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 (randomized prospective clinical evaluation research)

The treatment offered to forensic patients 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.

During a number of (standardized) musical assignments and improvisations the
patient will be confronted with stress enhancing situations (Hakvoort, 2004,
2007). These are some of the stressors patients refer to as triggers to their
crimes. During treatment the patients in the experimental group are offered a
primed, validated music therapy method well-tailored to the needs of forensic
patients and atuned to anger managment (Hakvoort 2004, 2006).

Each patient will be offered a total of 4 one hour music therapy assessment
sessions (2 pretest and 2 posttest)
The experimental group will be offered a music therapy angermanagement program
of 20 one-hour sessions.
There are No physical risks connected to this study.