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| BRIEF REPORT |
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| Year : 2020 | Volume
: 34
| Issue : 4 | Page : 196-198 |
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Therapeutic Factors in the Group Singing Therapy by Social Robot for Patients with Schizophrenia: A Pilot Study
Yin- Huang Liao M.Ed. 1, Chia- Chun Wu M.S. 2, En- Lin Yang M.A 3, Yi- Nuo Shih Ph.D 4
1 Department of Psychiatry, Cathay General Hospital, New Taipei City, Taiwan
2 Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University; Division of Psychiatry, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
3 Department of Music, College of Arts, Fu Jen Catholic University, New Taipei City, Taiwan
4 Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| Date of Submission | 26-Oct-2020 |
| Date of Decision | 27-Oct-2020 |
| Date of Acceptance | 28-Oct-2020 |
| Date of Web Publication | 17-Dec-2020 |
Correspondence Address:
Yi- Nuo Shih
No. 510, Chung Cheng Road, Hsinchuang, New Taipei City 24205
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/TPSY.TPSY_38_20
Objective: Fewer robots are being used for psychological care, the objective of this pilot study was to explore the therapeutic factors in the group singing therapy by social robot to interact with people with schizophrenia. Methods: In this pilot study, we recruited nine subjects who were aged between 28 and 62 years. They received four sections of group singing therapy given by asocial robot and an occupational therapist. Then, we collected a completed copy for therapeutic-factor questionnaire. Results: In this pilot study, the top three therapeutic factors in order were group cohesiveness, universality, and altruism. Conclusion: Social robot may be a good companion tool for chronic schizophrenia, and need to increase the number of subjects to improve the validity of the study results in the future.
Keywords: music therapy, occupational therapy, singing group, group cohesiveness
How to cite this article:
Liao YH, Wu CC, Yang EL, Shih YN. Therapeutic Factors in the Group Singing Therapy by Social Robot for Patients with Schizophrenia: A Pilot Study. Taiwan J Psychiatry 2020;34:196-8 |
How to cite this URL:
Liao YH, Wu CC, Yang EL, Shih YN. Therapeutic Factors in the Group Singing Therapy by Social Robot for Patients with Schizophrenia: A Pilot Study. Taiwan J Psychiatry [serial online] 2020 [cited 2023 Jun 11];34:196-8. Available from: http://www.e-tjp.org/text.asp?2020/34/4/196/303684 |
| Introduction | |  |
Music-related interventions may play a significant rôle in the treatment of mental disorders [1]. In recent years, schizophrenia has become an issue for this common, chronic mental illness, deserving a research attention. Group therapeutic singing is one auxiliary intervening method that has been widely adopted on psychiatric wards. Studies found that music can influence a patient's physio-psychological condition. While music can effectively reduce negative symptoms, it is also low-cost and nonintrusive, and has few side effects [2].
Other studies found that therapeutic singing in a group provides a soothing effect, as music activity can help patients to improve their communication with others [1]. During this process, patients have enhanced their self-confidence, their self-expression, and the ability to communicate their emotions [2]. Music therapy benefits societal wellbeing of the mentally ill [3]. As an intervening form, music-therapy group comprises writing/editing lyrics, music grooving, listening to music and singing songs, among which, group singing is about the most commonly used [2],[3].
Yalom in 1975 [4] identified several decisive, clinical therapeutic factors in the effects of group therapy, the 12 most successful factors based on patient feedback from a group-therapy episode [2],[3],[5]. Those 12 therapeutic factors are altruism, group cohesiveness, universality, interpersonal learning, development of socializing techniques, imparting of information, catharsis, imitative behavior, corrective recapitulation of the primary family group, self-understanding, instillation of hope, and existential factors. All these factors are often used as performance indicators to assess the effectiveness of group therapy [2],[5].
In recent years, the use of robots still mainly involves physiological applications, such as surgical operations and post-stroke habilitation [6],[7],[8]. Many fewer robots are used for psychological care or companion care. One previous study was found that using social robot as companion can increase patient's sense of comfort, and that even brief, daily robotic companionship can bring positive improvements to physical and mental health for patient with mental illness [9].
The above review of topics deserves further study. Due to the relatively small number of related research articles on this topic so far, the study of social robots for mental care certainly can use more developments [9]. In this pilot study, we intended to explore the therapeutic factors in the group singing therapy conducted by social robot to interact with patients with schizophrenia.
| Methods | | |
Study participants
We recruited nine participants in this pilot study. They were aged between 28 and 62 years, and were diagnosed with schizophrenia from a New Taipei City psychiatric rehabilitation homes.
The study was approved by the institutional review board of the Fu Jen Catholic University (IBB protocol number = C107174 and date of approval = February 18, 2020) with the stipulation of obtaining informed consents from study participants. All survey copies were collected anonymously. Written consent was collected immediately before the test, and participants were reminded that they can withdraw the participation in this study any time.
Assessment tool for therapeutic factors
The therapeutic factor questionnaire in this study is taken from Chinese Association of Group Psychotherapy's therapeutic factors flashcards. As for the assessment method, we have followed the way that previous investigators had given tests, the highest score is 10 points, the lowest score is two points [2],[6].
Social robot
One social robot is Zenbo® (ASUS Company, Taipei, Taiwan). It has the functions of playing songs and music, leading a singing along, and playing videos.
Procedures
Group singing therapy conducted by social robot and an occupational therapist one time a week, 50–55 min each time, for four times totally. Each singing-group therapy session includes 5–10 min of warm-up activities conducted by an occupational therapist, 40 min of main singing group activities only by social robot named Zenbo®, and then five minutes of group sharing and discussion conducted by occupational therapist. At the fourth week, ask nine subjects to answer therapeutic-factor questionnaire.
| Results | | |
As shown in [Table 1], the top three therapeutic factors in order are (a) group cohesiveness (8.222), universality (7.889), and altruism (7.667). The lowest three therapeutic factors in order are (a) catharsis (6.444), (b) interpersonal learning (6.778), and (c) imparting of information (6.889). | Table 1: Therapeutic factors in the group singing therapy by social robot for patients with schizophrenia (n = 9)
Click here to view |
| Discussion | | |
Social robot may be a good companion tool for mental health when medical manpower is scarce. The many symptoms of schizophrenia can be stabilized and alleviated by giving medications. But studies were found that even patients with schizophrenia who take medicine regularly, still face many problems with living and social adjustment. In addition, besides medication treatment, patients with chronic schizophrenia also have to consider psychosocial adjustment while trying to reintegrate into society. Accordingly, practitioners have introduced and applied to patients many methods not based on medication, such as group therapy [2],[5].
The group cohesiveness, universality and altruism are important therapeutic factors about psychosocial adjustment, and those three therapeutic factors are higher than others in this pilot study about group singing therapy by social robot to interact with patients with schizophrenia. As shown in [Table 1], catharsis was the lowest among the choices of therapeutic factors, suggesting that it is still difficult for robots to replace real human therapists to make patients with schizophrenia willing to share their thoughts and feelings.
Study limitations
The readers are warned not to over-interpret the study results about social robot for musical group therapy here because this pilot study has four study limitations:
- This pilot study has small sample with only nine participants with schizophrenia.
- We used only group singing as therapy intervention. The results of this study might not applicable to other types of group therapy.
- For social robot, we used only Zenbo® Other types of social robot may produce different conclusions.
- This pilot study had only post-test in therapeutic factor questionnaire rated through patient's self-report, no other assessment tools were used to assess efficacy.
Due to those three study limitations in this pilot study, we suggest that we need to increase the number of study participants to strengthen the validity of the study results, and to explore the therapeutic factors in other groups by social robot, such as health education group, in the future. Finally, we need to consider using some copies of more sophisticated questionnaire with numerical conclusion from statistical analysis.
Summary
Social robot may be a good companion tool for patients with chronic schizophrenia. We need to increase the number of subjects to improve the validity of the study results, and to do pre-test and post-test measurements to show the efficacy of treatment by participating the group therapy in the future.
| Financial Support and Sponsorship | | |
This study was supported by Grant 108-CGH-FJU-10 from Cathay General Hospital.
| Conflicts of Interest | | |
The authors declare no potential conflicts of interest in writing this report.
| References | | |
| 1. | Grebosz-Haring K, Thun-Hohenstein L: Effects of group singing versus group music listening on hospitalized children and adolescents with mental disorders: a pilot study. Heliyon 2018; 4: e01014.  |
| 2. | Wu CC, Hsu JL, Shih YN, et al.: Identifying the therapeutic factors in the group singing therapy on halfway house patients. Chin Group Psychother (Taipei) 2017; 23: 5-19. |
| 3. | Wang S, Agius M: The use of music therapy in the treatment of mental illness and the enhancement of societal wellbeing. Psychiatr Danub 2018; 30: 595-600. |
| 4. | Yalom ID: The Theory and Practice of Group Psychotherapy. 2nd ed. New York City: Basic Books, 1975. |
| 5. | Kanas N: Group therapy with schizophrenia patients. Am J Psychiatry 2006; 163: 937-8. |
| 6. | Chung MS, Kuo PJ, Tsu JH, et al.: Reliability and validity of Chinese version Yalom's therapeutic factors. Chin Group Psychother (Taipei) 2011; 17: 5-19. |
| 7. | Yen PL, Hsiao HM, Hung SS: Surgical robots towards the design concept of an intelligent tool for bone resection in total knee arthroplasty. J Biomech Eng 2009; 2: 51-64. |
| 8. | Iwamoto Y, Imura T, Suzukawa T, et al.: Combination of exoskeletal upper limb robot and occupational therapy improve activities of daily living function in acute stroke patients. J Stroke Cerebrovasc Dis 2019; 28: 2018-25. |
| 9. | Demange M, Lenoir H, Pino M, et al.: Improving well-being in patients with major neurodegenerative disorders: differential efficacy of brief social robot-based intervention for 3 neuropsychiatric profiles. Clin Interv Aging 2018; 13: 1303-11. |
[Table 1]
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