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Comparing Therapeutic Songwriting Techniques in Music Therapy for Emotional Processing 

Research Design Proposal

By Katie Wilkes
December 11, 2023


Therapeutic Songwriting (TSW) has been known in music therapy to be a dominant technique especially in treating populations in mental health and hospital settings. The majority of studies done on TSW focus on the outcomes and clinical examples instead of the development and detailed descriptions of TSW methods. There lies a gap in literature covering the development and applications of TSWs such as the song collage, also called music collage. The Song Collage Technique (SCT) utilizes sounds, songs, words, lyrics, or music and stitches the collection of sounds together to make a musical collage on a central theme or idea (Jackson & Heiderscheit, 2022).  Tamplin (2006) gives examples of case studies that incorporate the use of SCT within the context of those primarily with traumatic brain injury and spinal cord injury. Tamplin concludes that TSW Song Collage Technique (SCT) as we know it has a limited amounts of resources and descriptions of its clinical application. However, Baker and Tamplin (2006) have discussed its application in other areas of focus such as self-expression in processing trauma and how songwriting can assist identifying and expressing emotions. 

Themes such as self-expression and cultivating an identity have been explored, for example, in a study that explored the idea of discovering the self through songwriting with people with acquired neuro-disabilities in an inpatient rehabilitation program (Baker et al., 2017). The study focused on when and how often participants’ song lyrics contained content related to self-concept and/or identity-based domains. Participants were asked to create three songs of the past, present, and future self within six identified domains of self-concept. The lyrics went through a coding process that then compared and provided further insight in understanding the effectiveness the songwriting process has on building a new sense of self or identity.

Johnson and Heiderscheit (2018) surveyed music therapists in an inpatient adolescent mental health treatment center. They explored these music therapist’s individual clinical practice to identify goals addressed in music therapy sessions and examine music therapy interventions utilized in adolescent inpatient mental health units. The most addressed goals were to improve self-expression, improve self- esteem, increase positive socialization, and increase knowledge and use of coping skills. The most utilized interventions included song discussion, followed by lyric analysis, and songwriting/song composition. 

Another theme that has been explored in TSW has been the idea of measuring emotional processing. Rachman (1980) understands emotional processing to be “a process whereby emotional disturbances are absorbed and decline to the extent that other experiences and behavior can proceed without disruption” (p. 51). Whereas in the Emotional Processing Manual for the Emotional Processing Scale defines emotional processing as a broad term that refers to multiple possibilities in apparatuses and processes for a person to move from “emotional disturbance to resolution” (Baker et al., 2015). There is a small but significant amount of research to support TSW as a way of improving emotional expression and emotional processing (Baker, 2015). 

With the help of Silverman, Baker, and MacDonald’s (2016) continuing research, they conducted a study that looked at differentiating if flow and meaningfulness of songwriting functioned as predictors of therapeutic outcomes within songwriting interventions. The randomized controlled trials and patients were cluster randomized into three different categories of group songwriting, group lyric analysis, and waitlist control condition. In conclusion, flow was a greater a predictor of hope and readiness for change then meaningfulness.

Meaningfulness has also been explored in a study asking how two different forms of TSW were perceived by a participant with PPA in terms of the quality and meaningfulness of the activity, and as a modality for conducting communication therapy (Mantie-Kozlowski, et al., 2021). A 64-year-old woman participated in thirteen therapy sessions designed to increase her successful use of conversational repair strategies while engaged in TSW using two different techniques: Song Parody Technique (SPT) and modified Song Collage Technique (SCT). The use of spontaneous repair strategies (word finding and picture board) during TSW tasks was tallied from recorded sessions. Even in the face of declining linguistic and cognitive abilities, TSW provided an opportunity for enriched social interaction, self-expression, motivation, confidence, and enhanced quality of communication. TSW addressed the importance of maintaining relationships in a manner that supported individualized choice and dignity for the participant.

There is a lack of studies done on comparing multiple songwriting techniques that are emerging such as the song collage and an increased need of trauma-informed music therapy practices. Therapeutic songwriting has been seen to be an effective music therapy approach to emotional processing and trauma processing. 

Research Purpose

The purpose of this study is to compare the use of therapeutic songwriting techniques (song collage, word substitution, and song parody) in a single-session of group music therapy with regard to emotional processing for female-identifying young adults with post-traumatic stress disorder (PTSD). 

Method

Research Design 

This study will use a three-arm quasi-experimental multiple group design that compares three therapeutic songwriting techniques (song collage, word substitution, and song parody) regarding emotional processing for female-identifying young adults with post-traumatic stress disorder (PTSD) in mental health centers. Participants in the mental health facilities based on their assigned songwriting technique or other music therapy intervention, will attend a single-session music therapy group based for a total of 50-minute sessions for each group. Participants will complete the Emotional Processing Scale as a pretest and posttest.

Participants 

The sample will be drawn from pre-existing groups that consist of patients in mental health centers that treat trauma and stress-related disorders in Los Angeles County, CA. Cluster sampling will be employed, and the sample will be obtained by picking names out of a hat. The target population will be female-identifying young adults between ages of 18 to 35 years old diagnosed with PTSD. Twenty young women with PTSD will be selected from each mental health center to participate in the study. 

Independent and Dependent Variables 

The independent variable is the type of therapeutic songwriting technique, of which there are three levels: song collage, word substitution, and song parody. The dependent variable is emotional processing. The instrument used for the dependent measure is the Emotional Processing Scale. 

Instrumentation 

The instrument being employed is the Emotional Processing Scale (Baker et al., 2015). The EPS has been validated against existing assessment scales showing meaningful relationships with the regulation of emotion and psychological symptoms of anxiety and depression. The EPS is a 25-item measure designed to assess emotional processing. The purpose of the scale is to “identify, quantify, and differentiate different types of emotional processing styles in normal healthy individuals and those with psychological disorders” (p. 3). The EPS contains five subscales of five items – Avoidance, Emotional Experience, Suppression, Signs of Unprocessed Emotion, Controllability of Emotion – in which each item is on a 10-point Likert scale. 

Apparatus and Materials 

The participants in the experimental condition groups will be exposed to music from streaming services or other music services like YouTube. The music played will be determined by the music therapist for the purpose of guiding the songwriting process with the group. Depending on the clinic’s accessibility, a portable speaker may be used or a current stereo setup already in place in the clinic. In the non-experimental group, they will partake in a dominant instrument play music therapy session with percussion in place of songwriting. A print-out of the EPS test will be administered to participants in all experimental and non-experimental conditions. The music therapist will need at least a guitar or portable keyboard to conduct the therapeutic songwriting intervention. 

Procedure 

Therapeutic Songwriting/No Therapeutic Songwriting condition 
After participants have given consent to be part of the study, the facility client coordinator will escort study participants to the group therapy space. Each group will have a board-certified music therapist and a qualified professional that can administer the EPS test before and after treatment in the room where treatment is taking place. 

Orientation 

The primary investigator will provide a short, scripted introduction that goes over procedures, policies, and clinic services being provided when partaking in the study. After completing the orientation and consent forms are signed, the participants will be led to where the music therapy group session will be taking place while the primary investigator goes to a separate room waiting for results once the measures have been collected at the end of the session.

Completion of Measures
Following the orientation, the dependent measure, EPS, will be distributed to the participants before the group music therapy session begins. Participants will be asked to complete another EPS after the music therapy session ends. 

Intervention

The therapeutic songwriting intervention may entail the following events:
  • The music therapist will introduce one of the three song writing interventions (song collage word substitution, and song parody) to the treatment group by explaining how the client participates in the task.
    • Song Collage, also known as Music Collage, is the use of words and phrases that stem from already existing works, examples being songs, books, or lines in a movie. These words and lines chosen by the participants are then stitched together to create a mosaic of song lyrics that are shaped and structured into a song created by the entire group (Tamplin, 2006, p. 179). 
    • Word Substitution, also known as Fill-In-The-Blank Songwriting, is when the music therapist purposefully blanks out certain spots in an already existing song’s lyric. The blank is there for participants to fill in with their own words until all the blanks have been filled. The participants only objective is to focus on contributing lyrics. 
    • Song Parody is when only one aspect of a song is manipulated while all the other components of the song stay the same. An example being changing the lyrics, melody, harmony, or rhythm as well as other musical components of the song chosen. 
  • The music therapist will implement turn taking by giving each participant at least two to three turns to contribute to the songwriting process.   
  • Depending on the TSW technique being implemented, participants may contribute lyrics, choose a chord progression, suggest a song, or other alternative music ideas. 
  • After the participants have completed their song, the music therapist will play it through for the participants to listen to the final product. 
  • There will be a discussion facilitated by the music therapist asking open ended questions to the entire group of participants. 
  • The music therapist will end the group by thanking the group for participating. 

Proposed Analysis 

A One-Way ANOVA will be used to compare the group mean scores between a) song collage; (b) word substitution; (c) song parody; (d) control group. A Tukey’s post-hoc analysis will be conducted to evaluate the pair-wise differences between the group means to obtain the mean change scores of the six comparison groups. These six comparisons will identify the significance level of the adjusted p-values determining whether the null hypothesis or alternative hypothesis are statistically significant. The Null Hypothesis (H0): the EPS scores do not vary by treatment condition. The Alternative Hypothesis (Ha): the EPS scores do vary by treatment condition. 

Discussion

Significance of the Study 

While there are studies that address therapeutic song writing techniques, comparing more than two songwriting techniques can help in expanding their opportunities in application. This study may provide in expanding the knowledge of therapeutic songwriting techniques especially in the lack of research studies conducted about song collage or music collage technique. 

Limitations

This study attempts to explore the limitations found in studies on therapeutic songwriting techniques such as the comparison of therapeutic songwriting techniques, expanding the knowledge around song collage or music collage technique, the settings which it is applied to, and how TSW can aide in emotional processing within trauma-informed care. 

Limitations Related to Internal Validity
Internal Validity examines a study’s design and methods in its experimentation or examination in terms of establishing a strong causal relationship between treatment and non-treatment outcomes. In this study, there is a presence of selection threat due to non-random assignment because the population for this study is already limited in size and geographically it would not make sense to randomize within different facilities. The use of EPS lends itself to instrumentation threat and its relevance to participants diagnosed with post-traumatic stress disorder where the test has the most application with depression, anxiety, and emotional regulation. The scale could potentially be problematic when conducted with an inappropriate age and diagnostic population that it is not intended for. It also needs to be administered by a qualified professional. The funding needed for instrumentation may be expensive with a larger sample size. Lastly, changes in behavior may be a result of the participants knowing they are taking part in a study which could potentially be the subject effect called the Hawthorne Effect. 

Future studies could consider a change in choosing a target population that could be more generalizable such as expanding the genders used in the study and a different diagnostic criterion. Furthermore, instrumentation could be changed to a different scale or scale items. There are other scales and tests to consider that could be show more effectiveness than EPS as well as there could be more than one test administered. 

Limitations Related to External Validity 

External validity is the ability for a study’s results to be generalizable to common situations that occur in natural environments for the population at large. There are two kinds of external validity, population external validity and ecological external validity. Population External validity assesses the results of a study’s generalizability to a target population or a population with similar identifiers. Ecological external validity measures how an experiment can mimic the behaviors and experiences of an individual’s natural setting. 

In this study, there are limits to generalizing this population in terms of meeting population external validity. The perception of trauma to be diagnosed with post-traumatic stress disorder is different in each case. For example, someone might have experienced a severe car crash and someone else might have experienced domestic abuse which both can fit under the diagnosis of PTSD. Generalizing this population might be difficult without choosing one specific type of trauma. The way in which they process these experiences also may vary in amount of time needed to fully process. By narrowing down this study to female-identifying young adults with PTSD, it may address the same diagnosis with more accuracy. Future studies could address this through a more generalizable population as well as consider conducting the test for a longer period to observe its long-term effectiveness instead of single session. 

In terms of ecological external validity, this study occurs in mental health facilities that provide trauma-informed care and services. It could expand its positions of application in other settings such as other mental health focused groups such as Intensive Outpatient Programs, mental health groups, rehabilitation, or bereavement. Otherwise, there are little to no other real-world settings in which therapeutic songwriting can be applied for the purpose of emotional processing. 



Reflection
 

Justify why the design and method you chose was appropriate for the proposed study?
The reason I chose this approach of using a three-arm quasi-experimental multiple group design is because most studies done on TSW techniques focus on the outcomes and clinical examples instead of the development and detailed descriptions of TSW methods. There lies a gap in literature covering the development and applications of TSWs such as the song collage, also called music collage. By implementing a quasi-experimental multiple group design, I can observe the difference in the technique’s effectiveness for each group. Cluster sampling and picking names out of a hat seemed appropriate because the sample will be drawn from pre-existing groups that are patients in mental health centers that treat trauma and stress-related disorders. Since I could not mix groups from different facilities, pulling names out of a hat was the closest one could get to randomization. 

In what ways do you feel this study might contribute to the body of knowledge on this topic? 
There are studies that examine therapeutic songwriting techniques that are commonly used. However, there is a lack in comparing more than two TSWs as well as a gap in using it for emotional processing in trauma-informed care. Trauma-informed music therapy practices and approaches are limited. TSW is a common route to take when treating trauma in music therapy. By including this study in the body of knowledge it may also help with alternative or emerging therapeutic songwriting techniques to be acknowledge and expanded upon in other studies. 

How might the results of this type of study improve your own work (as a music therapist, music educator, or music researcher)? 

The results of this study may improve my work as a music therapist when working in mental health and knowing what TSW might be the strongest for certain backgrounds of people I may work with. It also gives me the opportunity to try three types of techniques to further understand its effectiveness with trauma-informed music therapy. As a music researcher the results may contribute to an incline in other TSW studies specifically going deeper into studying song or music collage as it is still a young and less developed technique in music therapy.   

What do you feel are the biggest challenges or roadblocks for conducting this study? 
It may be difficult to get patient participation given they are in a center for trauma treatment, and they may not be able to have the tools to engage effectively, let alone in a group setting. Collecting enough data may be an issue due to participants not wishing to continue the group session, not fill out the EPS test all the way, or not fill it out at all. A single session of group music therapy may not be enough for collecting data needed for the study to be successful in its findings.  

In what ways has this process of designing a research study influenced your own views of research? 
Research has become more accessible for me to read and understand concepts to then craft my own research ideas. It also has challenged my thinking being that research is rigid and has set rules to follow. However, the process of designing this research proposal has taught me that your questions or purpose will change over time as you continue to write it. Research requires you to be flexible and adaptable to different scenarios as well as think about them beforehand. By being an active participant in reading and conducting research, research has shown itself to me as being vitally important research to be clear and coherent for other clinicians to apply it in their settings. 

Reference


Baker, F. A. (2015). Therapeutic songwriting: Developments in theory, methods, and practice, 1st ed. Palgrave MacMillan. 

Baker, F., & Tamplin, J. (2006). Music therapy methods in neurorehabilitation: A clinician’s manual. Jessica Kingsley. 

Baker, F. A., Tamplin, J., MacDonald, R. A., Ponsford, J., Roddy, C., Lee, C., & Rickard, N. (2017). Exploring the self through songwriting: An analysis of songs composed by people with acquired neurodisability in an inpatient rehabilitation program. Journal of Music Therapy, 54(1), 35–54. https://doi.org/10.1093/jmt/thw018

Baker, R., Thomas, P., Thomas, S., Santonastaso, M., & Corrigan, E. (2015). Emotional Processing Scale Manual. Hogrefe. http://emotionalprocessingtherapy.org/

Jackson, N., & Heiderscheit, A. (2022). Compositional methods of music therapy. 200–202. Barcelona Publishers.

Johnson, K., & Heiderscheit, A. (2018). A survey of music therapy methods on adolescent inpatient mental health units. Journal of Music Therapy, 55(4), 463–488. https://doi.org/10.1093/jmt/thy015

Mantie-Kozlowski, A., Mantie R. A., & Keller, C. H. (2021). Therapeutic songwriting as a meaningful, relationship-oriented activity to establish authentic communicative opportunities during therapy for an individual with PPA. Aphasiology, 35(11), 1432–1447. https://doi.org/10.1080/02687038.2020.1812248

Rachman, S. (1980). Emotional processing. Behavior Research and Therapy, 18, 51–60. https://doi.org/10.1016/0005-7967(80)90069-8

Silverman, M. J., Baker, F. A., & MacDonald, R. A. (2016). Flow and meaningfulness as predictors of therapeutic outcome within songwriting interventions. Psychology of Music, 44(6), 1331–1345. https://doi.org/10.1177/0305735615627505

Tamplin, J. (2006). Song collage technique: A new approach to songwriting. Nordic Journal of Music Therapy, 15(2), 177–190. https://doi.org/10.1080/08098130609478164