The effect of music therapy interventions on assessment and behavior changes in the number of coping skills and social adequacy on newly admitted forensic psychiatric patients in the Netherlands.

The treatment offered to forensic psychiatric patients in the Netherlands focuses on the specific goal of relapse prevention. Research has shown that relapse prevention strongly depends upon static and dynamic factors (e.g. Douglas, Ogloff & Hart, 2003; Emmelkamp, Emmelkamp, De Ruiter & De Vogel, 2002; Nijman, 2005; Nijman & Bulten, 2006; Nijman, De Kruyk, Van Nieuwenhuizen, 2002; Webster, Mülller-Isberner & Fransson, 2002).
Static factors are personal characteristics that cannot be changed. Dynamic factors can develop over time and can be influenced by treatment. Some dynamic factors such as: poor social adequacy, negative coping skills, antisocial behavior and inability to maintain independency have proven to contribute to relapse into violence (Brand, 2006; Brand & Nijman, 2007). In order to offer forensic psychiatric patients an effective treatment, the therapist should attune to the specific difficulties of the population. The therapy should:
(a) be motivating,
(b) circumvent deceptive verbal behavior, and
(c) affect the dynamic factors.
Ideally, it should also (d) be evidence-based.

The proposed research will focus on a specific music therapy treatment procedure which focuses on three dynamic behavioral factors: impulse regulation, social and (negative) coping skills.

The proposed research has two main objectives. The first objective is to investigate behavioral change (on coping, social skills, and impulse regulation) of forensic psychiatric patients due to music therapy treatment. The second objective is to investigate whether a specific musical observation procedure is able to contribute to the assessment of coping skills of forensic psychiatric patients. A secondary objective is to study whether a musical observation checklist can be used as observation scale. Dependent variables in the proposed research are:
(a) the number of coping skills,
(b) the type of coping reactions,
(c) social skills, and
(d) impulsivity of patients;
each dynamic factors and therefore possible determinants for the probability of relapse into violent offences.The treatment will be tested using a randomized controlled trial (RCT) and multi-center research. A pre-post-test design of coping skills and/or social adequacy will be conducted. In the pretest, social and coping skills will be assessed during musical observatuion and in daily life for all newly admitted forensic patients.
Subsequently, two random groups will be created. One group will be offered a music therapy anger management program (additional to their treatment program). The other will partake only in the regular treatment (without music therapy). After 6 months, a posttest replicates the pretest and will measure social and coping skills during musical observation and in daily life of forensic patients.

The research tests two core propositions of music therapy research in forensic psychiatry:

1. There are some behavioral changes (on coping, social skills, and impuls regulation) of forensic psychiatric patients due to the music therapy treatment. And

2. A specific musical observation procedure is able to contribute to the assessment of coping skills of forensic psychiatric patients in stress-enhancing situations.

A secondary proposition is to study whether the FP40 music therapy coping list can be used as an observation scale to assess coping skills during music therapy.

In addition, three hypotheses will be tested about the mechanisms that explain the effect of the music therapy procedure. The transfer hypothesis states that there is a connection between the coping skills of patients in stress-enhancing situation during music therapy and their coping skills in daily life. The coping effect hypotheses specify how music therapy interventions positively affect the coping skills of forensic psychiatric patients.

Pre-assessment and post-assessment within 6 months per patient.

During a number of (defined) musical assignments and improvisations the patient will be confronted with stress enhancing situations, like rejection, powerlessness, incompetence, personal border-crossing and boredom. These are some of the stressors patients refer to as triggers to their crimes. A number of these assignments are described in Hakvoort (2004, 2007). During the musical observation patients initial social as well as coping reactions are observed and if possible discussed.

During treatment the patients in the experimental group are offered a cognitive-behavioral music therapy method well-tailored to the needs of forensic patients and atuned to angemanagment with protocol led music therapy interventions (Hakvoort 2002, 2006). During the music therapy assessment after the treatment period the assignments are repeated and elaborated to aessess differences in social reactions as well as coping skills.