RESEARCH ARTICLE

Self-Selected Individual Music Therapy for Depression during

Hospitalization for Cancer Patients: Randomized Controlled
Clinical Trial Study
Widiyono 1, Sri Setiyarini 2, Christantie Effendy 3
1
Medical-Surgical Nursing Department, School of Nursing, ScienceTechnology and Health Faculty, Sahid Surakarta University
2
Basic and Emergency Nursing Department, School of Nursing, Medicine Faculty, Universitas Gadjah Mada
3
Medical-Surgical Department, School of Nursing, Medicine Faculty, Universitas Gadjah Mada

ARTICLE INFO ABSTRACT

Received : 18 March 2019 Background: Depression is a psychological distress that often occurs on cancer patients.
Reviewed : 2 June 2019 Depression can increase patient perception about pain, resulting reduced drug efficacy and
Accepted : 27 September 2019 longer length of stay. Drug treatment for depression sometimes has side effects. Another
intervention to decrease depression on cancer patients is music therapy. Music therapy might
avoid polypharmacy in cancer patients. The purpose of this study was to determine the effects
of self-selected individual music therapy toward depression of cancer patients.
Keywords:
cancer, complementary and alternative Methods: The method used in this study was the randomized control trial (RCT). Simple Random
medicine (CAM), depression, music Sampling was assigned randomly by three researcher assistants to participants (N=70) of
therapy. intervention and control group. The intervention used was self-selected individual music therapy
(SeLIMuT). SeLIMuT was applied four times in 2 days with a duration of 15 minutes each session.
Beck Depression Inventory (BDI) was employed for selection purposes. The data were analyzed
using Mann-Whitney with p < 0.05 and 95% CI. The effectiveness of therapy was analyzed by the
effect size test using abs r.

Results: Based on the result of the bivariate analysis, there was an effect of giving self-selected
individual music therapy to reduce depression with depression gap in both groups with p-value
*Corresponding author: of 0.001 (p < 0.05). The value of the effect test obtained abs r = 0.82 (r > 0.5). At the end, the
Widiyono self-selected individual music therapy had moderate effect toward depression of cancer patients.
School of Nursing, 2nd Floor,
Sains Technology and Healthy Faculty, Conclusions: Music therapy is safe, inexpensive, and easy to use, for and by patients. The nurse can
Sahid Surakarta University. safely recommend any of these interventions for depression on cancer patients. Specific selections
Adi Sucipto 154, Jajar, Laweyan, Solo. or types of music may have different effects on different patients and may provide different effects
[email protected] at different time, so the use of self-selected individual music therapy is recommended.

INTRODUCTION were depressed. The increase of depression is in accordance

with the occurrence of disability and widespread stage of
Cancer incidence in the world increases from 12.7 cancer [3–7]. Depression improved patient perception
million to 14.1 million cases from 2008 to 2012. World towards pain, reducing drug efficacy and longer length
Health Organization (WHO) mentioned two-thirds of new of stay in the hospital and encouraging suicide [8].
cancer-related cases are always in countries with low- Observing the adverse effects of depression on the
to-middle social economies [1]. Cancer is a life- prognosis of disease, the depression management is
threatening disease as the condition of prognosis often important in preparation of intervention for cancer
worsens [2]. This disease has a serious impact on the patients [9–10]. Sometimes drug treatment has a side
quality of life of a person. The patients often experiences effects on cancer patients [11]. The use of Complementary
physical, psychosocial, spiritual and other problems [3]. and Alternative Medicine (CAM) in the treatment of
Psychosocial issues consist of anxiety, fear of undergoing cancer patients has increased lately. Globally, over 80%
treatment, relapse, and depression [4–5]. of cancer patients have used some types of CAM
Severe depression is estimated to occur in 16% to 25% therapies [10–12].
of cancer patients [6]. The study result of Effendy et al. [3] Music therapy can indeed exert a positive effect of
in 2014 showed that 34.4% of cancer patients in Indonesia psychological support like depression, whereas no

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DOI: http://dx.doi.org/10.33371/ijoc.v13i3.632
Self Selected Individual Music Therapy (SeLIMuT) WIDIYONO, ET AL

adverse effects of music therapy have been reported group. Simple random sampling was assigned by
so far [13]. The use of music therapy on depression of anonymizing participants and using a random number
cancer patients might avoid the polypharmacy [11]. table to distribute participants into either group:
Music therapy is one form of CAM that can be used intervention group (n = 35) and control group (n = 35).
to overcome depression in cancer patients [9–14]. It This study used single-blind. The subjects were not
has the advantage to be applied in a simple therapy informed about the allocation. Subjects in the
and cost-effective because the price is affordable and intervention group had access to this information.
the therapy is non-invasive, does not require a therapist
and does not cause side effects [15].
Instruments
Music therapy will be more effective if the individual
chooses his own preferred type of music [16–17]. Self- The instrument used in the study was Beck
selected individual music therapy is the planned use Depression Inventory (BDI) to measure the level of
of music to achieve therapeutic outcomes combined depression experienced by cancer patients [18]. Beck
with deep breath and the kind of song is chosen by Depression Inventory is a self-rating assessment and
the patient. This study aimed to evaluate the effect was used to evaluate the intensity of depressive
of self-selected individual music therapy toward symptoms based on the patient’s perception.
depression of cancer patients. The reasons above, make Depression assessment of 0 to 9 indicates normal, 10
the researcher use the self-selected music therapy as to 15 mild depression, 16 to 23 moderate depression,
a complementary therapy for cancer patients in and 24 to 63 severe depression. It is considered
overcoming depression. significantly different if there is a difference in the
average depression of 5 points between before and
after intervention.

METHODS
Procedure
Design Self-selected individual music therapy was a
procedure of providing music therapy with slow music
This study utilized a randomized controlled trial
criteria, stable tempo, soft dynamic, and consistent
study. Music therapy sessions took place in participants’
texture chosen according to the patient’s preferences,
rooms on the oncology unit after completing a pre-test.
combined with a deep breath. Intervention therapy
Data collection was conducted in inpatient unit I of Dr.
was applied four times in 2 days with duration about
Sardjito Hospital in Yogyakarta and Bougenvile-Teratai
15 minutes each session and the patient could listen
unit of Prof. Dr. Margono Soekarjo Hospital in
to music through MP3 Player and headphones. Self-
Purwokerto, Central Java, Indonesia. Data collection
selected individual music therapy was given to
occurred from March until May 2017. The patients were
patients in both groups. For the control group, music
recruited if they complied with inclusion criteria, agreed
therapy was given after the post-test had been
to be the participant, and had signed the inform consent.
performed.
The intervention group was given self-selected individual
The intervention was given in the afternoon to
music therapy (SeLIMuT) after measurement of
avoid interfering with the activities of the fixed
depression on pre-test while the control group was given
procedure of treatment in the room, so the patient
the treatment after the study had been complete (after
would feel more comfortable in doing music therapy.
finishing the post-test).
Before given music therapy, the author(s) checked the
general state, vital signs and complaints of patients
Research Participant to avoid the side effects that might be caused by the
Sampling was done by non-probability sampling with music therapy like headaches and ears drooped.
purposive sampling technique. Inclusion criteria for this To minimize the bias of this study, the author(s)
study were patients diagnosed with cancer, depressed made the data sample homogeneity with inclusion
(BDI > 9), who like music and did not experience hearing criteria. This study was approved by the Ethics
loss. Exclusion criteria were patients in emergency, Committee of the Medicine Faculty of Universitas Gadjah
listening music more than 20 minutes every day, using Mada with Ethical Clearance number of REF: KE/
anxiolytic drugs (such as thiopentyl and flumazenil) and FK/0150/EC/2017.
antidepressants. The number of samples was 70
respondents.
Statistical Analysis
The screening process was conducted to determine
the respondents who met the criteria and a simple The characteristics of demography data were
randomization process was done to determine the categorical by the homogeneity test with Chi-Square
respondents into either the intervention or control or Fisher Exact. The mean differences of the depression

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Self Selected Individual Music Therapy (SeLIMuT) WIDIYONO, ET AL

rates between the pre- and post-intervention of both RESULTS

groups (n = 35 on each group) were tested for
normality with Shapiro-Wilk test and the results were The demographic data of the respondents were
not normally distributed, so the data were analyzed divided to demographics and health condition of the
using Mann-Whitney with p < 0.05 and 95% CI. The respondents. Both intervention groups were compared
effectiveness of the therapy was performed by the with the control group (Table 1). The homogeneity of
effect size test using abs r. the demographic data in both groups showed that there
was no significant difference. This means that the
characteristics of the respondents of both groups are
Assessed for
Recruitment eligibility homogeneous or the same.
(N = 80)
Table 1. Demographic characteristics (n=70).

Didn't meet Group

eligibility
criteria Intervention Control
Characteristics
(n = 35) (n = 35)
(n = 70)
f (%) f (%)
Gender/Sex

Meet eligibility Female 26 (74.3) 25 (71.4)

criteria and Male 9 (25.7) 10 (28.6)
Enrollment asked for
consent Age
(N = 73) Early adulthood
5 (14.3) 7 (20.0)
(20–40 years)

Mature adults
26 (74.3) 25 (71.4)
For somatic (> 40–60 years)
reason (n=2)
The final adult
4 (11.4) 3 (8.6)
Due lack of (> 60 years)
interest (n = 1) Education level
Elementary school 24 (68.6) 19 (54.3)
Junior high school 5 (14.3) 8 (22.9)
Consent to
Randomization participate Senior high School 4 (11.4) 4 (11.4)
in study Diploma 0 (0) 3 (8.6)
(N = 70)
Bachelor 2 (5.7) 1 (2.9)
Marital status
Married 29 (82.8) 34 (87.1)
Widow 6 (17.2) 1 (2.9)
Work
Randomized to Randomized to Housewife 11 (31.4) 12 (34.3)
intervantion control group
group (n = 35) (n = 35) Entrepreneur 5 (14.3) 10 (28.6)
Civil servant 4 (11.4) 7 (20.0)

Analysis Private 2 (5.7) 0 (0.0)

Farmers 13 (37.3) 6 (17.1)

According to Table 2, the homogeneity of the health

Complete all Complete all
measures measures
condition data in both groups showed that there was
(n = 35) (n = 35) no significant difference. This means that the
characteristics of the health condition respondents of
Figure 1. Assessment for eligibility criteria both groups are homogeneous or the same.

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Table 2. Health condition (n=70) The depression conditions of the respondents in this
study can be known from the results of BDI. Based on
Group the results of BDI’s first measurements in both groups
Intervention Control (n=70), the majority of respondents answered that they
Characteristics (n = 35) (n = 35) postpone making decisions (45.7%), they felt that they
might be punished (50%), they felt sad (64.3%), they
f (%) f (%)
felt they could not enjoy everything as usual (57.1%),
Cancer types they cried more than usual (57.1%), they were more
Breast 12 (34.2) 10 (28.6) easily irritated or angry (57.1%), they were awakened
two to three hours early and they had difficulty sleeping
Rectum 7 (20.0) 2 (5.7)
back (48.6%), their appetites were not as big as usual
Cervix 6 (17.1) 3 (8.6) (47.1%) and they were anxious about their physical
Ovary 3 (8.6) 3 (8.6) health such as pain (54.3%).
The depression condition in the intervention group
Colon 2 (5.8) 4 (11.4) changed after SeLIMuT. Based on the results of BDI’s
Colli/Tiroid 1 (2.9) 3 (8.6) last measurements in the intervention group (n=35),
the majority of respondents answered that their making
Other (femur, pedis testis,
lung, nasopharynx, decisions was better than before (51.4%), they did
4 (11.4) 10 (28.6) not feel that they were being punished (34.3%), they
mandible)
did not feel sad (48.6%), they felt satisfied with
Duration of illness
everything (51.4%), they did not cry more than usual
< 2 year 22 (62.8) 24 (68.6) (60%), they did not feel more irritated than before
2–5 year 10 (28.6) 8 (22.9) (82.9%), they could sleep soundly (28.6%), their
appetites were as usual (28.6%), and they did not
> 5 year 3 (8.6) 3 (8.6) worry about their health beyond the usual (42.9%).
Type of therapy The depression condition in the last measurements
on the control group (n=35) had the same result
No treatment 2 (5.7) 2 (5.7)
compared with the first measurements.
Surgery 7 (20.0) 11 (31.4) According to Table 3, the mean difference in the
Chemotherapy 3 (8.6) 2 (5.7) pre-post depression rates of the intervention group
(n=35) result in p-value 0.001 (p<0.05) showed significant
Radiotherapy 2 (5.7) 0 (0.0)
depression difference before and after SeLIMut in
Surgery & Chemotherapy 16 (45.7) 19 (54.3) intervention groups. While in the control group (n=35),
Surgery & Radiotherapy 0 (0.0) 1 (2.9) result in p-value 0.196 (p>0.05) showed no significant
depression difference in the first and last measurements
Surgery, Chemotherapy, in the control group.
5 (14.3) 0 (0.0)
& Radiotherapy

Comorbid disease Table 3. Mean difference depression on each group (n=35)

No comorbid disease 27 (77.1) 26 (74.3)
Difference value on each group
Anemia 3 (8.6) 3 (8.6) Group Med. Mean
DM 2 (5.7) 2 (5.7) p-value 95% CI
(min-max) Rank
Asthma 2 (5.7) 2 (5.7) Intervention
0.001*c
(n = 35)
Hypertension 0 (0.0) 2 (5.7)
20.0
Hepatitis 1 (2.9) 0 (0.0) Pre-test 00.0 20.1-23.9
(13.0-34.0)
Smoking 13.0
Post-test 18.0 11.4-14.6
(2.0-23.0)
Yes 7 (20.0%) 8 (22.9)
Control
No 28 (80.0%) 27 (77.1) 0.196d
(n = 35)
Alcohol consumption 17.0
Pre-test 16.1 16.4-21.8
(10.0-4.0)
Yes 1 (2.9) 0 (0.0)
16.0
No 34 (97.1) 35 (100) Post-test 11.2 17.2-22.7
(11.0-5.0)
* significant (p < 0.050), d analysis using Wilcoxon

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Table 4. Mean difference of depression on two groups (n=70)

Difference value on both groups

Groups
Med. (min-max) Mean Rank p-value U Z r 95% CI

8.0
Intervention (n = 35) 18.0 7.2 -10.7
(3.0 -31.0)
0.001*d 28.0 -6.8 0.8e
0.0
Control (n = 35) 52.0 -2.1 -0.5
(-13.0 -9.0)
*significant (p < 0.05), d analysis using Mann-Whitney, e analysis ES using abs r

According to Table 4, the pre-post depression gap making, getting easily confused, impaired memory,
in both groups obtained p-value 0.001 (p < 0.05) which feeling of guilt or regret and lack of self-esteem [22–23].
means there is a significant effect of giving self-selected Stress can be observed from the result of BDI of the
individual music therapy to reduce depression. The effect respondents of both groups in the last measurement
test obtained abs r = 0.82 (r > 0.5) indicating that music showing that the respondents postponed making
therapy has a severe effect on depression decrease. decisions and felt that they might be harvested.
Stress is related to patients’ condition during
hospitalization. They said that the stress was caused
DISCUSSION by their illness and the feeling of boredom due to
monotonous activities such as being examined by
healthcare personnel, taking medication, eating diet
Based on the results of the screening, it was shown
foods from the hospital, and resting on the bed. The
that all cancer patients who were treated in oncology
state of stress in cancer patients is associated with
unit suffered from depression. The results showed that
the incidence of depression [24]. Stress conditions
SeLIMuT had an effect on depression both statistically
due to undergoing treatment will make cancer
and clinically. Significant effect of self-selected individual
patients think of the perceived depression more
music therapy administration on depression reduction
acutely [25].
can be seen in Table 4, which obtained value difference
In the intervention group of respondents, after being
between pre- and post-depression in both groups with
given self-selected individual music therapy, the majority
a p-value of 0.001 (p < 0.05).
answered that they made decision better than before
Self-selected individual music therapy has a moderate
and did not feel punished. The phenomenon can be
effect on reducing depression in cancer patients. The
explained by the fact that music has a component of
effect test resulted in absolute r test (abs r) of 0.82
tone and rhythm that can give a psychological effect
(r > 0.5). The result of this effect size is higher than
on the listener [26–27]. Electromagnetic wave-shaped
the study of Romito et al. [19] which got the result of
sound stimulation from music therapy will vibrate the
d = 0.52. This suggests that music has a moderate effect
eardrum and pass to the central nervous system
on decreasing depression. Different effect sizes in this
precisely on the limbic system that functions as
study may be due to music administration duration,
neurophysiology associated with feelings, memory,
wherein Romito et al. [19] study music therapy was
sensation, and motivation [28-29]. This result is similar
given only once (single session) when the patients were
to Jia et al. [10] that music intervention can improve
undergoing chemotherapy.
the emotion of cancer patients during disease
The positive impact of self-selected individual music
progression.
therapy to decrease depression in this study can be
Based on the result of BDI response of the initial
explained by the fact that self-selected individual music
measurement in both groups, the majority of respondents
therapy can reduce stress, improve mood, overcome
answered that they were feeling sad, could not enjoy
changes in motor function and behavior, and increase
everything as usual, cried more than usual, and were
relaxation.
more easily annoyed or angry. According to Nevid et
Stress is associated with the incidence of depression
al. [22], one of the common characteristics of depression
and will result in dysregulation of the Hypothalamic
is a change in mood conditions of feeling down, sad
Pituitary Adrenal (HPA) Axis that causes changes in
or cheap, crying more frequently and increased
serotonin metabolism and negatively affects cognitive
irritability. The symptoms of depression are included in
control in the frontal lobes of the brain, causing damage
affective manifestations [18].
to the hippocampus and decreased dopaminergic
Self-selected individual music therapy is able to
function [20–21]. The stress caused a decrease in
decrease the symptoms of depression that include those
cognitive abilities, difficulty in concentrating, decision

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Self Selected Individual Music Therapy (SeLIMuT) WIDIYONO, ET AL

affective manifestations. Based on the result of the last feeling anxious about their physical health for having
BDI measurement in the intervention group showing problems such as getting sicker and pain, stomachache,
that the majority of respondents said that they did not or constipation. Symptoms of such psychosomatic
feel sad, felt satisfied on everything, did not cry more depression include the categories of vegetative and
often than usual and did not feel more easily irritated physical manifestations [18]. The pain will have an
than before. The change can be explained by the fact impact on anxiety and depression [38].
that once the music sound stimulates the limbic system, After obtaining self-selected individual music therapy,
the music will call the memory or deep memories of the majority of respondents in the intervention group
the patients resulting in mood changes and can make did not worry about their health beyond the usual. It
a therapeutic effect by decreasing the depression in is supported by another study conducted by Romito et
patients [30]. al. [19] that mentioned music therapy could reduce
Besides, music can also cause effects of pleasure or psychological discomfort like anxiety.
euphoria for those who listen [31]. This effect is Self-selected individual music therapy mechanism in
equivalent to consuming caffeine and alcohol [32–33]. enhancing relaxation can be explained by the fact that
The happy or cheerful feelings can reduce the levels the stimulus of music will form a perfect alpha wave
of cortisol, epinephrine, and norepinephrine because and stimulate the release of the neurotransmitter
the music that has entered the pituitary gland is able serotonin which will be converted into melatonin and
to respond to the emotion through negative feedback provides a relaxing effect that can reduce depression
to the adrenal gland to suppress the release of the [11,28,36,37]. This audio stimulus also affects the
hormone [34]. The cheerful feeling was observed in the pituitary in the brain to produce endorphins that can
intervention group respondents who participated in reduce feelings of anxiety [39].
singing some memorized lyrics, moving the toes and The limitation of this study is that the stage of cancer
moving the wrists as the self-selected individual music was not examined because it was not recorded in the
therapy process progresses. medical record and the authors did not check the
The last BDI measurements showed that the majority surgical oncologist because of the limited time. However,
of respondents in both groups answered they woke up the study has looked at the general condition of the
two to three hours earlier and were having difficulty cancer patients prior to music therapy, both in the
to sleep again and the appetite was not as great as intervention and control groups.
usual. The symptoms of depression are included in
vegetative and physical manifestations [18].
In contrast to the non-intervention group, after CONCLUSIONS
getting self-selected individual music therapy, the
majority of the intervention group respondents answered
Music therapy is safe, inexpensive, and easy to use,
that they could sleep as soundly as usual and had normal
for and by patients. The nurse can safely recommend
appetite. The changes in the symptoms of depression
any of these interventions for depression on cancer
indicated that music therapy is a unique application to
patients. Specific selections or types of music may have
enhance personal that may create positive changes in
different effects on different patients and may provide
one’s behavior [35]. Changes to those conditions can
different effects at different time, so the use of self-
be explained by the fact that the sound waves issued
selected individual music therapy is recommended.
by music could generate alpha waves [36]. Alpha waves
are created in the cerebral cortex through a cortical
relationship with the thalamus and are the result of
spontaneous feedback of oscillations in the DECLARATIONS
thalamocortical system causing an increase of serotonin,
which is a neurotransmitter responsible for hunger and Competing of Interest
generating theta waves associated with mental activity, There is no conflict of interest in this study.
as well as delta waves associated with drowsiness
[36–37]. It was observable in the intervention group
because the respondents seemed to close their eyes
Acknowledgment
because they were feeling comfortable, and some even The authors thank our colleagues from SeLIMuT Team
fell asleep during the intervention. who provided insight, expertise that greatly assisted
The preliminary BDI measurement results showed the study, for their assistance with a particular technique
that the majority of respondents in both groups were and for comments that greatly improved the manuscript.

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neurochemestry of music. Trends in Cognitive of Medical Physiology, Eleventh Edition. 2007.
Sciences. 2013;17(4): 179–193. 38. Rayes-Gibby CC, Anderson KO, Morrow PK, Shete S,
32. DeNora T. Music in everyday life. Cambridge: Hassan S. Deppresive symptoms and health-related
University Press. 2000 quality of life in breast cancer survivors. J Women
33. Roth EW. Music therapy: the rhythm of recovery. Health. 2012;21(3): 311–328.
Case Manager. 2004.15: 52–56. 39. Wakim JH, Smith S, Guinn C. The efficacy of music
34. Nicholas, Humenick. How music works as a therapy. therapy. J Perianesth Nurs. 2010;25(4): 226–232.
Jakarta: Salemba Medika. 2002.
35. Djohan. Music therapy: theory and aplication.
Appendix
Yogyakarta: Galang Press. 2006.
36. Atwater H. Binaural Beats and the Regulation of Beck's Depression Inventory.
Arousal Levels. Hemi-Sinc Journal. 2009;1: 1–2.

Beck's Depression Inventory

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6.
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
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1 I am critical of myself for my weaknesses or mistakes.
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2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9.
 6.
0 I don't feel I am being punished.
1 I feel I may be punished.
Self Selected2Individual Music
I expect
Therapyto be punished.
(SeLIMuT) WIDIYONO, ET AL
3 I feel I am being punished.
7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.
11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.
14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look
unattractive
3 I believe that I look ugly.
15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.

17.
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0
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don't get
more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
 15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 Individual Music
Self Selected I have to (SeLIMuT)
Therapy push myself very hard to do anything. WIDIYONO, ET AL
3 I can't do any work at all.
16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.

17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or
constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.

INTERPRETING THE BECK DEPRESSION INVENTORY

Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circles zero on each question.
You can evaluate your depression according to the Table below.

Total Score____________________Levels of Depression

1-10____________________These ups and downs are considered normal

11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

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