Integration of cognitive behavioral therapy and music (CBT-Music) for intervention of anxiety in at-risk children : a feasibility randomized controlled trial

Abstract

Research interest in using music to improve well-being and to complement medical treatment in clinical settings has been growing exponentially in recent years. However, there have been only a handful of studies on integrating music with cognitive behavioral therapy (CBT). The purpose of this study was to develop an innovative program that integrated CBT group with music (CBT-Music) for anxiety prevention in at-risk children. Study one was a randomized controlled trial that examined the effectiveness of a newly developed CBT-Music group-based intervention for anxiety prevention in school-aged children. The protocol was built on the backbones of CBT core components delivered through a range of fun-filled interactive activities with music elements. Thirty-nine children (aged 6–10 years) recruited from the local school and community were randomized to either CBT-Music group or wait-list group. The CBT-Music group consisted of 8 weekly sessions for children and 3 parallel training sessions for their parents. All children were assessed at baseline, post-intervention and 3- to 6-month follow-up. It was found that as compared with wait-list controls, the children in the CBT-Music group showed significant greater improvements in overall well-being, overall coping and emotion support seeking at post-intervention, and the effects were maintained at follow-up. Anxiety symptoms were reduced with large effect size in the CBT-Music group at post-intervention, albeit not significantly different when compared with wait-list controls. However, at follow-up, children in the CBT-Music group continued to improve with further anxiety reduction, whereas no change in anxiety symptoms was found for the wait-list group, suggesting a possible delayed intervention effect. Study two was an in-depth qualitative study of the CBT-Music program. Data collected through interviews with the participants and feedback survey were analyzed to evaluate the program and participants’ experiences. The acceptability and perceived helpfulness of the CBT-Music program were shown to be high for both child and parent participants. Supplementary to the findings in RCT, a wider range of positive self-perceived changes in the participants were reported, such as parent-child communication, parents’ improvement in coaching skills, empathy and emotion management. Preliminary evidence supporting the benefits of integrating music to CBT intervention was found on reducing fear of stigma, increasing child’s and parent’s interests in joining the program, as well as facilitating children’s engagement and learning of CBT skills. To our knowledge, this was the first clinical trial to examine the integration of CBT and music as an indicated anxiety preventive intervention for at-risk children in school and community settings. The present study supported the feasibility of the CBT-Music group program with some positive outcomes in children. It also provided preliminary support on the beneficial effects of integrating music with CBT intervention, especially in facilitating engagement with young children and in increasing the willingness to receive prevention services for those in need. Future larger-scale research is needed on program development and empirical evaluation of program effectiveness.