24. Randomised controlled trial of piano ensemble intervention on social behaviour improvement in patients with avoidant personality disorder

Abstract Background Avoidant Personality Disorder (AvPD) is characterised by pervasive social inhibition, a sense of inadequate self-worth, and excessive sensitivity to negative evaluation, resulting in severely impaired social functioning. Creative arts therapies (such as music interventions) may serve as effective mediators for social rehabilitation by providing patients with non-verbal avenues for expression and emotional regulation. However, empirical research focusing on structured group piano ensemble interventions and systematically evaluating their impact on objective social behaviours in AvPD patients remains unexplored. This study aims to examine whether a 10-week group piano ensemble intervention programme can effectively improve social avoidance behaviours and social anxiety levels in individuals with AvPD. Methods The study employed a randomised controlled trial design, with 72 participants meeting DSM-5 diagnostic criteria for Avoidant Personality Disorder (AvPD) randomly assigned to either a piano intervention group (n = 36) or a routine supportive psychoeducation control group (n = 36). The intervention group received weekly 90-minute group piano ensemble training sessions, comprising individual rhythmic exercises, paired note call-and-response, group melody composition, and culminating in rehearsals of small ensemble pieces. The control group received supportive group psychoeducation at the same frequency. The primary outcome measures were social avoidance behaviours, assessed using the Social Avoidance and Distress Scale (SAD) and the Social Anxiety Scale (SAS). All scales were administered at baseline (T1), post-intervention (T2), and three months post-intervention (T3). Results The piano intervention group demonstrated significant reductions in both self-reported and observed social avoidance behaviours at T2 and T3 compared to T1 (all p<.001), with the magnitude of reduction significantly greater than that of the control group (all p<.001). A significant interaction effect was also observed for the secondary outcome measure, the SAS, indicating a significant decrease in anxiety levels within the intervention group. Detailed data are presented in Table 1. Discussion Research indicates that structured group piano ensemble interventions yield significant and sustained improvements in social avoidance behaviours and social anxiety levels among patients with avoidant personality disorder, demonstrating markedly superior efficacy compared to conventional supportive interventions. The notable enhancement in objective behavioural observation data is particularly crucial, confirming the intervention's effectiveness in facilitating genuine social interaction. This may stem from the ensemble setting creating a “task-centred” rather than “evaluation-centred” social context. Participants, immersed in musical collaboration, naturally reduced anxiety about social performance while practising non-verbal synchronisation and cooperative skills. Future research could explore the intervention's neural mechanisms (e.g., monitoring brain-to-brain synchronisation during collaboration via neuroimaging) and compare outcomes across different artistic modalities (e.g., painting, dance). Funding No. GXGZJG2022B172; No. LZJ2025B002.