Music therapy for prisoners: pilot randomised controlled trial and implications for evaluating psychosocial interventions

Music and well-being in carceral settings: a scoping review

Well-being is defined as the multi-dimensional experience of positive emotions, as well as life satisfaction, autonomy, and purpose. This scoping review examines the impact of musical practices on the well-being of incarcerated individuals and uniquely contributes to the literature by focusing on the relationship between music and power in carceral settings and by expounding on the ways in which musical practices both facilitate and inhibit experiences of well-being. Our review contributes to this body of literature by proposing three distinct ways musical practices may affect well-being: (1) Musical Practices and Psychological Outcomes, (2) Musical Practices and Identity Formation and (3) Musical Practices and Power.

Utilising survey data and qualitative information to inform a logic model to support older people in custody with common mental and physical health problems: Addressing the physical and mental health needs of older prisoners (the PAMHOP study)

A growing number of older people remain in custody each year resulting in an increasing number of common mental and physical health concerns. No prior evidenced-based targeted psychological interventions support this group of people, and little is known about their needs, current activities, and health-related problems. We addressed these gaps through a project involving older prisoners, prison staff and a project advisory group in one male and one female prison site in the North of England. Systematic review evidence supports the development of an implementation tool kit addressing strategies to develop and deliver interventions that are sustainable, acceptable, and feasible in the prison environment. Prison strategies need to specifically address the needs of older people in custody. Relatively inexpensive activities, with some thought to delivery and flexibility have the potential to benefit common mental and physical health, increasing quality of life, reducing high economic and social cost, mortality, and reoffending in this age group.

Motivation and music interventions in adults: A systematic review

ABSTRACTMusic is increasingly used in a wide array of settings, from clinical recovery to sports or well-being interventions. Motivation related to music is often considered as a possible working mechanism for music to facilitate these processes, however this has not previously been systematically evaluated. The current systematic review considered studies that involved music (therapy) interventions, together with motivation-related measures such as wanting to practise, liking the musical activities, or patient adherence to an intervention. Our objective was to examine whether music is related to increased motivation in task performance and/or rehabilitation settings, and whether this is in turn related to better clinical or training outcomes. Seventy-nine studies met the inclusion criteria, the majority of which (85%) indicated an increased level of motivation with music as compared to without. Moreover, in those studies where motivation was increased, clinical or other outcomes were improved in most cases (90%). These results support the notion of motivation as an underlying mechanism of music-based interventions, but more robust evidence is needed to ascertain which mechanisms are crucial in increasing motivation from a behavioural, cognitive, and neurobiological point of view, as well as how motivational mechanisms relate to other factors of effectiveness in music-based paradigms.

Creating a Benevolent World: Exploration of a Music-Based Rehabilitation Program for Formerly Incarcerated Individuals

Many studies discuss the impact of music programs on prison inmates. However, few studies have investigated the impact of music programs on formerly incarcerated individuals (FIIs), and none of them have focused on the programs' characteristics. This phenomenological study explores the characteristics of a music-based rehabilitation program for FIIs. Five FIIs and three staff members who participated in a group music program were interviewed. The following four themes emerged: Continuity-the importance of the FIIs' previous positive acquaintance with the program while still being in prison. Egalitarian approach-the importance of the staff treating the FIIs with understanding, tolerance, non-judgmentalism, and the use of an eye-level approach. Cultural sensitivity-the staff members' sensitivity to the FIIs' different backgrounds to form a connection. Playfulness-the program's ability to break free from a "fight-or-flight" mode and experience a counter mode of playfulness. The findings are discussed through the perspective of positive criminology.

How effective are digital/e-health interventions for supporting prisoners with mental ill-health? An integrative review

PURPOSE

There has been a move towards the implementation of digital/e-health interventions for some time. Digital/e-health interventions have demonstrable efficacy in increasing individual empowerment, providing timely access to psychological interventions for those experiencing mental ill-health and improving outcomes for those using them. This study aims to determine the efficacy of digital/e-health interventions for individuals detained in prison who experience mental ill-health.

DESIGN/METHODOLOGY/APPROACH

A systematic search of five academic databases - CINAHL, ASSIA, PsycINFO, Embase and Medline - was completed in December 2020 and updated in February 2022. The review was guided by the Whittemore and Knafl (2005) framework for integrative reviews. A total of 6,255 studies were returned and screened by title and abstract. A full-text screening of nine (n = 9) studies was conducted.

FINDINGS

No study met the inclusion criteria for the clinical efficacy of digital/e-health interventions in a prison setting. Subsequently, a review of the literature that made it to the full-text review stage was conducted, and gaps in the literature were identified to inform policy, practice and future research.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first integrative review conducted on the efficacy of digital/e-health interventions for mental ill-health in prison settings.

Expanding Knowledge About Music and Well-Being in Carceral Settings: A Methodological Review

This methodological review includes literature (1987-2022) concerning the role and influence of musical practices-including music therapy and participatory music interventions-on well-being in carceral settings such as jails, prisons, and immigration detention centers. We provide a thorough description of key methodological procedures used in 55 studies: (1) Key Elements of Research Questions; (2) Types of Musical Practices; (3) Musical Genres; (4) Methodologies and Designs; (5) Locations; (6) Theoretical Frameworks; and (7) Samples. Our review indicates that there is difficulty in conducting research in prisons due to limitations imposed on researchers, a paucity of randomized-control trials, and limited generalizability of results due to the heterogeneity of methodological approaches. We suggest that the literature base would benefit from increased attention to issues related to sampling procedures, research questions related to race and gender identity, as well as the delineation between the types of musical practices utilized by music interventions.

Effects of interventions on depression and anxiety in older people with physical health problems in the criminal justice system: a systematic review

The demand for health care in older people involved in the criminal justice system is high. The prevalence of mental and physical health conditions for people living in prison is greater than in community populations. After systematically searching 21 databases, we found no targeted interventions to support depression or anxiety for this group of people. 24 studies (including interventions of yoga, creative-arts-based programmes, positive psychology, or mindfulness-based interventions and psychotherapy) did contain people older than 50 years, but this only represented a minority (10%) of the overall study population. No single study reported outcomes of physical health. Future interventions need to consider the needs and views of this vulnerable group. Specific gendered and coproduced interventions are required to enhance the implementation, feasibility, and acceptability of interventions that are delivered in prisons.

Effectiveness and mechanisms of the arts therapies in forensic care. A systematic review, narrative synthesis, and meta analysis

Introduction

Mental health care provided to offenders with psychiatric problems in forensic settings mainly consists of verbal oriented treatments. In addition, experience-based therapies are used such as (creative) arts therapies: (visual) art therapy, music therapy, drama therapy and dance (movement) therapy. There are indications for effectiveness of arts therapies, but a systematic overview of effect studies of all arts therapies in forensic care is lacking.

Methods

First, we performed a systematic review. Second, Thematic Analysis was used to synthesize the qualitative narrative results and define the hypothesized mechanisms of change. Third, we performed a meta-analysis to investigate the effects of arts therapies in reducing psychosocial problems of offenders. Twenty-three studies were included in the review. Quality and risk of bias was assessed using EPHPP (Effective Public Health Practice Project).

Results

The included studies were heterogeneous in type of outcome measures and intervention characteristics. Synthesis of mechanisms of change involved in the methodical use of the arts in arts therapies resulted in a description of regulatory processes which are stimulated in arts therapies: perceptive awareness (interoceptive and exteroceptive), the regulation of emotions, stress, impulses, cognitions, social regulation, and self-expression. These processes play a role in developing prevention, coping and self-management skills. Eighteen studies were included in the meta-analyses (11 RCTs/CCTs; 7 pre-post studies). The meta-analyses indicated significant effects on both risk factors (psychiatric symptoms and addiction) and protective factors for criminal behavior (social functioning and psychological functioning). Effects on criminal and/or antisocial behavior were not significant, but this outcome measure was scarcely used among the studies.

Discussion

The analyses in this study should be considered explorative. More research is needed to gain more solid conclusions about effectiveness and mechanisms of change of arts therapies in forensic institutions. However, the results of this first systematic review, synthesis of mechanisms and meta-analysis in this field are promising and show effects of arts therapies on risk and protective factors in individuals in forensic institutions.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884, identifier: CRD42020217884.

Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review

PURPOSE OF THE REVIEW

The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings.

COLLECTION AND ANALYSIS OF DATA

Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020.

RESULTS AND CONCLUSIONS

The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries.

Development and validation of a peer support programme for the prisoners with mental and substance use disorders in India

BACKGROUND

The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands.

AIM

The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD).

METHOD

The PSP was developed by reviewing the literature and expert interviews and validated by seven experts.

RESULT

The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping.

CONCLUSION

This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings.

Effects of Arts and Psychomotor Therapies in Personality Disorders. Developing a Treatment Guideline Based on a Systematic Review Using GRADE

What is the effect of arts and psychomotor therapies, using art, dance, drama, music, movement and body awareness, in personality disorder treatment? This was explored by developing a treatment guideline based on a systematic review using the GRADE system within the context of the Dutch national multidisciplinary guidelines for treatment of personality disorders. Conclusions were formulated by a work group and based on the scientific substantiation and were integrated with other indications in the functioning of arts and psychomotor therapies in personality disorders. The first general search yielded 1,900 records which was brought back to 53 full-texts. Ultimately, 1 RCT and 2 pilot studies were included. Recommendations for treatment are that arts and psychomotor therapies are included in treatment, independent of age, sex or specific diagnostic characteristics. Arts and psychomotor therapies can be considered for purposes of coming into emotional contact with difficult aspects of patients and their experiences, to work on goals such as regulation of emotions, stress, identity/self-image, self-expression, mood/anxiety, relaxation, changing patterns and social functioning. Enlisting arts and psychomotor therapies for patients with a personality disorder is recommended because they value these therapies and perceive these to be effective. It could be considered to ask arts and psychomotor therapies to provide a contribution to the diagnostic process, to the problem analysis via observation and to determining treatment indication and treatment goals. More research is needed.

Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials

This study aims to evaluate the efficacy of music therapy on anxiety from randomized controlled trials (RCTs). The following electronic databases were utilized for selecting eligible studies that were published from inception to March 2021: PubMed, Cochrane Library, PsycINFO, Medline, Web of Science, and Embase. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the efficacy of music therapy on anxiety. Thirty-two studies with 1,924 participants were included in the meta-analysis. Music therapy lasted an average of 7.5 sessions (range, 1-24 sessions), while the average follow-up duration was 7.75 weeks (range, 1-16 weeks). Music therapy significantly reduced anxiety compared to the control group at post-intervention (SMD = -0.36, 95% CI: -0.54 to -0.17, p < 0.05), but not at follow-up (SMD = -0.23, 95% CI: -0.53 to 0.08, p >0.05). Subgroup analysis found a significantly positive effect of music therapy on anxiety in < 60 and ≥ 60 age-group (SMD = -0.31, 95% CI: -0.52 to -0.09, p < 0.05; SMD = -0.45, 95% CI: -0.85 to -0. 05, p < 0.05), developed and developing country group (SMD = -0.28, 95% CI: -0.51 to -0.06, p < 0.05; SMD = -0.49, 95% CI: -0.80 to -0.17, p < 0.05), < 12 and ≥ 12 sessions group (SMD = -0.24, 95% CI: = -0.44 to -0.03, p < 0.05; SMD = -0.59, 95% CI: -0.95 to -0.22, p < 0.05), respectively. Our study indicated that music therapy can significantly improve anxiety during treatment. But given that only eight RCTs reported the effects of music therapy at follow-up and the duration of follow-up was inconsistent, further researches are needed on the lasting effects after the intervention is discontinued.

Long-Term Effects of Short-Term Music Therapy for Prison Inmates: Six-Year Follow-Up of a Randomized Controlled Trial

For most interventions to reduce criminal recidivism, long-term effects are uncertain. Music therapy has shown effects on possible precursors of recidivism, but direct evidence on long-term effects is lacking. In an exploratory parallel randomized controlled trial, 66 inmates in a Norwegian prison were allocated to music therapy or standard care and followed up over a median of 6 years, using state registry data. Median time to relapse was 5 years, with no differences between the interventions. The imprisonment of most participants was too short to provide a sufficient number of therapy sessions. Sufficiently powered studies are needed to examine the long-term effects of appropriate doses of therapy.

Music therapy for stress reduction: a systematic review and meta-analysis

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

A Systematic Review of Quality of Life Assessments of Offenders

Strength-based theories of rehabilitation emphasize the importance of opportunities for offenders to achieve "good lives" to not re-offend. The extent to which these groups feel enabled to achieve a good life may be measured through subjective, overall quality of life (QoL). The aim is to systematically review the QoL instruments used among detained offenders and synthesize the factors related to their QoL. A systematic literature review was conducted to retrieve articles that assessed the overall QoL of a sample of detained offenders using a validated instrument. The instruments' specificity, dimensionality, and respondent and administrator burden were assessed, and factors reported as significantly related to QoL were summarized. In total, 41 articles were included in the review: 20 reported on forensic samples and 20 on prisoners, with one study randomly assigning offenders to either forensic treatment or prison. Among the included articles, 12 validated instruments were utilized. Only one instrument, the Forensic Inpatient Quality of Life Questionnaire, was specifically developed for and validated in forensic patients. Detained offending populations reported lower QoL than the general population, and those with untreated mental illness reported the lowest. The most consistent predictors of QoL longitudinally were social factors, while substance use and detention-specific variables were not consistently related. In general, the relationships between poor mental health, loneliness, and poor QoL seen in offenders are also seen among other marginalized populations. To improve the evidence base for QoL assessment in this vulnerable group, current gold standard QoL instruments should be validated in detained populations.

Who Can Get More Benefits? Effects of Mindfulness Training in Long-Term and Short-Term Male Prisoners

The aim of the present study was to examine the effects of a 6-week mindfulness training program on mental health, anxiety, depression, aggression, sleep quality, mood states, total mood disturbance, and perceived stress among male Chinese prisoners, and to explore whether the intervention effects differed in long-term and short-term prisoners. Eighty-three male prisoners completed the study, including 39 in the mindfulness training group and 44 in the waitlist control group. Results showed that, compared with the waitlist control group, mindfulness training group showed a significant improvement in mindfulness level (p < .0l), Symptom Checklist-90 (SCL-90; p < .00l), aggression (p < .05), sleep quality (p < .05), and total mood disturbance (p < .0l). Moreover, compared with the short-term prisoners, mindfulness training was more effective on the long-term prisoners in mindfulness level (p < .05), SCL-90 (p < .001), anxiety (p < .05), depression (p < .05), aggression (p < .05), total mood disturbance (p < .0l), and perceived stress (p < .0l). Given the study's innovation, we discussed its significance and limitations.

What works for wellbeing? A systematic review of wellbeing outcomes for music and singing in adults

Aims:

The role of arts and music in supporting subjective wellbeing (SWB) is increasingly recognised. Robust evidence is needed to support policy and practice. This article reports on the first of four reviews of Culture, Sport and Wellbeing (CSW) commissioned by the Economic and Social Research Council (ESRC)-funded What Works Centre for Wellbeing (https://whatworkswellbeing.org/).

Objective:

To identify SWB outcomes for music and singing in adults.

Methods:

Comprehensive literature searches were conducted in PsychInfo, Medline, ERIC, Arts and Humanities, Social Science and Science Citation Indexes, Scopus, PILOTS and CINAHL databases. From 5,397 records identified, 61 relevant records were assessed using GRADE and CERQual schema.

Results:

A wide range of wellbeing measures was used, with no consistency in how SWB was measured across the studies. A wide range of activities was reported, most commonly music listening and regular group singing. Music has been associated with reduced anxiety in young adults, enhanced mood and purpose in adults and mental wellbeing, quality of life, self-awareness and coping in people with diagnosed health conditions. Music and singing have been shown to be effective in enhancing morale and reducing risk of depression in older people. Few studies address SWB in people with dementia. While there are a few studies of music with marginalised communities, participants in community choirs tend to be female, white and relatively well educated. Research challenges include recruiting participants with baseline wellbeing scores that are low enough to record any significant or noteworthy change following a music or singing intervention.

Conclusions:

There is reliable evidence for positive effects of music and singing on wellbeing in adults. There remains a need for research with sub-groups who are at greater risk of lower levels of wellbeing, and on the processes by which wellbeing outcomes are, or are not, achieved.

Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis

OBJECTIVE

Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarize difficulties in conducting randomized clinical trials (RCTs).

METHOD

We systematically identified RCTs of psychological therapies with mental health outcomes in prisoners (37 studies). Effect sizes were calculated and meta-analyzed. Eligible studies were assessed for quality. Subgroup and metaregression analyses were conducted to examine sources of between-study heterogeneity. Thematic analysis reviewed difficulties in conducting prison RCTs.

RESULTS

In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials.

CONCLUSIONS

CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended. (PsycINFO Database Record

The Effectiveness of the Nanta-Program on Psychiatric Symptoms, Interpersonal Relationships, and Quality of Life in Forensic Inpatients with Schizophrenia

PURPOSE

The purpose of this study was to examine the effectiveness of the Nanta-program on psychiatric symptoms, interpersonal relationships, and quality of life (QoL) in forensic inpatients with schizophrenia (SPR).

METHODS

A quasi-experimental study employing a nonequivalent control group and pre-posttest design was conducted. Participants were 38 forensic inpatients with SPR from South Korea (experimental group=18, control group=20). The intervention was conducted in 12 sessions over 12 weeks, taking 90 min per session. Data were analyzed using χ²-test and t-test with SPSS 22.0 program.

RESULTS

The experimental group showed significant improvements in psychiatric symptoms (t=-2.73, p=.010) and slight improvement in interpersonal relationships (t=2.23, p=.0.34) after 12 weeks of group music therapy. There was no significant difference in QoL change between the two groups.

CONCLUSION

These findings indicate that the Nanta-program is an effective intervention program for improving psychiatric symptoms and interpersonal relationships of prisoners with schizophrenia.

The Effects of Mindfulness Training on Emotional Health in Chinese Long-Term Male Prison Inmates

Long-term imprisonment can cause severe emotional problems, which in turn can trigger behavioral problems, self-harm, and suicide. Mindfulness-based intervention can enhance emotional health. This study investigated the effects of a 6-week mindfulness training program on the emotional health of long-term male Chinese prison inmates. Forty long-term male prisoners completed a pretest and posttest, with 19 in the mindfulness training group and 21 in the waitlist control group. The treatment group showed a significant improvement in mindfulness level, anxiety, depression, tension-anxiety, depression-dejection, anger-hostility, confusion-bewilderment, and total mood disturbance. Implications and limitations of this study were discussed. These results support the use of a mindfulness-based intervention to enhance the emotional health of long-term male prison inmates.

Randomized Trial of Group Music Therapy With Chinese Prisoners: Impact on Anxiety, Depression, and Self-Esteem

This study investigated the effects of group music therapy on improving anxiety, depression, and self-esteem in Chinese prisoners. Two-hundred male prisoners were randomly assigned to music therapy (n = 100) or standard care (n = 100). The music therapy had 20 sessions of group therapy compared with standard care. Anxiety (State and Trait Anxiety Inventory [STAI]), depression (Beck Depression Inventory [BDI]), and self-esteem (Texas Social Behavior Inventory [TSBI], Rosenberg Self-Esteem Inventory [RSI]) were measured by standardized scales at baseline, mid-program, and post-program. Data were analyzed based on the intention to treat principle. Compared with standard care, anxiety and depression in the music therapy condition decreased significantly at mid-test and post-test; self-esteem improved significantly at mid-test (TSBI) and at post-test (TSBI, RSI). Improvements were greater in younger participants (STAI-Trait, RSI) and/or in those with a lower level of education (STAI-State, STAI-Trait). Group music therapy seems to be effective in improving anxiety, depression, and self-esteem and was shown to be most beneficial for prisoners of younger age or with lower education level.

Influence of Music Therapy on Coping Skills and Anger Management in Forensic Psychiatric Patients: An Exploratory Study

The effect of music therapy on anger management and coping skills is an innovative subject in the field of forensic psychiatry. This study explores the following research question: Can music therapy treatment contribute to positive changes in coping skills, anger management, and dysfunctional behavior of forensic psychiatric patients? To investigate this question, first a literature review is offered on music therapy and anger management in forensic psychiatry. Then, an explorative study is presented. In the study, a pre- and post-test design was used with a random assignment of patients to either treatment or control condition. Fourteen participants' complete datasets were collected. All participants received "treatment as usual." Nine of the participants received a standardized, music therapy anger management program; the five controls received, unplanned, an aggression management program. Results suggested that anger management skills improved for all participants. The improvement of positive coping skills and diminishing of avoidance as a coping skill were measured to show greater changes in music therapy participants. When controlling for the exact number of treatment hours, the outcomes suggested that music therapy might accelerate the process of behavioral changes.