oldfield 2005 Evidence based and Clinician Observed Kim 2008 Evidence based RCT Walworth 2007 Clinician observed Kern and Aldridge 2006 Case series Buday 1995 Case study randomised crossover Brownell 2001 Case studies quasi RCT Farmer 2003 RCT Hairston 1990 Clinician observed Thaut 1988 Experimental study Gold et al 2003 RCT Whipple 2004 Meta review) Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    14. 14. Edgerton 1994 - Mean Scores for group <ul><ul><li>change from first to last session significant (p < .01) </li></ul></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright (graph by CLE, reproduced from JMT)
    15. 15. Impact on a Meta Review <ul><li>Gold, C., Voracek, M., & Wigram, T . (2002). Effects of music therapy with mentally ill children and adolescents: A meta-analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines </li></ul><ul><li>Edgerton study: ES - d = 4.56 (Small effect = .20, Medium effect = .50 and large effect = .80 +) </li></ul><ul><li>This skewed the results of the meta review to suggest a large mean effect of music therapy when including all 11 studies in the analysis (d = .99) </li></ul><ul><li>When the Edgerton study was excluded as an outlier, the mean effect of music therapy for the remaining 10 studies fell to a more conservative medium to large effect (d =.61) </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    16. 16. Oldfield 2005: Music Therapy Diagnostic Assessment (MTDA) and Autism Diagnostic Observation Schedule (ADOS) study: Design <ul><li>Over a period of two years 30 children attending the Croft children’s Unit and receiving the ADOS and the MTDA were investigated </li></ul><ul><li>A scoring system for the MTDA, similar to the already existing ADOS scoring system was devised </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    17. 17. RESULTS <ul><li>There was a 72 % level of agreement when the findings from each assessment identified a diagnosis. The MTDA provided comparable information to the ADOS. Both are play based assessments, and therefore explore the nature of behaviour by a similar method </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    18. 18. Cochrane reviews <ul><li>The Cochrane Library </li></ul><ul><li>Dementia . 2003 ( Vink AC, Birks JS, Bruinsma MS, Scholten RJPM) </li></ul><ul><li>Schizophrenia or schizophrenia-like illnesses 2005 ( Gold C, Heldal TO, Dahle T, Wigram T) </li></ul><ul><li>Autism spectrum disorder 2006 ( Gold C, Wigram T, Elefant C.) 2006 </li></ul><ul><li>Coronary Heart Disease 2007 (Bradt & Dileo) </li></ul><ul><li>Depression . 2008 (Maratos AS, Gold C, Wang X, Crawford MJ.) </li></ul><ul><li>Dr. John Lumley, professor of Vascular Surgury and President of the Music Therapy Charity said that even Dr. Archie Cochrane would have been astonished, and disapproving of the way his dream of a library of quality research reviews are now being used to exclude all other evidence in funding priorities. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    19. 19. Music Therapy for Autistic Spectrum Disorder: A Cochrane Review Christian Gold , PhD Bergen University, Norway Tony Wigram PhD, Aalborg University, Denmark Cochavit Elefant PhD, David Yellin College, Israel Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    20. 20. Outcomes Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    21. 21. Findings <ul><li>MT may help children with ASD to improve communicative skills both gestural (p= .0006) and verbal (p=.0009) </li></ul><ul><li>whether these effects are persistent remains to be shown </li></ul><ul><li>LIMITATIONS: ARTIFICIAL EXPERIMENTAL SETTING: </li></ul><ul><ul><li>HIGH LEVEL OF STRUCTURE WITHIN MT </li></ul></ul><ul><ul><li>INTENSIVE, EXTREMELY SHORT-TERM MT </li></ul></ul><ul><li>for clinical practice: </li></ul><ul><ul><li>MT is a promising option to help children with ASD improve some of their core problems </li></ul></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    22. 22. Kim, J; Wigram, T & Gold, C (2008) The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. Journal of Autism and Developmental Disorder http://www.springerlink.com/content/a8303q12263805n4/ Main Question: Do children show observable and measurable changes in joint attention behavior in response to improvisational music therapy? Design: Repeated measures design with subjects randomly assigned to the order of experimental and control conditions. 10 subjects: Half the group had music therapy first and free play second, the other half had free play first and music therapy second Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    23. 23. Early Social Communication Scale (Mundy et al) – joint attention and social interaction Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    24. 24. Inter-observer reliability <ul><li>Dependent variable Agreement ICC </li></ul><ul><li>Eye contact frequency 0.96 </li></ul><ul><li>Joy frequency 0.91 </li></ul><ul><li>Emotional synchronicity 0.90 </li></ul><ul><li>Initiation of engagement by the child 0.93 </li></ul><ul><li>Musical synchronicity frequency 0.96 </li></ul><ul><li>Turn-taking frequency 0.94 </li></ul><ul><li>Initiation of interaction 0.86 </li></ul><ul><li>Imitation 0.69 </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    25. 25. Selected session analysis findings; music therapy vs. free play Eye contact Duration a significant effect (p <.0001) was found comparing the music therapy condition with free play Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    26. 26. Initiation of engagement by child with autism condition (p <.0001) , session (p= .0010) and session part (p= .0292). Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    27. 27. Therapeutic interventions <ul><li>Highest ‘success’ rate for any intervention: about 50% </li></ul><ul><ul><ul><li>no single therapy helps everyone </li></ul></ul></ul><ul><ul><ul><li>no single therapy helps everything </li></ul></ul></ul><ul><ul><ul><li>hard to know who will benefit from what </li></ul></ul></ul><ul><ul><ul><li> What helps? </li></ul></ul></ul><ul><ul><ul><li>early intervention </li></ul></ul></ul><ul><ul><ul><li>intense intervention </li></ul></ul></ul><ul><ul><ul><li>structure and predictability </li></ul></ul></ul><ul><ul><ul><li>increasing ‘attention’ to others </li></ul></ul></ul><ul><ul><ul><li>building up motivation </li></ul></ul></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    28. 28. Research Autism UK Website <ul><li>Music Therapy submission by Tony Wigram, Christian Gold & Amelia Oldfield </li></ul><ul><li>Evaluations by Prof. Tony Charman (UCL); Prof. Patricia Howlin (St. George’s Medical School & Prof. Dido Green (Guy’s Hospital) </li></ul><ul><li>Music Therapy graded with two ticks based on the research evidence: 2 ticks represents Strong Positive Evidence of effect. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    29. 29. 1, 2 & 3 tick interventions <ul><li>1 Tick: TEACCH; Social Stories, Gluton free Casein free diet, Milieu training, Visual Schedule </li></ul><ul><li>2 Ticks: Cognitive Behaviour Therapy; Music Therapy, Anti Depressents (also 3 Hazards); Melatonin </li></ul><ul><li>3 Ticks: Early Intensive Behavioural Intervention (LOVAAS); Olonzapine; PECS; Risperidone (also 3 Hazards) </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    30. 30. Relevant texts for EBP: 1 Research and Clinical <ul><li>Effectiveness of Music Therapy Procedures, Third Edition: AMTA Publications (2000) </li></ul><ul><li>Reviews of research and documentation in the following areas: </li></ul><ul><li>Music Research in medical Treatment </li></ul><ul><li>Music for Physical Rehabilitation </li></ul><ul><li>Music Therapy and Speech Rehabilitation for Brain Injured patients </li></ul><ul><li>Music with children who are hearing impaired </li></ul><ul><li>Music therapy for Visually impaired </li></ul><ul><li>Music Therapy with Disabled Children and Youth </li></ul><ul><li>Group Music Therapy in Acute Mental Health </li></ul><ul><li>Music Therapy for Older people </li></ul><ul><li>Music therapy in Hospice and Palliative care </li></ul><ul><li>An excellent resource, albeit now 10 years old, that offers an extensive resource of reviews, publications, and evidence based documentation. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    31. 31. Relevant texts for EBP: 2 Research <ul><li>Ansdell, G; Pavlicevic M & Proctor, S (2001) Presenting the Evidence: A Guide for Music Therapists Responding to the Demands of Clinical Effectiveness and Evidence-Based Practice. London: Nordoff Robbins Music Therapy Centre </li></ul><ul><li>Excellent resource </li></ul><ul><li>Helps students or early career clinicians. </li></ul><ul><li>The text also provides resources, help and references. </li></ul><ul><li>Again this is 9 years old, but still very relevant. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    32. 32. Relevant texts for EBP: 3 Research <ul><li>Dileo, C and Bradt, J (2005) Medical Music Therapy: A Meta-Analysis & Agenda for Future Research </li></ul><ul><li>Extraordinary range of research studies involving music therapy and music interventions. </li></ul><ul><li>Exclusively meta reviews that give statistically significant results or music and music therapy interventions. </li></ul><ul><li>These meta reviews give substantially more and comprehensive information, and demonstrates where music or music therapy is an indicated treatment </li></ul><ul><li>This text is a very substantial contribution to Evidence Based Practice. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    33. 33. Quantitative Research Studies 1994-2012 <ul><li>Cochavit Elefant (Israel) 1998-2002 </li></ul><ul><li>COMMUNICATION IN RETT SYNDROME </li></ul><ul><li>Dikla Kerem (Israel) 2003-2008 </li></ul><ul><li>INFANTS WITH COCHLEAR IMPLANTS </li></ul><ul><li>Karin Schou (Denmark) 2004-2007 </li></ul><ul><li>POST CARDIAC SURGURY PATIENTS </li></ul><ul><li>Marith Bergström-Isaacsön(Sweden) 2006-2012 AUTOMIC AROUSAL IN RETT SYNDROME </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    34. 34. Mixed design – quantitative and qualitative Research Studies 1994-2007 <ul><li>Hanne Mette Ochsner Ridder (Denmark) 1999–2003 </li></ul><ul><li>ALTZHEIMERS AND DEMENTIA </li></ul><ul><li>Lars Ole Bonde (2003-2005) (Denmark) </li></ul><ul><li>REHABILITATION OF CANCER SURVIVORS </li></ul><ul><li>Jinah Kim (Korea) 2003-2006 </li></ul><ul><li>JOINT ATTENTION IN AUTISM </li></ul><ul><li>Helen Odell- Miller (UK) 2002-2007 </li></ul><ul><li>EFFECTIVE INTERVENTIONS IN PSYCHIATRY </li></ul><ul><li>Carola Maack (Germany) 2006-2012 </li></ul><ul><li>COMPLEX POST TRAUMATIC STRESS DISORDER </li></ul><ul><li>Bolette Beck (Denmark) 2007-2013 </li></ul><ul><li>WORK RELATED STRESS DISORDERS </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    35. 35. Qualitative Research Studies 1993-2007 <ul><li>Wolfgang Mahns (Tyskland) 1993-1997 </li></ul><ul><li>INTELLECTUAL DISABILITY </li></ul><ul><li>Gudrun Aldridge (Tyskland) 1993-1997 </li></ul><ul><li>FEMALE CANCER PATIENTS </li></ul><ul><li>Niels Hannibal (Danmark) 1995-1999 </li></ul><ul><li>PSYCHIATRIC IN-PATIENTS </li></ul><ul><li>Ulla Holck (Danmark) 1996-2000 </li></ul><ul><li>COMMUNICATION IN AUTISTIC CHILDREN </li></ul><ul><li>Trygve Aasgaard (Norge) 1997-2000 </li></ul><ul><li>CHILDREN WITH CANCER </li></ul><ul><li>Jos De Backer (Belgien) 1998-2004 </li></ul><ul><li>ADULT PSYCHIATRY/PSYCHOTICS </li></ul><ul><li>Rudy Garred (Norge) 1999-2003 </li></ul><ul><li>PHILOSOPHICAL STUDY ON DIALOGUE </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    36. 36. Qualitative Research Studies 1993-2007 <ul><li>Torben Moe (Danmark) 1995 - 2000 </li></ul><ul><li>ADULT PSYCHIATRY/SCHIZOTYPICAL </li></ul><ul><li>Inge Nygaard Pedersen (Danmark) 2003-2007 </li></ul><ul><li>COUNTERTRANSFERENCE IN ADULT PSYCHIATRY </li></ul><ul><li>Randi Rolvsjord (Norge) 2004-2007 </li></ul><ul><li>RESOURCES OF PATIENTS: ADULT PSYCHIATRY </li></ul><ul><li>Sanne Storm Wich (Faroen) 2004-2009 </li></ul><ul><li>VOICE ASSESSMENT TOOL: ADULT PSYCHIATRY </li></ul><ul><li>Valgerour Jonsdottir (Island) 2005-2010 </li></ul><ul><li>RESOURCES OF PARENTS OF HANDICAPPED </li></ul><ul><li>Charlotte Lindvang (Danmark) 2005-2011 </li></ul><ul><li>SELF EXPERIENCE TRAINING IN MUSIC THERAPY </li></ul><ul><li>Lisa Summer (USA) 2007-2009 </li></ul><ul><li>GUIDED IMAGERY AND MUSIC: NORMAL POPULATION </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    37. 37. Relevant texts for EBP: 4 Clinician Observed <ul><li>Bruscia, K (Ed.)(1991) Case Studies in Music Therapy. Barcelona Publishers. Penn. USA. </li></ul><ul><li>Wigram, T and de Backer, J (1999) Clinical Applications of Music Therapy in Developmental Disability, Paediatrics and Neurology . Jessica Kingsley Publishers: London </li></ul><ul><li>Wigram, T and De Backer, J. (1999 ) Clinical Applications of Music Therapy in Psychiatry (1999) Jessica Kingsley Publishers: London </li></ul><ul><li>Hadley, S (2003) Psychodynamic Music Therapy: Case Studies Ed.Susan Hadley. Barcelona Publishers. Penn. USA. </li></ul><ul><li>These texts (and many more besides) address the second arm of Evidence Based Practice with well documented case examples of the effect of music therapy, from case reports by experienced clinicians </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    38. 38. Relevant texts for EBP: 5 Client reported <ul><li>Hibben, J (1999) Inside Music Therapy: Client Experiences. Barcelona Publishers </li></ul><ul><li>This text addresses the third arm of Evidence Based Practice – Client </li></ul><ul><li>reports. </li></ul><ul><li>Often forgotten – the clients’ experiences are critical and essential. </li></ul><ul><li>The story of Helen (Chapter 1, p.5) 18 year old suicidal depressed </li></ul><ul><li>patient in a high security hospital: “My intellect was always way ahead </li></ul><ul><li>of my emotions, but in music therapy I had no control over that intellect; </li></ul><ul><li>emotions came first in the music we played…Music Therapy opened up </li></ul><ul><li>channels that felt way beyond my understanding and clearly showed </li></ul><ul><li>my inability to connect my intellect to my emotions ” </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    39. 39. Relevant texts for EBP: 6 Client reported <ul><li>Hibben, J (1999) Inside Music Therapy: Client Experiences. Barcelona Publishers </li></ul><ul><li>Denise Grocke: The stories from Denize Grocke’s study on Pivotal </li></ul><ul><li>Moments in GIM (narrative 33), reported more comprehensively in her doctoral </li></ul><ul><li>study. In her interview of her pivotal GIM session, Bernadette talks about </li></ul><ul><li>finding her voice, and subsequently being able to make decisions in her life. </li></ul><ul><li>Inge Nygaard Pedersen: (in Wigram, T., Nygaard Pedersen, I., & </li></ul><ul><li>Bonde, L.O. (2002) A Comprehensive Guide to Music Therapy. Theory </li></ul><ul><li>Clinical Practice, Research and Training. London: Jessica </li></ul><ul><li>Kingsley Publications.) Reporting a case of a 41 year old man with personality </li></ul><ul><li>disorder, the thoughts of the client three years after the therapy finished are </li></ul><ul><li>written down by the client: </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    40. 40. SHORT SUMMARIES OF ARTICLES: ESSENTIAL INFORMATION <ul><li>Authors </li></ul><ul><li>Title </li></ul><ul><li>Subjects </li></ul><ul><li>Measures or data collected </li></ul><ul><li>Results </li></ul><ul><li>Conclusion </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    41. 41. EXAMPLE <ul><li>Hammer, Susan E. (1996) The Effects of Guided Imagery Through Music on State and Trait Anxiety, Journal of Music Therapy, 33 (1), 47-70. </li></ul><ul><li>A study investigating the effects of Guided Imagery through Music (GIM) and relaxation techniques on stress and anxiety levels. 16 subjects involved in alcohol and chemical dependency rehabilitation participated - consisting of an experimental group receiving 10 treatment sessions and a control group receiving no treatment. Stress levels were measured through the State-Trait Anxiety Inventory (STAI) and individual self-reports and evaluations. Test results showed that the experimental group experienced a decrease in perceived situational stress that was statistically significant. Verbal reports and observations corroborated this. Results indicate that GIM may be of benefit to persons with chronic stress and anxiety. </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    42. 42. EVIDENCE BASED PRACTICE Music Therapy in Psychiatry Prof. Tony Wigram CADIZ EU Conference 2010 Copyright Type of Evidence Gold 2007 Meta Review Odell-Miller 2007 Clinician Observed H annibal, N 1999 Case study clinician Observed Moe, T 2000 Case study clinician observed De Backer, J 2005 Case study clinician observed Nygaard Pedersen, I 2007 Phenomenological case studies Odell-Miller, H 2007 Survey Rolvsjord, R 2007 Case study clinician observed Storm, S 2007++ Experimental/ assessment tool Maack, C 2007++ RCT
    43. 43. Previous research <ul><li>Cochrane Review: Music Therapy for people with psychotic disorders </li></ul><ul><ul><li>rigorous inclusion criteria </li></ul></ul><ul><ul><li>4 RCTs to date (2 Chinese, 2 European) </li></ul></ul><ul><ul><li>MT vs. standard care, 1-3 months </li></ul></ul><ul><ul><li>positive effects on symptoms of schizophrenia (depending on number of therapy sessions) </li></ul></ul><ul><ul><ul><li>negative symptoms </li></ul></ul></ul><ul><ul><ul><li>general symptoms and (social) functioning </li></ul></ul></ul><ul><li>available: www.thecochranelibrary.com or www.uib-no/people/cgo022 </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    44. 44. Important review including both psychotic and non-psychotic patients(Gold 2007): Included studies <ul><li>15 studies included out of a pool of 166 </li></ul><ul><ul><li>8 RCTs, 3 CCTs, 4 uncontrolled studies </li></ul></ul><ul><ul><li>from all parts of the world (from Netherlands to China) </li></ul></ul><ul><li>most compared MT vs. standard care </li></ul><ul><li>included 689 patients total </li></ul><ul><ul><li>456 psychotic, 233 non-psychotic (mostly depression) </li></ul></ul><ul><ul><li>Number of sessions ranged from 6-78 </li></ul></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    45. 45. Findings on symptoms <ul><li>Effect on anxiety : Overall effect significant </li></ul><ul><li>p < .01 </li></ul><ul><li>Effect on general symptoms: sessions significant p < .01 </li></ul><ul><li>Effect on functioning: sessions significant p < .01 </li></ul><ul><li>Effect on depressive symptoms: sessions significant p < .001 </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    46. 46. Findings <ul><li>the effects of MT increase with the no. of sessions and negative symptoms respond more quickly than general symptoms </li></ul><ul><li>These results confirmed and extended findings from a previous review by </li></ul><ul><ul><li>confirming the ”dose-response” relationship </li></ul></ul><ul><ul><li>Including in the new sample non-psychotic disorders which further extended the findings </li></ul></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
    47. 47. CONCLUSION: WHAT DOES IT ALL MEAN!!! <ul><li>Research is vital to: </li></ul><ul><li>Establish the value of music therapy </li></ul><ul><li>Create jobs </li></ul><ul><li>Guide clinicians in the best and most effective approaches </li></ul><ul><li>Research for evidence: we have many studies that provide research evidence and clinician observation but.... </li></ul><ul><li>We need MORE research results </li></ul><ul><li>We need to use the research we have to argue our value </li></ul><ul><li>We need to find out more from our clients – what really does help them? </li></ul>Prof. Tony Wigram CADIZ EU Conference 2010 Copyright
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