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PPO 10-075 – HSR&D Study

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PPO 10-075
Guitars for Vets: Evaluating psychological outcome of a novel music therapy
Timothy R. Dillingham MD MS
Clement J. Zablocki VA Medical Center, Milwaukee, WI
Milwaukee, WI
Funding Period: September 2010 - September 2011

BACKGROUND/RATIONALE:
Post traumatic Stress disorder (PTSD) is a common condition for persons who have served in the Armed services during combat or deployment. Treatments include medications, cognitive behavioral therapy, and other social support mechanisms.

Our aim in this project is to critically evaluate the effects of a novel music therapy intervention on the symptoms of PTSD. Estimates developed by the Global Burden of Disease Study reveal that mental illness accounts for over 15% of the burden of disease on health and productivity in established market economies--more than the disease burden caused by all cancers combined.[1] Perhaps no industry has had the burden of mental disorders affect its labor force as severely and pervasively as the Armed Forces.

Post-Traumatic Stress Disorder (PTSD) is a common sequelae of severe emotional trauma that is often associated with combat exposure. The condition has been well documented in returning soldiers and is characterized by recurrent and distressing thoughts and feelings related to the trauma, persistent avoidance of reminders of the trauma, and increased arousal that disturbs sleep, concentration, and the ability to modulate anger. Persons suffering from PTSD often have difficulty relating to others, leading to loneliness and isolation, which further intensifies their psychiatric symptoms. Current treatment options for PTSD include psychotherapy, medication management, or a combination of those. Although these treatments have been shown to be effective, returning soldiers are often hesitant to seek and adhere to mental health therapies. PTSD-related avoidance, including difficulty trusting, may serve as a barrier to seeking or completing treatments. Furthermore, some PTSD medications have unacceptable side-effects in some individuals. The need is great, therefore, to identify and promote safe, effective strategies for self-management of PTSD among Veterans.


OBJECTIVE(S):
The objective was to assess the effectiveness of a novel music therapy on ammelorating the effects of PTSD. Specifically a 6 week guitar training program under the direction of seasoned instructors through a partnership with Guitars for Vets was assessed before and after intervention.

METHODS:
In this trial we recruited veterans in the Milwaukee region and the Zablocki VA Medical Center with significant PTSD symptoms. Forty subjects were recruited and randomized to either an immediate entry or a 6 week delayed entry group. Both groups received the intervention, but the delayed group received it after a 6 week period.

Each subject received a guitar that they keep after the study, music, supplies and instructions. They each had an hour of individual training each week and a weekly group instruction session.

FINDINGS/RESULTS:
This pilot study was remarkably successful. In less than a year we recruited our sample and analyzed the data. The results were compelling and showed positive benefits from the 6 week intervention.

Of the 68 Veterans who were self- or provider-referred to the program, 25 (36.7%) were ineligible due to (i) absence of a PTSD diagnosis (n=3); participation in ongoing intense psychotherapy (n =4) or substance abuse (n=2); current resident of the Domiciliary (n=8); inability to attend lessons due to distance from residence to the VA (n=8). Only 3 (4.4%) Veterans declined participation due to lack of interest, increasing our confidence in the feasibility of the proposed multicenter study. We enrolled 40 subjects who were eligible into the study.

Nearly half of all enrolled subjects were returning Veterans from the OIF/OEF recent conflicts. The mean age of Veterans enrolled in the study was 51 years old, ranging from 22 to 76 years old. The majority was male (90%). One-quarter were African American or Black, over half were married, and nearly one in five had a college degree. While 30% report still working full or part time, 45% were retired due to disability. Alcohol-related problems were evident in this sample and 20% reported having undergone a substance abuse treatment program in the past.

Bivariate comparisons of pre-and post-intervention outcomes reveal marked improvements in our primary outcome -PTSD symptoms, as measured by the PCLC scale (-14.2 points or 21% reduction in symptoms, p<0.01). Results also indicate that the intervention was effective in reducing depression symptoms (- 8 points or 27%, p <0.01, as measured by the Beck Depression Inventory); and improving health-related quality of life (+0.16 or 37% improvement relative to baseline, p=0.02, as measured by the EuroQoL). There were no statistically significant effects on perceived cognitive functioning or social isolation, however, although the directionality of change in both measures was consistent with expectations.


IMPACT:
Even though these pilot findings are strongly supportive of a treatment effect, results from a single center cannot legitimately be used as a foundation for recommending VA policy changes until they are duplicated in a large multicenter study. The proposed multicenter HSR&D MERIT study will test the hypothesis that the success of the Guitars for Vets intervention in Milwaukee is generalizable to a larger and more diverse group of Veterans. Equally as important will be to ascertain whether the effects are sustainable in the long run and cost-effective relative to usual VA PTSD care. The answers to these questions will be critical to understanding the potential health system benefits as well as clinical effectiveness that a VA-wide program would realize if such a successful intervention were implemented in the VA health system.

PUBLICATIONS:
None at this time.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational
Keywords: Anxiety Disorders, Behavioral Therapy, PTSD
MeSH Terms: none