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



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.


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.).


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




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