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• Published: 22 June 2021

Mental health and music engagement: review, framework, and guidelines for future studies

• Daniel E. Gustavson   ORCID: orcid.org/0000-0002-1470-4928 1 , 2 ,
• Peyton L. Coleman   ORCID: orcid.org/0000-0001-5388-6886 3 ,
• John R. Iversen 4 ,
• Hermine H. Maes 5 , 6 , 7 ,
• Reyna L. Gordon 2 , 3 , 8 , 9 &
• Miriam D. Lense 2 , 8 , 9  

Translational Psychiatry volume  11 , Article number:  370 ( 2021 ) Cite this article

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• Medical genetics
• Psychiatric disorders

Is engaging with music good for your mental health? This question has long been the topic of empirical clinical and nonclinical investigations, with studies indicating positive associations between music engagement and quality of life, reduced depression or anxiety symptoms, and less frequent substance use. However, many earlier investigations were limited by small populations and methodological limitations, and it has also been suggested that aspects of music engagement may even be associated with worse mental health outcomes. The purpose of this scoping review is first to summarize the existing state of music engagement and mental health studies, identifying their strengths and weaknesses. We focus on broad domains of mental health diagnoses including internalizing psychopathology (e.g., depression and anxiety symptoms and diagnoses), externalizing psychopathology (e.g., substance use), and thought disorders (e.g., schizophrenia). Second, we propose a theoretical model to inform future work that describes the importance of simultaneously considering music-mental health associations at the levels of (1) correlated genetic and/or environmental influences vs. (bi)directional associations, (2) interactions with genetic risk factors, (3) treatment efficacy, and (4) mediation through brain structure and function. Finally, we describe how recent advances in large-scale data collection, including genetic, neuroimaging, and electronic health record studies, allow for a more rigorous examination of these associations that can also elucidate their neurobiological substrates.

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Introduction.

Music engagement, including passive listening and active music-making (singing, instrument playing), impacts socio-emotional development across the lifespan (e.g., socialization, personal/cultural identity, mood regulation, etc.), and is tightly linked with many cognitive and personality traits [ 1 , 2 , 3 ]. A growing literature also demonstrates beneficial associations between music engagement and quality of life, well-being, prosocial behavior, social connectedness, and emotional competence [ 4 , 5 , 6 , 7 , 8 ]. Despite these advances linking engagement with music to many wellness characteristics, we have a limited understanding of how music engagement directly and indirectly contributes to mental health, including at the trait-level (e.g., depression and anxiety symptoms, substance use behaviors), clinical diagnoses (e.g., associations with major depressive disorder (MDD) or substance use disorder (SUD) diagnoses), or as a treatment. Our goals in this scoping review are to (1) describe the state of music engagement research regarding its associations with mental health outcomes, (2) introduce a theoretical framework for future studies that highlight the contribution of genetic and environmental influences (and their interplay) that may give rise to these associations, and (3) illustrate some approaches that will help us more clearly elucidate the genetic/environmental and neural underpinnings of these associations.

Scope of the article

People interact with music in a wide variety of ways, with the concept of “musicality” broadly including music engagement, music perception and production abilities, and music training [ 9 ]. Table 1 illustrates the breadth of music phenotypes and example assessment measures. Research into music and mental health typically focuses on measures of music engagement, including passive (e.g., listening to music for pleasure or as a part of an intervention) and active music engagement (e.g., playing an instrument or singing; group music-making), both of which can be assessed using a variety of objective and subjective measures. We focus primarily on music engagement in the current paper but acknowledge it will also be important to examine how mental health traits relate to other aspects of musicality as well (e.g., perception and production abilities).

Our scoping review and theoretical framework incorporate existing theoretical and mechanistic explanations for how music engagement relates to mental health. From a psychological perspective, studies have proposed that music engagement can be used as a tool for encouraging self-expression, developing emotion regulation and coping skills, and building community [ 10 , 11 ]. From a physiological perspective, music engagement modulates arousal levels including impacts on heart rate, electrodermal activity, and cortisol [ 12 , 13 ]. These effects may be driven in part by physical aspects of music (e.g., tempo) or rhythmic movements involved in making or listening to music, which impact central nervous system functioning (e.g., leading to changes in autonomic activity) [ 14 ], as well as by personality and contextual factors (e.g., shared social experiences) [ 15 ]. Musical experiences also impact neurochemical processes involved in reward processing [ 10 , 13 , 14 , 16 , 17 , 18 ], which are also implicated in mental health disorders (e.g., substance use; depression). Thus, an overarching framework for studying music-mental health associations should integrate the psychological, physiological, and neurochemical aspects of these potential associations. We propose expanding this scope further through consideration of genetic and environmental risk factors, which may give rise to (and/or interact with) other factors to impact health and well-being.

Regarding mental health, it is important to recognize the hierarchical structure of psychopathology [ 19 , 20 ]. Common psychological disorders share many features and cluster into internalizing (e.g., MDD, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD)), externalizing (e.g., SUDs, conduct disorder), and thought disorders (e.g., bipolar disorder, schizophrenia), with common variance shared even across these domains [ 20 ]. These higher-order constructs tend to explain much of the comorbidity among individual disorders, and have helped researchers characterize associations between psychopathology, cognition, and personality [ 21 , 22 , 23 ]. We use this hierarchical structure to organize our review. We first summarize the emerging literature on associations between music engagement and generalized well-being that provides promising evidence for associations between music engagement and mental health. Next, we summarize associations between music engagement and internalizing traits, externalizing traits/behaviors, and thought disorders, respectively. Within these sections, we critically consider the strengths and shortcomings of existing studies and how the latter may limit the conclusions drawn from this work.

Our review considers both correlational and experimental studies (typically, intervention studies; see Fig. 1 for examples of study designs). We include not only studies that examine symptoms or diagnoses based on diagnostic interviews, but also those that assess quantitative variation (e.g., trait anxiety) in clinical and nonclinical populations. This is partly because individuals with clinical diagnoses may represent the extreme end of a spectrum of similar, sub-clinical, problems in the population, a view supported by evidence that genetic influences on diagnosed psychiatric disorders or DSM symptom counts are similar to those for trait-level symptoms in the general population [ 24 , 25 ]. Music engagement may be related to this full continuum of mental health, including correlations with trait-level symptoms in nonclinical populations and alleviation of symptoms from clinical disorders. For example, work linking music engagement to subjective well-being speaks to potential avenues for mental health interventions in the population at large.

Within experimental studies, music interventions can include passive musical activities (e.g., song listening, music and meditation, lyric discussion, creating playlists) or active musical activities (e.g., creative methods, such as songwriting or improvisation and/or re-creative methods, such as song parody).

The goal of this scoping review was to integrate across related, but often disconnected, literatures in order to propose a comprehensive theoretical framework for advancing our understanding of music-mental health associations. For this reason, we did not conduct a fully systematic search or quality appraisal of documents. Rather, we first searched PubMed and Google Scholar for review articles and meta-analyses using broad search terms (e.g., “review” and “music” and [“anxiety” or “depression” or “substance use”]). Then, when drafting each section, we searched for additional papers that have been published more recently and/or were examples of higher-quality research in each domain. When giving examples, we emphasize the most recent and most well-powered empirical studies. We also conducted some targeted literature searches where reviews were not available (e.g., “music” and [“impulsivity” or “ADHD”]) using the same databases. Our subsequent framework is intended to contextualize diagnostic, symptom, and mechanistic findings more broadly within the scope of the genetic and environmental risk factors on psychopathology that give rise to these associations and (potentially) impact the efficacy of treatment efforts. As such, the framework incorporates evidence from review articles and meta-analyses from various literatures (e.g., music interventions for anxiety [ 26 ], depression [ 27 ]) in combination with experimental evidence of biological underpinnings of music engagement and the perspective provided by newly available methods for population-health approaches (i.e., complex trait genetics, gene–environment interactions).

Music engagement and well-being

A growing body of studies report associations between music engagement and general indices of mental health, including increased well-being or emotional competence, lending support for the possibility that music engagement may also be associated with better specific mental health outcomes. In over 8000 Swedish twins, hours of music practice and self-reported music achievement were associated with better emotional competence [ 5 ]. Similarly, a meta-ethnography of 46 qualitative studies revealed that participation in music activities supported well-being through management of emotions, facilitation of self-development, providing respite from problems, and facilitating social connections [ 28 ]. In a sample of 1000 Australian adults, individuals who engaged with music, such as singing or dancing with others or attending concerts reported greater well-being vs. those who engaged in these experiences alone or did not engage. Other types of music engagement, such as playing an instrument or composing music were not associated with well-being in this sample [ 4 ]. Earlier in life, social music experiences (including song familiarity and synchronous movement to music) are associated with a variety of prosocial behaviors in infants and children [ 6 ], as well as positive affect [ 7 ]. Thus, this work provides some initial evidence that music engagement is associated with better general mental health outcomes in children and adults with some heterogeneity in findings depending on the specific type of music engagement.

Music engagement and internalizing problems

MDD, GAD, and PTSD are the most frequently clustered aspects of internalizing psychopathology [ 19 , 24 , 29 , 30 ]. Experimental studies provide evidence for the feasibility of music intervention efforts and their therapeutic benefits but are not yet rigorous enough to draw strong conclusions. The most severe limitations are small samples, the lack of appropriate control groups, few interventions with multiple sessions, and publications omitting necessary information regarding the intervention (e.g., intervention fidelity, inclusion/exclusion criteria, education status of intervention leader) [ 31 , 32 , 33 ]. Correlational studies, by contrast, suggest musicians are at greater risk for internalizing problems, but that they use music engagement as a tool to help manage these problems [ 34 , 35 ].

Experimental studies

Randomized controlled trials have revealed that music interventions (including both music therapies administered by board-certified music therapists and other music interventions) are associated with reduced depression, anxiety, and PTSD symptoms [ 26 , 27 , 33 , 36 ]. A review of 28 studies reported that 26 revealed significantly reduced depression levels in music intervention groups compared to control groups, including the 9 studies which included active non-music intervention control groups (e.g., reading sessions, “conductive-behavior” psychotherapy, antidepressant drugs) [ 27 ]. A similar meta-analysis of 19 studies demonstrated that music listening is effective at decreasing self-reported anxiety in healthy individuals [ 26 ]. A review of music-based treatment studies related to PTSD revealed similar conclusions [ 36 ], though there were only four relevant studies. More recent studies confirm these findings [ 37 , 38 , 39 ], such as one randomized controlled trial that demonstrated reduced depression symptoms in older adults following musical improvisation exercises compared to an active control group (gentle gymnastic activities) [ 39 ].

This work is promising given that some studies have observed effects even when compared to traditional behavior therapies [ 40 , 41 ]. However, there are relatively few studies directly comparing music interventions to traditional therapies. Some music interventions incorporate components of other therapeutic methods in their programs including dialectic or cognitive behavior therapies [ 42 ], but few directly compare how the inclusion of music augments traditional behavioral therapy. Still other non-music therapies incorporate music into their practice (e.g., background music in mindfulness therapies) [ 43 , 44 ], but the specific contribution of music in these approaches is unclear. Thus, there is a great need for further systematic research relating music to traditional therapies to understand which components of music interventions act on the same mechanisms as traditional therapies (e.g., developing coping mechanisms and building community) and which bolster or synchronize with other approaches (e.g., by adding structure, reinforcement, predictability, and social context to traditional approaches).

Aside from comparison with other therapeutic approaches, an earlier review of 98 papers from psychiatric in-patient studies concluded that promising effects of music therapy were limited by small sample sizes and methodological shortcomings including lack of reporting of adverse events, exclusion criteria, possible confounders, and characteristics of patients lost to follow-up [ 33 ]. Other problems included inadequate reporting of information on the source population (e.g., selection of patients and proportion agreeing to take part in the study), the lack of masking of interviewers during post-test, and concealment of randomization. Nevertheless, there was some evidence that therapies with active music participation, structured sessions, and multiple sessions (i.e., four or more) improved mood, with all studies incorporating these characteristics reporting significant positive effects. However, most studies have focused on passive interventions, such as music listening [ 26 , 27 ]. Active interventions (e.g., singing, improvising) have not been directly compared with passive interventions [ 27 ], so more work is needed to clarify whether therapeutic effects are indeed stronger with more engaging and active interventions.

Correlational studies

Correlational studies have focused on the use of music in emotional self-regulation. Specifically, individuals high in neuroticism appear to use music to help regulate their emotions [ 34 , 35 ], with beneficial effects of music engagement on emotion regulation and well-being driven by cognitive reappraisal [ 45 ]. Music listening may also moderate the association between neuroticism and depression in adolescents [ 46 ], consistent with a protective effect.

A series of recent studies have used validated self-reported instruments that directly assess how individuals use music activities as an emotion regulation strategy [ 47 , 48 , 49 , 50 ]. In adults, the use of music listening for anger regulation and anxiety regulation was positively associated with subjective well-being, psychological well-being, and social well-being [ 50 ]. In studies of adolescents and undergraduates, the use of music listening for entertainment was associated with fewer depression and anxiety symptoms [ 51 ]. “Healthy” music engagement in adolescents (i.e., using music for relaxation and connection with others) was also positively associated with happiness and school satisfaction [ 49 ]. However, the use of music listening for emotional discharge was also associated with greater depression, anxiety, and stress symptoms [ 51 ], and “unhealthy” music engagement (e.g., ‘hiding’ in music to block others out) was associated with lower well-being, happiness, school satisfaction, and greater depression and rumination [ 49 ]. Other work has highlighted the role of valence in these associations, with individuals who listen to happier music when they are in a bad mood reporting stronger ability for music to influence their mood than those who listen to sad music while in a negative mood [ 52 , 53 ].

This work highlights the importance of considering individuals’ motivations for engaging with music in examining associations with well-being and mental health, and are consistent with the idea that individuals already experiencing depression, anxiety, and stress use music as a therapeutic tool to manage their emotions, with some strategies being more effective than others. Of course, these correlational effects may not necessarily reflect causal associations, but could be due to bidirectional influences, as suggested by claims that musicians may be at higher risk for internalizing problems [ 54 , 55 , 56 ]. It is also necessary to consider demographic and socioeconomic factors in these associations [ 57 ], for example, because arts engagement may be more strongly associated with self-esteem in those with higher education [ 58 ].

It is also necessary to clarify if musicians (professional and/or nonprofessional) represent an already high-risk group for internalizing problems. In one large study conducted in Norway ( N  = 6372), professional musicians were higher in neuroticism than the general population [ 56 ]. Another study of musician cases ( N  = 9803) vs. controls ( N  = 49,015) identified in a US-based research database through text-mining of medical records found that musicians are at greater risk of MDD (Odds ratio [OR] = 1.21), anxiety disorders (OR = 1.25), and PTSD (OR = 1.13) [ 55 ]. However, other studies demonstrate null associations between musician status and depression symptoms [ 5 ] or mixed associations [ 59 ]. In N  = 10,776 Swedish twins, for example, professional and amateur musicians had more self-reported burnout symptoms [ 54 ]. However, neither playing music in the past, amateur musicianship, nor professional musicianship was significantly associated with depression or anxiety disorder diagnoses.

Even if musicians are at higher risk, such findings can still be consistent with music-making being beneficial and therapeutic (e.g., depression medication use is elevated in individuals with depressive symptoms because it is a treatment). Clinical samples may be useful in disentangling these associations (i.e., examining if those who engage with music more frequently have reduced symptoms), and wider deployment of measures that capture emotion regulation strategies and motivations for engaging with music will help shed light on whether high-risk individuals engage with music in qualitatively different ways than others [ 51 , 57 ]. Later, we describe how also considering the role of genetic and environmental risk factors in these associations (e.g., if individuals at high genetic and/or environmental risk self-select into music environments because they are therapeutic) can help to clarify these questions.

Music engagement and externalizing problems

The externalizing domain comprises SUDs, and also includes impulsivity, conduct disorder, and attention-deficit hyperactivity disorder (ADHD), especially in adolescents [ 20 , 24 , 60 , 61 ]. Similar to the conclusions for internalizing traits, experimental studies show promising evidence that music engagement interventions may reduce substance use, ADHD, and other externalizing symptoms, but conclusions are limited by methodological limitations. Correlational evidence is sparce, but there is less reason to suspect musicians are at higher risk for externalizing problems.

Intervention studies have demonstrated music engagement is helpful in patients with SUDs, including reducing withdrawal symptoms and stress, allowing individuals to experience emotions without craving substance use, and making substance abuse treatment sessions more enjoyable and motivating [ 62 , 63 , 64 ] (for a systematic review, see [ 65 ]). Similar to the experimental studies of internalizing traits, however, these studies would also benefit from larger samples, better controls, and higher-quality reporting standards.

Music intervention studies for ADHD are of similar quality. Such interventions have been shown to reduce inattention [ 66 ], decrease negative mood [ 67 ], and increase reading comprehension for those with ADHD [ 68 ]. However, there is a great amount of variability among children with ADHD, as some may find music distracting while others may focus better in the presence of music [ 69 ].

Little research has been conducted to evaluate music engagement interventions for impulsivity or conduct disorder problems, and findings are mixed. For example, a music therapy study of 251 children showed that beneficial effects on communication skills (after participating in a free improvisation intervention) was significant, though only for the subset of children above age 13 [ 70 ]. Another study suggested the promising effects of music therapy on social skills and problem behaviors in 89 students selected based on social/emotional problem behaviors, but did not have a control group [ 71 ]. Other smaller studies ( N  < 20 each) show inconsistent results on disruptive behaviors and aggression [ 72 , 73 ].

Correlational studies on externalizing traits are few and far between. A number of studies examined how listening habits for different genres of music relate to more or less substance use [ 74 , 75 , 76 , 77 ]. However, these studies do not strongly illuminate associations between music engagement and substance use because musical genres are driven by cultural and socioeconomic factors that vary over the lifespan. In the previously cited large study of American electronic medical records [ 55 ] where musicianship was associated with more internalizing diagnoses, associations were nonsignificant for “tobacco use disorder” (OR = 0.93), “alcoholism” (OR = 1.01), “alcohol-related disorders” (OR = 1.00), or “substance addiction and disorders” (OR = 1.00). In fact, in sex-stratified analyses, female musicians were at significantly decreased risk for tobacco use disorder (OR = 0.85) [ 55 ]. Thus, there is less evidence musicians are at greater risk for externalizing problems than in other areas.

Regarding other aspects of externalizing, some studies demonstrate children with ADHD have poor rhythm skills, opening a possibility that working on rhythm skills may impact ADHD [ 78 , 79 ]. For example, music might serve as a helpful scaffold (e.g., for attention) due to its regular, predictable rhythmic beat. It will be important to examine whether these associations with music rhythm are also observed for measures of music engagement, especially in larger population studies. Finally, musicians were reported to have lower impulsiveness than prior population samples, but were not compared directly to non-musicians [ 80 , 81 ].

Music engagement and thought disorders

Thought disorders typically encompass schizophrenia and bipolar disorder [ 20 ]. Trait-level measures include schizotypal symptoms and depression symptoms. Much like internalizing, music interventions appear to provide some benefits to individuals with clinical diagnoses, but musicians may be at higher risk for thought disorders. Limitations of both experimental and correlational studies are similar to those for internalizing and externalizing.

Music intervention studies have been conducted with individuals with schizophrenia and bipolar disorder. A recent meta-analysis of 18 music therapy studies for schizophrenia (and similar disorders) [ 82 ] demonstrated that music therapy plus standard care (compared to standard care alone) demonstrated improved general mental health, fewer negative symptoms of schizophrenia, and improved social functioning. No effects were observed for general functioning or positive symptoms of schizophrenia. Critiques echoed those described above. Most notably, although almost all studies had low risk of biases due to attrition, unclear risk of bias was evident in the vast majority of studies (>75%) for selection bias, performance bias, detection bias, and reporting bias. These concerns highlight the need for these studies to report more information about their study selection, blinding procedure, and outcomes.

More recent papers suggest similar benefits of music therapies in patients with psychosis [ 83 ] and thought disorders [ 84 ], with similar limitations (e.g., one study did not include a control group). Finally, although a 2021 review did not uncover more recent articles related to bipolar disorder, they argued that existing work suggests music therapy has the potential both to treat bipolar disorder symptoms and alleviate subthreshold symptoms in early stages of the disorder [ 85 ].

Much like internalizing, findings from the few existing studies suggest that musicians may be at higher risk for thought disorders. In the large sample of Swedish twins described earlier [ 54 ], playing an instrument was associated with more schizotypal symptoms across multiple comparisons (professional musicians vs. non-players; amateur musicians vs. non-players; still plays an instrument vs. never played). However, no associations were observed for schizophrenia or bipolar disorder diagnoses across any set of comparison groups. Another study demonstrated that individuals with higher genetic risk for schizophrenia or bipolar disorder were more likely to be a member of a creative society (i.e., actor or dancer, musician, visual artist, or writer) or work in a profession in these fields [ 86 ]. Furthermore, musician status was associated with “bipolar disorder” (OR = 1.18) and “schizophrenia and other psychotic disorders” (OR = 1.18) in US electronic health records (EHRs) [ 55 ].

Interim summary

There is promising evidence that music engagement is associated with better mental health outcomes. Music engagement is positively associated with quality of life, well-being, social connectedness, and emotional competence. However, some individuals who engage with music may be at higher risk for mental health problems, especially internalizing and thought disorders. More research is needed to disentangle these contrasting results, including clarifying how “healthy” music engagement (e.g., for relaxation or social connection) leads to greater well-being or successful emotion regulation, and testing whether some individuals are more likely to use music as a tool to regulate emotions (e.g., those with high neuroticism) [ 34 , 35 ]. Similarly, it will be important to clarify whether the fact that musicians may be an at-risk group is an extension of working in an artistic field in general (which may feature lower pay or lack of job security) and/or if similar associations are observed with continuous music engagement phenotypes (e.g., hours of practice). As we elaborate on later, genetically informative datasets can help clarify these complex associations, for example by tested whether musicians are at higher genetic risk for mental health problems but their music engagement mitigates these risks.

Music intervention studies are feasible and potentially effective at treating symptoms in individuals with clinical diagnoses, including depression, anxiety, and SUDs. However, it will be essential to expand these studies to include larger samples, random sampling, and active control groups that compare the benefits of music interventions to traditional therapies and address possible confounds. These limitations make it hard to quantify how specific factors influence the effectiveness of interventions, such as length/depth of music training, age of sample, confounding variables (e.g., socioeconomic status), and type of intervention (e.g., individual vs. group sessions, song playing vs. songwriting, receptive vs. active methods). Similarly, the tremendous breadth of music engagement activities and measures makes it difficult to identify the specific aspects of music engagement that convey the most benefits to health and well-being [ 87 ]. It is therefore necessary to improve reporting quality of studies so researchers can better identify these potential moderators or confounds using systematic approaches (e.g., meta-analyses).

Various mechanisms have been proposed to explain the therapeutic effects of music on mental health, including psychological (e.g., building communities, developing coping strategies) [ 10 , 11 ] and specific neurobiological drivers (e.g., oxytocin, cortisol, autonomic nervous system activity) [ 12 , 13 , 14 ]. However, it will be vital to conduct more systematic research comparing the effects of music interventions to existing therapeutic methods and other types of creative activities (e.g., art [ 88 ]) to quantify which effects and mechanisms are specific to music engagement. Music interventions also do not have to be an alternative to other treatments, but may instead support key elements of traditional interventions, such as being engaging, enjoyable, providing social context, and increasing structure and predictability [ 89 ]. Indeed, some music therapists incorporate principals from existing psychotherapeutic models [ 42 , 90 ] and, conversely, newer therapeutic models (e.g., mindfulness) incorporate music into their practice [ 43 , 44 ]. It is not yet possible to disentangle which aspects of music interventions best synergize with or strengthen standard psychotherapeutic practices (which are also heterogeneous), but this will be possible with better reporting standards and quality experimental design.

To encapsulate and extend these ideas, we next propose a theoretical framework that delineates key aspects of how music engagement may relate to mental health, which is intended to be useful for guiding future investigations in a more systematic way.

Theoretical framework for future studies

Associations between music engagement and mental health may take multiple forms, driven by several different types of genetic predispositions and environmental effects that give rise to, and interact with, proposed psychological and neurobiological mechanisms described earlier. Figure 2 displays our theoretical model in which potential beneficial associations with music are delineated into testable hypotheses. Four key paths characterize specific ways in which music engagement may relate to (and influence) mental health traits, and thus represent key research questions to be addressed in future studies.

Progression of mental health problems is based on a diathesis-stress model, where genetic predispositions and environmental exposures result in later problems (which can be remedied through treatment). Potential associations with music engagement include (Path 1; blue arrows) correlated genetic/environmental influences and/or causal associations between music engagement and trait-level mental health outcomes; (Path 2; red arrows) interactions between music engagement and risk factors to predict later trait-level or clinical level symptoms; and (Path 3; gold arrow) direct effects of music engagement on reducing symptoms or improving treatment efficacy. Path 4 (orange arrows) illustrates the importance of understanding how these potential protective associations are driven by neuroanatomy and function. MDD major depressive disorder, GAD generalized anxiety disorder, PTSD posttraumatic stress disorder, SUD substance use disorder(s).

Path 1: Music engagement relates to mental health through correlated genetic and environmental risk factors and/or causation

The diathesis-stress model of psychiatric disease posits that individuals carry different genetic liabilities for any given disorder [ 91 , 92 , 93 ], with disorder onset depending on the amount of negative vs. protective environmental life events and exposures the individual experiences. Although at first glance music engagement appears to be an environmental exposure, it is actually far from it. Twin studies have demonstrated that both music experiences and music ability measures are moderately heritable and genetically correlated with cognitive abilities like non-verbal intelligence [ 94 , 95 , 96 , 97 ]. Music engagement may be influenced by its own set of environmental influences, potentially including socioeconomic factors and availability of instruments. Thus, music engagement can be viewed as a combination of genetic and environmental predispositions and availability of opportunities for engagement [ 98 ] that are necessary to consider when evaluating associations with mental health [ 54 ].

When examining music-mental health associations, it is thus important to evaluate if associations are in part explained by correlated genetic or environmental influences (see Fig. 3 for schematic and explanation for interpreting genetic/environmental correlations). On one hand, individuals genetically predisposed to engage with music may be at lower risk of experiencing internalizing or externalizing problems. Indeed, music engagement and ability appear associated with cognitive abilities through genetic correlations [ 3 , 99 ], which may apply to music-mental health associations as well. On the other, individuals at high genetic risk for neuroticism or psychopathology may be more likely to engage with music because it is therapeutic, suggesting a genetic correlation in the opposite direction (i.e., increased genetic risk for musicians). To understand and better contextualize the potential therapeutic effects of music engagement, it is necessary to quantify these potential genetic associations, while simultaneously evaluating whether these associations are explained by correlated environmental influences.

Variance in any given trait is explained by a combination of genetic influences (i.e., heritability) and environmental influences. For complex traits (e.g., MDD or depression symptoms), cognitive abilities (e.g., intelligence), and personality traits (e.g., impulsivity), many hundreds or thousands of independent genetic effects are combined together in the total heritability estimate. Similarly, environmental influences typically represent a multitude of factors, from individual life events to specific exposures (e.g., chemicals, etc.). The presence of a genetic or environmental correlation between traits indicates that some set of these influences have an impact on multiple traits. A Displayed using a Venn diagram. Identifying the strength of genetic vs. environmental correlations can be useful in testing theoretical models and pave the way for more complex genetic investigations. Beyond this, gene identification efforts (e.g., genome-wide association studies) and additional analyses of the resulting data can be used to classify whether these associations represent specific genetic influences that affect both traits equally (i.e., genetic pleiotropy ( B )) or whether a genetic influence impacts only one trait which in turn causes changes in the other (i.e., mediated genetic pleiotropy ( C )). Environmental influences can also act pleiotropically or in a mediated-pleiotropy manner, but only genetic influences are displayed for simplicity.

Beyond correlated genetic and environmental influences, music engagement and mental health problems may be associated with one another through direct influences (including causal impacts). This is in line with earlier suggestions that music activities (e.g., after-school programs, music practice) engage adolescents, removing opportunities for drug-seeking behaviors [ 100 ], increasing their social connections to peers [ 101 ], and decreasing loneliness [ 41 ]. Reverse causation is also possible, for example, if experiencing mental health problems causes some individuals to seek out music engagement as a treatment. Longitudinal and genetically informative studies can help differentiate correlated risk factors (i.e., genetic/environmental correlations) from causal effects of music engagement (Fig. 2 , blue arrows) [ 102 ].

Path 2: Engagement with music reduces the impact of genetic risk

Second, genetic and environmental influences may interact with each other to influence a phenotype. For example, individual differences in music achievement are more pronounced in those who engage in practice or had musically enriched childhood environments [ 97 , 98 ]. Thus, music exposures may not influence mental health traits directly but could impact the strength of the association between genetic risk factors and the emergence of trait-level symptoms and/or clinical diagnoses. Such associations might manifest as decreased heritability of trait-level symptoms in musicians vs. non-musicians (upper red arrow in Fig. 2 ). Alternatively, if individuals high in neuroticism use music to help regulate their emotions [ 34 , 35 ], those who are not exposed to music environments might show stronger associations between neuroticism and later depressive symptoms or diagnoses than those engaged with music (lower red arrow in Fig. 2 ). Elucidating these possibilities will help disentangle the complex associations between music and mental health and could be used to identify which individuals would benefit most from a music intervention (especially preventative interventions). Later, we describe some specific study designs that can test hypotheses regarding this gene-environment interplay.

Path 3: Music engagement improves the efficacy of treatment (or acts as a treatment)

For individuals who experience severe problems (e.g., MDD, SUDs), engaging with music may reduce symptoms or improve treatment outcomes. This is the primary goal of most music intervention studies [ 27 , 33 ] (Fig. 2 , gold arrow). However, and this is one of the central messages of this model, it is important to consider interventions in the context of the paths discussed above. For example, if music engagement is genetically correlated with increased risk for internalizing or externalizing problems (Path 1) and/or if individuals at high genetic risk for mental health problems have already been using music engagement to develop strategies to deal with subthreshold symptoms (Path 2), then may be more likely to choose music interventions over other alternatives and find them more successful. Indeed, the beneficial aspects of music training on cognitive abilities appear to be drastically reduced in samples that were randomly sampled [ 103 ]. Therefore, along with other necessary reporting standards discussed above [ 32 , 33 ], it will be useful for studies to report participants’ prior music experience and consider these exposures in evaluating the efficacy of interventions.

Path 4: Music engagement influences brain structure and function

Exploring associations between music engagement and brain structure and function will be necessary to elucidate the mechanisms driving the three paths outlined above. Indeed, there are strong links between music listening and reward centers of the brain [ 104 , 105 ] including the nucleus accumbens [ 106 , 107 ] and ventral tegmental areas [ 108 ] that are implicated in the reward system for all drugs of abuse [ 109 , 110 , 111 , 112 ] and may relate to internalizing problems [ 113 , 114 , 115 ]. Moreover, activity in the caudate may simultaneously influence rhythmic sensorimotor synchronization, monetary reward processing, and prosocial behavior [ 116 ]. Furthermore, music listening may help individuals control the effect of emotional stimuli on autonomic and physiological responses (e.g., in the hypothalamus) and has been shown to induce the endorphinergic response blocked by naloxone, an opioid antagonist [ 18 , 117 ].

This work focusing on music listening and reward processing has not been extended to music making (i.e., active music engagement), though some differences in brain structure and plasticity between musicians and non-musicians have been observed for white matter (e.g., greater fractional anisotropy in corpus callosum and superior longitudinal fasciculus) [ 118 , 119 , 120 , 121 ]. In addition, longitudinal studies have revealed that instrument players show more rapid cortical thickness maturation in prefrontal and parietal areas implicated in emotion and impulse control compared to non-musician children/adolescents [ 122 ]. Importantly, because the existing evidence is primarily correlational, these cross-sectional and longitudinal structural differences between musicians and non-musicians could be explained by genetic correlations, effects of music training, or both, making them potentially relevant to multiple paths in our model (Fig. 2 ). Examining neural correlates of music engagement in more detail will shed light on these possibilities and advance our understanding of the correlates and consequences of music engagement, and the mechanisms that drive the associations discussed above.

New approaches to studying music and mental health

Using our theoretical model as a guide, we next highlight key avenues of research that will help disentangle these music-mental health associations using state-of-the-art approaches. They include the use of (1) genetic designs, (2) neuroimaging methods, and (3) large biobanks of EHRs.

Genetic designs

Genetic designs provide a window into the biological underpinnings of music engagement [ 123 ]. Understanding the contribution of genetic risk factors is crucial to test causal or mechanistic models regarding potential associations with mental health. At the most basic level, twin and family studies can estimate genetic correlations among music ability or engagement measures and mental health traits or diagnoses. Genetic associations can be examined while simultaneously quantifying environmental correlations, as well as evaluating (bidirectional) causal associations, by testing competing models or averaging across different candidate models [ 102 , 124 ], informing Path 1.

By leveraging samples with genomic, music engagement, and mental health data, investigators can also examine whether individuals at higher genetic risk for psychopathology (e.g., for MDD) show stronger associations between music engagement measures and their mental health outcomes (Path 2). As a theoretical example, individuals with low genetic risk for MDD are unlikely to have many depressive symptoms regardless of their music engagement, so the association between depressive symptoms and music engagement may be weak if focusing on these individuals. However, individuals at high genetic risk for MDD who engage with music may have fewer symptoms than their non-musician peers (i.e., a stronger negative correlation). This is in line with recent work revealing the heritability of depression is doubled in trauma exposed compared to non-trauma exposed individuals [ 125 ].

Gene–environment interaction studies using polygenic scores (i.e., summed indices of genetic risk based on genome-wide association studies; GWAS) are becoming more common [ 126 , 127 ]. There are already multiple large GWAS of internalizing and externalizing traits [ 128 , 129 , 130 ], and the first large-scale GWAS of a music measure indicates that music rhythm is also highly polygenic [ 131 ]. Importantly, is not necessary to have all traits measured in the same sample to examine cross-trait relationships. Studies with only music engagement and genetic data, for example, can still examine how polygenic scores for depression predict music engagement, or interact with music engagement measures to predict other study outcomes. Figure 4 displays an example of a GWAS and how it can be used to compute and apply a polygenic score to test cross-trait predictions.

A GWAS are conducted by examining whether individual genetic loci (i.e., single-nucleotide polymorphisms, or SNPs, depicted with G, A, C, and T labels within a sample (or meta-analysis) differentiate cases from controls. The example is based on a dichotomous mental health trait (e.g., major depressive disorder diagnosis), but GWAS can be applied to other dichotomous and continuous phenotypes, such as trait anxiety, musician status, or hours of music practice. Importantly, rather than examining associations on a gene-by-gene basis, GWAS identify relevant genetic loci using SNPs from across the entire genome (typically depicted using a Manhattan plot, such as that displayed at the bottom of A ). B After a GWAS has been conducted on a given trait, researchers can use the output to generate a polygenic score (sometimes called a polygenic risk score) in any new sample with genetic data by summing the GWAS effect sizes for each SNP allele present in a participant’s genome. An individual with a z  = 2.0 would have many risk SNPs for that trait, whereas an individual with z = −2 would have much fewer risk SNPs. C Once a polygenic score is generated for all participants, it can be applied like any other variable in the new sample. In this example, researchers could examine whether musicians are at higher (or lower) genetic risk for a specific disorder. Other more complex analyses are also possible, such as examining how polygenic scores interact with existing predictors (e.g., trauma exposure) or polygenic scores for other traits to influence a phenotype or predict an intervention outcome. Created with BioRender.com.

Finally, longitudinal twin and family studies continue to be a promising resource for understanding the etiology and developmental time-course of the correlates of mental health problems. Such designs can be used to examine whether associations between music and mental health are magnified based on other exposures or psychological constructs (gene-by-environment interactions) [ 132 ], and whether parents engaged with music are more likely to pass down environments that are protective or hazardous for later mental health (gene-environment correlations) in addition to passing on their genes. These studies also provide opportunities to examine whether these associations change across key developmental periods. The publicly available Adolescent Brain Cognitive Development study, for example, is tracking over 10,000 participants (including twin and sibling pairs) throughout adolescence, with measures of music engagement and exhaustive measures of mental health, cognition, and personality, as well as neuroimaging and genotyping [ 133 , 134 ]. Although most large samples with genomic data still lack measures of music engagement, key musical phenotypes could be added to existing study protocols (or to similar studies under development) with relatively low participant burden [ 135 ]. Musical questionnaires and/or tasks may be much more engaging and enjoyable than other tasks, improving volunteers’ research participation experience.

Neuroimaging

Another way to orient the design of experiments is through the exploration of neural mechanisms by which music might have an impact on mental health. This is an enormous, growing, and sometimes fraught literature, but there is naturally a great potential to link our understanding of neural underpinnings of music listening and engagement with the literature on neural bases of mental health. These advances can inform the mechanisms driving successful interventions and inform who may benefit the most from such interventions. We focus on two areas among many: (1) the activation of reward circuitry by music and (2) the impact music has on dynamic patterns of neural activity, both of which are likely vectors for the interaction of music and mental health and provide examples of potential interactions.

Music and reward

The strong effect of music on our emotions has been clearly grounded in its robust activation of reward circuitry in the brain, and motivational and hedonic effects of music listening have been shown to be specifically modulated by dopamine [ 16 , 105 , 136 ]. The prevalence of reward and dopaminergic dysfunction in mental illness makes this a rich area for future studies. For example, emotional responses to music might be used as a substitute for reward circuit deficiencies in depression, and it is intriguing to consider if music listening or music engagement could potentiate such function [ 137 , 138 ].

Music and brain network dynamics

The search for neuronally based biomarkers of aspects of mental illness has been a central thrust within the field [ 139 ], holding promise for the understanding of heterogeneity within disorders and identification of common mechanistic pathways [ 140 ]. A thorough review is beyond the scope of this paper, but several points of contact can be highlighted that might suggest neuro-mechanistic mediators of musical effects on mental health. For example, neurofeedback-directed upregulation of activity in emotion circuitry has been proposed as a therapy for MDD [ 141 ]. Given the emotional effects of music, there is potential for using musical stimuli as an adjuvant, or as a more actively patient-controlled output target for neurofeedback. Growing interest in measures of the dynamic complexity of brain activity in health and disease as measured by magnetic resonance imaging or magneto/electroencephalography (M/EEG) [ 142 ] provides a second point of contact, with abnormalities in dynamic complexity suggested as indicative of mental illness [ 143 ], while music engagement has been suggested to reflect and perhaps affect dynamic complexity [ 144 , 145 ].

The caveats identified in this review apply equally to such neuro-mechanistic studies [ 146 ]. High-quality experimental design (involving appropriate controls and randomized design) has been repeatedly shown to be critical to providing reliable evidence for non-music outcomes of music engagement [ 103 ]. For such studies to have maximal impact, analysis of M/EEG activity not at the scalp level, but at the source level, has been shown to improve the power of biomarkers, and their mechanistic interpretability [ 147 , 148 ]. Moreover, as with genetic influences that typically influence a trait through a multitude of small individual effects [ 149 ], the neural underpinnings of music-mental health associations may be highly multivariate. In the longer term, leveraging large-scale studies and large-scale data standardization and aggregation hold the promise of gleaning deeper cross-domain insights, for which current experimentalists can prepare by adopting standards for the documentation, annotation, and storage of data [ 150 ].

Biobanks and electronic health records

Finally, the use of EHR databases can be useful in quantifying associations between music engagement and mental health in large samples. EHR databases can include hundreds of thousands of records and allow for examination with International Statistical Classification of Diseases and Related Health Problems codes, including MDD, SUD, and schizophrenia diagnoses. This would allow for powerful estimates of music-mental health associations, and exploration of music engagement with other health outcomes.

The principal roadblock to this type of research is that extensive music phenotypes are not readily available in EHRs. However, there are multiple ways to bypass this limitation. First, medical records can be scraped using text-mining tools to identify cases of musician-related terms (e.g., “musician”, “guitarist”, “violinist”). For example, the phenome-wide association study described earlier [ 55 ] compared musician cases and controls identified in a large EHR database through text-mining of medical records and validated with extensive manual review charts. This study was highly powered to detect associations with internalizing and thought disorders (but showed null or protective effects for musicians for SUDs). Many EHR databases also include genomic data, allowing for integration with genetic models even in the absence of music data (e.g., exploring whether individuals with strong genetic predispositions for musical ability are at elevated or reduced risk for specific health diagnosis).

EHRs could also be used as recruitment tools, allowing researchers to collect additional data for relevant music engagement variables and compare with existing mental health diagnoses without having to conduct their own diagnostic interviews. These systems are not only relevant to individual differences research but could also be used to identify patients for possible enrollment in intervention studies. Furthermore, if recruitment for individual differences or intervention studies is done in patient waiting rooms of specific clinics, researchers can target specific populations of interest, have participants complete some relevant questionnaires while they wait, and be granted access to medical record data without having to conduct medical interviews themselves.

Concluding remarks

Music engagement, a uniquely human trait which has a powerful impact on our everyday experience, is deeply tied with our social and cultural identities as well as our personality and cognition. The relevance of music engagement to mental health, and its potential use as a therapeutic tool, has been studied for decades, but this research had not yet cohered into a clear picture. Our scoping review and framework integrated across a breadth of smaller literatures (including extant reviews and meta-analyses) relating music engagement to mental health traits and treatment effects, though it was potentially limited due to the lack of systematic literature search or formal quality appraisal of individual studies. Taken together, the current body of literature suggests that music engagement may provide an outlet for individuals who are experiencing internalizing, externalizing, or thought disorder problems, potentially supporting emotion regulation through multiple neurobiological pathways (e.g., reward center activity). Conducting more rigorous experimental intervention studies, improving reporting standards, and harnessing large-scale population-wide data in combination with new genetic analytic methods will help us achieve a better understanding of how music engagement relates to these mental health traits. We have presented a framework that illustrates why it will be vital to consider genetic and environmental risk factors when examining these associations, leading to new avenues for understanding the mechanisms by which music engagement and existing risk factors interact to support mental health and well-being.

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Acknowledgements

This work was supported by NIH grants DP2HD098859, R01AA028411, R61MH123029, R21DC016710, U01DA04112, and R03AG065643, National Endowment for the Arts (NEA) research lab grants 1863278-38 and 1855526-38, and National Science Foundation grant 1926794. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or National Endowment for the Arts. The authors would like to thank Navya Thakkar and Gabija Zilinskaite for their assistance.

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Gustavson, D.E., Coleman, P.L., Iversen, J.R. et al. Mental health and music engagement: review, framework, and guidelines for future studies. Transl Psychiatry 11 , 370 (2021). https://doi.org/10.1038/s41398-021-01483-8

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REVIEW article

The state of music therapy studies in the past 20 years: a bibliometric analysis.

• 1 School of Kinesiology, Shanghai University of Sport, Shanghai, China
• 2 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
• 3 Department of Sport Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China

Purpose: Music therapy is increasingly being used to address physical, emotional, cognitive, and social needs of individuals. However, publications on the global trends of music therapy using bibliometric analysis are rare. The study aimed to use the CiteSpace software to provide global scientific research about music therapy from 2000 to 2019.

Methods: Publications between 2000 and 2019 related to music therapy were searched from the Web of Science (WoS) database. The CiteSpace V software was used to perform co-citation analysis about authors, and visualize the collaborations between countries or regions into a network map. Linear regression was applied to analyze the overall publication trend.

Results: In this study, a total of 1,004 studies met the inclusion criteria. These works were written by 2,531 authors from 1,219 institutions. The results revealed that music therapy publications had significant growth over time because the linear regression results revealed that the percentages had a notable increase from 2000 to 2019 ( t = 14.621, P < 0.001). The United States had the largest number of published studies (362 publications), along with the following outputs: citations on WoS (5,752), citations per study (15.89), and a high H-index value (37). The three keywords “efficacy,” “health,” and “older adults,” emphasized the research trends in terms of the strongest citation bursts.

Conclusions: The overall trend in music therapy is positive. The findings provide useful information for music therapy researchers to identify new directions related to collaborators, popular issues, and research frontiers. The development prospects of music therapy could be expected, and future scholars could pay attention to the clinical significance of music therapy to improve the quality of life of people.

Introduction

Music therapy is defined as the evidence-based use of music interventions to achieve the goals of clients with the help of music therapists who have completed a music therapy program ( Association, 2018 ). In the United States, music therapists must complete 1,200 h of clinical training and pass the certification exam by the Certification Board for Music Therapists ( Devlin et al., 2019 ). Music therapists use evidence-based music interventions to address the mental, physical, or emotional needs of an individual ( Gooding and Langston, 2019 ). Also, music therapy is used as a solo standard treatment, as well as co-treatment with other disciplines, to address the needs in cognition, language, social integration, and psychological health and family support of an individual ( Bronson et al., 2018 ). Additionally, music therapy has been used to improve various diseases in different research areas, such as rehabilitation, public health, clinical care, and psychology ( Devlin et al., 2019 ). With neurorehabilitation, music therapy has been applied to increase motor activities in people with Parkinson's disease and other movement disorders ( Bernatzky et al., 2004 ; Devlin et al., 2019 ). However, limited reviews about music therapy have utilized universal data and conducted massive retrospective studies using bibliometric techniques. Thus, this study demonstrates music therapy with a broad view and an in-depth analysis of the knowledge structure using bibliometric analysis of articles and publications.

Bibliometrics turns the major quantitative analytical tool that is used in conducting in-depth analyses of publications ( Durieux and Gevenois, 2010 ; Gonzalez-Serrano et al., 2020 ). There are three types of bibliometric indices: (a) the quantity index is used to determine the number of relevant publications, (b) the quality index is employed to explore the characteristics of a scientific topic in terms of citations, and (c) the structural index is used to show the relationships among publications ( Durieux and Gevenois, 2010 ; Gonzalez-Serrano et al., 2020 ). In this study, the three types of bibliometric indices will be applied to conduct an in-depth analysis of publications in this frontier.

While research about music therapy is extensively available worldwide, relatively limited studies use bibliometric methods to analyze the global research about this topic. The aim of this study is to use the CiteSpace software to perform a bibliometric analysis of music therapy research from 2000 to 2019. CiteSpace V is visual analytic software, which is often utilized to perform bibliometric analyses ( Falagas et al., 2008 ; Ellegaard and Wallin, 2015 ). It is also a tool applied to detect trends in global scientific research. In this study, the global music therapy research includes publication outputs, distribution and collaborations between authors/countries or regions/institutions, intense issues, hot articles, common keywords, productive authors, and connections among such authors in the field. This study also provides helpful information for researchers in their endeavor to identify gaps in the existing literature.

Materials and Methods

Search strategy.

The data used in this study were obtained from WoS, the most trusted international citation database in the world. This database, which is run by Thomson & Reuters Corporation ( Falagas et al., 2008 ; Durieux and Gevenois, 2010 ; Chen C. et al., 2012 ; Ellegaard and Wallin, 2015 ; Miao et al., 2017 ; Gonzalez-Serrano et al., 2020 ), provides high-quality journals and detailed information about publications worldwide. In this study, publications were searched from the WoS Core Collection database, which included eight indices ( Gonzalez-Serrano et al., 2020 ). This study searched the publications from two indices, namely, the Science Citation Index Expanded and the Social Sciences Citation Index. As the most updated publications about music therapy were published in the 21st century, publications from 2000 to 2019 were chosen for this study. We performed data acquisition on July 26, 2020 using the following search terms: title = (“music therapy”) and time span = 2000–2019.

Inclusion Criteria

Figure 1 presents the inclusion criteria. The title field was music therapy (TI = music therapy), and only reviews and articles were chosen as document types in the advanced search. Other document types, such as letters, editorial materials, and book reviews, were excluded. Furthermore, there were no species limitations set. This advanced search process returned 718 articles. In the end, a total of 1,004 publications were obtained and were analyzed to obtain comprehensive perspectives on the data.

Figure 1 . Flow chart of music therapy articles and reviews inclusion.

Data Extraction

Author Lin-Man Weng extracted the publications and applied the EndNote software and Microsoft Excel 2016 to conduct analysis on the downloaded publications from the WoS database. Additionally, we extracted and recorded some information of the publications, such as citation frequency, institutions, authors' countries or regions, and journals as bibliometric indicators. The H-index is utilized as a measurement of the citation frequency of the studies for academic journals or researchers ( Wang et al., 2019 ).

Analysis Methods

The objective of bibliometrics can be described as the performance of studies that contributes to advancing the knowledge domain through inferences and explanations of relevant analyses ( Castanha and Grácio, 2014 ; Merigó et al., 2019 ; Mulet-Forteza et al., 2021 ). CiteSpace V is a bibliometric software that generates information for better visualization of data. In this study, the CiteSpace V software was used to visualize six science maps about music therapy research from 2000 to 2019: the network of author co-citation, collaboration network among countries and regions, relationship of institutions interested in the field, network map of co-citation journals, network map of co-cited references, and the map (timeline view) of references with co-citation on top music therapy research. As noted, a co-citation is produced when two publications receive a citation from the same third study ( Small, 1973 ; Merigó et al., 2019 ).

In addition, a science map typically features a set of points and lines to present collaborations among publications ( Chen, 2006 ). A point is used to represent a country or region, author, institution, journal, reference, or keyword, whereas a line represents connections among them ( Zheng and Wang, 2019 ), with stronger connections indicated by wider lines. Furthermore, the science map includes nodes, which represent the citation frequencies of certain themes. A burst node in the form of a red circle in the center indicates the number of co-occurrence or citation that increases over time. A purple node represents centrality, which indicates the significant knowledge presented by the data ( Chen, 2006 ; Chen H. et al., 2012 ; Zheng and Wang, 2019 ). The science map represents the keywords and references with citation bursts. Occurrence bursts represent the frequency of a theme ( Chen, 2006 ), whereas citation bursts represent the frequency of the reference. The citation bursts of keywords and references explore the trends and indicate whether the relevant authors have gained considerable attention in the field ( Chen, 2006 ). Through this kind of map, scholars can better understand emerging trends and grasp the hot topics by burst detection analysis ( Liang et al., 2017 ; Miao et al., 2017 ).

Publication Outputs and Time Trends

A total of 1,004 articles and reviews related to music therapy research met the criteria. The details of annual publications are presented in Figure 2 . As can be seen, there were <30 annual publications between 2000 and 2006. The number of publications increased steadily between 2007 and 2015. It was 2015, which marked the first time over 80 articles or reviews were published. The significant increase in publications between 2018 and 2019 indicated that a growing number of researchers became interested in this field. Linear regression can be used to analyze the trends in publication outputs. In this study, the linear regression results revealed that the percentages had a notable increase from 2000 to 2019 ( t = 14.621, P < 0.001). Moreover, the P < 0.05, indicating statistical significance. Overall, the publication outputs increased from 2000 to 2019.

Figure 2 . Annual publication outputs of music therapy from 2000 to 2019.

Distribution by Country or Region and Institution

The 1,004 articles and reviews collected were published in 49 countries and regions. Table 1 presents the top 10 countries or regions. Figure 3 shows an intuitive comparison of the citations on WoS, citations per study, Hirsch index (H-index), and major essential science indicator (ESI) studies of the top five countries or regions. The H-index is a kind of index that is applied in measuring the wide impact of the scientific achievements of authors. The United States had the largest number of published studies (362 publications), along with the following outputs: citations on WoS (5,752), citations per study (15.89), and a high H-index value (37). Norway has the largest number of citations per study (27.18 citations). Figure 4 presents the collaboration networks among countries or regions. The collaboration network map contained 32 nodes and 38 links. The largest node can be found in the United States, which meant that the United States had the largest number of publications in the field. Meanwhile, the deepest purple circle was located in Austria, which meant that Austria is the country with the most number of collaborations with other countries or regions in this research field. A total of 1,219 institutions contributed various music therapy-related publications. Figure 5 presents the collaborations among institutions. As can be seen, the University of Melbourne is the most productive institution in terms of the number of publications (45), followed by the University of Minnesota (43), and the University of Bergen (39). The top 10 institutions featured in Table 2 contributed 28.884% of the total articles and reviews published. Among these, Aalborg University had the largest centrality (0.13). The top 10 productive institutions with details are shown in Table 2 .

Table 1 . Top 10 countries or regions of origin of study in the music therapy research field.

Figure 3 . Publications, citations on WoS (×0.01), citations per study, H-index, and ESL top study among top five countries or regions.

Figure 4 . The collaborations of countries or regions interested in the field. In this map, the node represents a country, and the link represents the cooperation relationship between two countries. A larger node represents more publications in the country. A thicker purple circle represents greater influence in this field.

Figure 5 . The relationship of institutions interested in the field. University of Melbourne, Florida State University, University of Minnesota, Aalborg University, Temple University, University of Queensland, and University of Bergen. In this map, the node represents an institution, and the link represents the cooperation relationship between two institutions. A larger node represents more publications in the institution. A thicker purple circle represents greater influence in this field.

Table 2 . Top 10 institutions that contributed to publications in the music therapy field.

Distribution by Journals

Table 3 presents the top 10 journals that published articles or reviews in the music therapy field. The publications are mostly published in these journal fields, such as Therapy, Medical, Psychology, Neuroscience, Health and Clinical Care. The impact factors (IF) of these journals ranged between 0.913 and 7.89 (average IF: 2.568). Four journals had an impact factor >2, of which Cochrane Database of Systematic Reviews had the highest IF, 2019 = 7.89. In addition, the Journal of Music Therapy (IF: 2019 = 1.206) published 177 articles or reviews (17.629%) about music therapy in the past two decades, followed by the Nordic Journal of Music Therapy (121 publications, 12.052%, IF: 2019 = 0.913), and Arts in Psychotherapy (104 publications, 10.359%, IF: 2019 = 1.322). Furthermore, the map of the co-citation journal contained 393 nodes and 759 links ( Figure 6 ). The high co-citation count identifies the journals with the greatest academic influence and key positions in the field. The Journal of Music Therapy had the maximum co-citation counts (658), followed by Cochrane Database of Systematic Reviews (281), and Arts in Psychotherapy (279). Therefore, according to the analysis of the publications and co-citation counts, the Journal of Music Therapy and Arts in Psychotherapy occupied key positions in this research field.

Table 3 . Top 10 journals that published articles in the music therapy field.

Figure 6 . Network map of co-citation journals engaged in music therapy from 2000 to 2019. Journal of Music Therapy, Arts in Psychotherapy, Nordic Journal of Music Therapy, Music Therapy Perspectives, Cochrane Database of Systematic Reviews. In this map, the node represents a journal, and the link represents the co-citation frequency between two journals. A larger node represents more publications in the journal. A thicker purple circle represents greater influence in this field.

Distribution by Authors

A total of 2,531 authors contributed to the research outputs related to music therapy. Author Silverman MJ published most of the studies (46) in terms of number of publications, followed by Gold C (41), Magee WL (19), O'Callaghan C (15), and Raglio A (15). According to co-citation counts, Bruscia KE (171 citations) was the most co-cited author, followed by Gold C (147 citations), Wigram T (121 citations), and Bradt J (117 citations), as presented in Table 4 . In Figure 7 , these nodes highlight the co-citation networks of the authors. The large-sized node represented author Bruscia KE, indicating that this author owned the most co-citations. Furthermore, the linear regression results revealed a remarkable increase in the percentages of multiple articles of authors ( t = 13.089, P < 0.001). These also indicated that cooperation among authors had increased remarkably, which can be considered an important development in music therapy research.

Table 4 . Top five authors of publications and top five authors of co-citation counts.

Figure 7 . The network of author co-citaion. In this map, the node represents an author, and the link represents the co-citation frequency between two authors. A larger node represents more publications of the author. A thicker purple circle represents greater influence in this field.

Analysis of Keywords

The results of keywords analysis indicated research hotspots and help scholars identify future research topics. Table 5 highlights 20 keywords with the most frequencies, such as “music therapy,” “anxiety,” “intervention,” “children,” and “depression.” The keyword “autism” has the highest centrality (0.42). Figure 8 shows the top 17 keywords with the strongest citation bursts. By the end of 2019, keyword bursts were led by “hospice,” which had the strongest burst (3.5071), followed by “efficacy” (3.1161), “health” (6.2109), and “older adult” (4.476).

Table 5 . Top 20 keywords with the most frequency and centrality in music therapy study.

Figure 8 . The strongest citation bursts of the top 17 keywords. The red measures indicate frequent citation of keywords, and the green measures indicate infrequent citation of keywords.

Analysis of Co-cited References

The analysis of co-cited references is a significant indicator in the bibliometric method ( Chen, 2006 ). The top five co-cited references and their main findings are listed in Table 6 . These are regarded as fundamental studies for the music therapy knowledge base. In terms of co-citation counts, “individual music therapy for depression: randomized controlled trial” was the key reference because it had the most co-citation counts. This study concludes that music therapy mixed with standard care is an effective way to treat working-age people with depression. The authors also explained that music therapy is a valuable enhancement to established treatment practices ( Erkkilä et al., 2011 ). Meanwhile, the strongest citation burst of reference is regarded as the main knowledge of the trend ( Fitzpatrick, 2005 ). Figure 9 highlights the top 71 strongest citation bursts of references from 2000 to 2019. As can be seen, by the end of 2019, the reference burst was led by author Stige B, and the strongest burst was 4.3462.

Table 6 . Top five co-cited references with co-citation counts in the study of music therapy from 2000 to 2019.

Figure 9 . The strongest citation bursts among the top 71 references. The red measures indicate frequent citation of studies, and the green measures indicate infrequent citation of studies.

Figure 10A presents the co-cited reference map containing 577 nodes and 1,331 links. The figure explains the empirical relevance of a considerable number of articles and reviews. Figure 10B presents the co-citation map (timeline view) of reference from publications on top music therapy research. The timeline view of clusters shows the research progress of music therapy in a particular period of time and the thematic concentration of each cluster. “Psychosis” was labeled as the largest cluster (#0), followed by “improvisational music therapy” (#1) and “paranesthesia anxiety” (#2). These clusters have also remained hot topics in recent years. Furthermore, the result of the modularity Q score was 0.8258. That this value exceeded 0.5 indicated that the definitions of the subdomain and characters of clusters were distinct. In addition, the mean silhouette was 0.5802, which also exceeded 0.5. The high homogeneity of individual clusters indicated high concentration in different research areas.

Figure 10. (A) The network map of co-cited references and (B) the map (timeline view) of references with co-citation on top music therapy research. In these maps, the node represents a study, and the link represents the co-citation frequency between two studies. A larger node represents more publications of the author. A thicker purple circle represents greater influence in this field. (A) The nodes in the same color belong to the same cluster. (B) The nodes on the same line belong to the same cluster.

Global Trends in Music Therapy Research

This study conducted a bibliometric analysis of music therapy research from the past two decades. The results, which reveal that music therapy studies have been conducted throughout the world, among others, can provide further research suggestions to scholars. In terms of the general analysis of the publications, the features of published articles and reviews, prolific countries or regions, and productive institutions are summarized below.

I. The distribution of publication year has been increasing in the past two decades. The annual publication outputs of music therapy from 2000 to 2019 were divided into three stages: beginning, second, and third. In the beginning stage, there were <30 annual publications from 2000 to 2006. The second stage was between 2007 and 2014. The number of publications increased steadily. It was 2007, which marked the first time 40 articles or reviews were published. The third stage was between 2015 and 2019. The year 2015 was the key turning point because it was the first time 80 articles or reviews were published. The number of publications showed a downward trend in 2016 (72), but it was still higher than the average number of the previous years. Overall, music therapy-related research has received increasing attention among scholars from 2000 to 2020.

II. The articles and reviews covered about 49 countries or regions, and the prolific countries or regions were mainly located in the North American and European continents. According to citations on WoS, citations per study, and the H-index, music therapy publications from developed countries, such as United States and Norway, have greater influence than those from other countries. In addition, China, as a model of a developing country, had published 53 studies and ranked top six among productive countries.

III. In terms of the collaboration map of institutions, the most productive universities engaged in music therapy were located in the United States, namely, University of Minnesota (43 publications), Florida State University (33 publications), Temple University (27 publications), and University of Kansas (20 publications). It indicated that institutions in the US have significant impacts in this area.

IV. According to author co-citation counts, scholars can focus on the publications of such authors as Bruscia KE, Gold C, and Wigram T. These three authors come from the United States, Norway, and Denmark, and it also reflected that these three countries are leading the research trend. Author Bruscia KE has the largest co-citation counts and is based at Temple University. He published many music therapy studies about assessment and clinical evaluation in music therapy, music therapy theories, and therapist experiences. These publications laid a foundation and facilitate the development of music therapy. In addition, in Figure 11 , the multi-authored articles between 2000 and 2003 comprised 47.56% of the sample, whereas the publications of multi-authored articles increased significantly from 2016 to 2019 (85.51%). These indicated that cooperation is an effective factor in improving the quality of publications.

Figure 11 . The percentage of single- vs. multiple-authored articles. Blue bars mean multiple-author percentage; orange bars mean single-author percentage.

Research Focus on the Research Frontier and Hot Topics

According to the science map analysis, hot music therapy topics among publications are discussed.

I. The cluster “#1 improvisational music therapy” (IMT) is the current research frontier in the music therapy research field. In general, music therapy has a long research tradition within autism spectrum disorders (ASD), and there have been more rigorous studies about it in recent years. IMT for children with autism is described as a child-centered method. Improvisational music-making may enhance social interaction and expression of emotions among children with autism, such as responding to communication acts ( Geretsegger et al., 2012 , 2015 ). In addition, IMT is an evidence-based treatment approach that may be helpful for people who abuse drugs or have cancer. A study applied improving as a primary music therapeutic practice, and the result indicated that IMT will be effective in treating depression accompanied by drug abuse among adults ( Albornoz, 2011 ). By applying the interpretative phenomenological analysis and psychological perspectives, a study explained the significant role of music therapy as an innovative psychological intervention in cancer care settings ( Pothoulaki et al., 2012 ). IMT may serve as an effective additional method for treating psychiatric disorders in the short and medium term, but it may need more studies to identify the long-term effects in clinical practice.

II. Based on the analysis of co-citation counts, the top three references all applied music therapy to improve the quality of life of clients. They highlight the fact that music therapy is an effective method that can cover a range of clinical skills, thus helping people with psychological disorders, chronic illnesses, and pain management issues. Furthermore, music therapy mixed with standard care can help individuals with schizophrenia improve their global state, mental state (including negative and general symptoms), social functioning, and quality of life ( Gold et al., 2009 ; Erkkilä et al., 2011 ; Geretsegger et al., 2017 ).

III. By understanding the keywords with the strongest citation bursts, the research frontier can be predicted. Three keywords, “efficacy,” “health,” and “older adults,” emphasized the research trends in terms of the strongest citation bursts.

a. Efficacy: This refers to measuring the effectiveness of music therapy in terms of clinical skills. Studies have found that a wide variety of psychological disorders can be effectively treated with music. In the study of Fukui, patients with Alzheimer's disease listened to music and verbally communicated with their music therapist. The results showed that problematic behaviors of the patients with Alzheimer's disease decreased ( Fukui et al., 2012 ). The aim of the study of Erkkila was to determine the efficacy of music therapy when added to standard care. The result of this study also indicated that music therapy had specific qualities for non-verbal expression and communication when patients cannot verbally describe their inner experiences ( Erkkilä et al., 2011 ). Additionally, as summarized by Ueda, music therapy reduced anxiety and depression in patients with dementia. However, his study cannot clarify what kinds of music therapy or patients have effectiveness. Thus, future studies should investigate music therapy with good methodology and evaluation methods ( Ueda et al., 2013 ).

b. Health: Music therapy is a methodical intervention in clinical practice because it uses music experiences and relationships to promote health for adults and children ( Bruscia, 1998 ). Also, music therapy is an effective means of achieving the optimal health and well-being of individuals and communities, because it can be individualized or done as a group activity. The stimulation from music therapy can lead to conversations, recollection of memories, and expression. The study of Gold indicated that solo music therapy in routine practice is an effective addition to usual care for mental health care patients with low motivation ( Gold et al., 2013 ). Porter summarized that music therapy contributes to improvement for both kids and teenagers with mental health conditions, such as depression and anxiety, and increases self-esteem in the short term ( Porter et al., 2017 ).

c. Older adults: This refers to the use of music therapy as a treatment to maintain and slow down the symptoms observed in older adults ( Mammarella et al., 2007 ; Deason et al., 2012 ). In terms of keywords with the strongest citation bursts, the most popular subjects of music therapy-related articles and reviews focused on children from 2005 to 2007. However, various researchers concentrated on older adults from 2017 to 2019. Music therapy was the treatment of choice for older adults with depression, Parkinson's disease, and Alzheimer's disorders ( Brotons and Koger, 2000 ; Bernatzky et al., 2004 ; Johnson et al., 2011 ; Deason et al., 2012 ; McDermott et al., 2013 ; Sakamoto et al., 2013 ; Benoit et al., 2014 ; Pohl et al., 2020 ). In the study of Zhao, music therapy had positive effects on the reduction of depressive symptoms for older adults when added to standard therapies. These standard therapies could be standard care, standard drug treatment, standard rehabilitation, and health education ( Zhao et al., 2016 ). The study of Shimizu demonstrated that multitask movement music therapy was an effective intervention to enhance neural activation in older adults with mild cognitive impairment ( Shimizu et al., 2018 ). However, the findings of the study of Li explained that short-term music therapy intervention cannot improve the cognitive function of older adults. He also recommended that future researchers can apply a quality methodology with a long-term research design for the care needs of older adults ( Li et al., 2015 ).

Strengths and Limitations

To the best of our knowledge, this study was the first one to analyze large-scale data of music therapy publications from the past two decades through CiteSpace V. CiteSpace could detect more comprehensive results than simply reviewing articles and studies. In addition, the bibliometric method helped us to identify the emerging trend and collaboration among authors, institutions, and countries or regions.

This study is not without limitations. First, only articles and reviews published in the WoS Science Citation Index Expanded and Social Sciences Citation Index were analyzed. Future reviews could consider other databases, such as PubMed and Scopus. The document type labeled by publishers is not always accurate. For example, some publications labeled by WoS were not actually reviews ( Harzing, 2013 ; Yeung, 2021 ). Second, the limitation may induce bias in frequency of reference. For example, some potential articles were published recently, and these studies could be not cited with frequent times. Also, in terms of obliteration by incorporation, some common knowledge or opinions become accepted that their contributors or authors are no longer cited ( Merton, 1965 ; Yeung, 2021 ). Third, this review applied the quantitative analysis approach, and only limited qualitative analysis was performed in this study. In addition, we applied the CitesSpace software to conduct this bibliometric study, but the CiteSpace software did not allow us to complicate information under both full counting and fractional counting systems. Thus, future scholars can analyze the development of music therapy in some specific journals using both quantitative and qualitative indicators.

Conclusions

This bibliometric study provides information regarding emerging trends in music therapy publications from 2000 to 2019. First, this study presents several theoretical implications related to publications that may assist future researchers to advance their research field. The results reveal that annual publications in music therapy research have significantly increased in the last two decades, and the overall trend in publications increased from 28 publications in 2000 to 111 publications in 2019. This analysis also furthers the comprehensive understanding of the global research structure in the field. Also, we have stated a high level of collaboration between different countries or regions and authors in the music therapy research. This collaboration has extremely expanded the knowledge of music therapy. Thus, future music therapy professionals can benefit from the most specialized research.

Second, this research represents several practical implications. IMT is the current research frontier in the field. IMT usually serves as an effective music therapy method for the health of people in clinical practice. Identifying the emerging trends in this field will help researchers prepare their studies on recent research issues ( Mulet-Forteza et al., 2021 ). Likewise, it also indicates future studies to address these issues and update the existing literature. In terms of the strongest citation bursts, the three keywords, “efficacy,” “health,” and “older adults,” highlight the fact that music therapy is an effective invention, and it can benefit the health of people. The development prospects of music therapy could be expected, and future scholars could pay attention to the clinical significance of music therapy to the health of people.

Finally, multiple researchers have indicated several health benefits of music therapy, and the music therapy mechanism perspective is necessary for future research to advance the field. Also, music therapy can benefit a wide range of individuals, such as those with autism spectrum, traumatic brain injury, or some physical disorders. Future researchers can develop music therapy standards to measure clinical practice.

Author Contributions

KL and LW: conceptualization, methodology, formal analysis, investigation, resources, writing—review, and editing. LW: software and data curation. KL: validation and writing—original draft preparation. XW: visualization, supervision, project administration, and funding acquisition. All authors contributed to the article and approved the submitted version.

This study was supported by the Fok Ying-Tong Education Foundation of China (161092), the scientific and technological research program of the Shanghai Science and Technology Committee (19080503100), and the Shanghai Key Lab of Human Performance (Shanghai University of Sport) (11DZ2261100).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abbreviations

WoS, Web of Science; ESI, essential science indicators; IF, impact factor; IMT, improvisational music therapy; ASD, autism spectrum disorder.

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Keywords: music therapy, aged, bibliometrics, health, web of science

Citation: Li K, Weng L and Wang X (2021) The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis. Front. Psychol. 12:697726. doi: 10.3389/fpsyg.2021.697726

Received: 20 April 2021; Accepted: 12 May 2021; Published: 10 June 2021.

Reviewed by:

Copyright © 2021 Li, Weng and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Xueqiang Wang, wangxueqiang@sus.edu.cn

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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38 Music Therapy Research: Context, Methodology, and Current and Future Developments

Jane Edwards, Deakin University

• Published: 09 June 2015
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Music therapy is an evidence-based profession. Music therapy research aims to provide information about outcomes that support music therapy practice including contributing to theoretical perspectives that can explain why changes occur during treatment. Music therapy research has been conducted in a range of health, education, and community contexts throughout the world. Initially many music therapy developments in the university sector occurred through the establishment of training programmes that were developed and delivered by music therapists with professional experience in leading services in education and health care. Now many music therapy training programmes are led by people with practice experience along with research qualifications, and some universities offer music therapy doctoral pathways. Music therapy research capacity has expanded through a notable increase in PhD graduates as well as an increase in funded research in music therapy. This chapter covers: (1) traditions, (2) trends, and (3) contexts for music therapy research.

Introduction

Research is the process by which new knowledge is developed, existing knowledge is extended, and new theoretical frameworks are founded. In health care, research provides evidence for effective ways of working with patients or clients to achieve positive change; maintaining or improving optimal health and well-being. Research methods in health and education are characterized by a guiding research question or hypothesis, a theoretical or epistemological 1 orientation adopted by the researcher, a data source, and a selected method of data collection and analysis that is agreed in advance of the research commencing. All research is bound by an ethical code which is assured by approval from an Institutional Review Board, or an ethics committee. This process confirms that the processes of the research will cause no harm or discomfort to the participants, and will add value to existing knowledge.

Music therapy research is usually undertaken within the context of a university with outreach to recruit patients or students in health care or education. Initially music therapy in the university sector was built up through training programmes that were developed and delivered by people with professional experience in developing and leading music therapy services in education and health care. As higher education institutions across the world have become increasingly invested in all academic staff being research active including attaining PhDs and regularly applying for competitive research funding this has influenced the landscape of music therapy within the higher education environment. Increasingly it is unusual to find a course leader who does not either have a PhD or is working towards a PhD. Full-time permanent academic positions across the university context internationally usually require that the person has a PhD and a substantial body of work that has contributed to knowledge development in their specialist field.

Traditions of research in music therapy

In the fledgling years of music therapy research a commitment to quantitative methods within a strict positivist epistemology can be observed, especially in research publications within the USA. This was partly because of the influence of behavior modification as a technique in therapy practice ( Madsen et al. 1968 ). Modifying behavior that could be observed and measured was the goal of music therapy. Many researchers used randomized controlled trials (RCT) to examine the effects of music therapy on behaviors of clients. RCTs are studies in which participants are randomly assigned to either a music therapy treatment group, or to a control group which does not receive the treatment. The RCT is considered a gold standard within medical research ( Greenhalgh 2014 ). It is a highly effective method by which to test the effects and benefit of pharmacological medications. It can also show treatment outcomes when groups are compared where one group receives a treatment and another group, matched with the treatment group, do not (see Robb and Burns , this volume). Because of the alignment of music therapy with allied health, and the delivery of many music therapy services within medical contexts, the use of the RCT has been common in music therapy research ( Bradt 2012 ).

The most important historical development in this type of research was the introduction of randomization, where participants or subjects are randomly assigned to one of the groups, whether treatment, control, or placebo (see Robb and Burns , this volume). This random allocation to groups minimizes bias and increases the likelihood that the results of the research will be trustworthy.

In the later part of the twentieth century music therapy research reports using new methods entered the published literature, and references to new methods can be observed (for example, Aigen 1993 ; Amir 1993a , b ; Comeau 1991 ; Forinash 1992 ; Forinash and Gonzalez 1989 ; Langenberg et al. 1993 ). The early years of qualitative methods followed along the same route as other allied health research where qualitative inquiry or qualitative research became a commonly used descriptor ( Edwards 2012 ). Although qualitative is a useful description for many research methods it is not in and of itself a method. Distinctions between methods and epistemologies within qualitative traditions have not always been well defined in music therapy research reports ( Aigen 2008 ), and also in other allied health research writings ( Carter and Little 2007 ). In the maturation of music therapy research a wider range of methods and traditions have been engaged, and knowledge about different methods has become more elaborated and differentiated. It is now agreed that all methods have an underlying epistemology, and in using qualitative method research it is essential to be able to state ones position in relation to the theory of knowledge creation to which one subscribes ( Edwards 2012 ). Frequently used qualitative research methods in music therapy are grounded theory (see Daveson this volume; O’Callaghan 1996b ; 2012 ), and phenomenology ( Ghetti this volume).

An important distinction between research methods is whether they use inductive or deductive processes. Inductive refers to the way in which the researcher allows the information to be induced from the data during analysis ( O’Callaghan and McDermott 2004 ; O’Callaghan 1996a ). The researcher looks closely at the data, usually text or arts based, and reflects on the materials allowing meanings to emerge. Research which is deductive uses a pre-defined criteria to examine the data. For example, looking for particular incidences of a word in text or measuring a baseline behavior then providing treatment and following up with a further measure. Deductive might also refer to research in which the themes to be examined are decided in advance even when a qualitative method is used.

Research is published in journals following a process of anonymous peer review. A paper is submitted to just one journal and then the editor sends an anonymized version of the paper for review to at least two professionals with expertise in the area of the paper’s content. The reviewers read the paper and provide feedback to the editor about their opinion of the paper. Reviewers can recommend the paper should be published, or they can request revisions, or they can recommend that the paper be rejected. It is not unusual that articles are rejected. It can be because the editor or reviewers do not think the topic of the paper is relevant to the journal, or there can be issues of quality with the research that deem it unsuitable for publication. Many researchers make revisions to rejected papers and then submit them to another journal. It is unacceptable to submit to more than one journal at a time, and authors must sign a declaration at submission that the work has not been published elsewhere or been submitted for review to another journal.

Peer reviewed articles appear in the following English language journals of music therapy: Australian Journal of Music Therapy, British Journal of Music Therapy, Canadian Journal of Music Therapy, Journal of Music Therapy, Music Therapy Perspectives, Nordic Journal of Music Therapy , the New Zealand Journal of Music Therapy , and Voices . There are also related journals which publish music therapy research papers including: Psychology of Music, Music and Medicine , and The Arts in Psychotherapy . Music therapy research also appears in medical and therapy journals (for example, Loewy et al. 2013 , O’Callaghan et al. 2014 ). Therefore when students are researching projects or writing papers are encouraged to search the journal literature as well as reading relevant books and book chapters.

Trends in music therapy research

In this part of the chapter three trends in music therapy research will be discussed: (1) music therapy and evidence-based medicine, (2) arts-based research, and (3) mechanisms of change in music therapy.

Music therapy and evidence-based medicine

A number of music therapists have considered the ways that the profession can respond to the imperative of evidence-based medicine (EBM). EBM can be traced back to the 1960s but it more formally entered the lexicon of health care practice through the 1990s ( Smith and Rennie 2014 ). As a PhD researcher in a department of Paediatrics and Child Health in the 1990s the author observed firsthand the shift in thinking about practice and services that occurred when EBM began to be a main point of interest for researchers, not just in medicine but also through nursing and allied health departments. In order to consider the implications for music therapy she gave a series of presentations which were then worked into scholarly papers for publication. After initial rejection some of the ideas were eventually published ( Edwards 2005 , 2004 , 2002 ). Since that time others have also written about EBM and music therapy (for example Abrams 2010 , and Standley 2012 ).

Rather than relying on the outcome of a single RCT to develop new practices in health care, EBM proposed an evidence hierarchy founded on single cases (weak evidence) through to meta-analyses (strong evidence). In a meta-analysis the research findings from a number of studies with patients who have similar characteristics are analyzed statistically to show whether the changes that have occurred across all of the studies are convincing enough to warrant inclusion of the treatment in standard care. Dileo and Bradt concluded that “Overall, EBP [practice] intends to assure that patient treatment is safe, effective, and cost-effective.”(2009, p. 170)

Abrams has positioned evidence-based music therapy having multiple benefits for the profession:

The virtues of an integral understanding of evidence-based music therapy practice are numerous. It can help promote clarity of the different roles, purposes, strengths, and limits of each domain of evidence. It provides accountability to core values, standards of integrity, and standards of rigor, all internally consistent within a given perspective in any given instance. Moreover, it encourages an awareness of the applicability and relevance of evidence to clinical work in any given case. Abrams 2010 , p. 374

Earlier conceptualizations of EBM pointed out that music therapists are often referred clients or patients for whom other therapeutic supports or treatments have not been effective ( Edwards 2005 ). Therefore because of the complexity of the client’s situation and their unique needs traditional processes of matching of clients in control and treatment groups in the traditional RCT might not be possible.

Concepts used in evidence are now turning towards music therapy participants’ views to be a better accessed and utilized form of evidence (for example, Ansdell and Meehan 2010 ). Although initially this author’s concerns about EBM focused on inappropriate application by managers to limit innovation and cut services, in practice EBM has some but not complete influence on service leaders’ decisions to support or close programmes. At the same time it has produced an outstanding number of music therapy meta-analyses published in the most important medical evidence database in the world, the Cochrane Library (for example Mössler et al. 2011 ).

Arts-based research

The arts are increasingly being used in health care and related research to learn about the experiences of care workers and recipients, to gain access to marginalized voices, and to communicate research findings to a wider audience. Ledger and Edwards 2011 , p. 313

Arts-based research is a movement that has developed internationally with minimal input from creative arts therapists. Ledger and Edwards (2011) provided a number of examples in which music therapists appeared reluctant to describe their research methods as arts based . This reluctance was hypothesized as emerging from anxiety about seeming scientific enough, especially when conducting research in health and medical contexts.

As artistic processes within music are central to music therapy practice, the use of music making or other creative arts processes could be considered compatible with the goals of music therapy inquiry. It is therefore puzzling why arts based processes are not more widely used in music therapy research.

Arts-based research was included in the main research textbook to date in music therapy ( Wheeler 2005 ). Dianne Austin and Michele Forinash make a distinction between arts based research and the studies that have analyzed music created in music therapy sessions. They have shown that the arts can be used at every step in the research process to develop rich and expressive findings. Arts-based research is explained as offering a valuable way to gain insights that might not otherwise be discoverable ( Austin and Forinash 2005 ).

Mechanisms of change in music therapy

Research contributes to knowledge about change, but researchers also have a responsibility to theorize why the change occurs. Research relevant to music therapy from the fields of psychology and neuroscience are key to understanding the mechanisms of change in music therapy. For example, music therapy relies on the evocative potentials of music to develop a way of relating between the therapist and the client that is helpful in meeting the client’s needs and contributing to their well-being. Some of these evocative capacities include the ability of music to influence affect. In order to be able to interact and support clients in a way that is helpful and informed, understanding how music influences emotional states is key. Music therapists have extensive experience and expertise in observation of musical responses. As an experienced music therapy practitioner the following mechanism as to how emotional response to music might occur makes sense to the author. Julin and Västfjäll have proposed that when humans listen to music all of the following psychological processes happen, not separately but concurrently, and this is why an emotional response occurs:

(1) brain stem reflexes, (2) evaluative conditioning, (3) emotional contagion, (4) visual imagery, (5) episodic memory, and (6) musical expectancy. Juslin and Västfjäll 2008 , p. 563

Their proposition is interesting for music therapy practitioners to engage in order to understand the instantaneous aspects of response over which an individual has no control, and to confirm that there is no one piece of music that has the same effect on every listener. However, many psychological theories such as these that are relevant to music therapy are silent on the core interpersonal and relational aspects of music therapy. Therefore neuropsychological and physiological theories need to be accessed in order to further understanding of music therapy as a relational practice.

Developing theories about brain growth indicate that infant brains develop in collaboration and interaction with other brains ( Schore 2010 ). Loving, predictable responsiveness from the adult care giver is essential for an infant’s healthy start in life. The failure of the infant-parental bond to coalesce and attachment to be formed is disastrous for the child’s ongoing development. This can occur because of maltreatment and/or neglect, or because of demands on the carer’s own resources result in them being unavailable to the infant’s needs. This has lifelong consequences on development, particularly the skills needed for social interaction with others, and the resilience to deal with stressful experiences and events. Neurosequential modelling proposes that the infant brain develops in stages.

The brain is organized in a hierarchical fashion with four main anatomically distinct regions: brainstem, diencephalon, limbic system, and cortex. During development the brain organizes itself from the bottom up, from the least (brainstem) to the most complex (limbic, cortical) areas. While significantly interconnected, each of these regions mediates distinct functions, with the lower, structurally simpler areas mediating basic regulatory functions and the highest, most complex structures (cortical) mediating the most complex functions. Each of these main regions develops, organizes, and becomes fully functional at different times during childhood… Perry 2009 , p. 243

This theory is important for music therapy because it provides information to explain why children who have not developed self-regulatory processes due to severe early relational trauma, for example what Perry described as the “overanxious, impulsive, dysregulated child” (p. 243), might behave differently in the regulating holding environment of music therapy where predictable structure can contain and support the child’s actions and spontaneity (for relevant case examples, see Drake 2011 ).

The therapeutic opportunities in music therapy lie not only in the client’s responses to music but equally and sometimes more importantly in the therapist-client relating. Porges’ Polyvagal Theory is so named because it associates two physiological systems with feelings of safety and security and explains how these function in interpersonal relating. These are:

(a) the commonly known fight-or-flight system that is associated with activation of the sympathetic nervous system… and (b) a less-known system of immobilization and dissociation that is associated with activation of a phylogenetically more ancient vagal pathway. Geller and Porges 2014 , p. 180

Using the Polyvagal Theory ( Porges 2011 ) Geller and Porges (2014) have illuminated therapeutic presence as a salient factor reliant on neurophysiological processes by which safety, security, and trust are experienced in the therapeutic relationship. Given that many people who seek or are referred to psychological services have experienced a breakdown of their capacity to cope, or to relate successfully with others, the ability to provide safety and security in the interpersonal space is crucial to providing opportunities for capacity building towards growth and change.

Expert therapists have reported that the experience of therapeutic presence involves concurrently (a) being grounded and in contact with one’s integrated and healthy self; (b) being open, receptive to, and immersed in what is poignant in the moment; and (c) having a larger sense of spaciousness and expansion of awareness and perception. This grounded, immersed, and expanded awareness also occurs with (d) the intention of being with and for the client in service of their healing process. By being grounded, immersed, and spacious, with the intention of being with and for the other, the therapist invites the client into a deeper and shared state of relational therapeutic presence. Geller and Porges 2014 , p. 180

Polyvagal theory has contributed to the development of new ways of working as well as supporting existing practices in music therapy. As Loewy (2011) noted:

… [Polyvagal Theory] contributes to the theoretical justification for the role that music therapy can play in activating neural circuits that regulate reactivity. Porges’ rationale for and description of feeding and rocking as primal attachment behaviors which influence vagal afferent pathways is an essential contributor to the current thinking about the importance of the quality of care in the first stage of life. Music therapy practices that activate somatomotor components which trigger visceral change influence attachment practices which are critically important in the early years. Loewy 2011 , p. 182

The relational dimensions of music therapy practice are underpinned by multiple psychobiological principles including those encapsulated in communicative musicality initially developed by Stephen Malloch in his postdoctoral work at Edinburgh University, which was then further elaborated ( Malloch and Trevarthen 2009 ). Malloch and Trevarthen (2009) documented how the development of the theory and observation of the presence of communicative musicality occurred through many decades of research in the last century. Importantly multiple theorists and researchers from a range of fields, whether during field observations or in laboratory based experimental work, noted the expressive, dance and song like interactions between infants and the adults who share loving relationships with them. These multiple perspectives result in the conclusion that:

… we are evolved to know, think, communicate, create new things and care for one another in movement—through a sense of being in rhythmic time with motives and in tune with feelings to share the energy and harmony of meaning and of relating. Malloch and Trevarthen 2009 , p. 8

Contexts for research

All research conducted with service users in music therapy involves a context. This may be a single site such as a school or a hospital (see Colwell , this volume), or multiple sites. It may involve a service such as an oncology department, or additionally it may involve participants who access multiple services, for example children with cerebral palsy. Each context differs as to how service users or students can be approached to be involved in the research, and who will act as formal or informal gate-keepers. Researchers planning projects need to factor in how the people who will contribute to managing the data collection of the project will be sorced, and how these potential gate-keepers will assist in managing the recruitment and involvement of service users. Often people who are crucial to the research such as gate-keepers receive little acknowledgement either in research reports, or in international publications. This can make it difficult for novice researchers to understand how crucial they are to conducting research which relies on data collection from service users or students ( Porter et al. 2014 ).

Clinicians working within a service are often the referring point for participation in a music therapy project. The clinician can decide whether a person who meets the criteria for the project is able to manage the requirements of the project participation, and would potentially benefit from being a research participant. Clinicians are protective of their clients or patients. Therefore the researcher must take care to ensure that the clinician has confidence in the researcher and the research processes, that participants will not be taxed or made demands of in any problematic way. The gatekeeper may also be encoraged to note that the client may end up receiving music therapy, and that this participation may be highly enjoyable and potentially therapeutically beneficial.

One contextual dimension that has received limited attention in the literature is the role of the researcher and how this differs from the role of music therapist. Ledger (2010a) has reflected on her experiences as a music therapy researcher undertaking an ethnographic research project in a hospital that was developing a new music therapy service. She wrote:

Returning to the familiar setting of a hospital brought to the fore a set of previously held positions and behaviors. I needed to manage not only the boundary between researcher and music therapist but also the boundaries between researcher and colleague, researcher and friend, and experienced music therapist and student. These boundaries needed to be negotiated and renegotiated throughout the duration of my ethnography. There were times when it was helpful to cross boundaries in order to build rapport and to show appreciation to the staff who contributed to my research. However, there were also times when I needed to establish clear boundaries and to reiterate my research intentions. Ledger 2010a , p. 300

Ledger’s further reflection reveals some of the dilemmas that can arise when conducting qualitative methods research ( Ledger 2010b ). Unlike other types of research where one might collect data through testing or questionnaires, ethnography involves participation and observation. Being aware of the need to manage and negotiate role identity is an important part of undertaking this work.

The future of music therapy research

As music therapy matures and grows as a field of practice it is developing its depth and breadth of research engagement. Contemporary research is immensely inspiring, especially for increasingly sounding the voices of service users ( Ansdell and Meehan 2010 ; Solli et al. 2013 ), and the careful development of research procedures which ensure the complexity of musical experiences are not lost in the need for research rigor ( Erkkilä et al. 2011 ). The development of greater sophistication in mixed methods research (see Erkkilä , this volume) will ensure that the outcomes of psychological testing or observation of the therapist will not be privileged over the lived experience of participants. The increasing harnessing of the capacities of technology in conducting systematic evaluation of music therapy services show promising developments ( Streeter et al. 2012 ). More robust theoretical engagement with neuroscience and psychophysiology (for example Loewy 2011 ) and social theories ( Baines 2013 ) will ensure that music therapy has strong theoretical bones upon which the flesh and sinew of competent practice can continue to grow.

Epistemology refers to theory of knowledge. All research has an epistemological foundation whether or not it is made explicit. For further information see Edwards (2012) .

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The study of music therapy: Current issues and concepts

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This book addresses the issues in music therapy that are central to understanding it in its scholarly dimensions, how it is evolving, and how it connects to related academic disciplines. It draws on a multi-disciplinary approach to look at the defining issues of music therapy as a scholarly discipline, rather than as an area of clinical practice. It is the single best resource for scholars interested in music therapy because it focuses on the areas that tend to be of greatest interest to them, such as issues of definition, theory, and the function of social context, but also does not assume detailed prior knowledge of the subject.

Some of the topics discussed include defining the nature of music therapy, its relation to current and historical uses of music in human well-being, and considerations on what makes music therapy work. Contemporary thinking on the role of neurological theory, early interaction theory, and evolutionary considerations in music therapy theory are also reviewed. Within each of these areas, the author presents an overview of the development of thinking, discusses contrasting positions, and offers a personalized synthesis of the issue. The Study of Music Therapy is the only book in music therapy that gathers all the major issues currently debated in the field, providing a critical overview of the predominance of opinions on these issues.

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• Music Therapy Arts & Humanities 100%
• Prior Knowledge Arts & Humanities 13%
• Academic Discipline Arts & Humanities 13%
• Music Arts & Humanities 10%
• Clinical Practice Arts & Humanities 10%
• Social Context Arts & Humanities 8%
• Well-being Arts & Humanities 8%
• Evolutionary Arts & Humanities 8%

T1 - The study of music therapy

T2 - Current issues and concepts

AU - Aigen, Kenneth S.

N1 - Publisher Copyright: © 2014 Taylor and Francis.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - This book addresses the issues in music therapy that are central to understanding it in its scholarly dimensions, how it is evolving, and how it connects to related academic disciplines. It draws on a multi-disciplinary approach to look at the defining issues of music therapy as a scholarly discipline, rather than as an area of clinical practice. It is the single best resource for scholars interested in music therapy because it focuses on the areas that tend to be of greatest interest to them, such as issues of definition, theory, and the function of social context, but also does not assume detailed prior knowledge of the subject.Some of the topics discussed include defining the nature of music therapy, its relation to current and historical uses of music in human well-being, and considerations on what makes music therapy work. Contemporary thinking on the role of neurological theory, early interaction theory, and evolutionary considerations in music therapy theory are also reviewed. Within each of these areas, the author presents an overview of the development of thinking, discusses contrasting positions, and offers a personalized synthesis of the issue. The Study of Music Therapy is the only book in music therapy that gathers all the major issues currently debated in the field, providing a critical overview of the predominance of opinions on these issues.

AB - This book addresses the issues in music therapy that are central to understanding it in its scholarly dimensions, how it is evolving, and how it connects to related academic disciplines. It draws on a multi-disciplinary approach to look at the defining issues of music therapy as a scholarly discipline, rather than as an area of clinical practice. It is the single best resource for scholars interested in music therapy because it focuses on the areas that tend to be of greatest interest to them, such as issues of definition, theory, and the function of social context, but also does not assume detailed prior knowledge of the subject.Some of the topics discussed include defining the nature of music therapy, its relation to current and historical uses of music in human well-being, and considerations on what makes music therapy work. Contemporary thinking on the role of neurological theory, early interaction theory, and evolutionary considerations in music therapy theory are also reviewed. Within each of these areas, the author presents an overview of the development of thinking, discusses contrasting positions, and offers a personalized synthesis of the issue. The Study of Music Therapy is the only book in music therapy that gathers all the major issues currently debated in the field, providing a critical overview of the predominance of opinions on these issues.

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U2 - 10.4324/9781315882703

DO - 10.4324/9781315882703

AN - SCOPUS:84909351276

BT - The study of music therapy

PB - Taylor and Francis

CY - New York

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Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis

Celia moreno-morales.

1 Department of Inorganic Chemistry, Organic Chemistry and Biochemistry, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain

Raul Calero

Pedro moreno-morales.

2 School of Nursing and Physiotherapy, University of Castilla-La Mancha, Toledo, Spain

Cristina Pintado

3 Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain

Associated Data

All datasets generated for this study are included in the article/ Supplementary Material .

Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with the pharmacological therapy.

Objective: We performed a systematic review and subsequent meta-analysis to check whether the application of music therapy in people living with dementia has an effect on cognitive function, quality of life, and/or depressive state.

Methods: The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as “music,” “brain,” “dementia,” or “clinical trial,” were used.

Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression.

Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies.

• Music therapy is used as a treatment for the improvement of cognitive function in people with dementia.
• The intervention based on listening to music presents the greatest effect on patients with dementia followed by singing.
• Music therapy improved the quality of life of people with dementia.
• Music has a long-term effect on depression symptoms associated with dementia.

Introduction

Approximately 50 million people worldwide have dementia, and it is projected to almost triple by 2050 ( 1 ). Dementia is an overall term for diseases and conditions characterized by progressive affectation of cognitive alterations, such as memory and language, as well as behavioral alterations including depression and anxiety ( 2 , 3 ). In order to ameliorate the symptoms of dementia, different intervention approaches, both pharmacological and non-pharmacological, have been trialed. Pharmacological interventions, such as acetylcholinesterase inhibitors, are mainly aimed to treat cognitive symptoms but without avoiding the course of the disease. Unfortunately, these therapies have limited effect on alleviating behavioral and psychological symptoms of dementia ( 2 , 4 ). On the other hand, non-pharmacological interventions can provide complementary therapy, offering versatile approaches to improve outcomes for people living with dementia and minimize behavioral occurrences as well as to improve or sustain quality of life ( 2 , 5 – 9 ). There are many types of non-pharmacological approaches, such as psychosocial and educational therapies (either with individuals or in groups) and physical or sensorial activities (music, therapeutic touch, and multisensory stimuli) ( 7 , 10 – 12 ). In particular, music therapy is thoroughly used in daily clinical practice in case of dementia ( 13 , 14 ). Many authors emphasize the positive effects of music on the brain. In this sense, several studies showed that people with dementia enjoy music, and their ability to respond to it is preserved even when verbal communication is no longer possible. These studies claimed that interventions based on musical activities have positive effects on behavior, emotion and cognition ( 2 , 15 , 16 ). Therefore, studying and playing music alter brain function and can improve cognitive areas, such as the neural mechanisms for speech ( 17 ), learning, attention ( 18 ), and memory ( 19 ). Music can also activate subcortical circuits, the limbic system, and the emotional reward system, provoking sensations of welfare and pleasure ( 14 ). In this regard, long-term musical training and learning of associated skills can be a strong stimulus for neuroplastic changes, in both the developing brain and the adult brain. These findings suggest the great capacity of music to enhance cerebral plasticity ( 13 , 16 , 20 ). Contrariwise, there are studies that question the specific effect of music therapy on people with dementia ( 21 ). With this background, the aim of this study is to analyze from an unbiased approach the effect of music therapy on the cognitive function, quality of life, and/or depressive state in people living with dementia.

Search Strategy and Selection Criteria

A systematic review was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) ( Figure 1 and Searching procedure of Supplementary Data ) ( 22 ). An independent literature search was conducted across Medline, PubMed Central, Embase, PsycINFO, and Cochrane library databases. We carried out the systematic review of the literature following a series of criteria as detailed below.

Flow of studies through the review process for systematic review and meta-analysis.

Initially, the search began with the terms “brain” and “music.” Later, “dementia” was added, and finally, “clinical trial” was included. The search period used was from 1990 to present. Next, a more in-depth study of selected trials was carried out. Duplicate studies were removed. All studies that compared any form and method of musical intervention with an intervention without music were evaluated. Lastly, those studies that were systematic analysis, reviews, and study protocols and those which do not evaluate cognitive function were excluded. All the trials chosen were designed as randomized controlled trials (RCTs).

Data Collection, Extraction, and Quality Assessment

Two authors (CMM and PMM) independently assessed publications for eligibility. Discrepancies or difficulties were discussed with a third review author (CP). Data were collected independently using a standardized data extraction form in order to summarize the characteristics of the studies and outcome data ( 23 ).

From each individual study, we extracted baseline information: publication and year, study design, participants (number, age, and sex ratio), Mini-Mental Status Examination (MMSE) score, and Clinical Dementia Rating (CDR) (clinical evaluation of dementia) when possible, as well as the design of each individual study (intervention method, frequency, duration, and time of evaluation of the results) ( Table 1 ).

Characteristics of the studies.

F1, follow-up 1 (short term); F2, follow-up 2 (long term); RCT, randomized clinical trial; CG, control group; AD, Alzheimer's disease; SG, singing group; MLG, music listening group; DG, dancing group; IMG, instrumental music group; MG, Music group .

In addition, at the beginning of the study, we assessed the quality of meta-analysis-included studies using the Physiotherapy Evidence Database (PEDro) scale and the Critical Appraisal Skills Program (CASP) scale ( Supplementary Tables 1 , 2 of the Supplementary Data ) ( 23 , 32 , 33 ).

Outcome Measures

The primary outcome defined to be compared was cognitive function evaluated through MMSE ( 34 ), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) ( 35 ), Revised Memory and Behavior Problems Checklist (RMBPC) ( 36 ), or Immediate and Deferred Prose Memory test (MPI and MPD, respectively) ( 37 ). Other comparative results, named as secondary outcomes, were quality of life, assessed through Quality of Life in Alzheimer's Disease (QOL-AD) ( 38 ), and depression, evaluated through Cornell–Brown Scale for Quality of Life in Dementia (CBS) and Geriatric Depression Scale (GDS) ( 39 , 40 ).

Statistical Analysis: Meta-Analysis

First, a comparison was made using the random-effects model. All outcomes were continuous variables [mean ± standard deviation (SD) of the change in the score before and after the therapy in the different diagnostic tests], and the standardized mean difference (SMD) was analyzed. All the analyses were carried out considering a confidence interval (CI) of 95%. Statistical heterogeneity was also tested by I 2 . I 2 <25% was identified as low heterogeneity ( 41 , 42 ). Finally, the publication bias was evaluated using funnel plot graphs ( 43 , 44 ). To further investigate the heterogeneity, meta-regression and subgroup analyses were performed to assess the primary outcome data and associations according to the method of intervention (interactive and passive), trial period, number of sessions per week, and effect of evaluation method used. The P values in the meta-regression revealed the overall significance of the influence factors.

Meta-analysis, heterogeneity study, and graphical representations were performed using R with the Metafor package ( 44 ). To digitize graphics and obtain numerical data from those trials that did not provide them, the GetData Graph Digitizer program ( Getdata-graph-digitizer.com ) was used.

Baseline Characteristics

Results of initial search and exclusions are shown in Figure 1 . A thorough reading of each article was carried out, and a summary of each of them is shown in Table 1 . Therefore, we finally stayed for the systematic review and meta-analysis with eight articles. The size of the studies was between 30 and 201 subjects, with a total of 816 subjects with mild to severe dementia, assigned randomly to both the intervention and control groups. All the people in the trials stayed in nursing homes or hospitals. Särkämö et al. divided the participants into three groups, an active group that sang, a passive group that listened to music, and a control group ( 24 , 25 ). On the other hand, Doi et al. evaluated two cognitive programs of leisure activities: dancing and playing musical instruments ( 26 ). Furthermore, Han et al. tested a multimodal cognitive improvement therapy (MCET) consisting of cognitive training, cognitive stimulation, reality orientation, physical, reminiscence, and music therapy against a sham therapy without music ( 27 ). In this line, Ceccato et al. tried the program Sound Training for Attention and Memory in Dementia (STAM-Dem), a manualized music-based protocol designed to be used in the rehabilitation of cognitive functions in people with dementia. Those in the control group continued with the normal “standard care” provided ( 28 ). While Lyu et al. compared the effect of singing on cognitive function and mood, Chu et al. assessed a protocol that includes playing an instrument, dancing, and listening to music. The effect size of all those studies reveals a general improvement in the results of the experimental group ( 29 , 30 ). Finally, Guétin et al. did not find a significant difference between the experimental and control groups when evaluating the cognitive function after an 18-month therapy based on listening to music ( 31 ).

All the studies had an acceptable quality as confirmed after applying the PEDro and CASP scales ( Supplementary Tables 1 , 2 , respectively, of the Supplementary Data ).

In case of medication (dementia, antipsychotic, and antidepressant medication and sedative or sleeping medication), it must have been stable prior to the trial. Since participants were randomized, there were no significant differences between the control and music-treated groups with regard to medication. Likewise, there were no significant differences between groups in the dementia severity and/or demographic variables.

Efficacy of Musical Intervention in Cognitive Function

Figure 2 summarizes the relevant results of the quantitative synthesis of the effect of music therapy for people living with dementia. First, we evaluated the effect of music therapy on cognitive function by analyzing eight studies (816 cases) ( Figure 2A ). In the random-effects model, SMD was −0.23 (95% CI: −0.44, −0.02), which suggested that musical intervention could be beneficial to improve cognitive function in people living with dementia. However, the trials showed very high heterogeneity [ I 2 value = 72% ( P < 0.0001)].

Summary of efficacy of music intervention on cognitive function and secondary outcomes. Forest plot. Overall efficacy of music intervention in people with dementia (A) on cognitive function. (B) on quality of life. (C) on quality of life of people after 6 months of treatment. (D) on depressive state (E) on depressive state after 6 months.

Subgroup analyses and meta-regression were used to further explore this source of heterogeneity ( Table 2 ). Two significant sources of heterogeneity were detected: the trial period and the intervention method (coefficient = 7.43, P = 0.006 and coefficient = 3.981; P = 0.046, respectively). Interestingly, we observed that shorter intervention periods (<20 weeks) and passive interventions methods (listening to music) had greater effect on people living with dementia than longer intervention periods or interactive interventions, such as singing and dancing ( Figure 2A ; Table 2 ). On the other hand, to play an instrument does not seem to have a positive effect on cognitive function. Nevertheless, it appears to be effective when it is combined with singing and listening to music, without improving the effect of just listening to music ( Figure 2A ). The funnel plot on the publication bias across cognitive studies appeared symmetrically low ( Supplementary Figure 1 of the Supplementary Data ).

Meta-regression for the effect of music intervention vs. control on cognitive function.

Efficacy of Musical Intervention in Quality of Life

A meta-analysis about the quality of life of people living with dementia after the intervention with music therapy was designed. The analysis included three studies (286 cases). The results suggested that there was an effect on the quality of life of patients once the intervention is finished (SMD = −0.36, 95% CI: −0.62, 0.10) ( Figure 2B ). On the other hand, no significant effect of music therapy was observed when carrying out the analysis (two studies; 166 cases) of the quality of life of people living with dementia 6 months after the intervention (SMD = −0.34, 95% CI: −0.78, 0.10) ( Figure 2C ). The heterogeneity of the studies was small in the short-term analysis but >25 in the long term ( I 2 = 12 and I 2 = 42, respectively).

Supplementary Figures 1B,C in the supplementary data represent the funnel plot about the quality of life measured after the intervention and 6 months later. Data indicate that there is no publication bias.

Efficacy of Musical Intervention in the Depressive State

Finally, in order to evaluate the influence of music therapy on the depressive state associated with dementia, in both the short and long terms, we analyzed its effect when the intervention had just ended and 6 months after the treatment. The result of the meta-analysis (5 studies, 342 cases) suggested that there was no short-term effect on the depressive state of the patients (SMD = 0.16, 95% CI: −0.54, 0.87) ( Figure 2D ). However, when studying the depressive state of patients 6 months after the intervention to know if there is a long-term effect (4 studies, 290 cases), the result indicated that music therapy could have a positive effect on the depressive state of people living with dementia (SMD = −0.25, 95% CI: −0.68, 0.18) ( Figure 2E ). In both cases, the heterogeneity of the studies was high [ I 2 = 89% ( P < 0.0001) in the short term; I 2 = 66% ( P < 0.01) in the long term]. The funnel plot of the depressive state after the intervention and about the depressive state at 6 months denotes that there is no publication bias ( Supplementary Figures 1D,E in the Supplementary Data ).

The main objective of this work was to study through systematic review and meta-analysis whether the application of music as a therapy has an effect on cognitive function, quality of life, and/or depressive state in a group of specific diseases such as dementia. Nowadays, there is a growing incidence of this pathology in the population ( 1 ), and therefore, it is necessary to develop treatments and activities to relieve its symptoms. In addition, there is not enough scientific evidence about the efficacy of music as a therapy on the cognitive and behavioral states of these patients.

Our results suggest that music therapy has a positive effect on cognitive function for people living with dementia. To reach that assumption, we performed a comprehensive systematic review that includes eight studies with 816 subjects. We observed that listening to music is the intervention type with the greatest positive effect on cognitive function. This could be explained because listening to music integrates perception of sounds, rhythms, and lyrics and the response to the sound and requires attention to an environment, which implies that our brain has many areas activated. Those events are linked to wide cortical activation ( 14 , 15 , 45 ). In addition, music training is a strong stimulus for neuroplastic changes. So music could decrease neuronal degeneration by enhancing cerebral plasticity and inducing the creation of new connections in the brain ( 46 , 47 ). However, the heterogeneity presented by the different studies included in the meta-analysis does not allow us to reach reliable conclusions ( I 2 = 75%). This heterogeneity may be due to the design of each study, the difference in the type of intervention carried out, and the number of participants among other variables ( 41 ). Meta-regression showed that the intervention method, interactive or passive, is a significant source of heterogeneity accounting for 45.1% of the total heterogeneity detected ( Table 2 ). We observed a significant effect on cognitive function in the passive intervention group ( P = 0.0004). This result is in agreement with our previous analysis where listening to music has the greatest effect. Other sources of heterogeneity found when we analyzed the effect of music therapy on the cognitive function were the intervention length and the number of sessions per week (34.4 and 9.4%, respectively), the latter not being significant ( Table 2 ). Based on the literature, there is a huge diversity in the scheduling of music treatment duration. In our case, sessions varied from 90 min once a week during 10 or 20 weeks to 60 min during 40 weeks. It seems that the length for the entire music intervention procedure might be a crucial element for successful results and seems to be associated with the intervention type ( 48 – 50 ). We observed that shorter intervention periods (<20 weeks) had a greater effect on people living with dementia than longer intervention ones. This finding is not enough to draw further conclusion due to the heterogeneity found. According to our results, although the number of sessions per week seems not to have an impact on music therapy effectiveness, a greater frequency of therapy seems to be of particular importance ( 48 ).

Xu et al. and Roman-Caballero et al. showed similar results in two meta-analysis studies conducted on musical intervention in cognitive dysfunction in healthy older adults ( 18 , 23 ). In fact, as in our study, the level of heterogeneity found was also very wide. Van der Steen et al. also analyzed music-based therapeutic intervention on cognition in people with dementia ( 51 ). They found low-quality evidence that music-based therapeutic interventions may have little or no effect on cognition. Nevertheless, they did not analyze the effects in relation to the overall duration of the treatment, the number of sessions, and the type of music intervention.

After analysis of the secondary outcomes, music therapy surprisingly did not have a marked effect. Regarding quality of life, our data suggested a positive effect once the therapy is finished, but it was not durable after 6 months of music intervention. On the other hand, the study evaluating the effect of music therapy on the depressive state of people living with dementia showed no improvement in the state of these patients when they were evaluated after the intervention. However, if the depressive state was evaluated after 6 months from treatment, a shift in favor of music therapy was observed. This result suggests that the effects of music are not immediate and that the design of progressive and continuous interventions is necessary in order to obtain successful results as has also been discussed by Leubner and Hinterberger ( 49 ).

Xu et al. observed that, both in the analysis of the depressive state and in the quality of life, music therapy does not have a positive effect ( 23 ). These data corroborate the results obtained in the short term in our study. However, they did not measure the effects of long-term music therapy. Furthermore, Dyer et al. found that music as a non-pharmacological intervention improves behavioral and psychological symptoms of dementia but concluded that further research is required ( 2 , 52 ). Van der Steen et al. also compared the effect music-based therapeutic intervention versus usual care or versus other activities on depression and emotional well-being ( 51 ). Likewise, at the end of treatment, they found low-quality evidence that the musical interventions may improve emotional well-being and quality of life.

Music is a pleasant stimulus, especially when it is adapted to one's personal preferences, and it can evoke positive emotions. Some studies have demonstrated that music therapy had an influence on levels of hormones such as cortisol. It also affects the autonomic nervous systems by decreasing stress-related activation ( 53 , 54 ). At the same time, some studies suggest that music promotes several neurotransmitters, such as endorphins, endocannabinoids, dopamine, and nitric oxide. This implies that music takes part in reward, stress, and arousal processes ( 55 ). However, the lack of standardized methods for musical stimulus selection is a common feature in the studies we have reviewed. Additionally, the absence of a suitable control of the intervention to match levels of arousal, attentional engagement, mood state modification, or emotional qualities between participants may be a reason for the differences between studies ( 55 ). Furthermore, our results have likely been influenced by the type of test used to evaluate depression symptoms. Most studies used questionnaires that were based on self-assessment. However, it is unclear whether this approach is valid to detect changes regarding symptom improvement. Future approaches should add measurements of physiological body reactions, such as skin conductance and heart rate, for more objectivity ( 49 ).

Conclusions

This study shows evidence with a positive trend supporting music therapy for the improvement of cognitive function in people living with dementia. Additionally, the study reveals a positive result for treatment of long-term depression, without showing an effect on short-term depression in these patients. Furthermore, music therapy seems to improve quality of life of people with dementia once the intervention is finished, but it does not have a long-lasting effect.

Limitations And Potential Explanations

This meta-analysis had several limitations. First, there are many clinical trials in development like {"type":"clinical-trial","attrs":{"text":"NCT03496675","term_id":"NCT03496675"}} NCT03496675 and {"type":"clinical-trial","attrs":{"text":"NCT03271190","term_id":"NCT03271190"}} NCT03271190 ( Clinicaltrials.gov ), whose completion is estimated to be in 2024 and 2022, respectively, which could not be included in this analysis ( 56 , 57 ). Secondly, there are several important limitations in the design of the trials included. First, some of the studies included had a very small sample size (<100 participants), which means that they may lack enough participants to detect differences between groups. Also, the musical interventions and the method used to evaluate the cognitive function and depression were diverse and make it difficult to state clearly their benefit when compared to usual care. The lack of standardized methods for musical stimulus selection is a common drawback in the studies we reviewed and a probable contributor to inconsistencies across studies ( 55 ).

Finally, we could not perform a subgroup analysis regarding dementia severity to evaluate when music intervention would be more appropriate in the disease trajectory. This was due to the fact that in all studies selected, participants with different dementia stage were randomly assigned to the intervention or control group. Besides, almost all trials in the literature were focused on the mild or moderate stage of dementia, and there were few studies about people living with severe dementia. However, those studies do not evaluate cognitive function ( 58 ).

Future Research Recommendation

Despite the limitations, music is a non-pharmacological intervention, noninvasive, and without side effects, and its application is economical ( 53 , 54 ). For this reason, in order to confirm the effect of musical interventions, more clinical trials on the effect of music therapy should be promoted. The tests should include a high number of participants, be robust, and be randomized. As explained, music therapy methods and techniques used in clinical practice are diverse. Therefore, it is necessary to design standardized clinical trials that evaluate cognitive function and the disease behavioral features through the same battery of tests to obtain comparable results. On the other hand, there were no high-quality longitudinal studies that demonstrated long-term benefits of music therapy. It is also important to develop study designs that will be sensitive to the nature and severity of dementia. Future music therapy studies need to define a theoretical model, include better-focused outcome measures, and discuss how the findings may improve the well-being of people with dementia as discussed by McDermott et al. ( 45 ). and many others ( 49 , 54 , 55 ).

The investment in research in this novel therapy could lead to its implementation as a new and alternative intervention together with current cognitive-behavioral and pharmacological therapies.

Data Availability Statement

Author contributions.

CM-M and PM-M: did systematic review and review the manuscript. CM-M and RC: meta-analysis. RC: meta-regression and sub-group analysis and review the manuscript. CP: design the study, conceptualization, supervision, wrote the paper.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2020.00160/full#supplementary-material

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Good Research Topics about Music Therapy

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Click to go directly to: Opt-in to Receive Printed Journal Copies! The Journal of Music Therapy Journal of Music Therapy - AMTA Member Access Portal Music Therapy Perspectives Music Therapy Perspectives - AMTA Member Access Portal Steps to Access Your Online Member Subscription to Research Journals Music Therapy Matters Monthly Other Publications from AMTA Imagine, early childhood newsletter 2010, 2011 & 2012 Back Issues of AMTA Journals Music Therapy - 1981-1996 journal Advertising in AMTA Publications

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The Journal of Music Therapy

Journal of Music Therapy webpage at Oxford University Press

Journal of music therapy amta member access portal.

A forum for authoritative articles of current music therapy research and theory, including book reviews and guest editorials. An index appears in issue four of each volume. ISSN #0022-2917

Subscriptions to the Journal of Music Therapy are now available for the current and upcoming year.  For subscription rate information and to subscribe to the Journal of Music Therapy , please contact AMTA's partner in publishing, Oxford Universtiy Press, https://academic.oup.com/jmt/subscribe

Mission statement.

The Journal of Music Therapy (JMT) is a forum for authoritative articles of current music therapy research and theory, including book reviews and guest editorials. Its mission is as follows:

The Journal of Music Therapy seeks to advance research, theory, and practice in music therapy through the dissemination of scholarly work. Its mission is to promote scholarly activity in music therapy and to foster the development and understanding of music therapy and music-based interventions. To this end, the journal publishes all types of research, including quantitative, qualitative, historical, philosophical, theoretical, and musical, and may include discipline, profession, and foundational research topics. The journal strives to present a variety of research approaches and topics, to promote critical inquiry, and to serve as a resource and forum for researchers, educators, and clinicians in music therapy and related professions.

Journal Content

The Journal of Music Therapy publishes only the very best of what is submitted and includes articles concerning the psychology of music, applied music therapy techniques, perception of music, and effects of music on human behavior. All papers for publication are selected on the basis of their quality and contribution to existing knowledge. About 30% of submitted manuscripts are accepted for publication and include but are not limited to qualitative, quantitative, and mixed methodologies; historical, descriptive, philosophical, or experimental designs; and integrative reviews, meta-analysis or meta-synthesis. Individual case studies or studies with very small numbers of subjects are rarely published; however, an extremely innovative case study may be accepted due to its unique contribution to knowledge. Conversely, articles of any type which do not advance the science and practice of music therapy are not accepted.

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Journal of Music Therapy Online Member Access

AMTA's journals are available to subscribers and current AMTA members who may access and search the online journals.  At times, articles may be published online as open access for a limited number of weeks.  For member access to articles that are not open access, go to www.musictherapy.org and log in in the upper right with your current member personal email address and password. Once logged into your personal member account, then go to Research>Music Therapy Journals and Publications and select the "Member Access Portal" link for your desired journal.  This is the member portal to AMTA's music therapy journals at Oxford University Press.  Just one more click on the link in the access portal and you will be directed to the journal page.   Once you are there, you may begin browsing the journals. You will see the unlocked padlocked icon next to articles that you are able to access and the AMTA Members account in the upper right.  This means you are logged into your online subscription and are able to browse the journal and its archives. Alternatively (for fewer steps), you can use the Quick Links for each journal on the AMTA home page after you initially log in.

Contributions to the Journal of Music Therapy

Please submit manuscripts and submission letters electronically using AMTA's online submission program at the URL/link below.  AMTA's online submission system is ScholarOne located at: http://mc.manuscriptcentral.com/jmt Please review all Instructions for Authors before submitting. Should you have any difficulties with your online submission, please contact via email:

Blythe LaGasse, PhD, MT-BC Editor, Journal of Music Therapy Colorado State University College of Liberal Arts, UCA 145D Fort Collins, CO 80523-1701 [email protected]

AMTA Journals Complaint Resolution Process

• The complaint or concern is raised, preferably in an email to the editorial office, including specific and detailed evidence to support the claim.
• The editor will notify the complainant that they will investigate and communicate the outcome but may not be in regular contact before the conclusion of the investigation. 
• The editor will notify the AMTA’s journal business manager and/or CEO, and journal publisher, and work with them to seek out all applicable industry guidelines concerning matters of research integrity and publication ethics (including those of the Committee on Publication Ethics), case examples, and AMTA Bylaws. 
• In consultation with the AMTA CEO and the publisher, the editor will review the issue in accordance with industry standards and best practices.
• During the investigation, the editor may consult with relevant experts and/or may form a committee for recommendation. All consultants are expected to maintain the confidentiality of the process and declare any conflicts of interest and, if appropriate, recuse themselves immediately. The editor will make the final decision.
• The editor will provide written explanation of the decision to the complainant. Journal of Music Therapy Email: [email protected]

Music Therapy Perspectives

Music therapy perspectives webpage at oxford university press, music therapy perspectives - amta member access portal, advertising in music therapy perspectives.

Designed to appeal to a wide readership, both inside and outside the profession of music therapy. Articles focus on music therapy practice, as well as academics and administration. ISSN #0734-6875

Subscriptions to Music Therapy Perspectives are now available for the current and upcoming year!  For subscription rate information and to subscribe to Music Therapy Perspectives , please contact AMTA's partner in publishing, Oxford University Press, https://academic.oup.com/mtp/subscribe

Music Therapy Perspectives seeks to promote the development of music therapy clinical practice through the dissemination of scholarly work. It publishes all forms of reports that have implications for music therapy practice including clinically-focused research reports, innovative developments, case studies, educational research, and theoretical articles. With a focus on clinical benefits of music therapy, Music Therapy Perspectives strives to serve as a resource and forum for music therapists, music therapy students and educators, and those in related professions.

Music Therapy Perspectives seeks to:

• Speak to the direct clinical and professional experiences of practicing music therapists, and in so doing advance the profession.
• Include information useful to music therapists, music therapy students, and professionals interested in the therapeutic uses of music.
• Address issues related to the supervision of music therapy students and the supervision of music therapists in both professional and advanced practice.
• Include articles addressing the education and training of music therapists.
• Address ethical concepts and issues as they pertain to music therapy education, training, research and professional practice.

Music Therapy Perspectives focuses on scholarly articles in the following areas:

• Music therapy models, methods and practices that reflect broad theoretical perspectives reflective of the AMTA Standards of Clinical Practice (professional and advanced).
• Information useful to clinical training directors, educators and administrators
• Discussions, commentaries and analyses of professional issues related to music therapy practice, such as ethics and licensure.
• Qualitative research consistent with the mission and objectives of the journal.
• Quantitative research, consistent with the mission and objectives of the journal, with small sample sizes that may serve as a foundation for larger research studies suitable for the Journal of Music Therapy and other relevant music therapy journals.
• Pilot projects that reflect new areas of clinical practice.
• Case Studies.
• Analyses of literature that expand clinical practice knowledge.
• Book Reviews.

Music Therapy Perspectives Online Member Access

Contributions to music therapy perspectives.

Please submit manuscripts and submission letters electronically using AMTA's online submission program at the URL/link below.  AMTA's online submission system is ScholarOne located at: http://mc.manuscriptcentral.com/mtp Please review all Instructions for Authors before submitting. Should you have any difficulties with your online submission, please contact via email:

Laura Beer, PhD, MT-BC (she, her) Editor,  Music Therapy Perspectives Associate Professor, Music Therapy Colorado State University Campus Delivery 1778 Fort Collins, CO 80523-1778  [email protected]

• The editor will provide written explanation of the decision to the complainant. Music Therapy Perspectives Email: [email protected]

Music Therapy

Music Therapy  was the official publication of the American Association for Music Therapy (AAMT) and was published annually from 1981 to 1996. The goal of the journal  Music Therapy  was to reflect a wide diversity of clinical, research and educational issues concerning the profession of music therapy during the years it was published. Now provided here for archival purposes, contributors to Music Therapy were practicing clinicians, music therapy educators, and professionals deeply involved in their organizations and dedicated to the enhancement of the music therapy profession.

Music Therapy Matters Monthly

This e-newsletter is provided to all current AMTA members as a benefit of membership in AMTA and published on the AMTA website under " Latest News ."  An abridged version is sent directly to the primary email address of record for each individual member.  For information on membership or subscribing, please contact the AMTA National Office at (301) 589-3300 or [email protected] . 

Archives of past issues can be found in the AMTA Member Toolkit on the AMTA website .  AMTA members joining after a specific issue was e-mailed out may check the Member Toolkit for access to all previous issues. 

Music Therapy Matters Monthly  Submission Guidelines

Music Therapy Matters is a monthly e-publication that welcomes article submissions from AMTA members.

Article submissions will be reviewed by the Editor and AMTA Executive Director and considered for inclusion based on available space and relevance to the music therapy profession and circulation of Music Therapy Matters Monthly .

Please note that while every effort will be made to include submissions received, they  will be published on a space-available basis.  Submissions may be edited for content, grammar and length.  Publication dates are subject to change, but generally happen around the 15th of each month. To contact the  Music Therapy Matters Monthly  Editor, please email  [email protected] or call 301-589-3300. Currently, Music Therapy Matters Monthly does not accept advertising.

Other Publications

In addition to research journals and newsletters, AMTA publishes a variety of other publications including texts and monographs such as the monograph series Effective Clinical Practice in Music Therapy, Music in Special Education, and Music Therapy and Premature Infants or Music Therapy in Pediatric Healthcare . AMTA also produces videos such as Music Therapy & Medicine: Partnerships in Care . Back issues of music therapy journals are available as well as products and informational brochures about the music therapy profession.

AMTA's complete publications catalog can be found in the AMTA online store.  Simply hover over the "Bookstore" menu item above and select "Visit the Bookstore."  Then, under "Shop for," choose "Merchandise" and "Select Category," choose "Publications" and click "Go."  You'll find a list of all books and publications AMTA offers or click this link to go directly there .

Book Proposals

AMTA welcomes book and publication proposals on music therapy. Music therapy professionals and academics are encouraged to consider donating manuscripts for publication consideration with AMTA. See the menu item Bookstore> Publish with AMTA for more information.

Imagine , early childhood newsletter 2010, 2011 & 2012

Click here to explore and read archived issues.

Browse the imagine archive using an innovative viewing mode. Learn about our AMTA early childhood network opportunities, international perspectives on early childhood music therapy, and the "imagine" editorial team. Be part of future issues by reading the guidelines for authors and submitting your paper.

Back Issues of AMTA Journals

Back issues of any of the Journal of Music Therapy and Music Therapy Perspectives can be found on the respective journal's website and may be downloaded for a fee. Please see link for each journal above and click on "Browse the Archives."

Copyright © 1998-2024. American Music Therapy Association® and its logo are registered trademarks with the U.S. Patent and Trademark office. Information, files, graphics, and other content on this site are the property of the American Music Therapy Association® and may not be used, reprinted or copied without the express written permission of the American Music Therapy Association.

The American Music Therapy Association® is a 501(c)3 non-profit organization and accepts contributions which support its mission. Contributions are tax deductible as allowed by law.

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Research 

Research is an integral component of music therapy as an evidence-based contemporary profession and discipline. in addition to exploring and demonstrating the impact of music therapy and ensuring high standards of practice, research evidence informs funding and policy making decisions in the field..

UK music therapists have been and continue to be integral in the development of regional and international research initiatives and collaborations, as well as in the provision of education within research active environments.

As part of its aim to promote the art and science of music therapy, BAMT supports and develops further research in music therapy. In particular BAMT aims:

• to promote current research activity and participation in research to both music therapists and public;
• to provide opportunities for music therapists to develop and share research ideas and skills;
• to enable small-scale research to happen through funding and to promote opportunities for larger funding;
• to increase awareness of current and emerging research evidence through links with stakeholders on national and international levels.

Research Work Areas

Bamt’s research agenda is currently implemented through four main research work areas, collaborations.

The BAMT Research Officer represents and advises the association in research-related matters. They can be contacted at [email protected]

• The BAMT Register of Surveys, Research and Evaluation Projects (ROSREP) provides information about music therapy research activity within the UK. It also enables researchers to recruit participants for ongoing studies.
• Other online research-related resources are listed on BAMT’s website, including the index and abstracts to the association’s peer-reviewed journal The British Journal of Music Therapy .
• The BAMT monthly e-bulletin keeps membership up to date with ongoing research activities and news.
• Access to the BAMT mailing list for sample recruitment purposes is offered to research organisations or individuals who conduct research at a professional or doctorate level. Project registration to ROSREP is a prerequisite for mailing list access.
• The BAMT Research Network provides a forum for sharing ideas, information and resources. Welcoming both experienced and novice researchers. The network provides opportunities for supporting and/or mentoring those seeking advice or guidance in research in its many guises.
• In addition to meetings and CPD events, the Research Network members receive research-related news through the network’s mailing list.
• BAMT’s Small Grants Scheme supports training and research in music therapy.
• Other funding opportunities, such as grants from the Music Therapy Charity , are circulated through the BAMT’s e-bulletin.
• BAMT is a member of The Music Research Consortium UK (MRC-UK) which represents UK professional organisations promoting research in music.
• BAMT is a member of the Council for Allied Health Professions Research (CAHPR) (previously Allied Health Professions Research Network, AHPRN) which develops AHP research, strengthens evidence of value and impact, and enhances patient care. BAMT members can access the CAHPR research hubs across the country to seek research advice as well as to attend CPD research events. 
• BAMT is open to be part of research collaborations in areas that are directly connected to the association’s charitable aims. Proposals can be sent to [email protected]

Call for Participants (updated 18.03.24)

Seeing Eye to Eye; An examination into music therapists’ understanding of the needs of people with both dementia and visual impairment within a UK care home setting.

https://app.onlinesurveys.jisc.ac.uk/s/angliaruskin/dementia-and-vision-impairment Thank you. Lozzie Hollis-Hills, Anglia Ruskin University Student

South American Indigenous Ritual: Insights for Music Therapy My name is George Murrell and I’m a final year Music Therapy MA student at the University of Roehampton. For my dissertation project, I’m exploring how can the ritual use of music by indigenous communities in Lowland South American can inform Western music therapy. I’m searching for music therapists who have lived-experience of at least one indigenous community in Lowland South America. Participation in the study will involve an interview of approximately 1 hour, either on Teams or in-person. If you are interested please contact me at  [email protected]  by 1/4/24. Please feel free to share this information widely with any others who may be interested or let me know if there are other networks that I might access to invite participants. Thank you. How Do Music Therapists Experience the Use of Breath in their Clinical Work in Palliative Care? Hello, my name is Elen Morgan-Williams, and I am a final-year MA Music Therapy student at the University of Roehampton. I am looking for participants for my research project: ‘How Do Music Therapists Experience the Use of Breath in their Clinical Work in Palliative Care?’ I am looking to interview three qualified and registered Music Therapists’ who have current or recent experience of delivering music therapy in palliative care. Participants should have experience of engaging with breath in their music therapy work. Interview Length: 45-60 minutes. Location: Online via Microsoft Teams. In-person interviews will be considered to accommodate individual circumstances. When: At a mutually convenient time in April. If you are interested in taking part in this study and would like further information, please contact Elen Morgan-Williams:  [email protected]  by 29th March 2024. I look forward to hearing from you. Thank you, Elen Morgan-Williams AN EXPLORATION OF THE IMPACT OF GENDER BIASES ON THE EXPERIENCES OF MALE MUSIC THERAPISTS WORKING IN ALL-FEMALE PSYCHIATRIC WARDS My name is Sertac Nidai and I am an MA Music Therapy student in my final year of training at the University of Roehampton. I am conducting a qualitative research study that aims to explore the question:  How do gender biases impact the experiences of male Music Therapists working in all-female psychiatric wards? I am inviting 3 male identifying Music Therapists with experience working in all-female psychiatric wards to participate in one hour online interviews. The interviews will be held on Teams and later analysed using Interpretative Phenomenological Analysis. If you are interested in participating in this project and would like further information please email  [email protected]  by 29th March.

Thank you. Invitation for research participants:  What are autistic music therapists’ experiences of countertransference in clinical work?

My name is Chantel Parsons, and I am an MA Music Therapy student in my final year of study at Roehampton University.  I am looking to interview three autistic music therapists (diagnosed or self-identifying) willing to speak about their experiences of countertransference in clinical work.

Participants will take part in a semi-structured individual interview in April via MS Teams, lasting approximately one hour.

If you are interested in participating in this project and would like more information, please email  [email protected]  by March 30 th .

Thank you! Tell Out My Soul: An Investigation of Music Therapists’ experiences of using hymns in palliative care My name is Bea Kinsey and I am a Music Therapy student at the University of Roehampton. I am currently in my final year of study and carrying out a research project that explores the question: How to do music therapists experience the role of hymns in their work in adult palliative care? It is a qualitative study, and will be carrying out semi-structured interviews, lasting an hour, about music therapists’ use of hymns in adult palliative care. I am looking for three music therapists who have experience in this area to take part. The interviews will be held on Teams or in person. If you are interested in taking part or would like more information, please email  [email protected]  by Friday 29th March 2024. Thank you!

How Music Therapy Helps Children Manage Bereavement UWE MA Music Therapy Postgraduate Student is looking for participants to take part in a dissertation research study.

To find out more about the study, and to consent to take part, please click on the link below:

Link to survey

Do you have experience of working with adoptees? Link to Survey

I am looking for participants to help with my music therapy MA research project. Are you an HCPC registered music therapist who has worked with at least one adoptee? If so, you are invited to complete a qualitative online questionnaire (via Qualtrics). This should take no longer than 15 - 30 minutes to complete. Following this, I aim to recruit 3 people to attend an online interview. These questions will relate to your experience of music therapy with adoptees and there is no right or wrong way to answer the questions. Your contribution is likely to offer valuable insight to music therapists and the adoption community. I will provide you with an information sheet and you will be asked to complete a consent form and a very brief demographic form to help me to ascertain the range of people taking part. To find out more and to register your interest, please click on the survey link or or contact me at:  [email protected] This project has been reviewed by, and received a favourable opinion from the UWE Psychology Ethics Committee: reference IM 150124 PEC 03 Email:  [email protected]  and this research is being supervised by Dr Joy Gravestock who you may also contact with  any questions on  [email protected]

Call for Music Therapists -  How do young people aged 10-16 with family violence  backgrounds present in music therapy? To read more and express interest in an interview please fill in this short survey available through this link -  https://uwe.eu.qualtrics.com/jfe/form/SV_39J3vqQ6o2GcmsS

Thank you in advance. Sarah Price, UWE

Please use 'keywords' in search box below to discover related content in the BAMT website.

80 Music Therapy Essay Topic Ideas & Examples

🏆 best music therapy topic ideas & essay examples, 📌 good research topics about music therapy, 🔍 interesting topics to write about music therapy, ❓ music therapy research questions.

• Music Therapy as a Social Work Intervention One of such interventions is music therapy which is aimed at helping people in a sensitive way accurately adjusting the possibilities this therapy may offer to the requirements of a particular client of a group […]
• Music Therapy as Experiential Activity For this reason, a technique was applied to the 10-year-old child with developmental delays to transform the lyrics of the favorite sad melody into a more positively inspiring and uplifting one. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Music Therapy for Schizophrenic Patients’ Quality of Life Consequently, the purpose of the project will be to review the existing literature and prepare a document with recommendations regarding MT in the discussed population, including psychiatric nurses’ acceptable role in delivering such interventions.
• Art and Music Therapy Coverage by Health Insurance However, I do believe that creative sessions should be available for all patients, and I am going to prove to you that music and art are highly beneficial for human health.
• Music Therapy in Healthcare Therefore, the article suggests that music can be used for relaxation, as well as managing the health issues that may arise due to the lack of relaxation.
• Music Therapy for Children With Learning Disabilities This review includes the evidence supporting music therapy as an effective strategy for promoting auditory, communication, and socio-emotional progression in children with ASD.
• Music Therapy as a Related Service for Students With Disabilities From a neuroscientific perspective, how would music intervention improve classroom behaviors and academic outcomes of students with ADHD as a way to inform policy-makers of the importance of music therapy as a related service?
• Substance Use Disorder: Possibility of Using Music Therapy In their study, Bourdaghs and Silverman address the possibility of using music therapy as the tool for promoting the socialization of people with a substance use disorder.
• Music Therapy: The Impact on Older Adults There is therefore the need to focus more energy to aid more understating on the role of music therapy on older residents.”The recent qualitative review of literature in the area of music and music therapy […]
• Music Therapy: Alternative to Traditional Pain Medicine The sources underline that therapists should pay attention to the subjects of music and their impact on the health of clients.
• The Role of Music Therapy as Alternative Treatment Music therapy is the use of music interventions to achieve individualized goals of healing the body, mind, and spirit. Thereafter, several developments occurred in the field of music therapy, and the ringleaders founded the American […]
• Music Therapy Effectiveness In addition to this, research has shown that stroke patients become more involved in therapy sessions once music is incorporated in the treatment program; this is the motivational aspect of music.
• Sound as an Element of Music Therapy This is one of the reasons why in the Abrams study the participants explained that they preferred the sound of rain, ocean waves and the soft strumming of a guitar as compared to the work […]
• Music Therapy Throughout the Soloist Globally, classical music in its sense has always been known to adjoin the listener to some transcendent understanding of the world order, the feeling of integrity with the Universe and enormous delight rising up from […]
• Music Therapy: Where Words Cease In spite of the fact that, as a rule, one indulges into art to find the shelter from the reality, the author of the book called The Soloist explores quite a different issue of the […]
• Active Music Therapy for Parkinson’s Disease
• Effectiveness of Music Therapy for Survivors of Abuse
• Music Therapy Effectiveness of Treatment of Alzheimer’s Disease
• The Link Between Ancestral Hormones and Music Therapy
• Analysis of the Effectiveness of Art and Music Therapy
• Music Therapy Usefulness for Cancer Patients
• Music Therapy Impact on Students With Emotional and Behavioral Disorders
• How Music Therapy Can Be Used to Reduce Pre-Operative Anxiety
• Healing Chronic Pain With Music Therapy
• Music Therapy Effect on the Wellness and Mood of Adolescents
• Comparing Cognitive Behavioral Therapy and Music Therapy
• Constructing Optimal Experience for the Hospitalized Newborn Through Neuro-Based Music Therapy
• Music Therapy: Considerations for the Clinical Environment
• “Dementia and the Power of Music Therapy” by Steve Matthews Analysis
• Music Therapy for Children With Autism Spectrum Disorder
• Discussing Music Therapy Reducing Stress Health and Social Care
• Does Music Therapy Help Children With Special Needs?
• Music Therapy for Delinquency Involved Juveniles Through Tripartite Collaboration
• Heidelberg Neuro-Music Therapy Enhances Task-Negative Activity in Tinnitus Patients
• Music Therapy for Post Traumatic Stress Disorder
• How Does Music Therapy Promote Positive Mental Health?
• Music Therapy and Its Positive Effects on the Brain
• The Relationships Between Learning and Music Therapy
• Music Therapy for Sexually Abused Children
• Managing Sickle Cell Pain With Music Therapy
• Music Therapy: How Does Music Impact Our Emotions
• Dealing With Depression With the Help of Music Therapy
• Effectiveness of Music Therapy and Drug Therapy for Children With Autism
• Music Therapy and Its Effect on the Levels of Anxiety
• The Link Between Music Therapy and Personality Theory Psychology
• How Music Therapy Improves Depression Among Older Adults
• Music Therapy: The Best Way to Help Children With Mental Illness
• Interventions of Music Therapy for Stress Reduction
• The Real Science Behind the Theory of Music Therapy
• Music Therapy Should Not Be Considered a Therapy
• Neurologic Music Therapy Training for Mobility and Stability Rehabilitation
• Nursing Theory for Music Therapy Quality Improvement Program
• The Help of Music Therapy in Pain Management
• Relationship Between Hypertension and Music Therapy
• Yoga and Music Therapy as Effective Methods of Stress Management
• What Is Music Therapy Used For?
• What Are Some Examples of Music Therapy?
• What Kind of Music Is Used in Music Therapy?
• What Are the Side Effects of Music Therapy?
• What Mental Illnesses Does Music Therapy Help?
• Can Music Therapy Help With Anxiety?
• What Type of Music Therapy Helps Depression?
• Does Music Therapy Actually Work?
• Do Psychiatrists Use Music Therapy?
• Do Doctors Recommend Music Therapy?
• How Long Does Music Therapy Last?
• Why Is Music Therapy Not Used?
• What Is a Typical Music Therapy Session Like?
• What Are the Two Main Benefits of Music Therapy?
• How Can Music Therapy Be Done at Home?
• What Does Music Therapy Do to the Brain?
• Is Music Therapy Good for Stress?
• Can Music Therapy Help With Trauma?
• What Ages Benefit From Music Therapy?
• What Is the First Step of Music Therapy?
• Does Music Therapy Include Talking?
• What Instruments Are Used for Music Therapy?
• What Is the Difference Between Sound Therapy and Music Therapy?
• Can You Do Music Therapy Without a Degree?
• Why Is Music Therapy Better Than Medicine?
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Home » 500+ Music Research Topics

500+ Music Research Topics

Music is a universal language that has the power to evoke emotions, bring people together, and express complex ideas and feelings. As a result, it has been the subject of extensive research and analysis across a wide range of fields, from psychology and neuroscience to sociology and cultural studies. Whether you are a music student, researcher , or simply a curious enthusiast, there are countless fascinating and important topics to explore within the realm of music research. From the history and evolution of different musical genres to the impact of music on human behavior and cognition, the possibilities for investigation and discovery are virtually endless. In this post, we will highlight some of the most interesting and relevant music research topics that you can explore in your own studies or simply as a way to deepen your appreciation and understanding of this rich and diverse art form.

Music Research Topics

Music Research Topics are as follows:

• The impact of music on memory retention.
• The evolution of hip-hop music and its influence on popular culture.
• The relationship between music and emotions.
• The role of music in religious and spiritual practices.
• The effects of music on mental health.
• The impact of music on athletic performance.
• The role of music in therapy and rehabilitation.
• The evolution of classical music through the ages.
• The impact of technology on music creation and distribution.
• The relationship between music and language acquisition.
• The cultural significance of music in different parts of the world.
• The influence of popular music on politics and social issues.
• The impact of music on academic performance.
• The role of music in film and television.
• The use of music in advertising and marketing.
• The psychology of musical preferences.
• The effects of music on sleep patterns and quality.
• The impact of music on creativity and productivity.
• The influence of music on fashion and style.
• The impact of music education on childhood development.
• The role of music in memory recall and nostalgia.
• The effects of music on physical health.
• The relationship between music and brain development.
• The impact of music on the immune system.
• The influence of music on social behavior.
• The evolution of jazz music and its impact on society.
• The role of music in cultural preservation and identity.
• The effects of music on stress levels and anxiety.
• The relationship between music and social movements.
• The impact of music on language learning and pronunciation.
• The effects of music on learning and cognition.
• The influence of music on political ideologies and movements.
• The impact of music on academic achievement.
• The relationship between music and cultural assimilation.
• The role of music in international diplomacy.
• The effects of music on physical performance and endurance.
• The impact of music on memory consolidation and recall.
• The influence of music on fashion trends and subcultures.
• The role of music in socialization and identity formation.
• The effects of music on perception and attention.
• The impact of music on decision making and judgment.
• The relationship between music and romantic attraction.
• The role of music in social justice movements.
• The effects of music on motor skills and coordination.
• The influence of music on cultural exchange and globalization.
• The impact of music on language and cultural barriers.
• The relationship between music and cultural appropriation.
• The role of music in community building and activism.
• The effects of music on motivation and goal setting.
• The influence of music on fashion advertising and marketing.
• The impact of music on social inequality and discrimination.
• The relationship between music and cultural hegemony.
• The role of music in political propaganda and manipulation.
• The effects of music on physical therapy and rehabilitation.
• The influence of music on cultural diplomacy and international relations.
• The impact of music on the environment and sustainability.
• The relationship between music and social hierarchies.
• The role of music in cultural exchange and intercultural communication.
• The effects of music on creative thinking and problem solving.
• The influence of music on consumer behavior and product preferences.
• The impact of music on social mobility and economic inequality.
• The relationship between music and cultural diversity.
• The role of music in intergenerational communication and conflict resolution.
• The effects of music on mood and emotional regulation.
• The influence of music on cultural authenticity and representation.
• The impact of music on memory in patients with Alzheimer’s disease.
• The impact of music on recovery and rehabilitation in individuals with physical injuries.
• The role of music in promoting cultural exchange and understanding in international education.
• The role of music in promoting cultural sensitivity and understanding in international relations.
• The role of music in promoting cultural sensitivity and understanding in international human rights.
• The effects of music on cognitive functioning and mental health in individuals with ADHD.
• The relationship between music and cultural representation in the food and beverage industry.
• The influence of music on cultural identity and mental health in individuals with mixed-sexual orientations.
• The impact of music on job satisfaction and retention in the finance industry.
• The role of music in promoting cultural diversity and understanding in international development.
• The effects of music on emotional regulation and depression in individuals with post-traumatic stress disorder.
• The relationship between music and cultural representation in the transportation industry.
• The influence of music on cultural identity and mental health in individuals with mixed-abilities.
• The impact of music on academic performance and motivation in college students.
• The role of music in promoting cross-cultural understanding and acceptance in international cooperation.
• The effects of music on social skills and behavior in individuals with autism spectrum disorder.
• The relationship between music and cultural representation in the entertainment industry.
• The influence of music on cultural identity and mental health in individuals with mixed-language backgrounds.
• The impact of music on creativity and innovation in the tech startup industry.
• The role of music in promoting cultural sensitivity and understanding in international peacekeeping.
• The effects of music on cognitive functioning and mental health in individuals with traumatic brain injury.
• The relationship between music and cultural representation in the travel industry.
• The influence of music on cultural identity and mental health in individuals with mixed-socioeconomic backgrounds.
• The impact of music on job satisfaction and productivity in the education industry.
• The role of music in promoting cultural diversity and understanding in international cooperation.
• The effects of music on emotional regulation and anxiety in individuals with generalized anxiety disorder.
• The relationship between music and cultural representation in the home appliance industry.
• The influence of music on cultural identity and mental health in individuals with mixed-culture backgrounds.
• The impact of music on academic performance and motivation in graduate students.
• The role of music in promoting cross-cultural understanding and acceptance in international diplomacy.
• The effects of music on social skills and behavior in individuals with attention deficit disorder.
• The relationship between music and cultural representation in the construction industry.
• The influence of music on cultural identity and mental health in individuals with mixed-spiritual backgrounds.
• The impact of music on creativity and productivity in the healthcare industry.
• The role of music in promoting cultural sensitivity and understanding in international justice.
• The effects of music on cognitive functioning and mental health in individuals with Parkinson’s disease.
• The relationship between music and cultural representation in the hospitality industry.
• The influence of music on cultural identity and mental health in individuals with mixed-political backgrounds.
• The impact of music on job satisfaction and retention in the automotive industry.
• The role of music in promoting cultural diversity and understanding in international diplomacy.
• The effects of music on emotional regulation and depression in individuals with major depressive disorder.
• The relationship between music and cultural representation in the telecommunications industry.
• The influence of music on cultural identity and mental health in individuals with mixed-ethnic and racial backgrounds.
• The impact of music on academic performance and motivation in high school students with disabilities.
• The role of music in promoting cross-cultural understanding and acceptance in international trade.
• The effects of music on social skills and behavior in individuals with borderline personality disorder.
• The relationship between music and cultural representation in the fashion industry.
• The influence of music on cultural identity and mental health in individuals with mixed-heritage backgrounds.
• The effects of music on cognitive functioning and mental health in individuals with schizophrenia.
• The relationship between music and cultural representation in the technology industry.
• The influence of music on cultural identity and mental health in individuals with mixed-race identities.
• The impact of music on job satisfaction and retention in the hospitality industry.
• The role of music in promoting cultural diversity and understanding in global development.
• The effects of music on emotional regulation and anxiety in individuals with social phobia.
• The relationship between music and cultural representation in the toy industry.
• The influence of music on cultural identity and mental health in individuals with mixed-faith backgrounds.
• The impact of music on academic performance and motivation in high school students.
• The effects of music on social skills and behavior in individuals with oppositional defiant disorder.
• The relationship between music and cultural representation in the beauty industry.
• The influence of music on cultural identity and mental health in individuals with mixed-ethnicity backgrounds.
• The impact of music on creativity and productivity in the fashion industry.
• The role of music in promoting cultural sensitivity and understanding in international aid.
• The effects of music on cognitive functioning and mental health in individuals with dementia.
• The relationship between music and cultural representation in the fitness industry.
• The influence of music on cultural identity and mental health in individuals with mixed-gender identities.
• The impact of music on job satisfaction and productivity in the technology industry.
• The role of music in promoting cultural diversity and understanding in international tourism.
• The effects of music on emotional regulation and depression in individuals with anxiety disorders.
• The relationship between music and cultural representation in the pet industry.
• The influence of music on cultural identity and mental health in individuals with mixed-education backgrounds.
• The impact of music on academic performance and motivation in middle school students.
• The effects of music on social skills and behavior in individuals with obsessive-compulsive disorder.
• The relationship between music and cultural representation in the home decor industry.
• The influence of music on cultural identity and mental health in individuals with mixed-sex identities.
• The impact of music on creativity and innovation in the gaming industry.
• The role of music in promoting cultural sensitivity and understanding in international conflict resolution.
• The effects of music on cognitive functioning and mental health in individuals with bipolar disorder.
• The relationship between music and cultural representation in the sports industry.
• The influence of music on cultural identity and mental health in individuals with mixed-nationality and mixed-linguistic backgrounds.
• The impact of music on job satisfaction and retention in the retail industry.
• The role of music in promoting cultural diversity and understanding in global governance.
• The effects of music on emotional regulation and anxiety in individuals with panic disorder.
• The relationship between music and cultural representation in the electronics industry.
• The influence of music on cultural identity and mental health in individuals with mixed-citizenship backgrounds.
• The impact of music on academic performance and motivation in elementary school students.
• The role of music in promoting cross-cultural understanding and acceptance in international security.
• The effects of music on social skills and behavior in individuals with conduct disorder.
• The relationship between music and cultural representation in the agriculture industry.
• The influence of music on cultural identity and mental health in individuals with mixed-religious backgrounds.
• The effects of music on cognitive functioning and mental health in individuals with traumatic brain injuries.
• The influence of music on cultural identity and mental health in individuals with disability identities.
• The role of music in promoting cross-cultural understanding and acceptance in the healthcare industry.
• The effects of music on emotional regulation and anxiety in individuals with post-traumatic stress disorder (PTSD).
• The influence of music on cultural identity and mental health in individuals with LGBTQ+ identities.
• The impact of music on job satisfaction and productivity in the gig economy.
• The role of music in promoting cultural sensitivity and understanding in education policy.
• The effects of music on social skills and behavior in individuals with autism spectrum disorder (ASD).
• The influence of music on cultural identity and mental health in individuals with mixed-age identities.
• The impact of music on creativity and innovation in the advertising industry.
• The role of music in promoting cultural diversity and understanding in urban planning.
• The effects of music on cognitive functioning and mental health in individuals with attention deficit hyperactivity disorder (ADHD).
• The relationship between music and cultural representation in the food industry.
• The impact of music on job satisfaction and retention in the nonprofit sector.
• The role of music in promoting cultural understanding and acceptance in international business.
• The effects of music on emotional regulation and depression in individuals with chronic pain.
• The relationship between music and cultural representation in the gaming industry.
• The influence of music on cultural identity and mental health in individuals with mixed-sexual orientation identities.
• The role of music in promoting cross-cultural communication and understanding in foreign policy.
• The effects of music on social skills and behavior in individuals with social anxiety disorder.
• The relationship between music and cultural representation in the craft industry.
• The influence of music on cultural identity and mental health in individuals with mixed-disability identities.
• The impact of music on creativity and productivity in the media industry.
• The role of music in promoting cultural sensitivity and understanding in corporate social responsibility.
• The effects of music on cognitive functioning and mental health in individuals with substance use disorders.
• The relationship between music and cultural representation in the automotive industry.
• The impact of music on job satisfaction and productivity in the education sector.
• The role of music in promoting cultural diversity and understanding in international law.
• The relationship between music and cultural representation in the wellness industry.
• The influence of music on cultural identity and mental health in individuals with mixed-nationality backgrounds.
• The impact of music on academic performance and motivation in adult learners.
• The role of music in promoting cultural understanding and acceptance in global governance.
• The relationship between music and cultural representation in the furniture industry.
• The influence of music on cultural identity and mental health in individuals with mixed-generational backgrounds.
• The impact of music on creativity and innovation in the film industry.
• The role of music in promoting cultural integration and social cohesion in diverse communities.
• The effects of music on cognitive functioning and mental health in individuals with multiple sclerosis.
• The relationship between music and cultural representation in the tech industry.
• The influence of music on cultural identity and mental health in second-generation immigrants.
• The role of music in promoting cross-cultural communication and understanding in diplomacy.
• The effects of music on emotional regulation and self-esteem in individuals with eating disorders.
• The relationship between music and cultural representation in the publishing industry.
• The influence of music on cultural identity and mental health in biracial and multiracial families.
• The impact of music on creativity and innovation in the workplace.
• The role of music in promoting cultural awareness and sensitivity in the criminal justice system.
• The effects of music on social skills and behavior in individuals with schizophrenia.
• The influence of music on cultural identity and mental health in individuals with refugee backgrounds.
• The role of music in promoting cultural understanding and acceptance in global marketing.
• The effects of music on emotional regulation and anxiety in individuals with obsessive-compulsive disorder (OCD).
• The influence of music on cultural identity and mental health in individuals with mixed religious backgrounds.
• The impact of music on academic achievement and retention in community college students.
• The role of music in promoting cultural exchange and understanding in international development.
• The effects of music on social skills and behavior in individuals with bipolar disorder.
• The relationship between music and cultural representation in the luxury goods industry.
• The influence of music on cultural identity and mental health in individuals with immigrant parents.
• The impact of music on creativity and productivity in the tech industry.
• The role of music in promoting cultural sensitivity and understanding in journalism.
• The effects of music on emotional regulation and depression in individuals with chronic fatigue syndrome.
• The relationship between music and cultural representation in the wine industry.
• The influence of music on cultural identity and mental health in individuals with non-binary gender identities.
• The impact of music on job satisfaction and productivity in remote workers.
• The role of music in promoting cultural diversity and understanding in international relations.
• The role of music in promoting cultural awareness and sensitivity in diplomacy.
• The effects of music on emotional regulation and self-esteem in individuals with body dysmorphia.
• The influence of music on cultural identity and mental health in individuals with immigrant grandparents.
• The role of music in promoting cultural understanding and acceptance in global advertising.
• The effects of music on social skills and behavior in individuals with borderline intellectual functioning.
• The relationship between music and cultural representation in the fragrance industry.
• The influence of music on cultural identity and mental health in individuals with mixed-citizenship status.
• The impact of music on creativity and productivity in the creative industries
• The relationship between music and social cohesion in diverse communities.
• The role of music in social justice movements and protests.
• The effects of music on pain management and perception.
• The influence of music on cultural hybridity and globalization.
• The impact of music on social identity and self-esteem.
• The relationship between music and cultural imperialism.
• The role of music in therapeutic settings for children and adolescents.
• The effects of music on language development in bilingual children.
• The influence of music on cultural representation in the media.
• The impact of music on interpersonal relationships and communication.
• The relationship between music and cultural hegemony in the digital age.
• The role of music in community-based initiatives for social change.
• The effects of music on mental health in marginalized communities.
• The influence of music on cultural identity and self-expression.
• The impact of music on academic engagement and success in at-risk students.
• The relationship between music and cultural appropriation in popular culture.
• The role of music in cultural diplomacy and international relations in the 21st century.
• The effects of music on cognitive processing in individuals with attention-deficit/hyperactivity disorder (ADHD).
• The influence of music on cultural hybridity and transnationalism.
• The impact of music on social justice advocacy and awareness-raising.
• The relationship between music and cultural resistance in marginalized communities.
• The role of music in the negotiation of cultural identities in the diaspora.
• The effects of music on language processing and learning in second language acquisition.
• The influence of music on cultural exchange and intercultural communication in the digital age.
• The impact of music on academic achievement in students with disabilities.
• The relationship between music and cultural hegemony in the music industry.
• The role of music in the socialization and empowerment of girls and women.
• The effects of music on physical health in individuals with chronic pain.
• The influence of music on cultural authenticity and representation in the tourism industry.
• The impact of music on the construction of gender and sexuality in popular culture.
• The relationship between music and cultural appropriation in the fashion industry.
• The role of music in promoting cross-cultural understanding and empathy.

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