research topics on music therapy

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.

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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

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• Published: 04 December 2023

Biological principles for music and mental health

• Daniel L. Bowling   ORCID: orcid.org/0000-0002-5303-5472 1 , 2  

Translational Psychiatry volume  13 , Article number:  374 ( 2023 ) Cite this article

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• Neuroscience
• Psychiatric disorders

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music’s specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music’s impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality—describing each element’s functional origins, development, phylogeny, and neural bases—is critical to advancing rational applications of music in mental health and wellness.

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Introduction.

Every day, hundreds of millions of people make or listen to music. This appetite is driven by music’s core effects on emotion [ 1 , 2 , 3 ], reward [ 4 ], and affiliation [ 5 ]. The value we place on these effects supports a 200 billion dollar per year industry in the US alone [ 6 ]. More and more, music’s core effects have come into focus for their alignment with core dimensions of mental health, e.g., mood, motivation, pleasure, and social functioning. Together with rapidly increasing awareness of mental health’s humanistic and financial importance, this alignment has sparked new investments in music-based interventions from government and industry [ 7 , 8 , 9 ]. This interest presents an opportunity for proponents of music’s therapeutic value to increase the specificity and rigor of its application and enhance our understanding of its clinical scope and efficacy.

Meeting this goal depends on a clear conception of music’s underlying biology as a source of principles for systematic applications towards specific clinical and subclinical goals. An awareness of such principles exists in music therapy [ 10 , 11 , 12 ], especially “neurologic” music therapies for motor rehabilitation [ 13 , 14 , 15 ], but applications in mental health remain highly variable, making it difficult to achieve a unified biologically-informed approach. Moreover, there are far too few music therapists to meet current mental health needs. In the US, for example, there are only about 10,000 board-certified music therapists, compared to about 58 million adults living with mental illness [ 16 , 17 ]. Assuming an average weekly caseload of 30 patients [ 18 ], total capacity to treat is therefore just 0.5%. Musicians represent another important source of insight, as they are ultimately the most skilled at titrating music’s neurophysiological impact. However, the inherently subjective nature of their “artistic” approach can preclude direct integration within a scientific model of health.

Given the uncertainty in defining the relationship between music and health, funders have sought to advance applications by casting a wide net. The National Institutes of Health, for example, has sponsored an extensive list of research topics involving music, including improving treatment response in cancer, stress and pain management in surgery, affect modulation in mood disorders, anxiolysis in anxiety disorders, social functioning in neurodevelopmental disorders, palliative care in advanced illness, neural rehabilitation after injury, and wellness through exercise [ 19 ]. This breadth is likely to puzzle many medical professionals and raise skepticism in more than a few. Can music really be such a panacea?

While skepticism is justified (as discussed in Section “Skepticism and need”), clear evidence of music’s effects on core mental health variables is readily apparent in our growing understanding of music’s biological foundations. Critically, these foundations provide a rational basis for standardizing and expanding music’s psychiatric applications and benefits. In this review, I outline a framework for music in human biology and describe some of its basic implications for standardized music-based interventions in mental health, with the goal of increasing biomedical integration and impact.

Developing a biological perspective

As far as we know, music has been with humans since our earliest existence. The first known evidence of human preoccupation with music comes from Stone Age flutes, carefully carved in wing bones and mammoth ivory some 40,000 years ago [ 20 ]. Over the course of recorded history, explanations of music and its power have been sought in terms of mythology, cosmology, mathematics, and physics, with many important insights along the way [ 21 , 22 ]. However, it was not until the 19th century that music came to be viewed in terms of human evolution. In 1871, based on observations of general similarity between human and animal vocalization, as well as the behavior of other “singing” mammals (like gibbons and howler monkeys), Darwin postulated a basis for music in sexual selection on social behavior. Specifically, he proposed that the vocalizations of our ancestors were likely more musical than linguistic, comprising greater regularity in pitch and time, and functioning mainly in signaling affect, attracting mates, and threatening rivals [ 23 ]. From this perspective, “music” provided the foundation for the evolution of human language, centering its underlying biology within the study of human cognition and communication more broadly [ 24 ].

Two aspects of this early account continue to shape modern biological music research or biomusicology (e.g. [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]). One is that music is, first and foremost, a form of social communication, with explicit origins in auditory-vocal interaction. The second is that singing and speaking—and thus, music and language—likely share a common origin in early hominids, as reflected by their many overlapping features, like being auditory-vocal by default, emotional expressive, and inherently social [ 25 ]. While many more specific details about the evolutionary origins of music remain under debate (cf [ 31 , 38 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]), a general view of music as rooted in social communication, with close ties to speech and language, is consistent across most theories and also central here.

Before proceeding, it is important to clarify that biomusicology chiefly concerns musicality rather than music per se. Whereas music is a cultural phenomenon of infinite variety [ 46 ], musicality is the genetically constrained and reliably developing set of neural capacities on which music production and perception rests [ 33 ]. It should be noted that this view departs significantly from common conceptions of music that center specific cultural manifestations and individual variation in preferences. Instead, a biological perspective centers music’s basic features in relation to pressures to evolve and develop neural capacities that support social communication. The following sections define this perspective with respect to four core elements of musicality—tonality, rhythm, reward, and sociality—reviewing essential concepts, biological bases, and evidence of clinical benefits, towards a framework for rational clinical translation.

Musical terms and definitions

Tones are a special class of sound stimuli that evoke a strong sense of pitch. Physically, they comprise regularly spaced pressure waves that repeat at frequencies between approximately 30–4000 Hz [ 49 ]. All musical cultures and traditions use tones [ 50 , 51 ], making neural sensitivity to tonality— defined simply as the use of tones to make music—a core element of human musicality. Tonality has primarily been considered from three perspectives. Harmony is focused on the organization of tones with respect to frequency. Melody is focused on the sequential organization of tones over time. Timbre is focused on the quality imparted to tones by their source and manner of production (e.g., a voice or a synthesizer, sounded gently or harshly, etc.) [ 52 ].

Conserved aspects of tonality

The most significant source of tones in the human auditory environment is vocal fold vibration in the larynx [ 53 , 54 ]. In speech, the frequency of vocal fold vibration fluctuates rapidly, leading to dynamic and variable tones (Fig. 1A ). In contrast, during song, these vibrations are modulated to emphasize particular frequencies and frequency relationships [ 50 , 51 , 55 ]. Beyond these “universal” features, many key aspects of harmony, melody, and timbre are widely observed across richly differentiated musical cultures and traditions.

A The same phrase spoken and sung by the same person to highlight how tones in music are related to tones in speech (based on Diana Deustch’s speech-to-song illusion). Variation in sound pressure over time (black) is overlaid with variation in the fundamental frequency of vocal fold vibration (the physical correlate of voice pitch; red). B On the left, the frequency relationships defined by the Japanese ritsu scale are presented along a vertical axis. Each relationship is calculated with respect to the lowest tone in the set (labeled “1.000”). On the right, the melody of the American gospel song “Amazing Grace” is shown using the same relationships. Conventional note letter names are listed at the right. C Timbral similarity of vocal and instrumental tones with parallel affective qualities. Top row: sound pressure waveforms with temporal envelopes shown in red. Bottom row: corresponding Fourier transforms with spectral envelopes shown in blue. These examples were selected to show similarity in temporal and spectral features of vocal and instrumental tones with parallel affective qualities.

In harmony, music almost always emphasizes a small set of tones defined by specific relationships to each other [ 51 ]. The simplest of these relationships—e.g., octaves (2:1) and fifths (3:2)—feature prominently in music worldwide [ 21 , 56 , 57 ], and particular sets of ratios called scales (or modes) are strikingly popular across cultural boundaries [ 21 , 57 , 58 ]. For example, the Western minor mode corresponds to what South Indian musicians call the Keeravani raga [ 59 ]. Similarly, the Japanese ritsu scale is also found in traditional Western folk songs like “Auld Lang Syne” and “Amazing Grace” (Fig. 1B ) [ 60 ]. In melody, tones tend to be arranged in arched or descending contours [ 21 , 51 ], traced mainly by small steps in pitch, with larger steps typically rising (Fig. 1B ) [ 61 , 62 , 63 , 64 ].

In timbre, specific temporal and spectral characteristics of tones give rise to specific perceptions of anatomical and affective source parameters, e.g., the ratio of low- to high-frequency energy in a tone is associated with size, valence, and arousal [ 65 , 66 ], rapid tone onsets signal a higher commitment of energy [ 67 ], and “rough” growl-like tones often convey anger or aggression [ 68 , 69 ] (Fig. 1C ). There is also widespread conservation in the use of tones for specific purposes. For example, lullabies typically comprise tones with relatively more low-frequency energy, sorted into simple repeating patterns [ 70 , 71 , 72 ]. Likewise, flatter contours with narrower pitch steps are favored for conveying somber affect [ 63 , 73 ]. Together, these and other broadly conserved aspects of tonality indicate a strong foundation in our shared biology.

Biological foundations of tonality

To model the biology underlying tonality, music scientists have developed vocal similarity theory (VST), the central tenet of which is that we perceive tones according to their behavioral significance in vocal communication [ 22 , 30 , 53 , 58 , 74 , 75 , 76 , 77 , 78 ]. VST is based on the fact that our experience with tones is dominated by the voice at evolutionary and individual time scales. This implies that the neurobiology of tone perception has primarily been shaped by pressure to contend with tones in the voice and their significance for adaptive behavior [ 22 , 53 , 75 ].

Phylogenetically, sensitivity to “tone of voice” is likely to have emerged very early in tetrapod evolution [ 79 ]. In mammals, auditory-vocal interaction is often central to social behavior and cognition, placing this sensitivity under intense selective pressure. Developmentally, the fetal brain begins responding to mother’s voice around the 24th week of gestation [ 80 ]. Over the ensuing weeks, these responses develop to the point that infants strongly prefer their mother’s voice at birth [ 81 ], an orientation that scaffolds the formation of our prototypical social bond, the modulation of affect through sound, and the development of communication more broadly [ 82 ]. Mechanistically, neural specialization for responding to vocal tones is evident throughout the auditory system, from enhanced representations of periodicity in the brainstems of humans and rats [ 83 , 84 ], to harmonically sensitive neurons in marmoset cortex [ 85 ], and pitch contour neurons in human cortex [ 86 ].

The culmination of this underlying biology is a brain that responds to tones reflexively by supplying percepts of meaning and intent as guides for behavior and cognition. This works because the acoustics of laryngeal vocalization are linked to source parameters at a statistical level [ 87 , 88 ]. For music, the implication of VST is that conserved aspects of tonality can be understood as consequences of the auditory system’s biological tuning to voices.

Applications of tonality in mental health

VST roots tonality in the bioacoustics of vocal affect, providing a principled basis for the assessment and manipulation of reflexive responses to musical tones, and their translation to psychiatry. For any given clinical goal related to the modulation of patient affect, VST predicts that proper applications of tonality require alignment with the statistical regularities that identify vocal expressions as conveying the emotion required to effect the desired physiological change. For example, a musical intervention aimed at relieving high anxiety and agitated negative mood should have tonal properties that align with a positive calming voice, such as extended falling pitch contours and low-frequency weighted timbres. Similarly, an intervention for depression should possess a gentle affirming tone, captured by more articulated contours that rise towards their ends. This approach naturally imbues musical tonality with a capacity to modulate listener feelings that parallels the corresponding tone of voice. However, because musical tones are (often) freed from the constraints of vocal expression—e.g., by instrumental production or release from linguistic demands—key regularities can be distilled and exaggerated to yield tones with supernormal neurophysiological effects.

Importantly, guidance derived from VST on how to use tonality to modulate affect largely corresponds with what musicians and music therapists have learned to do through subjective exploration and experience [ 76 , 89 ]. This is reflected in the effects of current musical treatments on dysregulated anxiety and mood. For example, receptive treatments (based on listening) can effectively reduce acute anxiety in chemotherapy [ 90 ], childbirth [ 91 ], and surgery [ 92 ]. A 2018 meta-analysis of 81 randomized controlled studies, involving over 6000 patients, found that music listening before, during, or after surgery significantly reduced anxiety symptoms, with an effect size equal to 69% of one standard deviation (Standard Mean Difference [SMD] = 0.69) [ 92 ]. Other meta-analyses indicate that music therapy can also be an effective anxiolytic beyond these acute medical contexts. A 2021 meta-analysis of 32 controlled studies with over 1,900 patients with anxiety showed significant anxiety reduction after an average of 7.5 music therapy sessions (SMD = 0.36). This effect was stronger in the subset of 11 studies with >12 sessions (SMD = 0.59), suggesting a dose-response effect [ 93 ]. For context, consider that estimated summary SMDs for first-line psychotherapies and pharmacotherapies lie between 0.28–0.44 and 0.33–0.45 respectively (but note that these numbers are based on much larger samples) [ 94 ].

Similarly positive effects of music therapy have been reported for affect disorders. A 2017 meta-analysis of 9 controlled studies including 411 patients diagnosed with a depressive disorder found that adding 6–12 weeks of music therapy to antidepressants and/or psychotherapy significantly reduced clinician-rated and patient-rated symptoms (SMD = 0.98 and 0.85 respectively) [ 95 ]. A 2020 meta-analysis focused specifically on receptive musical treatments found an even stronger effect when looking at depressive symptoms across patients with a wider variety of primary diagnoses, like heart disease, dementia, insomnia (SMD = 1.33, 17 controlled studies, 1,284 patients) [ 96 ]. The same paper also reports a significant effect for interactive treatment (based on making music; SMD = 0.57, 20 controlled studies, 1,368 patients) [ 96 ]. Both effects were apparent across variable depression severity levels and treatment courses (mean dosage was approximately 14 h, SD = 18, range = 0.33–126) [ 95 , 96 ]. For context, overall SMDs for psychotherapy and pharmacotherapy in depressive disorders have been estimated at 0.31 and 0.30 respectively (again, based on larger samples) [ 94 ].

While success of this kind might suggest that music therapy can do without VST, it should be noted that none of the aforementioned meta-analyses (and few of the individual studies that they cite) provide any details on the parameters of the music employed. This is largely because musical decisions are made on intuition rather than principle. Thus, while subjectivity has proven an essential guide in discovering music’s therapeutic applications, it also complicates scientific efforts to understand music’s therapeutic effects and standardize their application. VST addresses this challenge by providing objective guidelines for musical tonality based on specific therapeutic goals. This is a necessary step towards standardization, which is in turn required for expanding access to musical treatment.

Rhythm is the temporal patterning of sounds in music. The dominant feature of rhythm is temporal predictability, focused at rates ranging from approximately 0.5 to 5 Hz (30–300 beats per minute [bpm]) [ 97 , 98 , 99 ]. All musical cultures and traditions exhibit some temporal predictability in this range, making neural sensitivity to rhythm a second core element of musicality (no ranking implied) [ 50 , 51 ]. Investigations of rhythm typically identify two core components [ 100 ]. Pulse is the main cycle of rhythmic repetition perceived in music; it is generally what we synchronize to when we move in time with music. Meter refers more broadly to other rhythmic cycles perceived in music [ 101 ]. These encompass repetition rates that are both faster and slower than the pulse, defined by subdivisions of the pulse and multi-pulse cycles, respectively.

Conserved aspects of rhythm

As with tonality, key elements of rhythm are widely conserved across musical cultures and traditions. In pulse, acceptable rates (or tempos ) are highly constrained, showing a peak between approximately 1.33 and 2.67 Hz (80–160 bpm) across a variety of different musical traditions (Fig. 2A ) [ 98 , 102 ]. Intriguingly, this peak corresponds closely with dominant rates of periodicity in full-body human motion (e.g., 1.35–2.5 Hz [81–150 bpm] in walking) [ 98 ]. A second widely conserved aspect of pulse is that individual pulses tend to be isochronous or equally spaced in time [ 50 , 51 ]. There are traditions that also use unequal pulse spacing [ 103 ], but only in ways that retain predictability and thus allow interpersonal synchrony [ 104 , 105 ].

A A histogram of tempos from a sample of over 74,000 pieces of music. “DJ lists” refers to lists of song tempos used by disk jockeys to match pulse rates between tracks; “Radio” refers to songs found by randomly tuning into radio stations circa 2002; “Hits” refers to popular music from 1960–1990; and “styles” refers to a selection of music from divergent styles (e.g., renaissance polyphony and modern jazz). B One cycle from each of three rhythms with different meters, increasing in complexity from top to bottom. Circle size and shading indicate level of accenting (large/dark = strong), red stars and horizontal black brackets mark subgroups, and ellipsis denote repetition. Tin, Na , and Dhin are specific tabla drum strokes; tone, slap, bass , and touch are specific djembe drum stokes. The suku rhythm is based on section 5.3 of Polak (2010), with a timing ratio of 11:17:22 for the short-medium-long pulse patterns. C Hypothesized information flow through the network of brain areas implicated in rhythm perception. Additionally relevant brain areas include the hypothalamus, insula, and orbitofrontal cortex (see Fig. 3 ). The rhythm network is mostly bilateral despite being visualized in the left hemisphere here. Numbers refer to Brodmann areas. Insets show implicated structures in situ. Panel A is adapted from Moelants (2002) with permission from the author.

In meter, rhythmic cycles that are faster than the pulse also exhibit characteristic rates, mostly in the range of 2–8 Hz (120–480 bpm; typical of finger or wrist motion), and involving subdivisions of the pulse rate by factors of two or three [ 99 , 101 ]. Faster cycle rates are found in some traditions, e.g., 10–15 Hz [600–900 bpm] in djembe [ 103 ] or death metal [ 106 ], but this is relatively rare. For cycles at rates slower than the pulse, rhythmic patterning is almost always marked by variations in acoustic emphasis called accenting [ 100 ] (Fig. 2B ). A simple example of accenting comes from the marching rhythm “ one , two , one , two , ”, a repeating two-pulse cycle in which the first pulse is accented. Increasing in complexity, the meter of rūpak tāl in North Indian music is defined by a repeating seven-pulse cycle with multiple levels of accent set into groups of three and two [ 107 ]. More complex still are the drum patterns of Malian djembe music. For example, in suku, a repeating twelve-pulse cycle with multiple levels of accent is set into groups of three, each of which has a non-isochronous “short-medium-long” pulse pattern [ 103 ]. In sum, despite impressive diversity, rhythms from around the world are characterized by a restricted tempo range, multi-layered patterning, accenting, and predictability.

Further evidence that rhythm relies on conserved biology comes from the fact that the acoustic stimulus, taken alone, is often an insufficient basis for direct derivations of pulse and meter. Instead, these core aspects of rhythm depend on the interaction of sonic events and the brain [ 100 , 101 ]. Multiple lines of evidence indicate that humans possess specialized neural mechanisms that reflexively identify and reinforce temporal regularity in sequential auditory stimuli. These mechanisms (described in greater detail below) are specialized in that they are common to most humans but apparently rare among other animals. Individuals from many species can be trained to move in reaction to a pulse, but human movements are shifted forwards in time to anticipate, rather than lag behind, upcoming events [ 108 ]. We also synchronize flexibly, easily adjusting to tempo changes that disrupt or defeat synchrony in experiments with other species (parrots represent an interesting exception) [ 40 ].

More evidence of specialization comes from our curious tendency to spontaneously impose accenting on acoustic sequences that lack it. For example, we are apt to hear alternation or triplets in sequences of physically identical events, a perceptual imposition that can be differentiated electroencephalographically [ 109 ]. A final piece of evidence for specialized neural mechanisms in human rhythm perception is the global popularity of syncopation , especially in dance music [ 110 , 111 , 112 ]. Syncopation balances anticipation, built from sounds occurring on-the-pulse, against its systematic violation by sounds occurring off-the-pulse [ 113 ]. Perceiving syncopation thus depends on a conserved ability to form an internal model of regular temporal structure that is strong enough to withstand substantial ill-fitting sonic data [ 111 ]. Together, these and other broadly conserved aspects of rhythm indicate a strong foundation in our shared biology.

Biological foundations of rhythm

To model the biology underlying rhythm, music scientists have developed Neural Resonance Theory (NRT), the central tenet of which is that rhythm perception depends on endogenous oscillations in neural circuitry [ 97 , 114 , 115 , 116 ]. NRT holds that such oscillations spontaneously entrain to stimulus-evoked neural responses to modulate receptivity, prediction, and motor reactivity, thus providing a mechanistic basis for pulse and meter. While this “resonant” capacity is maximally engaged by music, its primary utility appears to be in processing spoken language, which, despite being less temporally regular than music, is still sufficiently regular (between 2–8 Hz [120–480 bpm] [ 102 ]) for entrained oscillations to aid in parsing phonemes, syllables, and phrases [ 117 , 118 ]. This implies that rhythm perception is intimately linked to vocal communication, just like tone perception.

A related aspect of NRT is that neural activity in auditory cortices readily couples with neural activity in parts of the brain that regulate movement, especially cortical areas and subcortical structures involved in motor planning, such as the supplementary motor and premotor cortices, the dorsal striatum, and the cerebellum [ 119 , 120 , 121 , 122 , 123 ] (Fig. 2C ). Activity in these parts of the brain increases in response to rhythm, even in the absence of movement [ 122 ], suggesting that auditory-motor interaction may be essential to rhythm perception. The link between rhythm and movement has also been explored in studies of groove , a psychological concept defined by variation in the degree to which a musical stimulus inspires movement. People generally agree about degrees of groove in music [ 124 , 125 ], with research suggesting a basis in common acoustical and structural features of rhythm, such as emphasized low-frequency energy (“bass”) [ 126 , 127 ] and moderate levels of syncopation [ 111 , 112 , 127 , 128 ]. Notably, groove is broadly associated with positive affect [ 111 , 125 , 129 , 130 ], making it directly relevant to mental health.

Applications of rhythm in mental health

So far, the clinical value of NRT has mainly been studied in the context of music therapies aimed at improving sensory and motor functions [ 131 ] (including speech [ 132 ]). However, even in these contexts, mental health benefits are often apparent. For example, in a 2021 meta-analysis of 17 randomized controlled studies testing musical interventions in Parkinson’s disease, a sub-analysis of 8 studies with mental health measures found significant benefits for mood, motivation, and emotional well-being in music conditions compared to standard care (SMD = 0.38, N  = 273 patients) [ 133 ]. Positive mental health outcomes have also been observed in response to receptive music therapy after stroke [ 134 , 135 ]. For example, one widely-cited study found that listening to music for at least one hour per day over a two-month period significantly lowered self-reported depression at 3 months post-stroke, as compared to standard medical care and rehabilitation [ 136 ]. Intriguingly, this study also reported benefits of music listening for cognitive function (memory and attention) in a well-controlled comparison to audio-book listening [ 136 ].

The capacity of rhythm to entrain activity in broad auditory-motor networks and simultaneously increase positive affect can also be hypothesized to account for a significant proportion of the benefits of musical treatments for anxiety and depression (see Section “Applications of tonality in mental health”). Specifically, engaging these networks with high-groove rhythms may provide an efficient way to disrupt maladaptive patterns of brain activity associated with negative affect and self-focused negative rumination [ 137 , 138 , 139 ]. Related to this hypothesis, there is growing evidence that groove is important for understanding the effects of music on cognition, particularly in the context of repetitive effortful work, which can often generate negative affect [ 135 , 140 , 141 , 142 , 143 , 144 , 145 ]. For example, in one recent study, listening to a high-groove drum loop for just 3 min was found to be more effective than noise at improving performance on a subsequent repetitive behavioral task measuring context-dependent response inhibition (a “Stroop” test). This effect of rhythm was specific to participants who reported enjoying the drum loop and its groove. These participants also exhibited significantly greater (dorsolateral) prefrontal cortical activity during the Stroop test in the drum-loop condition, as measured using functional Near Infra-Red Spectroscopy [ 141 ].

Experimental evidence for positive effects of rhythm on certain types of cognition accords with longstanding evidence from ethnographic literature. Specifically, rhythmic music has often been used to positively transform the experience of work otherwise experienced as negative and draining (e.g., harvesting food, military drills, and moving cargo) [ 145 , 146 ]. Similarly, musicians commonly experience “being in the groove” as a pleasant state of focus that offsets burdens associated with extended periods of high level performance (e.g., on tour) [ 125 , 129 , 147 ]. Such effects can be understood as rhythmically-driven increases in motivation and effort [ 143 ], potentially reflecting increased engagement of key cortico-basal ganglia-thalamo-cortical loop circuitry (see Fig. 2B ). They are particularly well-characterized in the context of physical exercise, where music can increase enjoyment and reduce perceived exertion [ 148 ], but such benefits may also extend to less muscular tasks (see discussion of the Mozart effect in Section “Another crest in the music and health hype cycle?”). In sum, the biological foundations of rhythm provide insight into how music can be applied to address challenges in mental health associated with mood, cognition, and motivation.

Music and brain reward circuitry

While the framework described so far is based on an analytic separation of tonality and rhythm, the health applications of several other core elements of musicality are better considered in terms of music as a whole. Perhaps the best example is our fundamental attraction to music, as reflected in its marked capacities to stimulate wanting, liking, and learning. Over the past several decades, neuroimaging studies have demonstrated that taking pleasure in music is closely associated with activity in classical brain reward circuitry [ 26 , 149 ], including the mesolimbic dopamine pathway between the ventral tegmental area (VTA) and the nucleus accumbens (NAc) [ 4 ]. Early studies used positron emission tomography with the radiolabeled dopamine D 2 receptor ligand, [ 11 C]raclopride, to show that musical frisson [ 150 ] — moments of peak neural excitement, piloerection, and “chills” that occur during music listening—are associated with surges in dopamine binding within the NAc [ 151 , 152 ]. Additional evidence that music stimulates mesolimbic reward comes from functional magnetic resonance imaging studies showing, for example, that the magnitude of an individual’s NAc response to music correlates with their subjective liking for it [ 153 ].

At the level of brain networks, functional neuroimaging studies have also found that the time-course of musically-stimulated NAc activity is tightly coupled with that of activity in the VTA and hypothalamus [ 154 ]. This has led to the proposal of a “tripartite network” at the core of musical reward, with the hypothalamic node linking desire and pleasure to autonomic and neuroendocrine effects (Fig. 3A ) [ 128 , 154 , 155 ]. Beyond this core, musical reward also engages an extended network of brain areas including the auditory, frontal, and insular cortices, as well as the amygdala and hippocampus, all of which also exhibit temporal coupling with the NAc during music listening [ 149 , 153 , 154 ]. These extended connections are presumed to situate musical reward with respect to sensory, integrative, somatic, affective, and memory-based aspects of musical responding, respectively.

A A model of the extended musical reward network including the tripartite core (red outline) and associated cortical areas and subcortical structures (gray outline). Arrows indicate significant positive temporal correlation in blood-oxygenation-level-dependent activity between the indicated areas during pleasurable music listening. Numbers refer to Brodmann areas ( B ) A close-up of the tripartite core showing dopaminergic (blue), opioideric (green), and oxytocinergic (red) circuitry hypothesized to underpin music’s capacity to stimulate social connection. In rodent models (on which this panel is based) the derivation of reward from positive social interaction requires the oxytocinergic projections from the PVN to the NAc and VTA. C Interactions within the PVN between oxytocin and CRF. Oxytocin decreases the excitability of CRF neurons in mouse hypothalamic slices, and may further inhibit CRF release by modulating CRFR1-positive neurons. Note that music may also have effects on CRF that are independent of oxytocin. ARC arcuate nucleus, CRFR1 CRF receptor type 1, NAc nucleus accumbens, POMC proopiomelanocortin, PVN paraventricular nucleus, VTA ventral tegmental area.

Lastly, as in the processing of other rewarding stimuli like food, sex, and drugs, the hedonic aspects of musical reward are partially dependent on opioidergic mechanisms. This has been shown pharmacologically, as treatment with the (predominantly μ-) opioid receptor antagonists naloxone and naltrexone significantly reduces pleasure in response to musical stimuli [ 156 , 157 ]. Thus, although the work described in this section has been carried out almost entirely with “Western” listeners, the results, taken together with the widespread enjoyment of music around the world, strongly support the sensitivity of brain reward circuitry to musical stimulation as a third core element of musicality.

Applications of musical reward in mental health

In keeping with the central importance of reward in our everyday lives, this element of musicality has extremely broad implications for mental health. Dysfunction in brain reward circuitry contributes to a wide range of psychopathology, including mood disorders, anxiety disorders, substance use disorders, eating disorders, obsessive-compulsive disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, conduct disorder, Tourette’s syndrome [ 158 ], and schizophrenia. This suggests that the benefits of many current musical treatments may be attributable to normalizing effects of tonality and rhythm on otherwise aberrant activity in brain reward circuitry. Thus, in addition to effects on core dimensions of mental health (e.g., anxiety, mood, cognition, and motivation), musical treatments have also been found efficacious in more specific cases of psychopathology that specifically feature reward dysfunction. Some examples include: substance-use disorder, where adding music therapy to standard treatment can improve motivation to rehabilitate and abstinence [ 159 ]; anorexia nervosa, where interactive music therapy can stimulate reductions in post-meal anxiety that exceed those of other treatments [ 160 ]; and Tourette’s syndrome, where music listening, performance, and even imagined performance, can be an effective tic suppressant [ 161 ].

Further evidence of music’s efficacy against reward-related dysfunction comes from treatments applied to prominent transdiagnostic symptoms, like fatigue [ 162 ], apathy [ 163 , 164 ], and anhedonia [ 165 ]. For example, in a study of nursing home residents age 60+ with mild-to-moderate dementia, a twelve-week interactive music therapy intervention significantly reduced apathy and improved communication, in comparison with a treatment-as-usual control [ 163 ]. The effect sizes were relatively small (SMD = 0.32 and 0.15 respectively), but given the central importance of apathy in dementia and other psychopathology [ 166 , 167 , 168 ], they represent an important starting point for further investigation. In sum, the capacity of music to modulate brain reward circuitry provides a strong mechanistic basis for its benefits across a wide variety of functional disorders in mental health. A better understanding of how and when music stimulates reward is thus critical to advancing music’s therapeutic benefits for mental health.

Converging evidence indicates that engaging in music with other people is an effective way to stimulate interpersonal affiliation and social connection [ 44 ]. Psychological experiments, for example, have repeatedly shown that interpersonal temporal coordination (or “synchrony”) in behavior—a defining feature of musical interaction—strengthens social bonds between participants. This has been measured in terms of increased feelings of affiliation and self-other similarity [ 169 , 170 ], trust behaviors in economic games [ 171 , 172 ], and real-world cooperation [ 173 , 174 , 175 , 176 , 177 ] (reviewed in [ 178 ]). Another line of evidence comes from physiological experiments showing that recreational forms of behavioral synchrony—e.g., in group singing, drumming, or exercise—can upregulate oxytocin secretion [ 155 , 179 , 180 , 181 , 182 ], downregulate cortisol secretion [ 155 , 181 , 183 , 184 , 185 ], modulate immune reactivity [ 182 , 184 , 185 ], and decrease pain [ 186 , 187 ].

In addition to behavioral synchrony, music almost certainly facilitates affiliation and social connection through inducing synchrony in affect. This is perhaps best illustrated by the Iso Principle for mood management in music therapy, one of a few core methods that remains consistent across diverse approaches and therapeutic goals [ 188 ]. Iso Principle is the practice of initiating treatment sessions with music that is parameterized to match the patient’s current mood, creating a basis of shared affect that can then be leveraged to shift mood through musical changes. While the neural basis of synchrony’s effects on social neurobiology has yet to be studied in detail (see [ 189 ] for leading hypotheses), at a psychological level it appears to work through empathetic processes that increase trust and promote openness to further interaction and direction [ 190 ].

A final line of evidence comes from ethnographic and historical observations indicating that music (and dance) are commonly associated with contexts involving high levels of social cohesion. Major examples include religious rituals, cooperative labor, and military drill, as well as overt expressions of group solidarity like political chants, football songs, and national anthems [ 145 , 146 ]. Taken together, these findings strongly support the sensitivity of neural mechanisms supporting affiliation and social connection to musical stimulation as a fourth core element of musicality.

Oxytocin and social reward

Although many artistic and aesthetic experiences are capable of eliciting intense pleasure, music stands out for the regularity with which it does so [ 157 ]. Research suggests that frisson, for example, are induced by music at about four times the rate that they are induced by other stimuli, including the visual arts and literature combined [ 191 ]. This begs the question of why music is so rewarding.

A potential hint comes from the fact that frisson are also induced at high rates by inspirational speech [ 191 , 192 ]. From a mechanistic perspective, this can be taken as support for the hypothesis that the reward potency of music (and speech) reflects high temporal predictability relative to other artistic stimuli [ 150 , 153 ], which is particularly well-suited to anticipatory aspects of reward processing [ 193 ]. At the same time, phylogenetic and developmental perspectives have given rise to the hypothesis that the reward potency of music reflects its basis in social communication [ 149 ]. In this non-mutually exclusive view, music’s capacity to stimulate reward processing also reflects the activity of evolved neural mechanisms that develop to afford the voice with major modulatory control over the rewards of social interaction.

Interest in the link between music and social reward has led many researchers to posit a role for the hypothalamic neuropeptide oxytocin in musicality [ 5 , 44 , 149 , 194 , 195 ], following on its essential functions in affiliative behavior and social bonding (Fig. 3B ) [ 196 , 197 , 198 , 199 , 200 ]. More specifically, music can be hypothesized to stimulate endogenous oxytocin mechanisms that upregulate dopaminergic (and related opioidergic) aspects of reward processing [ 198 ], thereby increasing sensitivity to musical rewards in social context. An important corollary of this hypothesis also addresses the anti-stress effects of music [ 201 ], as music-induced oxytocin release in the hypothalamus may also modulate local corticotropin releasing factor (CRF) circuitry to downregulate activity in the hypothalamic-pituitary-adrenal axis and the sympathetic division of the autonomic nervous system (Fig. 3C ) [ 202 , 203 , 204 , 205 , 206 ].

Applications of sociality in mental health

Social functioning—as reflected in the structure, function, and quality of an individual’s social connections—is a critical determinant of mental health in patients across prominent psychiatric disorders [ 207 , 208 ] as well as the general public [ 209 , 210 ]. This implies that effects of musical treatment of the neurobiology of social functioning may be of even broader significance than closely related effects on brain reward circuitry. However, before describing the clinical evidence supporting such effects, it should be noted that the extent to which musical treatment must involve live interaction to impact social neurobiology is presently unclear. Sound recording is only 160 years old, which implies that the vast majority of our collective experience with music has occurred in social contexts. Accordingly, there is an important sense in which listening to recorded music, even alone, may remain inherently social in neurobiological terms. Our attribution of recorded music to a person (or people) with communicative intent is essentially reflexive [ 211 ], particularly when it comprises vocals. It is also clear that recorded music is often a potent stimulus for behavioral and affective synchrony. Thus, listening to music alone may stimulate social neurobiology in many of the same ways as live musical interaction. Nevertheless, until shown otherwise, it seems reasonable to assume that live interaction is the more potent stimulus for leveraging music’s effect on sociality (e.g., see [ 212 , 213 , 214 ]).

Operationally, social functioning is targeted by interactive approaches to music therapy designed to support interpersonal responding, coordination, and synchrony [ 11 , 215 ]. A large body of evidence supports the benefits of such approaches in autism spectrum disorders [ 216 , 217 , 218 , 219 , 220 , 221 ]. Some of this evidence is summarized in a 2022 meta-analysis of 26 controlled studies including 1,165 children with diagnoses of an autism spectrum disorder (ranging from mild to severe). This analysis compared music therapy to non-musical standard care or a “placebo” therapy over an average duration of 2.5 months (SD = 2.0), with session frequency varying from daily to weekly in shorter and longer studies respectively [ 216 ]. Directly after the intervention, significant benefits associated with music therapy included improvement in clinical global impression (risk ratio=1.22, 8 studies, 583 patients), reduced total autism symptom severity (SMD = 0.83, 9 studies, 575 patients), and better quality of life for clients and/or their families (SMD = 0.28, 3 studies, 340 patients). During the intervention, music therapy was also associated with significant improvements in non-verbal communication (SMD = 1.06, 3 studies, 50 patients) and behavioral adaptation (SMD = 1.19, 4 studies, 52 patients); in the 1–5 months following the intervention, music therapy was associated with reduced total autism symptom severity (SMD = 0.93, 2 studies, 69 patients) and improved self-esteem (SMD = 0.86, 1 study, 35 patients) [ 216 ]. For context, the overall SMD for autism interventions based on Applied Behavior Analysis (a common non-musical behavioral therapy) has been estimated at 0.36 for treating general autism symptoms (based on 14 studies with 555 patients) [ 222 ].

Further evidence supporting the benefits of music therapy for social functioning comes from studies on schizophrenia [ 223 ]. A 2020 meta-analysis of 15 controlled studies involving 964 adults diagnosed with schizophrenia or a schizophrenia-like disorder highlighted significant improvements in negative symptoms (such as flat affect, poor social interactions, and apathy) when adjunct interactive and/or receptive music therapy was compared to standard care (SMD = 0.56) [ 164 ]. This aligns with an earlier 2017 meta-analysis that more specifically investigated social functioning, reporting benefits from two controlled studies involving adults with schizophrenia in which music therapy was compared to antipsychotic medication (SMD = 0.72, N  = 160 patients) [ 224 ]. For context, the SMD of antipsychotic medications for treating negative symptoms in schizophrenia has been estimated at 0.35, based on 167 studies with 28,102 patients [ 225 ].

There is also some evidence that musical interventions can impact social functioning in Alzheimer’s disease and related dementias. For example, individual studies have reported significant benefits of interactive music therapy on language functioning [ 226 ] and receptive music therapy on social engagement [ 227 ]. However, reviews and meta-analyses suggest that such social effects are mainly derivative from primary benefits that reduce agitation, anxiety, and depression [ 228 , 229 ].

Finally, outside of the clinic, musical therapy has long been valued as a non-verbal path to social connection in children with special needs [ 215 , 221 ], as well as a way to combat social isolation and loneliness, particularly in older adults living alone and/or with serious disease [ 184 , 230 ]. In sum, music’s capacity to stimulate the neurobiology of affiliation and social connection is associated with benefits in multiple major mental health disorders and across the lifespan.

Individual differences in musicality

Despite strong foundations in our shared biology, there is also substantial individual variation in neural sensitivity to the core elements of musicality. At the low end of the spectrum are individuals who cannot carry a tune or dance in time, some of whom find music irritating and actively avoid it [ 231 ]. Conversely, at the high end are individuals who find it difficult to live without music, some of whom create works of art that transcend their geographic and temporal horizons [ 232 ]. This high degree of individual variation in musical appreciation and engagement implies that there may also be substantial variation in individual capacity to benefit from musical treatment. In this section and the next I review research on understanding individual variation in musicality, outlining how its measurement may be used to increase the precision with which musical treatments are applied. Accordingly, I argue that better applications of music in mental health depend not only on aligning the neurophysiological effects of music’s core elements with specific clinical targets, but also on matching treatment content to individual differences in musicality.

Psychoacoustic testing

Tests of tone and rhythm perception have long served as the primary way to measure individual differences in musicality. Performance on the most basic of these tests—e.g., measuring sensitivity to harmony and pulse—tends to be positively skewed [ 233 ], reflecting a commonplace competency for music similar to that which we possess for language [ 41 ]. Nevertheless, there is still considerable variation in basic test scores, and this is increased for tests that probe more sophisticated musical abilities [ 234 ].

Environmental factors

Researchers have traditionally sought explanations for individual differences in musicality based on environmental factors. One of the most important environmental factors is formal training , a process by which individuals explicitly learn specific motor skills and rules for music performance and composition [ 235 ]. Formal training is particularly important for explaining sophisticated musical abilities, e.g., as assessed by Goldsmith’s Musical Sophistication Index (Gold-MSI) [ 234 ]. Another important environmental factor is musical enculturation , i.e., the process of implicitly learning the statistical properties of the music to which one is developmentally exposed. Many studies have demonstrated effects of training and enculturation on psychoacoustic tests (e.g. [ 236 , 237 ]). Though sometimes framed as evidence against biological constraints, such effects may be better considered in terms of how biological constraints manifest in the face of environmental variation [ 56 , 78 ].

Biological factors

Progress is also being made towards understanding the genetic basis of musicality [ 27 ]. Early work provided evidence that genetic factors explain surprising amounts of phenotypic variability in psychoacoustic test performance (e.g., 70–80% in tone perception [ 238 ]), as well as time spent practicing music (e.g., 40–70% [ 239 ]; see also [ 240 ]). More recently, genome-wide association (GWA) techniques have been applied to musicality [ 241 , 242 , 243 ]. The largest of these GWA studies to date has focused on rhythm perception [ 243 ]—assessed via the question “can you clap in time with a musical beat?”—in a sample of over 606,825 individuals, accessed via an academic collaboration with 23andMe, Inc. The results indicated that beat perception and synchronization depend on many genes, with variation at 69 loci spread across 20 chromosomes being significantly associated with survey responses after linkage disequilibrium pruning. Additional analyses found enriched expression of genes implicated by these loci in brain-specific regulatory elements as well as fetal brain tissue, indicating potential roles in regulating neurodevelopment. Similar analyses focused on the adult brain found enriched expression in structures implicated in rhythm and reward, including the frontal and temporal cortices, cerebellum, basal ganglia, nucleus accumbens, and hypothalamus (see Figs. 2 C and 3B ).

Although complex traits like our sensitivity to rhythm are expected to be polygenic [ 243 ], some studies have also focused on associations between musicality and individual genes. One of the best studied genes in this context is AVPR1A , which encodes the vasopressin 1A receptor, a major component of the arginine vasopressin and oxytocin signaling pathways [ 196 , 244 ]. Genetic variation in the promotor region of AVPR1A has been associated with phenotypic variation in psychoacoustic test scores [ 245 , 246 ], time spent attentively listening to music [ 247 ], and being a dancer as opposed to another type of athlete [ 248 ]. Variation in AVPRA1 has also been associated with verbal memory [ 249 ], acoustic startle [ 250 ], amygdala activity [ 251 ], prosocial behavior [ 252 ], pair-bonding [ 253 ], and autism [ 254 ]. As intriguing as these associations are, however, it should also be noted that several studies have looked and failed to find associations between musical ability/behavior and AVPR1A polymorphism [ 242 , 255 ]. Other genes of particular interest include VRK2 , FANCL , MAPT , MAPK3 , GATA2 , GBE1 , GPM6A , PCDH7, SCL64A , and UGT8 among others (see [ 27 ] and [ 243 ]).

Lastly, progress in understanding the biology underlying individual differences in musicality has also come from studies of disordered music perception. Congenital amusia [ 256 ] is an umbrella term for lifelong deficits in music perception that prevent people from singing in tune [ 257 ], dancing in time [ 258 ], or deriving pleasure from music [ 259 ]. Deficits in tone perception (or tone deafness ) is the best studied form of congenital amusia: it runs in families [ 238 , 260 ] and is associated with decreased connectivity between the auditory cortices and the inferior frontal gyrus [ 261 , 262 ], potentially reflecting abnormal frontotemporal cortical development [ 263 ]. The prevalence of tone deafness is approximately 1.5%, with as many as 4.2% of people exhibiting a lesser form of impairment [ 264 ]. Deficits in rhythms perception (or beat deafness ) appears to be at least as common [ 264 ]. Finally the prevalence of music-specific anhedonia , which, as the name implies, occurs despite otherwise normal hedonic functioning, is estimated at about 5% [ 265 ].

Hypotheses for precision medicine

Faced with questions about whether a patient is sufficiently musical to engage in treatment, many music therapists provide reassurance, as a significant part of their practice is dedicated to finding adaptive ways to leverage music’s capacities to align with individual strengths [ 266 , 267 ]. While this resource-oriented approach has the benefit of allowing music therapists to work with almost anyone, the framework proposed here can potentially offer more systematic guidelines for determining whether a patient is likely to benefit from musical treatment. Fundamentally, patients with a history of strong engagement with music and keen sensitivity to its tonal, rhythmic, rewarding, and social elements would appear to be good candidates for musical treatment, especially if neurophysiological systems influenced by one or more core elements of musicality are implicated by their symptoms. Conversely, those patients who report disliking music, find it unrewarding, or otherwise qualify for congenital amusia, would seem to have a lower likelihood of benefiting.

In between these extremes are individuals whose specific musicality profiles —conceived as a series of measurements describing sensitivity to each core element of musicality—have important potential to inform decisions about treatment content. As an example, treatment for a patient with below-average tone perception, but normal sensitivity to musical reward, rhythm, and sociality could be personalized to align with their musicality profile by focusing on the neurophysiological effects of rhythm in an affiliative interactive context in which tonal elements are minimized or omitted.

Defining musicality profiles

While measurements of underlying biology may improve assessments of individual differences in musicality in the future, current efforts must rely on psychoacoustic tests and surveys. Among the most promising for determining suitability for musical treatment is the Barcelona Music Reward Questionnaire (BMRQ) [ 265 ], a survey of 20 self-reported items that assess the degree to which an individual takes pleasure in different aspects of music. For individuals with normal scores on the BMRQ, further insight may be gained through a series of basic psychoacoustic tests, like the scale test and out-of-key test (for evaluating tone perception) and the off-beat test (for evaluating rhythm perception) from the Montreal Battery of Evaluation of Amusia (MBEA [ 233 , 268 ]; see MBEMA for testing children aged 6 to 10 [ 269 ]). If a more comprehensive assessment is desired, clinicians can deploy the Gold-MSI (for musical sophistication) [ 234 ] or the computerized beat alignment test (for rhythm) [ 270 ].

Although not explicitly focused on music, it may also be useful to assess a patient’s level of social functioning and anxiety (e.g., with the Social Responsivity Scale [SRS] [ 271 ] and Liebowitz Social Anxiety Scale [LSAS] [ 272 ] respectively), as the results could inform decisions about the extent to which a musical intervention should target social functioning. Interactive music therapy can be hypothesized to be most effective in cases where social functioning and social anxiety are both low. By contrast, in cases where social anxiety (or anxiety more generally) is high, the most effective approach may instead require limiting social interaction, at least at first. In keeping with this hypothesis, interactive approaches to music therapy in dementia (where anxiety is often high) are significantly less effective than receptive approaches at reducing agitation and behavioral problems [ 229 ]. Similarly, in music therapy for autism—which is predominantly interactive—high comorbidity with anxiety disorders may help explain some of the heterogeneity in trial results (cf [ 273 , 274 ].). Lastly, in cases where a patient is unable to complete surveys or perform perceptual tests due to developmental delay or cognitive impairment, interviewing caregivers about the patient’s history of music engagement and social functioning can offer valuable insights into their potential sensitivity to musical treatment.

Idiosyncratic preferences

Beyond tailoring musical treatments to align neurophysiological effects with clinical targets and individual musicality profiles, treatments may also be customized based on individual music preferences or “taste” [ 275 , 276 ]. In receptive music therapy, for example, it’s common for patients to nominate songs they like, with therapists providing oversight for alignment with therapeutic goals [ 89 ]. One major advantage of this approach is that listening to preferred music can be especially rewarding [ 151 , 277 ]. This is often attributed to the familiarity of preferred music, which facilitates expectations, their fulfillment, and associated memories and emotions [ 150 , 278 , 279 ]. Other potential benefits of preferred music include fostering a sense of safety, enhancing engagement, and reducing stress [ 280 , 281 , 282 ]. However, personal memories and associations can also make the therapeutic value of preferred music difficult to control, especially if not carefully reviewed [ 283 ]. This is because what a person likes is not necessarily aligned with their therapeutic goals. A prime example is that people with depression often prefer music that maintains or exacerbates their sadness [ 284 , 285 , 286 ] (but see [ 285 , 287 , 288 ]). Accordingly, despite the benefits of preferred music, using novel or unknown music is advisable in some contexts.

Having already changed how people discover new music, algorithmic music recommendation systems may also find applications in mental health. However, the issue of mismatch between what a person likes and their treatment goals remains significant here as well. For example, listening to strongly preferred or popular music while attempting to focus tends to decrease task performance [ 140 , 142 ]. In the extreme, the lifestyle associated with many forms of popular music is linked to substance abuse, risk-taking, suicide, homicide, and accidental death among practitioners [ 289 ]. This highlights the fact that engagement with music is not necessarily health-positive (cf [ 290 , 291 , 292 ].). In therapeutic contexts, though, there are still many cases in which tailoring musical interventions to idiosyncratic preferences can be beneficial. For example, in receptive music therapy for Alzheimer’s disease, listening to familiar, preferred music appears to carry benefits for self-awareness [ 293 ]. Similarly, in depression, preferred music is likely to be the most effective stimulus for normalizing brain affect and reward functions, provided that it has been properly vetted to avoid stimulating negative affect. Finally, when a patient has normal sensitivity to musical reward but only within a very restricted genre (e.g., from their youth [ 294 ]), or, reports enjoying music despite poor tone and rhythm perception [ 295 ], understanding their idiosyncratic preferences may be necessary to design effective treatment.

In sum, determining the therapeutic value of aligning musical treatment with idiosyncratic preferences is of central importance for musical applications in mental health. That said, progress in this kind of preference matching should be incorporated within a broader precision paradigm as advocated here, which aims to align the specific neurophysiological effects of musicality’s core elements with specific clinical targets and individual differences in associated responsivity.

Skepticism and need

In this final section, I address several important points of skepticism regarding the premise of the biological framework presented here, i.e., the hypothesis that music can do more for mental health.

Benefits from music to mental health are already at saturation

In addition to the effects of musical treatment described above (see Sections “Applications of tonality in mental health.”, “Applications of rhythm in mental health”, “Applications of musical reward in mental health”, & “Applications of sociality in mental health”.), there is strong evidence that people derive mental health benefits from more casual engagement with music. During the height of the COVID-19 pandemic, for example, more than half of 4,206 survey respondents reported engaging with music as a coping strategy, using it to derive reward, modulate mood, and/or reduce stress and anxiety [ 296 ]. Similar positive functions are apparent in pre-pandemic research as well (alongside more social functions) [ 2 , 297 , 298 , 299 ]. Associations between music and healing have also been found in many cultures throughout human history, suggesting a potentially ancient relationship [ 300 , 301 ]. Thus, even though music lies outside the mainstream of mental health care, many people are already using music to improve their condition.

Nonetheless, there are multiple ways in which music’s mental health benefits may be increased. First, expanding access to musical treatment is essential [ 302 ]; as stated in the introduction, music therapists in the US only have the capacity to treat 0.5% of adults with mental illness. I have argued that this necessitates standardizing and applying treatments within a biological framework. Second, the popular perception of music as entertainment needs to evolve to encompass its therapeutic benefits. Explaining musical treatments in biomedical terms and normalizing therapeutic modes of listening can facilitate this shift. Third, the balance in music education needs to pivot away from individual performance and back towards widespread attainment of basic skills (e.g., social singing and dancing, listening, reflecting, curating, etc.), with an explicit focus on developing lifelong tools for mental health and wellness [ 303 ].

Another crest in the music and health hype cycle?

Even if one accepts that music has expandable mental health benefits, the importance of music’s potential might still seem overblown, here and elsewhere. It is worth revisiting the Mozart effect in this context, as an example of music’s real effects and associated hyperbolic overinterpretation. In 1993, a study published in the journal Nature reported that 10 min of listening to a spirited Mozart sonata, versus speech-based relaxation, or silence, improved performance on a subsequent spatial reasoning task [ 144 ]. After being picked up by popular press, this finding was transformed into the notion that “listening to Mozart actually makes you smarter” [ 304 ], which was subsequently used to market books and other media for benefits purportedly backed by science [ 305 ]. Backlash from the scientific community in the form of criticism and further investigation eventually came to show that the Mozart effect amounts to a relatively small but replicable performance boost that generalizes to other types of music (and speech) which stimulate enjoyment and arousal (SMD = 0.37 in meta-analyses) [ 143 , 305 , 306 ]. Thus, while we should remain guarded against hype surrounding claims about music’s potential benefits, the example of the Mozart effect should also remind us not to counter hype with dismissal.

Low quality studies undermine claims of clinical value

The randomized double-blind placebo-controlled trial remains the gold standard for evidence in clinical medicine. However, this approach was primarily designed to test the efficacy of drug therapies, a history that creates problems for using it to test behavioral interventions, such as music therapy or psychotherapy [ 307 , 308 ]. Central problems include: difficultly blinding patients and therapists to their assigned condition (treatment or control), designing appropriate “placebo” treatments, and perceived difficulty in standardizing treatment without jeopardizing therapeutic integrity [ 308 , 309 ]. These problems are compounded in trials that rely on self- and/or clinician-reported outcomes (which is standard in much mental health research [ 309 ]). Consequently, concerns over study quality have often been cited in expressions of doubt over music’s clinical value (e.g. [ 302 , 308 ]).

A quick survey of modern clinical research in music therapy shows that such criticism has been well-received. Improvements in control conditions and blinded outcome assessments have been gradually implemented and evidence from more carefully conducted trials has begun to accumulate. Over the last decade, there has also been a surge in meta-analytic syntheses of this work, most of which explicitly assess risk-of-bias alongside their conclusions, although they do not typically take the next step of adjusting effect size estimates accordingly (cf [ 96 , 310 ].). Overall, bias assessments suggest that the certainty of evidence supporting benefits from musical treatment in mental health is moderate to low. Nonetheless, this level of certainty is consistent with many treatments in psychiatry [ 94 ]. The assertion that studies of musical treatment are especially suspect is thus poorly substantiated. Interested readers should consult bias assessments in these meta-analyses [ 93 , 95 , 96 , 133 , 164 , 216 , 224 , 229 ], and review individual studies that exemplify high-quality research on musical treatments for conditions such as anxiety [ 311 , 312 ], depression [ 313 , 314 ], autism [ 274 , 315 ], psychosis [ 316 , 317 ], and dementia [ 318 , 319 ].

Mental health needs

In concluding this section, it is useful to briefly consider musical treatment in the context of current mental health needs. In 2007, mental health disorders were estimated to account for 14% of global disease burden [ 320 ]. In 2021, an estimated 22.8% of adults in the United States had a diagnosable mental illness, with 12.7% of adolescents having serious thoughts of suicide [ 17 ]. In opposition to this growing psychopathology, first-line treatments in psychiatry are often criticized for their limited effectiveness [ 94 , 320 , 321 ]. Quantifying this point, a 2022 meta-analytic evaluation of 3,782 clinical trials examining the most common adult mental health disorders across a total sample size of 650,514 patients estimated summary effect sizes of just 0.34 SMD for psychotherapy and 0.36 SMD for pharmacotherapy [ 94 ]. In depression, SMDs <0.88 represent changes in a patient’s presentation that are typically too small to be detected by a clinician, suggesting that the effects of standard treatments for depression commonly lack clinical significance [ 94 , 322 , 323 ]. A similar SMD threshold in schizophrenia is 0.73 [ 94 , 324 ]. It is crucial to note that small summary effect sizes in meta-analyses are averages, and thus obscure the reality that a minority of patients have experienced clinically significant benefits under current treatments (due to poorly understood individual differences in treatment response). Nevertheless, the data at hand clearly indicate that new treatments are urgently needed [ 94 ].

It is in this context that advancing new standardized music-based interventions is important, not only because music affects core dimensions of mental health through the biology of tonality, rhythm, reward, and sociality, but because these avenues present an accessible, easy-entry, and low-risk approach to addressing problems for which we need solutions. Music is poorly conceived as a panacea. Instead, it has real effects on human neurobiological functions that feature prominently in mental illness, and thus has important potential in treating their disorder.

The effects of music on mental health and wellness are drawing more attention now than ever before. Efforts to better understand music’s benefits and increase their integration into medicine are complicated by their impressive diversity and a lack of clarity regarding underlying biology. This review has addressed these challenges by synthesizing progress in music research from psychology, neuroscience, and psychiatry to create a framework for defining music’s neurophysiological effects and their clinical scope in biological terms. This framework includes four core elements of human musicality: tonality , based on tone perception and the bioacoustics of vocal emotional expression, with applications targeting mood and anxiety; rhythm , based on neural resonance, anticipation, and auditory-motor entrainment, with applications targeting mood, cognition, and motivation; reward , based on engagement of classic brain reward circuitry and the reinforcement of successful communication, with broad applications in stimulating positive affect and normalizing reward function; and sociality , based on synchrony and the neurobiology of affiliation, with broad applications in treating social dysfunction and increasing social connectedness. This framework rationalizes many observed benefits of musical treatment and provides a path towards a precision approach to increasing their impact. As the world continues to change and we face new challenges to mental health and wellness, music will continue to provide real biologically mediated relief. Understanding and leveraging this fact towards better treatments and interventions in psychiatry presents an important opportunity to diversify and improve care during times of pressing need.

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The author would like to thank Drs. Dale Purves, Concetta Tomaino, and Karen Parker for comments on drafts of this manuscript, as well as Drs. Daniel Levitin, Patrick Savage, and two anonymous reviewers for constructive feedback during peer review. This work was supported by NIMH grant K01MH122730.

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Daniel L. Bowling

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Bowling, D.L. Biological principles for music and mental health. Transl Psychiatry 13 , 374 (2023). https://doi.org/10.1038/s41398-023-02671-4

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The Transformative Power of Music in Mental Well-Being

• August 01, 2023
• Healthy living for mental well-being, Patients and Families, Treatment

Music has always held a special place in our lives, forming an integral part of human culture for centuries. Whether we passively listen to our favorite songs or actively engage in music-making by singing or playing instruments, music can have a profound influence on our socio-emotional development and overall well-being.

Recent research suggests that music engagement not only shapes our personal and cultural identities but also plays a role in mood regulation. 1 A 2022 review and meta-analysis of music therapy found an overall beneficial effect on stress-related outcomes. Moreover, music can be used to help in addressing serious mental health and substance use disorders. 2 In addition to its healing potential, music can magnify the message of diversity and inclusion by introducing people to new cultures and amplifying the voice of marginalized communities, thereby enhancing our understanding and appreciation for diverse communities.

Healing Trauma and Building Resilience

Many historically excluded groups, such as racial/ethnic and sexual minorities and people with disabilities, face systemic injustices and traumatic experiences that can deeply impact their mental health. Research supports the idea that discrimination, a type of trauma, increases risk for mental health issues such as anxiety and depression. 3

Music therapy has shown promise in providing a safe and supportive environment for healing trauma and building resilience while decreasing anxiety levels and improving the functioning of depressed individuals. 4 Music therapy is an evidence-based therapeutic intervention using music to accomplish health and education goals, such as improving mental wellness, reducing stress and alleviating pain. Music therapy is offered in settings such as schools and hospitals. 1 Research supports that engaging in music-making activities, such as drumming circles, songwriting, or group singing, can facilitate emotional release, promote self-reflection, and create a sense of community. 5

Empowerment, Advocacy and Social Change

Music has a rich history of being used as a tool for social advocacy and change. Artists from marginalized communities often use music to shed light on social issues (.pdf) , challenge injustices, and inspire collective action. By addressing topics such as racial inequality, gender discrimination, and LGBTQ+ rights, music becomes a powerful medium for advocating for social justice and promoting inclusivity. Through music, individuals can express their unique experiences, struggles, and triumphs, forging connections with others who share similar backgrounds. Research has shown that exposure to diverse musical genres and artists can broaden perspectives, challenge stereotypes, and foster empathy among listeners especially when dancing together. 7

Genres such as hip-hop, reggae, jazz, blues, rhythm & blues and folk have historically served as platforms for marginalized voices, enabling them to reclaim their narratives and challenge societal norms. The impact of socially conscious music has been observed in movements such as civil rights, feminism, and LGBTQ+ rights, where songs have played a pivotal role in mobilizing communities and effecting change. Music artists who engage in activism can reach new supporters and help their fans feel more connected to issues and motivated to participate. 6

Fostering Social Connection and Support

Music can also serve as a catalyst for social connection and support, breaking down barriers and bridging divides. Emerging evidence indicates that music has the potential to enhance prosocial behavior, promote social connectedness, and develop emotional competence. 2 Communities can leverage music’s innate ability to connect people and foster a sense of belonging through music programs, choirs, and music education initiatives. These activities can create inclusive spaces where people from diverse backgrounds can come together, collaborate, and build relationships based on shared musical interests. These experiences promote social cohesion, combat loneliness, and provide a support network that can positively impact overall well-being.

Musicians and Normalizing Mental Health

Considering the healing effects of music, it may seem paradoxical that musicians may be at a higher risk of mental health disorders. 8 A recent survey of 1,500 independent musicians found that 73% have symptoms of mental illness. This could be due in part to the physical and psychological challenges of the profession. Researchers at the Max Planck Institute for Empirical Aesthetics in Germany found that musically active people have, on average, a higher genetic risk for depression and bipolar disorder.

Commendably, many artists such as Adele, Alanis Morrisette, Ariana Grande, Billie Eilish, Kendrick Lamar, Kid Cudi and Demi Lovato have spoken out about their mental health battles, from postpartum depression to suicidal ideation. Having high-profile artists and celebrities share their lived experiences has opened the conversation about the importance of mental wellness. This can help battle the stigma associated with seeking treatment and support.

Dr. Regina James (APA’s Chief of the Division of Diversity and Health Equity and Deputy Medical Director) notes “Share your story…share your song and let's help each other normalize the conversation around mental wellness through the influence of music. My go-to artist for relaxation is jazz saxophonist, “Grover Washington Jr” …what’s yours?” Submit to [email protected] to get featured!

More on Music Therapy

• Music Therapy Fact Sheets from the American Music Therapy Association
• Music Therapy Resources for Parents and Caregivers from Music Therapy Works

By Fátima Reynolds DJ and Music Producer Senior Program Manager, Division of Diversity and Health Equity American Psychiatric Association

• Gustavson, D.E., 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
• Golden, T. L., et al. (2021). The use of music in the treatment and management of serious mental illness: A global scoping review of the literature. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.649840
• Schouler-Ocak, M., et al. (2021). Racism and mental health and the role of Mental Health Professionals. European Psychiatry, 64(1). https://doi.org/10.1192/j.eurpsy.2021.2216
•  Aalbers, S., et al. (2017). Music therapy for Depression. Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.cd004517.pub3
• Dingle, G. A., et al. (2021). How do music activities affect health and well-being? A scoping review of studies examining Psychosocial Mechanisms. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.713818
• Americans for the Arts. (n.d.). A Working Guide to the Landscape of Arts for Change. Animating Democracy. http://animatingdemocracy.org/sites/default/files/Potts%20Trend%20Paper.pdf
• Stupacher, J., Mikkelsen, J., Vuust, P. (2021). Higher empathy is associated with stronger social bonding when moving together with music. Psychology of Music, 50(5), 1511–1526. https://doi.org/10.1177/03057356211050681
• Wesseldijk, L.W., Ullén, F. & Mosing, M.A. The effects of playing music on mental health outcomes. Sci Rep 9, 12606 (2019). https://doi.org/10.1038/s41598-019-49099-9

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Music’s power over our brains

Armed with more interest and funding, researchers are investigating how music may enhance brain development and academic performance and even help people recover from COVID-19

Vol. 51, No. 8 Print version: page 24

• Cognition and the Brain
• Neuropsychology

One of the most poignant early images of the coronavirus pandemic was of Italians playing music and singing from their balconies even as the virus ravaged their cities. Others soon followed suit, including pop stars streaming live performances from their homes and choirs sharing concerts via Zoom—all trying to provide connection during a frightening and uncertain time.

Of course, music has been bringing people together for millennia, and not just during crises. And in the last few decades, investigators have been training their attention on the so-called universal language of music—how it affects our brains and how it might be used to facilitate health and healing. That interest is now being fueled by new research attention and funding: In June, the Global Council on Brain Health, an independent science and policy collaborative devoted to understanding brain health, released a report concluding that music has “significant potential to enhance brain health and well-being for individuals of different ages and different levels of health” and making recommendations for future study. And last year, Sound Health , a program launched by the National Institutes of Health (NIH) and the Kennedy Center, in association with the National Endowment for the Arts (NEA), awarded $20 million over five years to support its first 15 research projects on the topic, including several headed by psychologists.

“Why is music so captivating for us?” asks Thomas Cheever, PhD, staff assistant to NIH Director Francis Collins, MD, PhD, for Sound Health and a program director at the National Institute of Neurological Disorders and Stroke. “The more we understand about that, the more fascinating it’s going to be, and the more we are going to learn about how the brain works in general.” Psychologists and neuroscientists are particularly interested to find out which neural pathways are affected by music, how music influences children’s development, and how music interventions may help people with a range of physical and mental health conditions, including Alzheimer’s disease, schizophrenia, delirium and Parkinson’s disease.

And they are adding COVID-19 to the conditions they are trying to ease. Babar A. Khan, MD, assistant professor of medicine at the Indiana University School of Medicine in Indianapolis, for example, is using a Sound Health grant to test a music intervention with patients who have delirium, including those with COVID-19. Delirium—an acute, short-term condition marked by confusion and emotional disruption—afflicts as many as 80% of patients who are in the intensive care unit for respiratory failure, including those with COVID.

If the intervention proves helpful, says Khan, “it will be used immediately during the course of the current pandemic.”

Enhancing child development

One ongoing research interest is how music may affect youth in terms of language development, attention, perception, executive function, cognition and social-emotional development. Psychologist Assal Habibi, PhD, an assistant research professor at the University of Southern California Dornsife’s Brain and Creativity Institute, has been investigating these topics for the past seven years in collaboration with the Los Angeles Philharmonic Youth Orchestra, known as YOLA, an after-school program that brings low-income youngsters together to learn, play and perform music. Now in its final year, the study has been tracking brain and learning outcomes of 75 children who are either participating in YOLA, a community sports program or no after-school program.

Data published from the first few years of the intervention show that YOLA participants gradually develop auditory and cognitive advantages over youth who aren’t involved in music. After the second year of the study, the YOLA participants showed greater ability to perceive pitch, rhythm and frequency of sounds, as well as enhanced development in the auditory pathway, the neurological route that connects the inner ear to auditory association areas in the brain ( Developmental Cognitive Neuroscience , Vol. 21, 2016). After the third and fourth years in the program, they also began to perform better on tasks unrelated to music, including on executive function tasks involving working memory and delayed gratification—likely because of the discipline required to patiently learn pieces of music, Habibi says. In addition, youth involved in YOLA showed greater development in brain areas related to language and auditory processing, and greater neuronal connectivity in the corpus callosum, the nerve bundle that connects the brain’s right and left hemispheres ( Cerebral Cortex , Vol. 28, No. 12, 2018).

“We obviously expected their musical skills to get better,” she says, “but it seems a broad range of other skills are also impacted by music.”

Habibi now has a grant from the NEA to follow these same children into adolescence to see whether the brain benefits they derived early on translate into real-life behaviors and decisions as teens—choice of peers, for example, or whether they show up to class. She also has an NIH Sound Health grant to compare differences in executive functioning among bilingual youth who are learning music and those who are learning music but only speak one language.

“As a developmental psychologist, I don’t think there’s just one pathway to better executive function in children,” she explains. “So, it will be interesting for us to identify different mechanisms and understand how each one works.”

Music and mental illness

Researchers are also exploring whether music may prove to be a helpful therapy for people experiencing depression, anxiety and more serious mental health conditions. A study of 99 Chinese heart bypass surgery patients, for example, found that those who received half an hour of music therapy after the operation—generally light, relaxing music of their own choice—had significantly lower self-reports of depression and anxiety than those who rested or received conventional medical check-ins in the same time frame ( Journal of Cardiothoracic Surgery , Vol. 15, No. 1, 2020). Meanwhile, in conjunction with the Global Council on Brain Health’s strong endorsement of more research on music and brain health, an AARP survey of 3,185 adults found that music has a small but statistically significant impact on people’s self-reported mental well-being, depression and anxiety.

Others are examining whether music interventions could benefit those with serious mental illness. Yale experimental psychologist and cognitive neuroscientist Philip Corlett, PhD, for example, will use a Sound Health grant to test an intervention in which people with schizophrenia come together to write and perform music for one another. The work builds on Corlett’s developing model of schizophrenia, which maintains that people with the disorder have difficulty revising and updating their views of self and reality based on newly emerging events, considered a central feature of the healthy human brain. Making music with others—which involves both positive social interactions and a type of expression with predictable outcomes—could allow participants to experience more realistic predictions and hence foster their sense of predictability and security, he hypothesizes.

“If we can show that music-making changes the mechanisms that we think underwrite these symptoms [of schizophrenia],” Corlett says, “then we can figure out its active ingredients and ultimately come up with ways to deliver this to people who need it.”

Therapy for older adults

The impact of music on older adults’ well-being is likewise of keen interest to researchers, who are looking at how music therapy may help verbal fluency and memory in people with Alzheimer’s disease ( Journal of Alzheimer’s Disease , Vol. 64, No. 4, 2018) and how singing in a choir may reduce loneliness and increase interest in life among diverse older adults ( The Journals of Gerontology: Series B , Vol. 75, No. 3, 2020). Music even shows promise in preventing injury: A study by Annapolis, Maryland–based neurologic music therapist Kerry Devlin and colleagues showed that music therapy can help older adults with Parkinson’s disease and other movement disorders improve their gait and reduce falls ( Current Neurology and Neuroscience Reports , Vol. 19, No. 11, 2019).

Still others are investigating how music can help people recover from serious illnesses and conditions, including, now, COVID-19. In a pilot study, Khan of Indiana University showed that patients with delirium on mechanical ventilators who listened to slow-tempo music for seven days spent one less day in delirium and a medically induced coma than those listening to their favorite music or to an audio book ( American Journal of Critical Care , Vol. 29, No. 2, 2020). Now, with his Sound Health grant, he is comparing the effects of slow-tempo music or silence on 160 participants with delirium, including COVID-19 patients on ventilators in hospitals in Indianapolis.

Studies like these underscore music’s potential as a safe and effective medical intervention, as well as the importance of conducting more research on which kinds of music interventions work for whom, when and how, including during this difficult time, adds Cheever.

“How do we get [music therapy] into the same realm as other interventions that are the standard of care for any given indication?” he says. “The answer to that, I think, is a solid evidence base.”

Further reading

NIH/Kennedy Center Workshop on Music and the Brain: Finding Harmony Cheever, T., et al., Neuron , 2018

Effects of Music Training on Inhibitory Control and Associated Neural Networks in School-Aged Children: A Longitudinal Study Hennessy, S.L., et al., Frontiers in Neuroscience , 2019

Decreasing Delirium Through Music: A Randomized Pilot Trial Khan, S.H., et al., American Journal of Critical Care , 2020

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Music Therapy Journals and Publications

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 activity is critical to the advancement of the music therapy profession as it enhances the understanding of music as unique human behavior and provides best practice guidelines for clinicians. 

Masters Theses and Clinical Projects

Alison Belinsky (clinical project), Development of a Musical Executive Function Training protocol for adults with schizophrenia

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Ruthanne Cain (clinical project), The Role of Musical Triggers in Substance Use Disorder

Carolyn Dachinger (thesis), Impulsivity and Performance on a Music-based C ognitive R ehabilitation P rotocol in Persons with Alcohol Dependence

Angela Davis (thesis), The Effect of Film S core on Emotion and Self-talk

Jenny Denk (thesis), An Exploratory Study Examining the Impact of a Music Therapy Support Group on Perceived Stress, Anxiety, and Depression in Long-term Caregivers

Esther Hood (clinical project), Developing the Music Assessment of Pediatric Voice (MA-PV)

Anqi Jiang (thesis), The Effect of Rhythmic Auditory Stimulation (RAS) on Gait in Young Children with Cerebral Palsy

Amy Kalas (thesis), Joint Attention Responses to Simple versus C omplex Music of Children with Autism Spectrum D isorder

Stephanie Kawzenuk (thesis), Music Therapy Undergraduate Education and S tudent Clinical Training Learning

Erin Keenan (thesis), The Immediate Effects of Rhythm on the Timing of U pper Extremity Movements in Patients with Parkinson ’ s Disease

Emily Lambert (thesis), Rhythmic Motor Tempo in Elderly with Mild Cognitive Impairment

Katherine Lantigua (clinical project), Development of a Music Attention Control Training (MACT) program to improve selective attention in toddlers with developmental delay

Allison Lockhart (thesis), The Effect of Rhythmic Proprioceptive Input on Attention in Children with Autism Spectrum Disorder (ASD): An Exploratory Study

Jessica MacLean (thesis), An Exploratory Study to Examine a Drumming-to-Speech Intervention for Prosody Perception in Preschoolers with Cochlear Implants

Brianna McCulloch (thesis), The Effect of Music on Alternating Attention in a M atch/mismatch Task in Children with Autism Spectrum Disorder

Alecia Meila (thesis), Exploring the Use of Music Interventions on Emotion Competence in Individuals with Special Needs: A Systematic Review

Brea Murakami (thesis), Music as a Mnemonic Device for Verbal Recall in Healthy Older Adults

Andy Panavides (thesis), The Role of Personality and M ood in Music-use in a High C ognitive Task

Allison Pindale (thesis), The Effect of Musical Mnemonics and Music Training on Word Recall

Evan Privoznik (thesis), Perception of Music-Emotion in Veterans with Post-Traumatic Stress Disorder

Marlén Rodrigeuz-Wolfe (thesis), The Effect of Preferred Music Listening on Pain Tolerance in a C old-pressor Task

Hilary Yip (thesis), A Rhythmic Cueing in Martial Arts Protocol For the Motor Skills of Children with Autism: An Exploratory Pilot Study 

Doctoral Dissertations

Carolyn Dachinger, The Effect of a Music-movement Intervention on Arousal and C ognitive Flexibility in O lder Adults with and without Mild N eurocognitive Disorder

Eunju Jeong, Music Therapy Assessment of Attention for Traumatic Brain Injury

Linda Lathroum, The Relationship between Pitch Processing and Phonological A wareness in Five- to Six-year-old Children

Hayoung Lim, Developmental Speech and Language Training through Music for Children with Autism Spectrum Disorders

Julie Stordahl, The Influence of Music on Depression, Affect, and B enefit finding Among Women at the Completion of Treatment for Breast Cancer

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• Music Therapy Theses

Reising, M. M. (2022). Music therapy for patients who are mechanically ventilated: A phenomenological study.

Smith, W. L. (2022). What about black music? Exploring a gap in music therapy training .

Santiago, K. (2022). The music in me: The impact of music therapy on identity development in college students. A phenomenological inquiry.

McAfee, A. L. (2021). Promoting self-determination in music therapy with individuals with I/DD who communicate extraverbally: Reflections and implications for practice.

Kiefer, E. K. (2021). Heartbeat recordings in music therapy: A sequential-explanatory mixed methods study.

Cooke, C. J. (2020). Maximizing referrals and acceptance of medical music therapy: A sequential-explanatory mixed methods study.

Beebe, K. J. (2020). Perceptions of self-determination in music therapy for individuals diagnosed with intellectual disabilities: A survey of music therapists.

Tart, M. F. (2019). Music therapy for infants with neonatal abstinence syndrome in the NICU: A qualitative content analysis .

Solberg, S. (2019). Neurologic music therapy to improve speaking voice in individuals with Parkinson’s disease.

Berry, A. (2019). A collaborative coalition: Action research response to a music therapy group for gender and sexual minority college students.

Esposito, K. (2019).   Creating new music therapy programs in medical settings: A phenomenological inquiry.

Mercier, A. E. (2019).  The use of creative arts in music therapy supervision: A sequential-explanatory mixed methods study.

Bodry, K. L. (2018). Clinical applications of feminist theory in music therapy: A phenomenological study.

Waller-Wicks, C. (2018). Music therapy and expressive arts to promote self-awareness and self-care in direct care staff: A phenomenological inquiry .

Donley, J. M. (2017). Understanding how Western-trained music therapists incorporate Chinese culture in their practice In China: An ethnographic study .

Lingafelt, H. H. (2017). Psychological factors in the use of music therapy with individuals experiencing pain: A survey of current practice.

Neel, K. M. (2017). Self-care for students: A pilot study on self-care education on the pre-internship music therapy students.

Barmore, E. A. (2017). The Bonny Method of Guided Imagery and Music (GIM) and eating disorders: Learning from therapist, trainer, and client experiences.

King, K. W. (2016). The practice of teaching therapeutic songwriting: A survey of educators and internship supervisors.

Grimmer, M. S. (2016). Cross-cultural music therapy: Reflections of music therapists working internationally .

Dorris, A. D. (2015). Music therapy when death is imminent: A phenomenological inquiry .

Renshaw, S. (2015). The use of rap music in music therapy treatment with adolescents and young adults: A survey.

Stith, C. C. (2015). The effects of musical tempo and dynamic range on heart rate variability in healthy adults.

Honig, T. J. (2014). Wilderness imagery in the Bonny Method of Guided Imagery and Music: A phenomenological inquiry .

Tate, C. E. (2014). Breaking the silence: A qualitative study on the use of Guided Imagery and Music, expressive arts, and a body-centered perspective to address women's issues .

Barwick, C. A. (2014). Describing the subtle factors that influence moments of interactive responses during music therapy sessions for people with late-stage Alzheimer’s disease and other related major neurocognitive disorders: A multiple case study.

Johnson, A. E. (2014). Benefits and challenges of therapeutic songwriting with deaf adolescent girls: A qualitative feasibility study .

Rosenblum, S. O. (2014). Group music therapy versus individual verbal therapy for mandated college students.

Wilson, S. H. (2014). Music therapy support groups for family caregivers of individuals residing in long- term care facilities: A survey of music therapists and interviews with current family caregivers.

Chwalek, C. M. (2013). The use of dialectical behavior therapy (DBT) in music therapy: A survey of current practice.

Rayburn, A. D. (2013). A phenomenological inquiry into systemic music therapy to accompany the grief journey of a boy with high functioning autism.

Deans, C. M. (2012). The use of dreamwork with the Bonny Method of Guided Imagery and Music: A survey of current practice .

Roberts, S. M. (2012). Current use of augmentative and alternative communication in music therapy: A survey and case study .

Dempsey, D. (2011). Grief rock band: The use of music therapy interventions to decrease depressive symptoms and facilitate expression of grief in bereaved adolescents.

Biron, R. N. (2010). Supporting pregnancy and childbirth using techniques from music therapy, counseling, and doula training .

Cloud, J. P. (2010). The use of music therapy and motivational interviewing with college student drinkers to invite “change talk.”

Hoyle, J. L. P. (2010). The role of music therapy in the bereavement process of adults with intellectual disabilities.

Leonard, K. R. (2010). A search for wholeness: Songs of healing for adolescents with emotional and behavioral disorders.

Brown, L. R. (2009). The effect of music therapy social skills interventions on children with behavioral and emotional disabilities or autism .

Schwantes, M. B. (2007). Music therapy with Mexican migrant farm workers in rural NC: A pilot study .

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Good Research Topics about Music Therapy

• Active Music Therapy for Parkinson’s Disease
• Effectiveness of Music Therapy for Survivors of Abuse
• Music Therapy Effectiveness for 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
• 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
• Music Therapy for Children with Autism Spectrum Disorder
• Discussing Music Therapy: Reducing Stress, Health, and Social Care
• 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

Interesting Topics to Write about Music Therapy

• How Does Music Therapy Promote Positive Mental Health?
• 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
• 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
• 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

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• Brain Behav Immun Health
• v.18; 2021 Dec

Music, mental health, and immunity

Music is a crucial element of everyday life and plays a central role in all human cultures: it is omnipresent and is listened to and played by persons of all ages, races, and ethnic backgrounds. But music is not simply entertainment: scientific research has shown that it can influence physiological processes that enhance physical and mental wellbeing. Consequently, it can have critical adaptive functions. Studies on patients diagnosed with mental disorders have shown a visible improvement in their mental health after interventions using music as primary tool. Other studies have demonstrated the benefits of music, including improved heart rate, motor skills, brain stimulation, and immune system enhancement. Mental and physical illnesses can be costly in terms of medications and psychological care, and music can offer a less expansive addition to an individual's treatment regimen. Interventions using music offers music-based activities in both a therapeutic environment (Music therapy) with the support of a trained professional, and non-therapeutic setting, providing an atmosphere that is positive, supportive, and proactive while learning non-invasive techniques to treat symptoms associated with various disorders – and possibly modulate the immune system.

1. Introduction

Music can play a crucial role to support people at all stages of life: from helping new-born babies develop healthy bonds with their parents to offering vital, sensitive, and compassionate palliative care at the end of life. Singing to new-borns, a widespread activity practised worldwide, has been demonstrated to have valuable benefits such as improving mother-infant interaction and reducing infant distress ( Vlismas et al., 2013 ; Mualem and Klein, 2013a ). In the same way, music has been reported as an aid in the reduction of anxiety and agitation in older adults with senile dementia ( Sung et al., 2012 ).

The clinical and evidence-informed use of music interventions to accomplish individualised goals within a therapeutic relationship is defined as Music therapy ( Press Release on Mus, 2014 ). Established as a profession after World War II, Music therapy has become an important part of internationally therapeutic and healthcare settings ( Greenberg and Rentfrow, 2017 ). Even long before that, Pythagoras (c.570 – c.495 BC), the Ancient Greek philosopher and mathematician, prescribed various musical scales and modes to cure an array of physical and psychological conditions ( Greenberg and Rentfrow, 2017 ). Music therapy is part of the Creative Arts Therapies ( Mind [Internet]. [cited 2, 2021 ), in which arts-based activities are used in a therapeutic environment, with the support of a trained professional. Creative Arts Therapies are particularly effective for people who face barriers in expressing themselves with spoken languages, such as individuals with communication deficits or people with mental health difficulties who find it difficult to talk about their experiences and feelings in words. These therapies provide a safe and supportive environment to enable and encourage the patients to express themselves in whatever way possible, encouraging self-expression and development supported by the therapeutic relationship ( Ahessy, 2013 ). Music therapy interventions involve a therapeutic process developed between the patient (or client) and therapist through the use of personally tailored music experiences ( de Witte et al., 2019 ).

This distinguishes Music therapy from other music interventions, offered mainly by medical or healthcare professionals ( de Witte et al., 2019 ; Agres et al., 2021 ). In fact, music can be utilized not only through a setting lead by a professional Music therapist, but also with individuals and groups in a variety of settings. A wide range of musical styles and instruments can be used, including the voice, enabling people to create their unique musical language to explore and connect with the world and express themselves. Bringing out emotions and thoughts through methods of verbal and nonverbal expression and exploration - such as dance and body movement, music, art ( Havsteen-Franklin ), and expressive writing ( Pennebaker and Chung, 2007 ; Rebecchini, 2019 ) - may deactivate the avoidance mechanism and enable the elaboration of emotions and distress. As Juslin and Vastfjall (2008) , and Levitin ( British Association for M, 2021 ) have underlined, music has evolved from emotional communication, and the musical components of speech provide honest communication about emotions. Because musical participation and response do not depend solely on the ability to speak, music is particularly effective for people who have difficulty communicating verbally ( British Association for M, 2021 ). Hence, working with music can be life-changing for people affected by disability, injury, or mental disorders.

The potential of music to affect mood, cognition, and behavior has been demonstrated in several studies. On a negative side, some studies have shown that men who were exposed to music with misogynistic lyrics displayed higher levels of aggressive behavior than did those who were exposed to neutral music, especially when the aggressive behavior was directed at a female target person. Men also recalled more negative attributes of women after exposure to misogynistic music ( Barongan, Hall ). And when the music contained men-hating lyrics, women recalled more negative than positive attributes about men ( Fischer and Greitemeyer, 2006 ). Furthermore, playing loud music incessantly to prisoners has been reported as a form of “music torture” designed to cause extreme discomfort. In fact, it's been a practice against which the legal charity Reprieve set up its “zero-dB” campaign ( zero, 2021 ) the 60th anniversary of the Universal Declaration of Human Rights in December 2008.

There is a vast body of evidence demonstrating that Music therapy is beneficial both physically and mentally. Recently the attention has also focused on whether general music activities, not led by therapists, can enhance the mental health and wellbeing of service users ( de Witte et al., 2019 ; Fancourt et al., 2016 ). Studies on patients diagnosed with mental disorders such as anxiety, depression, and schizophrenia have shown a visible improvement in their mental health after general music and Music therapy interventions ( Fancourt et al., 2016 ; McCaffrey et al., 2011 ; Mössler et al., 2011 ; Erkkilä et al., 2011 ). Moreover, studies have demonstrated other benefits of music and Music therapy, including improved heart rate, motor skills, stimulation of the brain ( Bradt et al., 2013 ; Magee et al., 2017 ; Norton et al., 2009 ) and enhancement of the immune system ( Taylor, 1997 ; Fancourt et al., 2014 ; Li et al., 2021 ).

Although music might have initially evolved as a pure art expression with entertainment scopes, it is now clear that music can affect physiological processes, improving physical and mental wellbeing. Consequently, it can have critical adaptive functions.

1.1. The role of music since first interactions

The use of the voice through singing is a unique form of interaction and expression. Singing is closely linked to the first forms of interaction between a mother and her infant. The body of research on parent-infant communication has shown that humans' earliest contact has many musical qualities ( Trevarthen and Malloch, 2000 ; Stern, 2010 ). As Dissanayake suggested ( Dissanayake, 2000 ), a mother's use of rhythmical movement appears to be an essential component for the expression communicated while singing with her infant.

Evidence has underlined that a mother's touch and rhythmical movements, co-created with her infant during musical interactions, are central to the infant's feelings of pleasure ( Longhi, 2008 ) and a healthy mother-infant relationship ( Hatch and Maietta, 1991 ). As a mother emotionally engages with her infant, her sensitivity and affection are communicated through her voice ( Fernald, 1989 , 1992 ; Rock et al., 1999 ), touch and facial expressions ( Papoušek and Papoušek, 1987 ; Stack and Muir, 1992 ), and rhythmical movements ( Hatch and Maietta, 1991 ). This co-created communicative interaction has been demonstrating a ‘communicative musicality’ due to its intrinsic music and dance-like qualities of the regularity of pulse and sensitive exchange of gestural narratives ( Malloch and Trevarthen, 2009 ). The positive emotional arousal and synchronisation between a mother and her child could be the root of a positive mother-infant relationship, thus essential for future child development ( Hodges, 1980 ; Mualem and Klein, 2013b ).

A study conducted by Vlismas et al. (2013) on the effect of music and movement on mother-infant interactions showed that maternal engagement in a music and movement programme resulted in changes to both mothers' and infants' behavior. Specifically, it showed that the effect of the programme increased the mothers' self-reported use of music and enjoyment of interactions with their infants; the mothers' self-reported attachment to their infants; the dyadic reciprocity between mother and infant; and the attentional and affective aspects of mothers' speech.

2. Music, music therapy and mental health

Utilising music as a structured intervention in treating mental illnesses such as anxiety, depression and schizophrenia has been reported as beneficial in relieving symptoms ( Mössler et al., 2011 ; Erkkilä et al., 2011 ), while improving mood and social interactions ( Edwards, 2006 ). Some people with mental disorders may be too disturbed to use verbal language alone efficiently as a therapeutic medium. Thus, the musical interaction might support and provide musical resources and competencies very beneficial for patient's everyday life. Music can have unique motivating, relationship-building, and emotionally expressive qualities ( Solli, 2008 ; Rolvsjord, 2001 ).

Numerous studies have focused on the effect of music interventions on individuals in clinical settings. Many of these studies concluded that music interventions positively impact mood and anxious or depressive symptoms in both children ( Kim and Stegemann, 2016 ; Yinger and Gooding, 2015 ; Kemper and Danhauer, 2005 ) and adults ( Carr et al., 2013 ; van der Wal-Huisman et al., 2018 ). Reviews of the evidence have suggested that Music therapy may improve mental health in children and adolescents and communication in children with autistic spectrum disorder ( Gold et al., 2007 ; Whipple, 2004 ). In the same way, clinical reports and pre-experimental studies have suggested that Music therapy may be an effective intervention for adult patients with mental health problems across the world. A recent review which aimed to identify, summarise, and synthesise different experimental studies addressing the effects of Music therapy alone or Music therapy added to standard care on mental health ( Lee and Thyer, 2013 ) has shown the therapy alone or added to standard care to have significantly better effects than psychotherapy ( Castillo-Pérez et al., 2010 ), verbal relaxation ( Lin et al., 2011 ), standard care ( Erkkilä et al., 2011 ; Lin et al., 2011 ; Yang et al., 2009 ) and no treatment ( Mohammadi et al., 2011 ; Siedliecki and Good, 2006 ).

Mental health diseases such as depression and anxiety can have devastating consequences both for patients and their families. Symptoms can be severe and debilitating, leaving individuals alone and isolated. Relationships among family and friends may suffer, and individuals may not receive the support needed to manage their disease. Music can improve symptoms associated with mental illness, but it can also provide an environment for social interaction. As Choi, Lee, and Lim described ( Choi et al., 2008 ), Music therapy helps the individual to express emotions while producing a state of mental relaxation, and consequently it can be beneficial in decreasing symptoms of depression and anxiety, while enhancing interpersonal relationships.

Other music interventions - not lead by a professional music therapist - such as group drumming have been very effective, leading to the enhancement of psychological states, specifically fewer depressive symptoms and greater social resilience ( Fancourt et al., 2016 ): there is a growing body of evidence demonstrating the effects of community group on mental health ( Estevao et al., 2021 ; Clift and Morrison, 2011 ; Coulton et al., 2015 ). For example, a study conducted with mothers suffering from postnatal depression found that mothers with moderate-severe depressive symptoms who participated in 10 weeks of music and singing classes with their babies had a significantly faster improvement in symptoms than mothers who participated in usual care groups ( Fancourt and Perkins, 2018 ).

In the same way, using Music therapy to decrease psychological stress during pregnancy has been reported as an appropriate alternative therapy for pregnant women suffering from mental health problems attempting to avoid the side effects associated with medication. A study conducted in 2007 with the aim of examining the effects of Music therapy on reducing psychological stress during pregnancy reported that listening to music for at least 30 minutes daily substantially reduced psychological stress, anxiety, and depression ( Chang et al., 2008 ). Hence, listening to music daily during pregnancy can generate considerable health benefits.

These experimental results indicate that music promotes psychological health both during pregnancy, and the entire lifetime; it can be easily used in many environments, and it can also be tailored to personal preferences to enhance mental health.

2.1. Music and immune system

The immune system, composed by molecular and cellular components, is a complex system of structures and processes that have evolved to protect us from disease. The function of these components is divided up into nonspecific mechanisms, those which are innate to an organism, and responsive responses, which are adaptive to specific pathogens. The innate immune system represents the first line of defense against infection and includes cells and proteins that are nonspecific to particular antigens. The adaptive immune system provides a secondary, antigen-specific response during which cells with a memory for specific pathogens are created. The adaptive immune system has the capacity to recognize and respond to virtually any protein or carbohydrate imaginable; yet, without the innate immune system to instruct it—in effect, telling it whether, when, how, and where to respond—it is powerless ( Clark and Kupper, 2005 ). As the literature shows, the immune system is strongly associated with mood, psychological condition, and hormonal balance ( Segerstrom and Miller, 2004 ). Thus, as a result of negative mood, psychological stress affects the immune system and may cause dysregulation leads to a change in the humoral and cellular immunity and increases health risks.

Psychological stress can have detrimental effects on both immune system responses, leading to a weakening of defenses against new pathogens and increasing in systemic inflammation ( Chanda and Levitin, 2013a ; Maddock and Pariante, 2001 ). While inflammation is a local, protective response to microbial invasion or injury, it must be fine-tuned and regulated precisely, because deficiencies or excesses of the inflammatory response cause morbidity and shorten lifespan ( Tracey, 2002 ; Bassi et al., 2018 ). Because stress can be a predisposing factor to diseases associated with immunologic responses ( Maddock and Pariante, 2001 ), increased exposure to stressful situations expands the risk of mental and physical disorders ( Hazelgrove et al., 2021 ). Acute stress can affect basal sensitivity, increasing or decreasing pain threshold in acute and chronic pain processes. For the fact that acute and chronic pain are potent stressors, they can alter the body homeostasis: pain can be an activator of the hypothalamic-pituitary-adrenal axis (HPA axis), the major system responsible for stress responses, which may be hypoactive or hyperactive under chronic or persistent stress conditions ( Timmers et al., 2019 ). In turn, the HPA axis modulation directly affects the release levels of glucocorticoids, ‘hormones of stress’, which induce anti-inflammatory and immunosuppressive effects at pharmacological doses, whereas at physiological levels they play an essential regulatory role in the immune system ( Pariante and Miller, 2001 ). Thus, stress can negatively affect the cardiovascular, neuroendocrine, and immune systems, which, consequently, may impair recovery, increase the risk for adverse effects, and delay hospital discharge ( Biondi and Zannino, 1997 ).

Although psychological stress cannot be eliminated, there are ways in which the perception of stress and ability to adapt to stressors can be altered: music has been adapted as a form of stress management and studies have confirmed the effect of music on the reduction of stress responses in the cardiovascular and endocrine system ( Taylor, 1997 ; Mojtabavi et al., 2020 ). Specifically, music has been shown to modify heart rate, respiration rate, perspiration, and other autonomic systems ( Blood et al., 1999 ), supporting reports that many people use music to achieve physical and psychological balance. Lifestyle choices that reduce stress are thought to be highly protective against diseases ( Dimsdale, 2008 ), and music may be among these ( Dileo et al., 2007 ; Nilsson, 2008 ).

The human's biological stress response is highly adaptive in the short term: it is an elegant choreography ( Chanda and Levitin, 2013b ) of neuroendocrine, autonomic, metabolic, and immune system activity that involves multiple feedback loops at the level of the central and peripheral nervous systems ( Landgraf and Neumann, 2004 ). Together these systems trigger short term adaptive behaviours, including arousal, vigilance, focused attention, and temporarily inhibit functions that are nonessential during a crisis, such as eating, digestion, growth, and sex drive. At the same time, cardiovascular changes such as elevated heart rate and rapid breathing are helpful to increase oxygenation and glucose supply to the brain and skeletal muscles.

However, as already mentioned, the prolonged activation of these systems has devastating consequences for health. Continuous and elevated circulating levels of glucocorticoids (e.g., cortisol) act as neurotoxins, weakening the ability of neurons and other cells to resist injury and making them more vulnerable to the effects of toxins and the normal attrition process ( Landgraf and Neumann, 2004 ). Furthermore, although glucocorticoids act as an immunosuppressant under acute stress conditions, they may promote a state of chronic low-grade inflammation in the long term ( Gouin et al., 2008 ). These neurotoxic and pro-inflammatory effects of chronic stress have been linked to a host of adverse health outcomes such as susceptibility to infectious diseases, anxiety and depression ( Pitharouli et al., 2021 ), and cardiovascular diseases ( Chrousos, 2009 ; Lupien et al., 2009 ).

As many studies have demonstrated, neuroinflammation is the cause of several mental diseases such as depression and anxiety ( Zheng et al., 2021 ; Troubat et al., 2021 ). Hence, attention has increasingly focused on the effect of music as a possible anti-inflammatory mechanism in these central inflammatory conditions. A recent work conducted by Dasy Fancourt (2014) - the first systematic review that aimed to assess published studies dealing with psychoneuroimmunological effects of music - showed that music can have effects on various neurotransmitters, cytokines, and hormones ( Fancourt et al., 2014 ). Specifically, fifty-six of the sixty-three studies included in the author's systematic review linked psychoneuroimmunological effects of music to the stress response.

Salivary Immunoglobulin A (s-IgA), a first-line in the defence against bacterial and viral infections ( Woof and Kerr, 2006 ) and a reliable marker of the functional status of the entire mucosal immune system ( Hucklebridge et al., 2000 ), has been revealed to be particularly responsive to music, increasing following exposure to a range of styles of music including both relaxing and stimulating music, as well as for both active involvements and simply listening to recorded music ( Fancourt et al., 2014 ). Strong patterns have also been noticed concerning cortisol, which repeatedly decreased in response to relaxing recorded music ( Fancourt et al., 2014 ). There also appeared to be patterns in the response of epinephrine and norepinephrine, which have been shown to decrease in response to relaxing recorded music ( Leardi et al., 2007 ).

Another study conducted to determine if (i) musical activity could produce a significant change in the immune system measured by s-IgA, and if (ii) active participation in musical activity had a different effect on the immune system than passive participation showed that S-IgA levels of the active group (playing music and singing) had more significant increase than those of the passive group (listening only) ( Kuhn, 2002 ). This result suggested that active participation in musical activity produces a more significant effect on the immune system than passive participation.

Overall, changes have been observed across various immune response biomarkers, including leukocytes, cytokines, immunoglobulins, and hormones and neurotransmitters associated with immune response ( Fancourt et al., 2014 ). Music has begun to be taken seriously in healthcare settings as research findings have started to link the beneficial effects of music on stress to a broader impact on health ( Haake, 2011 ). If music can mediate anti-inflammatory effects, evidenced by decreased levels of inflammatory biomarkers (see Table 1 ), there may be biological plausibility for its use in the care of ill patients. The results of these studies provide further confirmation that the immune system can be enhanced by music and, as Daisy Fancourt has underlined, the trend towards positive findings of the effect of music on psychoneuroimmunological response strongly supports further investigation in this field ( Fancourt et al., 2014 ).

Table 1

Markers of inflammation and immune response influenced by music .

2.1.1. Other biological effects

In the last decade, there has been growing interest in music's chemical and biological effects ( Table 1 ) ( Khan et al., 2018 ). Some studies have focused on whether music can affect the same neurochemical reward systems as other reinforcing stimuli. Does music have the earmarks of a rewarding stimulus, including the ability to motivate an individual to learn and engage in goal-directed behavior to obtain a pleasurable feeling ( Chanda and Levitin, 2013b )? As Salimpoor et al. have underlined ( Salimpoor et al., 2015 ), dopamine activity can explain why an individual would be motivated to keep listening to a piece of music, or to seek out that music in the future. However, it cannot alone explain the experience of pleasure when listening to music. Berridge and colleagues described ‘hedonic hotspots’ in the nucleus accumbens (NAc) and ventral pallidum that are explicitly linked to the display of pleasure and are triggered by opioid signalling ( Berridge and Kringelbach, 2013 ). Thus, there are crucial interactions between the dopamine and opioid systems. A rapid increase in dopamine release in humans induces euphoria, with the level of euphoria correlating with the level of ventral striatal dopamine release, which also leads to robust increases of endorphin release in the NAc ( Drevets et al., 2001 ). On the other hand, opioid antagonists block the subjective ‘high’ caused by strong dopamine release ( Jayaram-Lindström et al., 2004 ). Consequently, it seems reasonable to hypothesize that a strong induction of dopamine release caused by music can trigger opioid stimulation of so-called hedonic hotspots. In the other direction, the opioid system robustly modulates dopamine release in to the NAc ( Hjelmstad et al., 2013 ). This likely provides a mechanism through which music that is experienced as pleasing can enhance dopamine-mediated positive prediction error signaling and reinforcement learning. Thus, the association of dopamine release and NAc activation during peak musical pleasure may be a direct manifestation of this opioid–dopamine interaction ( Salimpoor et al., 2015 ).

There is an increasing body of evidence demonstrating the functional activation ( Blood and Zatorre, 2001 ; Brown et al., 2004 ; Jeffries et al., 2003 ; Koelsch et al., 2006 ), network connectivity ( Menon and Levitin, 2005 ), and central dopamine release ( Salimpoor et al., 2011 ) during the perception of pleasurable music. A review conducted by Chanda and Levitin (2013b) showed that studies that used positron emission tomography (PET) to investigate regional cerebral blood flow (rCBF) during experienced musical pleasure ( Blood and Zatorre, 2001 ; Brown et al., 2004 ; Jeffries et al., 2003 ) suggested that music reward involve the activation of the NAc, as well as opioid-rich midbrain nuclei known to regulate morphine analgesia and descending inhibition of pain ( Jeffries et al., 2003 ). NAc activation was also reported during listening to unfamiliar pleasant music compared to rest ( Brown et al., 2004 ) and during singing compared to speech ( Jeffries et al., 2003 ). On the other hand, listening to techno-music induced changes in neurotransmitters, peptides and hormonal reactions, related to mental state and emotional involvement: techno music increased plasma cortisol, adrenocorticotropic hormone, prolactin, growth hormone and norepinephrine levels ( Gerra et al., 1998 ). The neuroendocrine pattern induced by this fast music (techno music) turned out to be similar to the biological reaction to psychological stress ( Henry, 1992 ).

Other studies that used higher resolution functional magnetic resonance imaging (fMRI) to investigate the neural correlates of music pleasure ( Koelsch et al., 2006 ; Menon and Levitin, 2005 ; Salimpoor et al., 2011 ; Janata, 2009 ) showed that musical reward is dependent on dopaminergic neurotransmission within a similar neural network as other reinforcing stimuli: pleasant (consonant – positive emotional valence) and unpleasant (dissonant – negative emotional valence) music were contrasted, and the results confirmed activation of the ventral striatum and Rolandi operculum during pleasurable music listening, while strong deactivations were observed in the amygdala, hippocampus, parahippocampal gyrus, and the temporal poles in response to pleasant music ( Koelsch et al., 2006 ). Activation of the anterior superior insula in response to pleasant music has also been observed: a significant finding because of the insula's connectivity to the NAc and its role in the activation of the emotional circuitry and reward system ( Pavuluri et al., 2017 ) which, in turn, increases the innate and adaptive immune system ( Ben-Shaanan et al., 2016 ). All these structures have previously been implicated in the emotional processing of stimuli with (negative) emotional valence ( Heinzel et al., 2005 ; Siegle et al., 2002 ). The results of the studies mentioned above indicate that these structures respond to auditory information with emotional valence, and that listening to music has the capacity to up-as well as down-regulate neuronal activity in these structures.

3. Conclusion and limitations

The increasing evidence of the benefits of music activities and Music therapy provided by the literature is a driving force for developing music-based therapies services in the health care sector. By promoting physical and psychological health, music can be an effective treatment option suitable for every environment and people of every age, race, and ethnic background.

Since music is a complex topic, there are some aspects that this mini review has not fully addressed, such as the role of the autonomic nervous system involved in musical activities; the involvement of music as a possible component of an “enriched environment” ( Kempermann, 2019 ); and, finally, the beneficial effects of rhythmical movements and physical musical activities, and their contribution to the preference for treatment options.

Figure 1. Lavinia Rebecchini is an Italian psychologist currently doing a Ph.D at the Department of Psychological Medicine at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London. She graduated from Università Cattolica del Sacro Cuore of Milan and, after completing her Master of Science in Developmental Psychology with full marks, she decided to move to London to broaden her horizons. She started as an intern at the Perinatal Psychiatry section of the Stress, Psychiatry, and Immunology Laboratory (SPI Lab) at the IoPPN and, after being hired as a Research Assistant, she then decided to further cultivate her strong interest in the perinatal mental health field with a PhD. She has always been interested in perinatal psychiatry and the relationship between mothers and their children. Her Ph.D at the SPI Lab is concentrating on mother-infant interaction with mothers suffering from perinatal depression. With her Ph.D project, she focuses on which implications perinatal depression may carry for the developing mother-infant relationship. She looks at whether an intervention of music and singing sessions can help mothers develop compensatory skills to interact with their children appropriately so to better respond to their infants' needs. In addition to her academic experiences, during her free time, she has always volunteered to help children and families in need. She is determined and enthusiastic, and her eight years' experience in alpine skiing competitions has allowed her to build strong determination in achieving her goals.

Declaration of competing interest

The author Lavinia Rebecchini declares that there are no conflicts of interest.

Acknowledgements

Dr Rebecchini is supported by a kind gift from Michael Samuel through King's College London & King's Health Partners, by the UK National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust, and by the Wellcome Trust SHAPER programme (Scaling-up Health-Arts Programme to scale up arts intervention; award reference 219425/Z/19/Z).

Dr. Lavinia Rebecchini.

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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 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 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.
• 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 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?
• 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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• Chicago (A-D)
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Testosterone therapy: A safe and effective gender-affirming hormone therapy for trans men

Researchers discover significant body composition changes and minimal long-term side effects in transgender men undergoing testosterone therapy.

Transgender individuals often face unique challenges in aligning their physical bodies with their true gender identity. Among the various methods employed, gender-affirming hormone therapy (GAHT) stands as a vital means for transgender men to achieve physical changes in consonance with their gender identity. Navigating the complexities that come with gender transition, transgender individuals seek medical interventions to alleviate gender dysphoria and align their bodies with their gender identity.

For transgender men, testosterone therapy holds promise in inducing masculinizing effects such as increased muscle mass, cessation of menstruation, and deepening of the voice. However, the lack of comprehensive research on the long-term effects and safety of testosterone therapy poses significant challenges in clinical decision-making and underscores the persistent taboo surrounding transgender healthcare. To address this pressing need, a study led by Assistant Professor Yusuke Tominaga along with Dr. Tomoko Kobayashi and Dr. Motoo Araki from the Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan dives into understanding the long-term physical effects and safety profile of testosterone therapy for transgender men, shedding light on crucial aspects of hormone administration and its impact on body composition. Their research findings were published in Andrology on 2 April 2024.

"The research team was inspired to investigate this area as we noticed the lack of a standardized regimen for testosterone dosage and administration. Our aim was to understand how hormone dosages are adjusted to align more closely with typical male testosterone levels in the bloodstream," explains Dr. Tominaga.

Analyzing data from transgender men who commenced GAHT between May 2000 and December 2021, the researchers meticulously recorded physical findings, blood test results, and menstrual cessation rates. They then compared the effects of testosterone on body composition changes and laboratory parameters, stratifying participants into low-dose and high-dose groups based on their testosterone dosage.

The findings of the study revealed that both low-dose and high-dose testosterone regimens demonstrated favorable outcomes, with no significant differences observed in menstrual cessation rates up to 12 months. Over time, participants exhibited a decrease in body fat percentage and an increase in lean body mass, indicative of the desired masculinizing effects of testosterone therapy.

Notably, the high-dose group exhibited greater gains in lean body mass during the initial year of therapy, suggesting a potential strategy for individuals seeking more rapid changes in body composition. Importantly, the study found no evidence of long-term, dose-dependent side effects such as polycythemia or dyslipidemia, reassuring both clinicians and transgender individuals regarding the safety profile of testosterone therapy.

Reflecting on the significance of their findings, Dr. Tominaga explains, "Our study contributes valuable evidence on the long-term effects of testosterone therapy, providing crucial insights for clinicians managing transgender healthcare. By elucidating the safety and efficacy of hormone therapy, we hope to alleviate uncertainties surrounding transgender healthcare and empower individuals to make informed decisions about their treatment."

This study opens the door to more inclusive and evidence-based care by illuminating the long-term effects and safety of testosterone therapy for transgender men.

• Men's Health
• Wounds and Healing
• Prostate Cancer
• Personalized Medicine
• Gender Difference
• Intelligence
• Testosterone
• Hormone replacement therapy
• Personalized medicine
• Maggot therapy
• MMR vaccine
• Pharmaceutical company
• Occupational therapy
• Chinese food therapy

Story Source:

Materials provided by Okayama University . Note: Content may be edited for style and length.

Journal Reference :

• Yusuke Tominaga, Tomoko Kobayashi, Yuko Matsumoto, Takatoshi Moriwake, Yoshitaka Oshima, Misa Okumura, Satoshi Horii, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Morito Sugimoto, Yasuyuki Kobayashi, Masami Watanabe, Yuzaburo Namba, Yosuke Matsumoto, Mikiya Nakatsuka, Motoo Araki. Trans men can achieve adequate muscular development through low‐dose testosterone therapy: A long‐term study on body composition changes . Andrology , 2024; DOI: 10.1111/andr.13640

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