Background: Music therapy can lift mood and reduce agitation for people living with dementia (PwD) in community and residential care settings, potentially reducing the prevalence of distress behaviours. However, less is known about the impact of music therapy on in-patient psychiatric wards for PwD. Aims: To investigate the impact of music therapy on two in-patient psychiatric wards for PwD. Method: A mixed-methods design was used. Statistical analysis was conducted on incidents involving behaviours reported as ‘disruptive and aggressive’ in 2020, when music therapy delivery varied because of the COVID-19 pandemic. Semi-structured interviews conducted online with three music therapists and eight ward-based staff were analysed using reflexive thematic analysis. Results: Quantitative findings showed a significant reduction in the frequency of behaviours reported as disruptive and aggressive on days with in-person music therapy (every 14 days) than on the same weekday with no or online music therapy (every 3.3 or 3.1 days, respectively). Qualitative findings support this, with music therapy reported by music therapists and staff members to be accessible and meaningful, lifting mood and reducing agitation, with benefits potentially lasting throughout the day and affecting the ward environment. Conclusions: We identified a significant reduction in the occurrence of distress behaviours on days with in-person music therapy when compared with no music therapy. Music therapy was reported to be a valuable intervention, supporting patient mood and reducing agitation. Interventional studies are needed to investigate the impact of music therapy and its optimum mode of delivery.

People with advanced dementia are at increased risk of institutionalization and experiencing distress. Research suggests that music therapy could reduce distress, but less is known about the causal mechanisms. Here we conducted a realist review to develop a program theory for how music therapy may reduce distress and improve well-being for people with advanced dementia in institutional settings. Initially, data were extracted from key literature alongside secondary reflexive thematic analysis of semi-structured interviews and stakeholder consultation. Subsequently, systematic literature searches were conducted along with a stakeholder survey. Data were extracted to iteratively refine the rough theory. Finally, the program theory was presented to stakeholder groups for consolidation. The theory outlines the core elements of the music therapy intervention alongside the individual, interpersonal and institutional contexts required to instigate hidden mechanisms, including meeting the unmeet needs of the person with dementia in the moment and increasing communication and understanding of music therapy among staff and family members. Outcomes include short-term reductions in distress and improved well-being, with the potential for music to become embedded in the management of distress and regulation of the care environment within the institution. Insufficient data were found to theorize infrastructural factors impacting the use of music therapy with this population. This theory should be tested through empirical research and used to inform clinical practice and policy.

Background: The National Institute for Health and Care Excellence guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress behaviours, such as agitation and depression. However, little is known about the characteristics and outcomes of psychosocial interventions or the facilitators and barriers to implementation on inpatient mental health dementia wards which provide care for people with dementia who are often experiencing high levels of distress. Methods: A systematic search was conducted on MEDLINE, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, and Scopus in May 2023, following PRISMA guidelines. Reference and citation searches were conducted on included articles. Peer-reviewed literature of any study design, relating to psychosocial interventions in inpatient mental health dementia wards, was included. One author reviewed all articles, with a third of results reviewed independently by a second author. Data were extracted to a bespoke form and synthesised using a narrative review. The quality of included studies was appraised using the Mixed Methods Appraisal Tool. Results: Sixteen studies were included in the synthesis, which together included a total of 538 people with dementia. Study methods and quality varied. Psychosocial interventions delivered on wards included music therapy (five studies), multisensory interventions (four studies), multicomponent interventions (two studies), technology-based interventions (two studies), massage interventions (two studies) and physical exercise (one study). Reduction in distress and improvement in wellbeing was demonstrated inconsistently across studies. Delivering interventions in a caring and individualised way responding to patient need facilitated implementation. Lack of staff time and understanding of interventions, as well as high levels of staff turnover, were barriers to implementation. Conclusion: This review highlights a striking lack of research and therefore evidence base for the use of psychosocial interventions to reduce distress in this vulnerable population, despite current healthcare guidelines. More research is needed to understand which psychosocial interventions can reduce distress and improve wellbeing on inpatient mental health dementia wards, and how interventions should be delivered, to establish clinical and cost effectiveness and minimise staff burden.

Recent findings indicate that Music Therapy (MT) and Music-Based Interventions (MBIs) may reduce craving symptoms in people with Substance Use Disorders (SUD). However, MT/MBIs can lead SUD clients to recall memories associated with their drug history and the corresponding strong emotions (addiction memories). Craving is a central component of SUD, possibly linked to relapse and triggered by several factors such as the recall of memories associated with the drug experience. Therefore, to address the topic of what elements can account for an improvement in craving symptoms after MT/MBIs, we conducted a narrative review that (1) describes the brain correlates of emotionally salient autobiographical memories evoked by music, (2) outlines neuroimaging and neurophysiological studies suggesting how the experience of craving may encompass the recall of emotionally filled moments, and (3) points out the role of perineuronal nets (PNNs) in addiction memory neuroplasticity. We highlight how autobiographical memory retrieval, music-evoked autobiographical memories, and craving share similar neural activations with PNNs which represent a causal element in the processing of addiction memory. We finally conclude by considering how the neuroplastic characteristics of addiction memory might represent the ground to update and/or recalibrate, within the therapy, the emotional content related to the recall.

Music therapy research and practice is growing in the field of dementia in residential and community settings. However, less is known about the prevalence and practice of music therapy in acute inpatient settings for people living with dementia. An online survey was distributed to the membership of the British Association for Music Therapy (BAMT) in the UK. Descriptive statistics were generated for quantitative data and thematic analysis was conducted on qualitative data. Fifteen music therapists responded (12.1% of BAMT members working in dementia care). The majority (80%) of respondents were employed by NHS Trusts, and most therapists spent half to one day on acute wards per week. Results showed similarities in patterns of working and theoretical approaches, with live, interactive, instrumental music making used by all and many drawing upon psychodynamic and person-centred approaches to inform their work. Techniques used included singing precomposed songs and instrumental improvisation. All respondents worked during the COVID-19 pandemic, with much variation between NHS Trusts. The challenges and positive aspects of working during the pandemic included a negative impact on staff and patients’ physical and psychological wellbeing, and a raised profile of the arts therapies, respectively. Further research is needed to evaluate the impact of music therapy on people living with dementia in acute NHS settings and raise awareness of how music therapy could help wards to meet the needs of service users as specified in the National Institute for Health and Clinical Excellence (NICE) guidelines.

Music interventions support functional outcomes, improve mood, and reduce symptoms of depression in neurorehabilitation. Neurologic music therapy (NMT) has been reported as feasible and helpful in stroke rehabilitation but is not commonly part of multidisciplinary services in acute or subacute settings. This study assessed the feasibility and acceptability of delivering NMT one-day-per-week in a subacute neurorehabilitation centre over 15 months. Data were collected on the number of referrals, who referred, sessions offered, attended, and declined, and reasons why. Staff, patients, and their relatives completed questionnaires rating the interventions. Patients completed the Visual Analog Mood Scales (VAMS) pre and post a single session. Forty-nine patients received 318 NMT sessions (83% of sessions offered). NMT was rated as helpful or very helpful as part of the multidisciplinary team (n = 36). The highest ratings were for concentration, arm and hand rehabilitation, and motivation and mood. VAMS scores (n = 24) showed a reduction in ‘confused’ (−8.6, p = 0.035, effect size 0.49) and an increase in ‘happy’ (6.5, p = 0.021, effect size = 0.12) post NMT. The data suggest that a one-day-per-week NMT post in subacute neurorehabilitation was feasible, acceptable, and helpful, supporting patient engagement in rehabilitation exercises, mood, and motivation.