Efficacy of music therapy and predictors of sleep disturbance among patients with chronic schizophrenia: A prospective study

  • Mei-Jou Lu
    Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan

    Department of Nursing, School of Nursing, Fooyin University, Kaohsiung City 83102, Taiwan
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  • Wan-Yi Chen
    Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
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  • Dian-Jeng Li
    Corresponding author at: Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd Rd., Lingya Dist., Kaohsiung City 802, Taiwan.
    Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City 802211, Taiwan

    Department of Nursing, Meiho University, Pingtung Country 91202, Taiwan
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Published:April 11, 2022DOI:


      • To explore the efficacy of music therapy on sleep disturbance.
      • A comparative study of patients with chronic schizophrenia.
      • The results showed the promising efficacy of music therapy in the intervention group.
      • Irreligious patients and those with chronic diseases were associated with better efficacy.
      • The efficacy of music therapy in the older patients was not as pronounced.


      Study objectives

      Patients with schizophrenia often suffer from sleep disturbance. Music therapy, as a non-invasive intervention, may have benefit on sleep problem in such population. Our study aimed to investigate the efficacy of music therapy on sleep disturbance among patients with schizophrenia.


      This prospective study recruited participants with schizophrenia along with sleep disturbances in the chronic wards. Patients in the control group received standard care, and those in the intervention group received additional music therapy before sleeping at night for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the severity of sleep disturbance. The generalized estimating equation (GEE) was used to analyze measure the difference of change in PSQI scores between both groups at the baseline and four weeks later. It was also applied to find the predictors of treatment efficacy within intervention group.


      A total of 66 (31 in control group and 35 in intervention group) participants were recruited. After adjusting with the demographic variables, the change of PSQI among intervention group was significantly more than the change among control group (Group × time; Estimate = −7.05, p < 0.001), indicating the efficacy of music therapy. In addition, irreligious patients and those with chronic medical disease predicted better efficacy. Whereas, elderly patients had compromising efficacy of music therapy.


      Music therapy demonstrated its merit on sleep disturbance among patients with schizophrenia. Whereas, healthcare workers should consider the variability of severity in schizophrenia during clinical practice.


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        • Allred K.D.
        • Byers J.F.
        • Sole M.L.
        The effect of music on postoperative pain and anxiety.
        Pain Management Nursing. 2010; 11: 15-25
        • Backhaus J.
        • Junghanns K.
        • Broocks A.
        • Riemann D.
        • Hohagen F.
        Test-retest reliability and validity of the Pittsburgh sleep quality index in primary insomnia.
        Journal of Psychosomatic Research. 2002; 53: 737-740
        • Benson K.L.
        Sleep in schizophrenia: Pathology and treatment.
        Sleep Medicine Clinics. 2015; 10: 49-55
        • Blanc J.
        • Seixas A.
        • Donley T.
        • Bubu O.M.
        • Williams N.
        • Jean-Louis G.
        Resilience factors, race/ethnicity and sleep disturbance among diverse older females with hypertension.
        Journal of Affective Disorders. 2020; 271: 255-261
        • Bloch B.
        • Reshef A.
        • Vadas L.
        • Haliba Y.
        • Ziv N.
        • Kremer I.
        • Haimov I.
        The effects of music relaxation on sleep quality and emotional measures in people living with schizophrenia.
        Journal of Music Therapy. 2010; 47: 27-52
        • Blood A.J.
        • Zatorre R.J.
        Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion.
        Proceedings of the National Academy of Sciences of the United States of America. 2001; 98: 11818-11823
        • Brown B.
        • Rutherford P.
        • Crawford P.
        The role of noise in clinical environments with particular reference to mental health care: A narrative review.
        International Journal of Nursing Studies. 2015; 52: 1514-1524
        • Busner J.
        • Targum S.D.
        The clinical global impressions scale: Applying a research tool in clinical practice.
        Psychiatry (Edgmont). 2007; 4 (Retrieved from): 28-37
        • Buysse D.J.
        • Reynolds III, C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research.
        Psychiatry Research. 1989; 28: 193-213
        • Chafin S.
        • Roy M.
        • Gerin W.
        • Christenfeld N.
        Music can facilitate blood pressure recovery from stress.
        British Journal of Health Psychology. 2004; 9: 393-403
        • Chan M.S.
        • Chung K.F.
        • Yung K.P.
        • Yeung W.F.
        Sleep in schizophrenia: A systematic review and meta-analysis of polysomnographic findings in case-control studies.
        Sleep Medicine Reviews. 2017; 32: 69-84
        • Chang E.T.
        • Lai H.L.
        • Chen P.W.
        • Hsieh Y.M.
        • Lee L.H.
        The effects of music on the sleep quality of adults with chronic insomnia using evidence from polysomnographic and self-reported analysis: A randomized control trial.
        International Journal of Nursing Studies. 2012; 49: 921-930
        • Chang Y.S.
        • Chu H.
        • Yang C.Y.
        • Tsai J.C.
        • Chung M.H.
        • Liao Y.M.
        • Chou K.R.
        The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials.
        Journal of Clinical Nursing. 2015; 24: 3425-3440
        • Chouinard S.
        • Poulin J.
        • Stip E.
        • Godbout R.
        Sleep in untreated patients with schizophrenia: A meta-analysis.
        Schizophrenia Bulletin. 2004; 30: 957-967
        • Davies L.M.
        • Drummond M.F.
        Economics and schizophrenia: The real cost.
        The British Journal of Psychiatry. Supplement. 1994; (Retrieved from): 18-21
        • Dencker S.J.
        • Malm U.
        • Lepp M.
        Schizophrenic relapse after drug withdrawal is predictable.
        Acta Psychiatrica Scandinavica. 1986; 73: 181-185
        • Dijkstra K.
        • Pieterse M.
        • Pruyn A.
        Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: Systematic review.
        Journal of Advanced Nursing. 2006; 56: 166-181
        • Drahota A.
        • Ward D.
        • Mackenzie H.
        • Stores R.
        • Higgins B.
        • Gal D.
        • Dean T.P.
        Sensory environment on health-related outcomes of hospital patients.
        Cochrane Database of Systematic Reviews. 2012; CD005315
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behavior Research Methods. 2007; 39: 175-191
        • Feng F.
        • Zhang Y.
        • Hou J.
        • Cai J.
        • Jiang Q.
        • Li X.
        • Li B.A.
        Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis.
        International Journal of Nursing Studies. 2018; 77: 189-196
        • Guo S.
        • Sun W.
        • Liu C.
        • Wu S.
        Structural validity of the Pittsburgh sleep quality index in chinese undergraduate students.
        Frontiers in Psychology. 2016; 7: 1126
        • Hirokawa E.
        Effects of music listening and relaxation instructions on arousal changes and the working memory task in older adults.
        Journal of Music Therapy. 2004; 41: 107-127
        • Holm M.
        • Taipale H.
        • Tanskanen A.
        • Tiihonen J.
        • Mitterdorfer-Rutz E.
        Employment among people with schizophrenia or bipolar disorder: A population-based study using nationwide registers.
        Acta Psychiatrica Scandinavica. 2021; 143: 61-71
        • Jespersen K.V.
        • Koenig J.
        • Jennum P.
        • Vuust P.
        Music for insomnia in adults.
        Cochrane Database of Systematic Reviews. 2015; 8CD010459
        • Jia R.
        • Liang D.
        • Yu J.
        • Lu G.
        • Wang Z.
        • Wu Z.
        • Chen C.
        The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis.
        Psychiatry Research. 2020; 293113464
        • Katz D.A.
        • McHorney C.A.
        The relationship between insomnia and health-related quality of life in patients with chronic illness.
        The Journal of Family Practice. 2002; 51 (Retrieved from): 229-235
        • Kavak F.
        • Unal S.
        • Yilmaz E.
        Effects of relaxation exercises and music therapy on the psychological symptoms and depression levels of patients with schizophrenia.
        Archives of Psychiatric Nursing. 2016; 30: 508-512
        • Labbe E.
        • Schmidt N.
        • Babin J.
        • Pharr M.
        Coping with stress: The effectiveness of different types of music.
        Applied Psychophysiology and Biofeedback. 2007; 32: 163-168
        • Lafeuille M.H.
        • Laliberte-Auger F.
        • Lefebvre P.
        • Frois C.
        • Fastenau J.
        • Duh M.S.
        Impact of atypical long-acting injectable versus oral antipsychotics on rehospitalization rates and emergency room visits among relapsed schizophrenia patients: A retrospective database analysis.
        BMC Psychiatry. 2013; 13: 221
        • Li D.J.
        • Chung K.S.
        • Wu H.C.
        • Hsu C.Y.
        • Yen C.F.
        Factors affecting the dose of methadone among patients receiving methadone maintenance therapy in Taiwan.
        The American Journal on Addictions. 2018; 27: 225-230
        • Lunsford-Avery J.R.
        • Orr J.M.
        • Gupta T.
        • Pelletier-Baldelli A.
        • Dean D.J.
        • Smith Watts A.K.
        • Mittal V.A.
        Sleep dysfunction and thalamic abnormalities in adolescents at ultra high-risk for psychosis.
        Schizophrenia Research. 2013; 151: 148-153
        • Manoach D.S.
        • Pan J.Q.
        • Purcell S.M.
        • Stickgold R.
        Reduced sleep spindles in schizophrenia: A treatable endophenotype that links risk genes to impaired cognition?.
        Biological Psychiatry. 2016; 80: 599-608
        • Manoach D.S.
        • Stickgold R.
        Abnormal sleep spindles, memory consolidation, and schizophrenia.
        Annual Review of Clinical Psychology. 2019; 15: 451-479
        • Mossler K.
        • Chen X.
        • Heldal T.O.
        • Gold C.
        Music therapy for people with schizophrenia and schizophrenia-like disorders.
        Cochrane Database of Systematic Reviews. 2011; 12CD004025
        • Nilsson U.
        • Unosson M.
        • Rawal N.
        Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial.
        European Journal of Anaesthesiology. 2005; 22: 96-102
        • Pedersen I.N.
        • Bonde L.O.
        • Hannibal N.J.
        • Nielsen J.
        • Aagaard J.
        • Bertelsen L.R.
        • Nielsen R.E.
        Music therapy as treatment of negative symptoms for adult patients diagnosed with schizophrenia-study protocol for a randomized, controlled and blinded study.
        Medicines (Basel). 2019; 6
        • Salandin A.
        • Arnold J.
        • Kornadt O.
        Noise in an intensive care unit.
        The Journal of the Acoustical Society of America. 2011; 130: 3754-3760
        • Taylor D.J.
        • Mallory L.J.
        • Lichstein K.L.
        • Durrence H.H.
        • Riedel B.W.
        • Bush A.J.
        Comorbidity of chronic insomnia with medical problems.
        Sleep. 2007; 30: 213-218
        • Ulfarsdottir L.O.
        • Erwin P.
        The influence of music on social cognitive skills.
        Arts in Psychotherapy. 1999; 26: 81-84
        • Wang S.
        • Agius M.
        The use of music therapy in the treatment of mental illness and the enhancement of societal wellbeing.
        Psychiatria Danubina. 2018; 30 (Retrieved from): 595-600
        • Weber S.R.
        • Pargament K.I.
        The role of religion and spirituality in mental health.
        Current Opinion in Psychiatry. 2014; 27: 358-363
        • White J.
        • Xu X.
        • Ellison C.G.
        • DeAngelis R.T.
        • Sunil T.
        Religion, combat casualty exposure, and sleep disturbance in the US military.
        Journal of Religion and Health. 2018; 57: 2362-2377
        • Yan D.Q.
        • Huang Y.X.
        • Chen X.
        • Wang M.
        • Li J.
        • Luo D.
        Application of the Chinese version of the Pittsburgh sleep quality index in people living with HIV: Preliminary reliability and validity.
        Front Psychiatry. 2021; 12676022
        • Zeger S.L.
        • Liang K.Y.
        Longitudinal data analysis for discrete and continuous outcomes.
        Biometrics. 1986; 42 (Retrieved from): 121-130