Abstract
This clinical project was designed to develop a therapeutic protocol to meet the needs of adults receiving inpatient mental health care. The outcome serves as a resource for clinicians, providing specific intervention elements and adaptations considered most appropriate for addressing executive functioning skills in adults with schizophrenia. The project was completed over the course of 12 months at Jackson Behavioral Health Hospital. Weekly observations over a 14-week period revealed a need for the practice of impulse control and cognitive flexibility with this population. The supporting literature reveals a clear overlap between the neural structures implicated in executive functioning as well as the diagnosis of schizophrenia, including the prefrontal cortex and the inferior frontal gyrus. Music experiences, such as music listening and musical improvisation, also utilize such neural structures as well as facilitate the relationship between subcortical ( emotional) and cortical (cognitive) structures that is necessary for appropriate executive functioning. The overlap supports the hypothesis that music experiences have the potential to effectively practice impulse control and cognitive flexibility in individuals with schizophrenia. Thus, three Musical Executive Function Training (MEFT) experiences were developed to practice and enhance these skills. One MEFT experience was ensemble conducting, in which individuals conducted an ensemble of patients performing on percussive instruments. An additional MEFT percussion improvisation experience involved learning and repeating rhythmic patterns on various percussion instruments. Finally, the MEFT music listening experience consisted of the student music therapist performing songs of various genres on guitar or keyboard as patients sang along and/or accompanied on percussion instruments. To enhance therapeutic effectiveness, each experience incorporated emotional engagement and verbal processing. In designing and implementing the MEFT experiences, special attention was given to the Therapeutic Functions of Music, in particular the musical elements of melody, rhythm, harmony, and dynamics. More specifically, the functions emphasized the musical elements required to elicit emotional engagement and attention, as well as practice impulse control and cognitive flexibility. The MEFT experiences were implemented across 121 hours over seven months with approximately 250 patients during 70 group sessions. Observations made by the student music therapist of patient behaviors and responses resulted in analysis of successful components of each experience. One such observation was the importance of providing a live, aestheticallypleasing musical stimulus that is patient-preferred. Additional musical components required for the practice of impulse control and cognitive flexibility included repertoire and musical elements that exhibit the Gestalt principles of perception. Verbal, physical, and musical modeling of desired behaviors and outcomes as well as adaptations to each experience, appropriate for varying levels of functioning, were also considered. This document also provides a list of limitations to the project, such as unpredictable level of functioning, as well as ensuing recommendations, including clinician assessment of level of functioning during the introduction to the MEFT experience. Thus, the culmination of this clinical project results in a protocol for clinicians, including adaptations, for three MEFT experiences to practice impulse control and cognitive flexibility in adults with schizophrenia.