Table 1 TIDieR [47] summary of the Synchrony group music therapy with songwriting intervention

1 Brief name

Synchrony group music therapy with songwriting for chronic depression

2 Why

Chronic depression is associated with challenges with low mood, motivation and social isolation. Group formats may promote social integration, interaction, provide emotional and social support and offer potential cost-effectiveness [3, 29]

Music therapy has promising evidence in treating depression [31] and offers a different therapeutic encounter. The intervention may be appealing and motivating encouraging attendance and engagement. Music has an immediate (often positive) impact upon mood [34] which may reduce symptom distress and within groups (especially singing), can promote social bonding [35]. Musical improvisation may support initial nonverbal communication of feeling states and aid patients in learning to name these [41]. Group songwriting may further aid verbal expression of internal experiences and is associated with improved quality of life [33]. Patient and carer groups value the accessibility of singing and importance of an ‘end product’ in promoting self-esteem, self-efficacy and achievement in recovery

By offering a regular intensive group format, patients will have opportunities to make music together thus providing opportunities to build trust and bond with others, improve mood and build relationships. We hypothesise this will lead to short-term reduction in psychological distress and improved social functioning. The above will contribute to improved self-esteem and self-efficacy and taken as a whole, a reduction in depression symptoms. Secondary impacts of reduced depression will be improved satisfaction with services, reduced impact of depression upon work and life and improved quality of life

3 What: materials

• Range of large and hand held percussion instruments, e.g. large: Djembe drum, bongos, conga, snare, tom toms / small: cabassa, castanets, cowbell, triangle, various shakers, chimes

• Tuned instruments: guitar, electric keyboard and/or acoustic piano, auto harp, xylophone, ballaphone, marimba, glockenspiel, harmonica, thumb piano, chime bars, hand bells, etc

• 2–4 microphones for recording and stand

• Recording equipment: zoom digital audio recorder, iPad with compatible external microphone and Garageband or similar software

• Amplification for iPad and electric guitar/keyboard where required

• Projector to connect to iPad for song ideas

• Speakers for playback

• Flipchart and blu-tack

4 What: procedures

Group music therapy with songwriting, based on an adapted songwriting intervention [33] and informed by psychodynamic music therapy for depression [40] and resource-oriented music therapy [36]

1. Pre-therapy induction session with music therapists to meet each other, set expectations, answer questions and introduce the equipment and sorts of music-making that will happen

2. Text message reminders sent to participants to encourage group attendance

3. First session: Extended introductions, overview of 14-week schedule, group rules, introduction to songwriting

4. General group structure and format: Instrumental/body warm up and check in. Initial sessions use reflection on a piece of music brought to the session by a group member. Music therapists encourage group discussion. Warm-up improvisation using a theme from previous discussion to prepare for songwriting. Group reflection on the experience and ideas/themes they wish to take forward into the songwriting. Group songwriting with option to rehearse and/or perform elements. End of session check in on how feeling now compared to the beginning. Reflection on the group events and decisions

5. Sessions 2–31: Songwriting and developing group song list

6. Sessions 32–42: Group review and closure—Sessions are dedicated to reviewing the songs written, including possibility to rehearse and record or perform. Reflection on group processes and relationships

5 Provider

Two HCPC-registered NHS music therapists

6 How

Face-to-face, group format, up to 10 participants per group

7 Where

Community centre, room with space to seat up to 12 (10 participants and 2 music therapists). Some décor such as paintings, plants, natural light. Reasonable soundproofing from interior to exterior. Room to be free from interruption or loud external noise for duration of session. Wifi to enable access to the internet for song-sharing and mobile phone signal

8 When/how much

a) Intensity

High intensity

b) Frequency

Three sessions per week

c) Session time

90 min consisting of 60 min session with 15 min pre/post for socialisation

d) Overall duration

14 weeks

9 Tailoring

Group structure was permitted to become more flexible (in terms of improvisation and songwriting content) as sessions progressed to tailor to the evolving needs of the group. Songwriting elements are used interchangeably where appropriate to aid the songwriting process (creating lyrics, developing the song, choosing genre, developing rhythmic structure, developing verse/chorus melody, choosing mode/harmony, adding instrumental accompaniment/possibilities for improvisation, rehearsing, final song performance)

10 Modifications

Participants unable to attend regularly were encouraged and supported to stay in contact with the music therapists and to return when they could. This meant some participants attended only once or twice per week, and some did not attend for an extended period in the group therapy

Songwriting was not used in the wait-list group

11 How well: Planned fidelity strategies and assessment

Pre-designed fidelity checklist completed by music therapists every session

Observer-rated fidelity checklist completed by independent music therapist rater

12 How well: Actual

Mean adherence of 44.45% (SD 25.94) with moderate reliability when coded by an independent rater. All manual components were used but with different sections occurring at different points in the therapy process