Making Music to Treat Symptoms of Psychosis

Our brains anticipate sensory signals—such as sight, sound, smell, or touch—by relying on past experiences. When we bite into an apple, for example, we expect a sweet crunch because of all the other times we have eaten one.

Some neuroscientists believe that this neural processing, known as predictive coding, helps ease the brain’s cognitive load and facilitate faster learning. But at times, these expectations or predictions can go wrong, resulting in the hallucinations and delusions that can come with psychosis, a mental state where the mind loses touch with reality.

In a new study published April 9 in the journal Psychosis, Yale scientists demonstrated a way to help those with psychosis re-engage with their surroundings through making music.

“Music is a Golden Road for making predictions,” says Philip Corlett, PhD, an associate professor of psychiatry at Yale School of Medicine and the senior author of the study. When one sings the lyric, “Sweet Caroline …,” for example, the mind conjures the ensuing melody: “Bab, bab, baa …”

Because of this strong link between music and prediction, Corlett’s research group at the Belief, Learning, and Memory Lab set out to assess the impact of song-making on psychotic illnesses, particularly hallucinations.

“People have hallucinations because their predictions are too strong, and that makes them see and hear things that other people don't see or hear,” Corlett says. Making music might be an avenue to help dysfunctional brains regain their ability to make good predictions, he says. “Like a roller coaster, music is a safe way of having our expectations violated whilst not having to experience any kind of dangerous and unsafe things.”

For the project, Corlett partnered with Adam Christoferson, a music facilitator, a member of the Citizens Community Collaborative at the Yale Program for Recovery and Community Health, and founder of Musical Intervention, an organization that uses music-making for rehabilitation and community building in New Haven.

Corlett became interested in music therapy for psychosis after observing its effect on patients he met at the Connecticut Mental Health Center.

“I saw some people who I'd seen for the past 10 years or so, coming in and out of the center, not really improving very much,” Corlett says. “And then they sat with Adam for an hour, and they seemed to come alive; they weren't as negative or finding it hard to express their emotions or connect with others. And I just thought I wanted to be part of this by exploring the science behind it.”

The researchers recruited 20 people between the ages of 18 and 65 in Connecticut to participate in a six-week longitudinal study. The individuals, who were either referred by their clinicians or self-registered, had schizophrenia or experienced distressing auditory hallucinations at least once per week.

During their initial visit, the participants completed a set of psychometric questionnaires to assess their tendencies toward hallucinations and paranoia. They also participated in an interview with the study facilitators.

For the next four visits, the participants formed groups of five and met weekly for two hours to write songs with guidance from a professional musician. They received recording equipment, including a microphone, guitar, keyboard, and drums, and were encouraged to write their own lyrics.

At the final visit, the participants filled out the same set of questionnaires and sat for a post-session interview.

“We wanted to longitudinally assess people's changes objectively,” says Deanna Greco, a PhD student in the Corlett lab and the first author of the study.

The researchers did not find a decrease in hallucinations for all participants, but those with less severe hallucinations reported experiencing less paranoia after the sessions.

The researchers also noted a change in the participants’ language. Previous research has shown that people who experience severe psychosis use first-person pronouns (I, me, mine) more often than plural pronouns (we, us, ours), which can indicate social isolation and distress.

After the participants’ final interview, “we were seeing a decrease in their first-person pronoun usage and an increase in plural pronoun usage,” Greco says.

Individuals with psychosis often experience social isolation, paranoid thoughts, and stigma. While the participants came with varying levels of psychosis, they all benefited from the group music activities by gathering with the community and rekindling their creativity, Greco says.

For Christoferson, the result was a validation of what he had seen in the field for the last 25 years of running similar groups. “The Yale study shows the validity of the Musical Intervention approach,” he says. To him, the song-making activities offer the participants a sense of identity and a way to express their emotions and creativity, which in turn affects their livelihood.

Treating psychosis with music therapy “is a really exciting area of research,” Corlett says.

Individuals with psychosis are typically prescribed antipsychotics to reduce symptoms such as hallucinations and delusions. These medications can cause unpleasant side effects, including difficulty concentrating, lack of motivation, and lethargy.

“Our approach may be outside of the purview of clinical medicine,” Corlett says. “But the study showed that we can do proper clinical scientific research on music therapy, and that it can do just as well as the more standard and traditional treatments, and perhaps better in some cases, because people come back, they want more, and they don't experience negative side effects.”

As a follow-up to this study, Corlett and his team are investigating how music as an intervention changes brain circuitry. “I suspect that it does something permanently in the brain,” he says. “And we want to find out what that is.”