Songwriting May Hit the Right Therapeutic Note in PTSD

Nancy A. Melville

April 03, 2019

CHICAGO — A novel, collaborative songwriting intervention may reduce symptoms of posttraumatic stress disorder (PTSD), new research suggests.

In the small but innovative study, veterans and service members who were teamed up with songwriters from the Songwriting With: Soldiers (SW:S) program showed a 33% decrease in scores on the PTSD Checklist, Military Version (PCL-M) after 4 weeks.

"We hypothesize that our veterans showed improvement because they used their personalized narrative of trauma and experiences, and thus this may be a unique form of exposure therapy for this population," co-investigator Ron Hirschberg, MD, assistant professor of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, told Medscape Medical News.

"This hypothesis is supported by a significant reduction in symptoms of hyperarousal, which occurs during exposure therapy as well," Hirschberg said.

The findings were presented here at the Anxiety and Depression Association of America (ADAA) Conference 2019.

Sharing Stories Through Music

The clinically meaningful benefits of music have been well documented in everything from neurodegenerative disorders to molar extraction, the researchers note.

In addition, "the use of integrative health modalities to support treatment of stress-related mental health conditions among military populations has been on the rise," they add.

Working with the Home Base Program for veterans and family care in Boston, the investigators teamed up with SW:S, a Nashville-Tennessee-based organization aimed at introducing the art of songwriting to veterans with PTSD.

The current study included 10 veterans and active duty service members (90% men; average age, 35 years) who had a history of PTSD and depression; six also had a history of traumatic brain injury. All were paired with an SW:S songwriter for a 2-hour session of collaborative songwriting.

"This study was meant for any veteran, regardless of their musical background or ability. So there was no expectation that veterans would write their own music," co-investigator Louisa Sylvia, PhD, associate professor of psychology at Harvard Medical School, told Medscape Medical News.

"Instead, they share their story with a professional songwriter and together they write the song, which is completed and recorded before they go home that day," said Sylvia, who is also the director of health and wellness at the Red Sox Foundation and the Massachusetts General Hospital Home Base program. 

The participants were encouraged to listen to their songs daily over a 4-week follow-up period.

They were also provided with a FitBit for recording of physiologic variables such as heart rate and number of steps, and had psychological assessments prior, during, and after the intervention.

All of the veterans had taken part in a previous intensive therapy program, but psychotherapy was not part of the songwriting intervention.

Substantial Improvement

Results showed a significant 33% decrease in PTSD symptoms from baseline to follow-up, as shown by scores on the PCL-M (46.9 vs 39.0, P = .03).

Decreases in depression, as assessed on the Patient Health Questionnaire-9, were smaller (22%) but also observed (P = .07). However, there were no significant changes observed in physiologic data from pre- to post-intervention.

"We were surprised to see such substantial improvements, given that participants were recruited after a 2-week intensive clinical program for PTSD. So baseline symptoms where mild to moderate or not severe," Sylvia said.

With the encouraging results, the researchers are planning larger studies.

"Given the positive results from our pilot study, both in improving symptoms as well as in its acceptability (such as veterans very much enjoyed recording, listening, and sharing their song), we are seeking more funding to better understand how collaborative songwriting helps veterans to feel better," Sylvia said.

She noted that the investigators recently submitted a grant to examine whether veterans' psychophysiologic response, such as heart rate or respiratory rate, "is muted when listening to their song, suggesting that they are experiencing improvements in hyperarousal symptoms."

"This study would help us to identify the mechanism or cause for symptom improvement in veterans with PTSD," she added.

400 Songs

The SW:S program hosts retreats and workshops where veterans and military service members team up with accomplished songwriters.

While emphasizing that the endeavor is not a music therapy program, Mary Judd, cofounder and program director, says it was developed after observing profound effects among veterans who were taking part in informal songwriting collaborations with songwriter and longtime friend, Darden Smith.

Smith, the founder and creative director of SW:S, "was writing a song with a veteran, and what I saw happening was so much of the positive psychology research being played out right in front of me, where a young man who had been in the Army for 5 years was sitting down with someone whom he had nothing in common with, sharing stories and having this unique experience," Judd told Medscape Medical News.

"You could see this release coming over the veteran, and at the end there was a song that encapsulated one of the man's stories," she said.

Judd added that research has associated such positive experiences with greater resilience, and that veterans clearly seem transformed by the experience.

Veterans are often referred to SW:S through contacts with VA Hospitals and Veterans Centers, as well as by mental health professionals. There is no fee for participation.

"We just ask that they get themselves here on their own. The program is otherwise funded by donations and volunteers," Judd said.

According to the organization's website, more than 400 military members and family members have cowritten more than 400 songs.

Effort Applauded

Commenting on the findings for Medscape Medical News, Beth Salcedo, MD, president of the ADAA and medical director of the Ross Center, Washington, DC, said she applauds the effort as offering an important option for individuals struggling with PTSD.

"There is such a stigma for mental health in general, but especially for veterans with PTSD. So I think anything that engages people with any kind of mental illness and doesn't feel as stigmatizing is awesome," Salcedo said.

She added that "there is a lot of science" in terms of what music does for attention and memory.

"So I think looking at any kind of new intervention for groups that are disenfranchised or haven't responded well to treatment is a really smart way to go," said Salcedo. "The songwriting process may allow people to access emotions that they can't otherwise reach just through talking; so it may make sense to pursue this further."

The study investigators and Salcedo have reported no relevant financial relationships. Judd is the cofounder and program director of SW:S.

Anxiety and Depression Association of America (ADAA) Conference 2019: Abstract S1-165. Presented March 29, 2019.

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