February, 2015 - Western State Hospital Internship Program

February 02 2015

Article Review: Schizophrenia and Personality Disordered Patients’ Adherence to Music Therapy (Hannibal, N., et al., 2012)

Introduction
The researchers believe that music therapy can be used to effectively treat schizophrenia, depression, and personality disorders. When utilizing both a psychodynamic and relational approach to treatment, music therapy can be used to create the necessary conditions for psychological change and support. The techniques used are both active and receptive: 1) active techniques include making music and/or musical improvisation, such as musical composition (e.g., song writing) or musical performance; 2) receptive techniques include listening and responding to music.

Music therapy is the most common treatment modality for schizophrenia and personality disorders in Denmark. Music therapy has been demonstrated to improve global assessment of functioning, depression, anxiety, and symptoms of psychosis. Improvements can be seen within 12 sessions; however, large effect sizes can be seen after 16-51 sessions. In this study, the researchers investigated treatment adherence for music therapy for both treatment groups (schizophrenia and personality disorders). They were examining two components: 1) general treatment adherence between the two groups; and, 2) factors that could predict treatment adherence. Treatment adherence was defined as staying in treatment during the length of time that was agreed upon. Rates of dropout / discontinuation was used to assess lack of treatment adherence.

Materials and Methods
The researcher examined medical records of 27 patients that began music therapy treatment in 2005-2006 across three psychiatric centers in Denmark in this one year follow up study. The following data was collected: demographic variables, psychiatric variables, and therapeutic variables (e.g., prior therapeutic experiences, concurrent therapeutic experiences, etc.). Of the 27 participants, 10 were diagnosed with Schizophrenia and 17 with a Personality Disorder. Of the 27 participants, 12 were male and 15 were female. Participant ages ranged from 19-59; the mean age was 30. Of the 27 participants, 22 were receiving medication at onset of the study; by the conclusion of the study, 24 were receiving medication. 20 of the participants received group music therapy sessions, while 7 received individual sessions. The majority (24/27) of the participants received music therapy in an outpatient setting.

Results
Of the 27 total participants, only three dropped out. Participants in the Schizophrenia category had a 90 % adherence rate; those in the Personality Disorder category had an 87 % adherence rate. The average number of sessions was 18. The researchers were unable to determine any identifying predictors for adherence (e.g., diagnosis, sex, age, etc.).

Discussion
This study was a naturalistic follow up study examining the adherence rates for music treatment of participants diagnosed with Schizophrenia and participants diagnosed with a Personality Disorder. The findings yielded from this research suggest that patients with Schizophrenia and Personality Disorders can adhere to music therapy treatment. This finding is a contrast from previous research, which indicated that similar patient populations had a low treatment adherence rate when in a music therapy group. The researchers cite the development of a therapeutic alliance between client and clinician as a process that is integral to a successful treatment outcome. Based on the results from the present study, it can be inferred that it is possible to build a strong therapeutic alliance despite severity of illness (as the participants in the current study had severe psychotic and non-psychotic issues).

A limitation of the current study is the low sample size (N = 27). Due to a dropout rate of only three, it is difficult to draw inferences based on demographic, diagnostic, or therapeutic variables. Further, the researchers did not provide data regarding demographic data for those that dropped out, data regarding comorbidity amongst the participants, or data regarding what type of personality disorder a participant had been diagnosed with. Regardless, the present study demonstrates that patients with a primary diagnosis of either Schizophrenia or a Personality Disorder can adhere to music therapy, and it should be viewed as a viable treatment modality for these populations. This can lead the way for further research studies in which a larger number of patients with Schizophrenia and/or Personality Disorders can be assessed.

Hannibal, N., Pedersen, I., Hestb, T., Rensen, T., and Rgensen, P. (2012). Schizophrenia and personality disorder patients’ adherence to music therapy. Nord J Psychiatry, 66, p. 376-379.

Faisal Roberts, MA
WKPIC Doctoral Intern

February 02 2015

Friday Factoids: Common Myths about Panic Attacks

Panic attacks are often described as a sudden fear of dying, going crazy, with an on slot of somatic experiences (e.g., palpitations, sweating, shaking, chest pains, dizziness, paresthesias, etc.). Panic attacks in isolation have a high prevalence in society and result in significant impairment (Kessler et al., 2006). Though not considered a mental disorder, according to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), panic attacks can occur with any anxiety disorder or other mental disorder (American Psychiatric Association, 2013). However, as noted by psychologist Ricks Warren of the University of Michigan there are several myths associated with the experience of panic attacks (Holmes, 2015).

Warren indicates many believe that panic attacks are merely an overreaction to stress. The experience of a panic attack far surpasses being too worried or high strung, instead in the course of a panic attack, one’s fight or flight response is triggered. Individuals feel they are in danger and must avoid the trigger. Others believe that individuals can pass out from a panic attack. Actually, as Warren notes, during a panic attack an individual’s blood pressure actually increases, which is counter to the experience of fainting, where there is a dip in blood pressure. Yet, other physical symptoms are experienced and often individuals feel they may be experiencing a heart attack. Some believe panic attacks are the same as anxiety. In fact they are distinct, while anxiety is considered an overarching term concerning worry, panic attacks are considered episodes. Consequently, one can develop worry about having a panic attack, which alludes to the development of panic disorder.

Warren also highlights misconceptions that some believe panic is a lifelong problem and that it is difficult to relate to someone with panic attacks. Actually, pharmacological and therapeutic interventions have shown to be effective, and through empathy and compassion one can offer support to those who suffer from panic attacks. Finally, it is common to hear people advise taking deep breaths to calm panic or even to avoid what causes the panic attacks. First, deep breaths often incite a hyperventilation state, which exacerbates symptoms of dizziness and numbness; instead, taking shallow breaths has shown to be effective. Furthermore, the act of avoidance leads to living a restrictive life. Instead, it is important to understand that engaging in such safety behaviors reinforces fear; yet, working through these fears alongside a professional can demonstrate how one can overcome them as well as subsequent panic attacks.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Holmes, L. (2015). 9 panic attack myths we need to stop believing. Retrieved from
http://www.huffingtonpost.com/2015/01/29/panic-attack-myths_n_6509750.html

Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006).

The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry, 63(4), 415–424. doi:10.1001/archpsyc.63.4.415

Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee

February 02 2015

Friday Factoid: Self-Affirmation Can Affect Brain Function

The practice of self-affirmation or statements that reflect on one’s core values and beliefs has recently shown to impact how our brain accepts medical advice that is difficult to hear (Simple interventions, 2015).

Researchers at the University of Pennsylvania’s Annenberg School for Communication, alongside researchers at the University of Michigan and the University of California Los Angeles, have examined activity in the ventromedial prefrontal cortex (VMPFC) on a sample of 67 sedentary adults as they were given typical medical advice. The experimental design consisted of participants wearing devices on their wrists to measure activity levels for one week before and one month after receiving feedback of brain activity in the VMPFC. During the monitoring period, all participants were sent text messages related to health risks and activity levels (e.g., “According to the American Heart Associations, people at your level of physical inactivity are at much higher risk for developing heart disease”). The experimental group, in addition to receiving the overall health message, was also sent self-affirmation messages. Results indicate that when self-affirmations were paired with health messages there was an increase in activity in the VMPFC and participants were more likely to follow the advice given.

In theory, the use of self-affirmation helps one reflect on core values, and when people are affirmed, their brains process information differently (Simple interventions, 2015). Thus, self-affirmation allows one to receive threatening messages as more valuable and personally relevant. Furthermore, the VMPFC is an area of the brain that increases activity when individuals think about themselves and when values are ascribed to ideas (Simple interventions, 2015). It is noted that activity in the VMPFC during the reception of a health message can predict behavior change better than one’s own intentions of changing (Simple interventions, 2015). These findings suggest that self-affirmations facilitate change by altering how our brain responds to messages that are counter to our current behaviors.

As a result, it is fitting to quote the character Stuart Smalley from Saturday Night Live, “I’m good enough, I’m smart enough, and dog-gone-it, people like me.”

References

Simple interventions can make your brain more receptive to health advice. Retrieved from (2015, February 2).

To review original article:

Falk, E. B., O’donnell, M. B., Cascio, C. N., Tinney, F., Kang, Y,…Strecher, V. J. (2015). Self-affirmation alters the brain’s response to health messages and subsequent behavior change. Proceedings of the National Academy of Sciences, in press. Epub ahead of print retrieved from http://www.pnas.org/content/early/2015/01/29/1500247112.short?rss=1

Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee

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Monthly Archives: February 2015

Article Review: Schizophrenia and Personality Disordered Patients’ Adherence to Music Therapy (Hannibal, N., et al., 2012)

Friday Factoids: Common Myths about Panic Attacks

Friday Factoid: Self-Affirmation Can Affect Brain Function

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