REVIEW article

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

\nKailimi Li&#x;

  • 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.

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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.

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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 .

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

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

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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.

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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.

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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.

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

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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.

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

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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).

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

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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.

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

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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.

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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.

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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: 22 June 2021

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

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

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

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  • Medical genetics
  • Psychiatric disorders

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

Introduction

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

Scope of the article

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

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

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

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

figure 1

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

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

Music engagement and well-being

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

Music engagement and internalizing problems

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

Experimental studies

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

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

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

Correlational studies

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

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

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

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

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

Music engagement and externalizing problems

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

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

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

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

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

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

Music engagement and thought disorders

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

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

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

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

Interim summary

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

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

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

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

Theoretical framework for future studies

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

figure 2

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

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

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

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

figure 3

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

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

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

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

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

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

Path 4: Music engagement influences brain structure and function

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

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

New approaches to studying music and mental health

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

Genetic designs

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

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

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

figure 4

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

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

Neuroimaging

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

Music and reward

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

Music and brain network dynamics

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

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

Biobanks and electronic health records

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

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

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

Concluding remarks

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

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Acknowledgements

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

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

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Music and Health: What You Need To Know

Man playing saxophone

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Can music be good for you?

Yes, according to a growing body of research. Listening to or making music affects the brain in ways that may help promote health and manage disease symptoms.

Performing or listening to music activates a variety of structures in the brain that are involved in thinking, sensation, movement, and emotion. These brain effects may have physical and psychological benefits. For example, music causes the release of brain chemicals (neurotransmitters and hormones) that can evoke emotional reactions, memories, and feelings and promote social bonds. Music can even affect the structure of the brain. Certain structures in the brain have been found to be larger in musicians than nonmusicians, with particularly noticeable changes in people who started their musical training at an early age.

Increasing evidence suggests that music-based interventions may be helpful for health conditions that occur during childhood, adulthood, or aging. However, because much of the research on music-based interventions is preliminary, few definite conclusions about their effects have been reached. Many reports on the potential benefits of music-based interventions come from observations of individuals or small groups of people. Evidence of this type is valuable for suggesting new ideas, but carefully designed, scientifically rigorous studies of larger numbers of people are needed to provide stronger evidence on whether music-based interventions are effective for specific purposes.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} What is music therapy?

Music therapy is a health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs. The term “music therapy” is not a description of a specific type of intervention. Instead, it indicates the education, training, and credentials of the therapist who is delivering the intervention.

Music therapy may involve a variety of different activities, including music improvisation, music listening, song writing, music performance, and learning through music. Music therapists may work in many different settings, such as hospitals, outpatient clinics, nursing homes, senior centers, rehabilitation facilities, or schools.

Some of the music-based interventions described in this fact sheet fit the definition of music therapy, but others do not. For example, music-based interventions that involve listening to recorded music are often delivered by health professionals other than music therapists (such as nurses), and therefore do not fit the definition of music therapy.

You can learn more about music therapy on the website of the American Music Therapy Association .

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Can music be harmful?

In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. You can find out about this type of hearing loss on the National Institute on Deafness and Other Communication Disorders website .

In addition, because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music. Extensive playing of musical instruments can lead to pain and injury. Music-based interventions that involve exercise or other types of movement could also lead to injury if appropriate safety precautions are not taken.

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The preliminary research that has been done so far suggests that music-based interventions may be helpful for anxiety, depressive symptoms, and pain associated with a variety of health conditions, as well as for some other symptoms associated with dementia, multiple sclerosis, Parkinson’s disease, and other conditions. 

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As mentioned in other sections of this fact sheet, there’s evidence that music-based interventions may help to relieve pain associated with specific health conditions. The two review articles listed below describe evidence indicating that music may be helpful for pain more generally. Newer research continues to find evidence that music may be helpful for pain from a variety of causes, but not every study has shown a beneficial effect. 

  • A 2016 review looked at 97 studies (9,184 participants) of music-based interventions for acute or chronic pain associated with a variety of health problems and medical procedures. The overall evidence suggested that music-based interventions may have beneficial effects on both pain intensity and emotional distress from pain and may lead to decreased use of pain-relieving medicines.
  • A 2017 review of 14 randomized trials (1,178 participants) of music-based interventions for various types of chronic pain found that the interventions reduced self-reported chronic pain and associated depressive symptoms, with a greater effect when the music was chosen by the participant rather than the researcher. The study participants had a variety of conditions that can cause chronic pain, including cancer, fibromyalgia, multiple sclerosis, or osteoarthritis, and most of the interventions involved listening to recorded music.
  • Many but not all newer studies of music-based interventions for pain have had promising results. For example, in recent studies, music-based interventions were helpful for pain associated with childbirth, cancer chemotherapy, a procedure in which shock waves are used to break up kidney stones, retrieval of eggs for in vitro fertilization, treatment of nose fractures, and sickle cell disease. However, music didn’t seem to be helpful for reducing moderate pain further after use of a lidocaine spray for loop electrosurgical excision (a gynecological procedure), and the results of studies on pain during cystoscopy (a procedure in which a tube is inserted into the bladder) and pain during colonoscopy were inconsistent.

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Music-based interventions have been evaluated for their effects on anxiety in a variety of disease conditions and health care settings. Some examples are given in this section, and others are discussed in the sections on specific health conditions. Most studies have had promising results, except for studies on anxiety associated with dental care.

  • A 2013 review of 26 studies (2,051 participants) showed that listening to recorded music significantly reduced anxiety in people who were waiting to have surgery. However, there was potential for bias in most of the studies because the investigators who performed the studies knew which participants had listened to music.
  • A 2016 review of 17 studies (1,381 participants) that evaluated the effect of music-based interventions on anxiety in adults with cancer suggested that the interventions may have a large anxiety-reducing effect. However, there was a high risk of bias in the studies. 
  • A 2015 review of 5 studies (290 participants) in people who were having dialysis treatments suggested that listening to music reduced anxiety. However, these studies have limitations because of their small size and high risk of bias.
  • A 2018 review concluded that it’s unclear whether listening to music is helpful for dental anxiety. Some studies have suggested that listening to music as a distraction may not be adequate to reduce anxiety in children or highly anxious adults who are having dental care. More active types of music-based interventions (for example, a music-assisted relaxation technique that’s taught to the patient in advance) might be helpful in dental settings but have not been evaluated in formal studies.  

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It’s uncertain whether music-based interventions are helpful for people with ASD.

  • A 2021 review of 22 studies (850 participants) on music therapy for children with ASD was unable to reach any definite conclusions on whether adding music therapy to their care is beneficial, although some studies had promising results. For example, some studies of educational music therapy (involving techniques such as musical games) showed possible benefits on the children’s speech, and some studies of improvisational music therapy (in which children produce music) showed possible benefits on social functioning.
  • One particularly notable study of music therapy for children with ASD (which was included in the review described above) was a multinational trial involving 364 children from 9 countries. It is the largest study completed so far, and its design was especially rigorous. In this study, the severity of symptoms related to difficulties in social communication did not differ between children who received music therapy along with standard care and those who received standard care alone.

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Preliminary evidence suggests that music-based interventions may be helpful for several types of distress in people with cancer.

  • A 2021 review of randomized controlled trials (studies in which participants were randomly assigned to a music-based intervention group or a control group), which included 81 trials and 5,576 participants, concluded that in adults with cancer, music interventions may have a large anxiety-reducing effect, a moderately strong beneficial effect on depression, a moderate pain-reducing effect, and a large effect on the quality of life. Most of the trials had a high risk of bias, so their results need to be interpreted with caution. Only seven of the studies included in this review involved children. Two of these studies suggested a beneficial effect on anxiety; no other conclusions could be reached from the small amount of evidence available.
  • A 2021 review of 11 studies (491 participants) on music interventions for children and adolescents with cancer, which included some studies that were less rigorous than a randomized controlled trial, found evidence suggesting that music-based interventions may decrease anxiety, perceived pain, and depression symptoms and improve state of mind, self-esteem, and quality of life.

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A 2021 systematic review of 12 studies (812 participants) showed that music-based interventions were helpful for shortness of breath, anxiety, and sleep quality in adults with COPD but were not helpful for depression. Because the studies were brief (several days to 12 months) and because researchers measured effects in different ways in different studies, there is some uncertainty about the conclusions.

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Much research is being done on the potential benefits of music-based interventions for people with cognitive impairment or various types of dementia, such as Alzheimer’s disease. Limited evidence suggests that music-based interventions may improve emotional well-being, behavioral challenges, and quality of life in people with these conditions. Whether the interventions have benefits for cognitive functioning is unclear; effects might depend on the population studied or the type of intervention used.

  • A 2018 review evaluated 22 studies (1,097 participants) of music-based interventions for people with dementia who were living in institutions. Some of the interventions were receptive (listening to music), some were active (singing, playing instruments, moving to music, etc.), and some were a combination of the two. The evidence from these studies indicated that music-based interventions probably reduce depressive symptoms and improve overall behavioral challenges. They may also improve emotional well-being and quality of life and reduce anxiety. However, the interventions may have little or no effect on agitation, aggression, or cognitive function.
  • A 2021 review looked at 21 studies (1,472 participants) of people with either mild cognitive impairment or mild or moderate dementia; some of the people studied were living in institutions, but others were living in the community. All the music interventions were active; studies that only involved listening to music were not included. Nine of the studies (495 participants) were included in a quantitative analysis of effects on cognitive functioning; this analysis indicated that the music-based interventions had a small beneficial effect. There was also some evidence for beneficial effects on mood and quality of life.

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A 2017 review looked at 9 studies (421 participants) of music-based interventions in adults or adolescents with depression. There was moderate-quality evidence that adding music-based interventions to usual treatment improved depression symptoms when compared with usual treatment alone. Music-based interventions also helped decrease anxiety levels and improve functioning of people with depression (for example, their ability to maintain involvement in work, activities, and relationships).

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A 2020 systematic review of 7 studies (334 participants) found evidence that music-based interventions were beneficial for pain, depression, and quality of life in people with fibromyalgia. However, the amount of research was limited, and the quality of the research was low.

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A 2021 review of music-based interventions for people with multiple sclerosis (10 trials, 429 participants) found consistent evidence that the interventions were beneficial for coordination, balance, some aspects of gait and walking, emotional status, and pain, but no effect was observed for mental fatigability or memory.

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Researchers are evaluating the potential benefits of several types of music-based interventions for Parkinson’s disease symptoms. 

  • Rhythmic auditory stimulation.  Rhythmic auditory stimulation uses pulsed sounds (such as those produced by a metronome) to help people synchronize their movements to the rhythm of the sounds. This technique is used to help people with Parkinson’s disease improve their ability to walk. A 2021 analysis of 5 studies (209 total participants) showed significant improvements in gait speed and stride length in people with Parkinson’s disease who participated in rhythmic auditory stimulation. However, the quality of evidence was low, and the number of studies and participants was small.
  • Music-based movement therapy.  Music-based movement therapy combines physical activities such as dance or rhythmic exercises with music. Therapies that involve physical activity have been shown to be helpful for a variety of Parkinson’s disease symptoms. Adding music to the therapy might have additional benefits by providing auditory cues for movement and making the activities more enjoyable. A 2021 analysis of 17 studies (598 participants) of music-based movement therapy showed evidence of improvements in motor function, balance, freezing of gait, walking speed, and mental health but not gait cadence, stride length, or quality of life.
  • Singing. The potential benefits of singing for people with Parkinson’s disease have been studied primarily in terms of effects on speech. In a 2016 review of 7 studies (102 participants), 5 studies found some evidence of a beneficial effect on speech.

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Music-based interventions are widely used in neonatal intensive care units. However, evidence for physiological benefits for newborn infants is limited. 

  • In a 2020 review of 16 studies (826 infants), 12 of the studies found some evidence of benefits on physiological outcomes (such as heart rate or oxygen saturation), but several of the studies included only small numbers of infants, and the intervention methods used varied from one study to another. The reviewers concluded that the current data are insufficient to confirm physiological benefits. No harmful effects of music-based interventions were seen in the studies included in this review.

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Music-based interventions have been evaluated as adjunct treatments (additions to usual treatment) for people with schizophrenia. A 2020 review of 18 studies (1,212 participants) indicated that adjunct music-based interventions may improve a group of schizophrenia symptoms known as “negative symptoms,” such as reduced emotion and self-neglect, as well as depression symptoms and quality of life. However, music-based interventions did not reduce “positive symptoms,” such as hallucinations and delusions. The quality of the evidence was low.

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Listening to music may improve sleep quality in people with insomnia.

  • A 2022 review looked at 13 studies (1,007 participants) that examined the effect of listening to recorded music in people with insomnia. The studies suggested music had no effect on insomnia severity compared to no treatment or treatment as usual. Moderate-certainty evidence did suggest, however, that listening to music has a beneficial effect on subjective sleep quality. The studies also provided low-certainty evidence that listening to music might help improve the speed of falling asleep, the length of time spent sleeping, and the amount of time a person is asleep compared to the total time spent in bed.
  • It’s common for older people to have trouble sleeping. A 2021 review looked at 16 studies of music-based interventions for sleep in older adults (812 participants); 11 studies evaluated music listening, and the other 5 evaluated more complex interventions. The results were mixed, with some studies suggesting that the music interventions were helpful, while others did not.

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Music-based interventions, particularly music therapy, may be helpful for improving physical and psychological markers associated with stress, according to two related reviews.

  • In a 2020 review with 104 studies (9,617 participants), investigators looked at the effects of a variety of music-based interventions on measures associated with stress, including both physical measures (heart rate, blood pressure, and levels of stress-related hormones) and psychological measures (anxiety, nervousness, restlessness, and feelings of worry). The music-based interventions had a small-to-medium sized beneficial effect on the physical measures and a medium-to-large beneficial effect on the psychological measures. 
  • A second review looked at 47 studies (2,747 participants) of music therapy (excluding other music-based interventions) and found an overall medium-to-large beneficial effect on stress-related outcomes. The effects were greater than those seen in the larger review. The investigators who performed the review suggested that the opportunity for music therapists to tailor interventions to the needs of individual patients might account for the difference.

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Music-based interventions may be helpful in the rehabilitation of people who have had a stroke. A 2019 review of 27 studies (730 participants) found positive effects on physical status (upper-limb activity, various aspects of walking, balance), cognition (paying attention, communication), and mood. In particular, rhythmic auditory stimulation (which involves the use of a metronome combined with physical activities) had beneficial effects on gait and balance, and receptive music therapy (which involves listening to music while performing another task) was helpful for mood and some aspects of cognitive function.

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Tinnitus is the symptom that people often describe as “ringing in the ears,” although it can also sound like roaring, clicking, hissing, or buzzing. It can be caused by noise-induced hearing loss, blockage of the ear canal by earwax, ear or sinus infections, or other health conditions, or by starting or stopping various medications. Sometimes, tinnitus has no obvious cause.

  • Sound therapies. Various types of sounds, including music, have been used to try to mask tinnitus. However, according to a 2019 review of studies conducted up to that time, the effects of these sound therapies are modest; few people achieve complete remission of tinnitus from sound therapies.
  • Notched music therapy. A specific type of music therapy called “notched” music therapy has been suggested as a possible way to reduce the severity of tinnitus. Notched music therapy involves listening to music that has been modified to remove sounds close in frequency to the frequency of the tinnitus sound perceived by the patient. Two recent studies that compared notched music with conventional music did not find notched music to be more helpful in reducing the symptoms or impact of tinnitus. However, some earlier studies suggested that the loudness of tinnitus sounds could be reduced with notched music therapy.

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NIH and the John F. Kennedy Center for the Performing Arts, in association with the National Endowment for the Arts, are sponsoring an initiative called Sound Health to increase understanding of music’s effect on the brain and the potential clinical applications. The first Sound Health research projects began in 2019. Some projects are investigating music’s mechanism of action in the brain and how music may be applied to treat symptoms of disorders such as Parkinson’s disease, stroke, and chronic pain. Others are looking at the effects of music on children’s developing brains.

Topics of NCCIH-supported studies within the Sound Health initiative include:

  • The effects of music-based interventions on neurodevelopment and pain response in preterm infants
  • Using self-generated rhythmic cues to enhance gait in people with Parkinson’s disease
  • The impact of singing interventions on markers of cardiovascular health in older people with cardiovascular disease

In collaboration with the Foundation for the NIH and the Renée Fleming Foundation, NIH has developed a toolkit for rigorous, reproducible, well-powered music-based interventions for brain disorders of aging, such as Alzheimer’s disease, Parkinson’s disease, and stroke. Three workshops were held in 2021 to gather input from experts in a variety of relevant fields, and a request for information was issued to get stakeholder feedback. The toolkit , which was released in 2023, will be pilot tested in demonstration projects. NCCIH is playing a lead role in this effort.

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Nccih clearinghouse.

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: [email protected] (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

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  • Aalbers   S, Fusar-Poli L, Freeman RE, et al.  Music therapy for depression . Cochrane Database of Systematic Reviews. 2017;(11):CD004517. Accessed at cochranelibrary.com on October 29, 2021.
  • Bieleninik Ł, Geretsegger M, Mössler K, et al.  Effects of improvisational music therapy vs enhanced standard care on symptom severity among children with autism spectrum disorder. The TIME—a randomized clinical trial . JAMA. 2017;318(6):525-535.
  • Bradt J, Dileo C, Magill L, et al. Music interventions for improving psychological and physical outcomes in cancer patients . Cochrane Database of Systematic Reviews. 2016;(8):CD006911. Accessed at cochranelibrary.com on October 29, 2021.
  • Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety . Cochrane Database of Systematic Reviews. 2013;(6):CD006908. Accessed at cochranelibrary.com  on October 29, 2021.
  • Burrai F, Apuzzo L, Zanotti R. Effectiveness of rhythmic auditory stimulation on gait in Parkinson disease: a systematic review and meta-analysis . Holistic Nursing Practice. June 11, 2021. [Epub ahead of print].
  • Cheever T, Taylor A, Finkelstein R, et al. NIH/Kennedy Center workshop on music and the brain: finding harmony . Neuron. 2018;97(6):1214-1218.
  • Collins FS, Fleming R. Sound health: an NIH-Kennedy Center initiative to explore music and the mind . JAMA. 2017;317(24):2470-2471.
  • de Witte   M, da Silva Pinho A, Stams G-J, et al. Music therapy for stress reduction: a systematic review and meta-analysis . Health Psychology Review. 2022;16(1):134-159.
  • de Witte   M, Spruit A, van Hooren S, et al. Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses . Health Psychology Review. 2020;14(2):294-324.
  • Dorris   JL, Neely S, Terhorst L, et al. Effects of music participation for mild cognitive impairment and dementia: a systematic review and meta-analysis . Journal of the American Geriatrics Society.  2021;69(9):2659-2667.
  • Foroushani SM, Herman CA, Wiseman CA, et al. Evaluating physiologic outcomes of music interventions in the neonatal intensive care unit: a systematic review . Journal of Perinatology. 2020;40(12):1770-1779.
  • Garza-Villareal   EA, Pando V, Vuust P, et al. Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis . Pain Physician. 2017;20(7):597-610.
  • Jespersen KV, Pando-Naude V, Koenig J, et al. Listening to music for insomnia in adults . Cochrane Database of Systematic Reviews. 2022;(8):CD010459. Accessed at cochranelibrary.com on September 8, 2022.
  • Lee   JH. The effects of music on pain: a meta-analysis . Journal of Music Therapy. 2016;53(4):430-477.
  • van der Steen   JT, Smaling HJ, van der Wouden JC, et al. Music-based therapeutic interventions for people with dementia . Cochrane Database of Systematic Reviews. 2018;(7):CD003447. Accessed at cochranelibrary.com on October 29, 2021.

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  • Atipas   S, Therdphaothai J, Suvansit K, et al. A randomized, controlled trial of notched music therapy for tinnitus patients. Journal of International Advanced Otology. 2021;17(3):221-227.
  • Barnish J, Atkinson RA, Barran SM, et al. Potential benefit of singing for people with Parkinson’s disease: a systematic review. Journal of Parkinson’s Disease. 2016;6(3):473-484.
  • Bird HA. Overuse syndrome in musicians. Clinical Rheumatology. 2013;32(4):475-479.
  • Bradt J, Teague A. Music interventions for dental anxiety. Oral Diseases. 2018;24(3):300-306.
  • Brancatisano O, Baird A, Thompson WF. Why is music therapeutic for neurological disorders? The therapeutic music capacities model. Neuroscience and Biobehavioral Reviews. 2020;112:600-615.
  • Buglione A, Saccone G, Mas M, et al. Effect of music on labor and delivery in nulliparous singleton pregnancies: a randomized clinical trial. Archives of Gynecology and Obstetrics.  2020;310(3):693-698.
  • Burrai F, Magavern EF, Micheluzzi V, et al. Effectiveness of music to improve anxiety in hemodialysis patients. A systematic review and meta-analysis. Holistic Nursing Practice. 2020;34(6):324-333.
  • Cakmak O, Cimen S, Tarhan H, et al. Listening to music during shock wave lithotripsy decreases anxiety, pain, and dissatisfaction. A randomized controlled study. Wiener Klinische Wochenscrift.  2017;129(19-20):687-691.
  • Ç elebi D, Y ı lmaz E, Ş ahin ST, et al. The effect of music therapy during colonoscopy on pain, anxiety and patient comfort: a randomized controlled trial. Complementary Therapies in Clinical Practice. 2020;38:101084.
  • Chantawong N, Charoenkwan K. Effects of music listening during loop electrosurgical excision procedure on pain and anxiety: a randomized trial. Journal of Lower Genital Tract Disease. 2017;21(4):307-310.
  • Cheung CWC, Yee AWW, Chan PS, et al. The impact of music therapy on pain and stress reduction during oocyte retrieval—a randomized controlled trial. Reproductive Biomedicine Online. 2018;37(2):145-152.
  • Çift   A, Benlioğlu C. Effect of different musical types on patient’s relaxation, anxiety and pain perception during shock wave lithotripsy: a randomized controlled study. Urology Journal. 2020;17(1):19-23.
  • Gonz á lez-Mart í n-Moreno   M, Garrido-Ardila EM, Jim é nez-Palomares M, et al. Music-based interventions in paediatric and adolescents oncology patients: a systematic review. Children. 2021;8(2):73.
  • Huang J, Yuan X, Zhang N, et al. Music therapy in adults with COPD. Respiratory Care. 2021;66(3):501-509.
  • Jia   R, Liang D, Yu J, et al. The effectiveness of adjunct music therapy for patients with schizophrenia: a meta-analysis. Psychiatry Research. 2020;293:113464.
  • Ko SY, Leung DYP, Wong EML. Effects of easy listening music intervention on satisfaction, anxiety, and pain in patients undergoing colonoscopy: a pilot randomized controlled trial. Clinical Interventions in Aging. 2019;14:977-986.
  • Koelsch S. A neuroscientific perspective on music therapy. Annals of the New York Academy of Sciences. 2009;1169:374-384.
  • Le Perf   G, Donguy A-L, Thebault G. Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review. Topics in Stroke Rehabilitation.  2019;26(6):473-484.
  • Lopes   J, Keppers II. Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials. Arquivos de Neuro-psiquiatria.  2021;79(6):527-535.
  • Mayer-Benarous   H, Benarous X, Vonthron F, et al. Music therapy for children with autistic spectrum disorder and/or other neurodevelopmental disorders: a systematic review. Frontiers in Psychiatry. 2021;12:643234.
  • McClintock G, Wong E, Mancuso P, et al. Music during flexible cystoscopy for pain and anxiety – a patient-blinded randomized control trial. BJU International. 2021;128 Suppl 1:27-32. 
  • Mumm J-N, Eismann L, Rodler S, et al. Listening to music during outpatient cystoscopy reduces pain and anxiety and increases satisfaction: results from a prospective randomized study. Urologia Internationalis . 2021;105(9-10):792-798. 
  • Ortega   A, Gauna F, Munoz D, et al. Music therapy for pain and anxiety management in nasal bone fracture reduction: randomized controlled clinical trial. Otolaryngology—Head and Neck Surgery. 2019;161(4):613-619.
  • Perković R, Dević K, Hrkać A, et al. Relationship between education of pregnant women and listening to classical music with the experience of pain in childbirth and the occurrence of psychological symptoms in puerperium. Psychiatria Danubina. 2021;33(Suppl 13):260-270.
  • Petrovsky DV, Ramesh P, McPhillips MV, et al. Effects of music interventions on sleep in older adults: a systematic review. Geriatric Nursing.  2021;42(4):869-879.
  • Pienkowski M. Rationale and efficacy of sound therapies for tinnitus and hyperacusis. Neuroscience. 2019;407:120-134.
  • Piromchai   P, Chompunut S, Kasemsiri P, et al. A three-arm, single-blind, randomized controlled trial examining the effects of notched music therapy, conventional music therapy, and counseling on tinnitus. Otology & Neurotology. 2021;42(2):335-340.
  • Robb SL, Hanson-Abromeit D, May L, et al. Reporting quality of music intervention research in healthcare: a systematic review. Complementary Therapies in Medicine. 2018;38:24-41.
  • Rodgers-Melnick SN, Matthie N, Jenerette C, et al. The effects of a single electronic music improvisation session on the pain of adults with sickle cell disease: a mixed methods pilot study. Journal of Music Therapy.  2018;55(2):156-185.
  • Silverman MJ, Gooding LF, Yinger O. It’s…complicated: a theoretical model of music-induced harm. Journal of Music Therapy. 2020;57(3):251-281.
  • Speranza L, Pulcrano S, Perrone-Capano C, et al. Music affects functional brain connectivity and is effective in the treatment of neurological disorders. Reviews in the Neurosciences. March 24, 2022. [Epub ahead of print].
  • Tang   H, Chen L, Wang Y, et al. The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy. Supportive Care in Cancer. 2021;29(12):7299-7306.
  • Wang M, Yi G, Gao H, et al. Music-based interventions to improve fibromyalgia syndrome: a meta-analysis. Explore. 2020;16(6):357-362.
  • Wolff AL, Ling DI, Casey EK, et al. Feasibility and impact of a musculoskeletal health for musicians (MHM) program for musician students: a randomized controlled pilot study. Journal of Hand Therapy. 2021:34(2):159-165.
  • Zhou   Z, Zhou R, Wei W, et al. Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: a systematic review and meta-analysis. Clinical Rehabilitation. 2021;35(7):937-951.

Acknowledgments

NCCIH thanks Wen Chen, Ph.D., Emmeline Edwards, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of this fact sheet. 

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Related Topics

Music and Health - Systematic Reviews/Reviews/Meta-analyses (PubMed®)

Music and Health - Randomized Controlled Trials (PubMed®)

For Consumers

6 Things You Need To Know About Music and Health

For Health Care Providers

Music and Health

Research 

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

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

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

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

Research Work Areas

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

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

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

Call for Participants!

My name is Caroline Lang. I am a final year master’s student at the University of the West of England, studying a degree in Music Therapy

Are you a Music Therapist who works with children who are currently or have previously received hospital treatment which has involved an invasive medical procedure? The main purpose of this research is to explore the role that music therapy plays in supporting children who are undergoing hospital treatment that involves an invasive medical procedure(s). Participation involves a qualitative interview which will last up to 1 hour. If you are interested in taking part or have any questions? Please contact: [email protected] .

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

Book cover

  • © 2023

Music Therapy and Music-Based Interventions in Neurology

Perspectives on Research and Practice

  • Kerry Devlin 0 ,
  • Kyurim Kang 1 ,
  • Alexander Pantelyat 2

Center for Music and Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

You can also search for this editor in PubMed   Google Scholar

Synthesizes the current knowledge about how music can help patients with Neurological diseases

Fills a need for a guide of clinical interventions for music therapy

Written for those looking to include music as part of their Neurological disease treatment

Part of the book series: Current Clinical Neurology (CCNEU)

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  • Table of contents

About this book

Editors and affiliations, about the editors, bibliographic information.

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Table of contents (17 chapters)

Front matter, introduction: principles and overview of music therapy and music-based interventions.

Kerry Devlin, Kyurim Kang, Alexander Pantelyat

Mechanisms of Music Therapy and Music-Based Interventions

  • Takako Fujioka, Andrea McGraw Hunt

Music for Stroke Rehabilitation

  • Anna Palumbo, Soo Ji Kim, Preeti Raghavan

Music for Traumatic Brain Injury and Impaired Consciousness

  • Jeanette Tamplin, Janeen Bower, Sini-Tuuli Siponkoski

Music for Movement Disorders

  • Yuko Koshimori, Kyurim Kang, Kerry Devlin, Alexander Pantelyat

Music for Speech Disorders

  • Yune Sang Lee, Michelle Wilson, Kathleen M. Howland

Music for Memory Disorders

  • Hanne Mette Ridder, Concetta Tomaino

Music for Neuro-oncological Disorders

  • Claudia Vinciguerra, Valerio Nardone, Matthias Holdhoff

Music Therapy and Music-Based Interventions for Neurologic Palliative Care

  • Noah Potvin, Maegan Morrow, Charlotte Pegg

Music for Autoimmune Neurological Disorders

  • Cindybet Pérez-Martínez, Flor del Cielo Hernández, Jamie Shegogue

Music for Epilepsy

  • Robert J. Quon, Ondřej Strýček, Alan B. Ettinger, Michael A. Casey, Ivan Rektor, Barbara C. Jobst

Music for Surgical/Perioperative Care

  • Kelly M. Webber, Myrna Mamaril

Telehealth Music Therapy in Adult Neurological Care

  • Amy Clements-Cortés, Melissa Mercadal-Brotons

Therapeutic Technology for Music-Based Interventions

  • Kirsten Smayda, Brian Harris

Music Therapy and Music-Based Approaches with Autistic People: A Neurodiversity Paradigm-Informed Perspective

  • Hilary Davies, Michael B. Bakan

Psychosocial Aspects of Music Therapy

  • Amanda Rosado, Rebecca Vaudreuil

Conclusions and Future Directions

Back matter.

This book synthesizes knowledge about the myriad ways music can support the physical and psychosocial needs of people living with neurological diagnoses. It may be a useful tool for those working or training as music therapists, as well as clinicians and patients interested in the use of music and rhythm to address individualized healthcare goals.

The editors of this book advocate for a collaborative, holistic approach to the implementation of music-based interventions, acknowledging that different (and at times, conflicting) approaches do exist – and that different patients may require exploration of different approaches to have their needs and desires met in ways most meaningful to them. The book’s many contributors embody this desire to hold space for wide-ranging views on clinical practice through the ways they share their own perspectives as music therapists, neurologists, nurses, speech and language pathologists, and neuroscience researchers from across the globe.

Each chapter is centered around clinical work in context with a specific patient community – be that a diagnosis (e.g., movement disorders), shared culture (e.g., autistic culture), disease stage (e.g., end of life), or targeted clinical need (e.g., psychosocial support and/or functional performance) – and features a summary of available research with case examples and clinical descriptions to highlight different conceptualizations of the role of music in the care of patients with neurologic diagnoses. 

  • Music therapy
  • Neurological diseases
  • Neuroscience
  • Movement disorders
  • Memory disorders
  • Neuro-Oncological Disorders
  • Autoimmune neurological disorders
  • Traumatic brain injury
  • Psychosocial Aspects

Alexander Pantelyat, M.D.

Associate Professor of Neurology,

Johns Hopkins University School of Medicine

Director, Johns Hopkins Atypical Parkinsonism Center/CurePSP Center of Care/Co-Principal Investigator, LBDA Research Center of Excellence

Co-Director, Johns Hopkins Movement Disorders Fellowship Program

Director, Johns Hopkins Center for Music and Medicine

Baltimore, MD, USA

Kerry Devlin, MMT, LPMT, MT-BC

Senior Music Therapist

Kyurim Kang, Ph.D., LPMT, MT-BC, NMT

Book Title : Music Therapy and Music-Based Interventions in Neurology

Book Subtitle : Perspectives on Research and Practice

Editors : Kerry Devlin, Kyurim Kang, Alexander Pantelyat

Series Title : Current Clinical Neurology

DOI : https://doi.org/10.1007/978-3-031-47092-9

Publisher : Humana Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

Hardcover ISBN : 978-3-031-47091-2 Published: 17 February 2024

Softcover ISBN : 978-3-031-47094-3 Due: 03 March 2025

eBook ISBN : 978-3-031-47092-9 Published: 16 February 2024

Series ISSN : 1559-0585

Series E-ISSN : 2524-4043

Edition Number : 1

Number of Pages : XV, 234

Number of Illustrations : 6 b/w illustrations, 6 illustrations in colour

Topics : Neurology , Neurosciences

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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

JMTcover

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

MTMmasthead

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

imagine2013

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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Opera legend Renee Fleming teams up with Dr. Francis Collins to study how music can improve health

Jeffrey Brown

Jeffrey Brown Jeffrey Brown

Anne Azzi Davenport

Anne Azzi Davenport Anne Azzi Davenport

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  • Copy URL https://www.pbs.org/newshour/show/geneticist-and-opera-singer-team-up-to-study-how-music-can-improve-health

Giants in their fields of music and science are merging their knowledge to propel advancements in body and mind. A recent international gathering of researchers, therapists and artists took stock of what is known and what is yet to be discovered. Jeffrey Brown reports for our ongoing arts and health coverage on CANVAS.

Read the Full Transcript

Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

Amna Nawaz:

Two giants of music and science are merging their knowledge to propel advancements in body and mind.

Researchers, therapists, and artists from around the world gathered to explore what is known and what is yet to be discovered.

Jeffrey Brown takes a look and a listen for our ongoing arts and health coverage on Canvas.

Jeffrey Brown :

She is a singer, one of the world's most beloved sopranos. But at times in her remarkable career, Renee Fleming has experienced terrible bouts of somatic pain, the body's way of distracting her from the mental anxiety brought from performance.

Renee Fleming, Singer:

I was never a natural performer. And so I just kept reading and reading about the mind-body connection, trying to understand more about what was causing this, et cetera. And I discovered that the medical profession and neuroscientists were studying music. And I asked him why one day.

He is the renowned physician-geneticist best known for his landmark discoveries of disease genes and leadership of the Human Genome Project.

Dr. Francis Collins, Former Director, National Institutes of Health: Today, we celebrate the revelation of the first draft of the human book on life.

Francis Collins headed the National Institutes of Health, the world's largest supporter of biomedical research, for 12 years until 2021.

Dr. Francis Collins:

I'm a doctor. I want to find every possible way to help people who are suffering from illnesses or other kinds of life experiences that are limiting their ability to flourish. I want to make everybody flourish, and music is such a powerful source of that kind of influence.

Together, they are leading proponents of a marriage of arts and health, advocates for research, understanding, and practice in the nexus of music and the brain.

We talked recently on the NIH campus about their music and health initiative, now in its seventh year.

Renee Fleming:

I believe the arts should be embedded in health care across the boards.

Embedded meaning?

Meaning, we already have it in many, many places. Many hospitals have discovered just how beneficial it is to have creative arts therapists on staff. Children's hospitals should have a creative arts studio, I think, available to parents and their children and families. So, I just think it should be everywhere in health care.

It's a growing movement, one we have been reporting on around the country, including neuroscientists at Johns Hopkins studying music's impact on dementia patients, a hospital at the University of Florida incorporating arts into its care, individuals who've suffered traumatic brain injuries, like former Congresswoman Gabby Giffords, playing the French horn to help rewire her brain and rebuild her ability to speak.

Our understanding of the brain's connections and responses is still in early stages, Francis Collins says, with projects like the NIH-funded BRAIN Initiative helping show how individual circuits connect and respond. We do know some basics, however.

I think you can say the acoustic cortex, which is where your brain processes incoming sound, and particularly musical sound, does have some pretty interesting circuits. It's also plastic. It responds to training.

If you look at the brain of somebody who had intense musical training before age 7, you can actually see that part of the cortex is a little larger than in somebody who did not have that. So, our brains are responding to the environment very clearly in that way.

And then you can say, OK, if you have a musical experience that affects you, you can see how that signal that starts out in the acoustic cortex spreads to many other parts of the brain.

Maybe you have had an MRI? Renee Fleming got in and sang for two hours.

When I show this video to people, I always say, well, no Grammys for this performance.

One interesting finding, that for an experienced singer like Fleming, her brain circuits were more active while she thought about or imagined singing than when she actually sang.

Did that surprise you?

It surprised me a great deal. It's also — I think what's even more surprising to me is that music actually is in every known mapped part of the brain. So it's extraordinarily diverse and throughout the entire brain, as we know, as we currently understand it.

The research so far has a wide range of implications for child development, Alzheimer's, and other forms of dementia, Parkinson's, and other conditions and interventions.

Some research goes on in labs, some in the world, as in a study in which individuals were offered singing lessons. One group was given individual training, the other as part of a chorus.

For 12 weeks, and to just see what happens as far as their health, the people that had individual singing, they did OK. The people in the choir, by all kinds of measures, were actually affected in a very positive way.

Many of them had chronic pain. Their chronic pain was noticeably reduced. They had various measures of personal attitudes. Their attitude toward generosity went straight up, and their oxytocin levels went up too, as another sort of hormonal measure of good will, good sense of health.

My favorite is, postpartum depression is tremendously benefited by singing in a choir. I would never have — I wouldn't have guessed that.

Having even one risk factor…

In fact, you know those advertisements for drugs we're all bombarded with?

Ask your doctor or pharmacist if Paxlovid is right for you.

Renee Fleming has one she'd like to see.

Ask your doctor if music therapy is right for you.

As a kind of prescription.

Exactly. Exactly.

(Crosstalk)

The prescription. Why not?

Yes, but you have to — you're saying it still has to be shown exactly in a scientific method…

… for a doctor to be willing to prescribe it.

Sure. That's our system, and I'm totally behind it. You need evidence that this actually isn't just a nice thing; it actually improves outcomes.

I'm pretty convinced from the data we have that's the case for various places, but let's tighten that up. Let's make it absolutely incontrovertible. And then you will have a better chance with the insurance companies saying OK, because that may save them money in the long run.

Let's listen to this melody line as it floats all the way up.

At this recent gathering and others, Fleming and Collins are advancing new findings through a variety of collaborations, including NIH Music and Health with 20 NIH institutes, the Kennedy Center's Sound Health partnership, and the Renee Fleming Foundation.

Everything you're talking about requires a kind of buy-in from your communities, the arts world and the science world. But is there still pushback?

There's a bit, but I think were getting some real momentum going. It doesn't hurt that scientists are also musicians. At least, many of them are.

This workshop, we invited multiple leadership at NIH to come and take part, and they all said pretty much yes, and they went away saying, that was even more interesting than I thought.

A young person now goes to the music conservatory, you want them to study therapy, science, health?

Well, these would be divisions within a conservatory or university.

But there's definite buy-in now. But when I started, people were saying exactly what you're saying, is, well, we have too much to do already with what were doing, in terms of presenting, and we're strapped, and the funding is difficult, et cetera, et cetera.

But I think pretty much everyone is on board now, because we're community service providers. So, I think people who run performing arts organizations and conservatories are starting to see the benefit of it.

And these two don't just talk about bringing their disciplines together. They have been known to give it literal form, as amateur musician Francis Collins accompanies science-fascinated Renee Fleming.

For the "PBS NewsHour," I'm Jeffrey Brown at the National Institutes of Health in Bethesda, Maryland.

And Fleming has edited a collection of essays from scientists, artists, and therapists called "Music and Mind: Harnessing the Arts for Health and Wellness." That's due out this spring.

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In his more than 30-year career with the NewsHour, Brown has served as co-anchor, studio moderator, and field reporter on a wide range of national and international issues, with work taking him around the country and to many parts of the globe. As arts correspondent he has profiled many of the world's leading writers, musicians, actors and other artists. Among his signature works at the NewsHour: a multi-year series, “Culture at Risk,” about threatened cultural heritage in the United States and abroad; the creation of the NewsHour’s online “Art Beat”; and hosting the monthly book club, “Now Read This,” a collaboration with The New York Times.

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Addressing yale’s history of slavery — and building a stronger community.

Kimberly Goff-Crews and Charles Warner

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On Feb. 16, Yale University marked a milestone in its comprehensive, long-term examination of the university’s historical role in and associations with slavery, publishing a related peer-reviewed book and announcing several new commitments and actions in response to its findings.

The book, “Yale and Slavery: A History,” which is available in a free digital version , was authored by Yale Professor David W. Blight with the Yale and Slavery Research Project, a group convened in 2020 to better understand the university’s history — specifically its formative ties to slavery and the slave trade. The group included faculty, staff, students, and New Haven community members.

To mark the occasion, Yale also hosted a campus event, broadcast via livestream, in which members of the university and New Haven communities highlighted the research project’s findings and Yale’s new commitments to create a stronger community. See photo slideshow above and watch a recording of the full event .

The findings of the Yale and Slavery Research project, Salovey said Friday, “provide a deeper, more honest understanding of who we are and how we got here.

“ The efforts of the team give us a necessary foundation from which to build a stronger, more knowledgeable and more vibrant university — indeed a more vibrant society.”

Other speakers included Kimberly Goff-Crews, the university secretary and vice president for university life; Blight, Sterling Professor of History and African American Studies and director of the Gilder Lehrman Center for the Study of Slavery, Resistance, and Abolition at Yale; and project member Charles Warner, chairman of the Connecticut Freedom Trail, member of the Amistad Committee Inc. Board of Directors, and chairman of the Dixwell Congregational Church History Committee.

Learn about the project and its findings at the Yale and Slavery Research Project website .

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

Celia moreno-morales.

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

Raul Calero

Pedro moreno-morales.

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

Cristina Pintado

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

Associated Data

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

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

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

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

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

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

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

Introduction

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

Search Strategy and Selection Criteria

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

An external file that holds a picture, illustration, etc.
Object name is fmed-07-00160-g0001.jpg

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

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

Data Collection, Extraction, and Quality Assessment

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

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

Characteristics of the studies.

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

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

Outcome Measures

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

Statistical Analysis: Meta-Analysis

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

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

Baseline Characteristics

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

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

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

Efficacy of Musical Intervention in Cognitive Function

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

An external file that holds a picture, illustration, etc.
Object name is fmed-07-00160-g0002.jpg

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

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

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

Efficacy of Musical Intervention in Quality of Life

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

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

Efficacy of Musical Intervention in the Depressive State

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

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

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

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

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

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

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

Conclusions

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

Limitations And Potential Explanations

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

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

Future Research Recommendation

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

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

Data Availability Statement

Author contributions.

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

Conflict of Interest

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

Supplementary Material

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

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    Music therapy is a diverse field and music therapy research increasingly reflects that diversity. Many methods and approaches are used to examine the various facets of music therapy practice and theory. This chapter provides an overview of music therapy research, and provides basic information about how research is conducted in this field.

  13. Music as medicine

    The researchers found that listening to and playing music increase the body's production of the antibody immunoglobulin A and natural killer cells — the cells that attack invading viruses and boost the immune system's effectiveness. Music also reduces levels of the stress hormone cortisol. "This is one reason why music is associated with ...

  14. Mental health and music engagement: review, framework, and ...

    Our goals in this scoping review are to (1) describe the state of music engagement research regarding its associations with mental health outcomes, (2) introduce a theoretical framework for...

  15. Music Therapy

    Music Therapy in Mental Health Treatment. Lori F. Gooding PhD, MT-BC, in Music Therapy: Research and Evidence-Based Practice, 2018 Conclusion. Music therapy has been successfully implemented with both children and adults in a wide range of settings. It has been shown to be a flexible treatment modality and to be able to promote wellness as well as address the needs of those with SEMIs.

  16. The State of Music Therapy Studies in the Past 20 Years: A Bibliometric

    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 ).

  17. Music and Health: What You Need To Know

    Learn how music can affect the brain and the body, and how music-based interventions may be helpful for various health conditions. Find out about the research supported by the National Institutes of Health (NIH) and the National Center for Complementary and Integrative Health (NCCIH) on music therapy, music listening, song writing, and more.

  18. Music Therapy with Specific Populations: Fact Sheets, Resources

    Autism Spectrum Disorders: Music Therapy Research and Evidenced-Based Practice Support; Habilitation: Music Therapy Research and Evidenced-Based Practice Support; Music Therapy and Special Education Services Brief Update of Published Evidence; Music Therapy in Mental Health - Evidenced-Based Practice Support

  19. British Association for Music Therapy :: Research

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

  20. Effects of music and music therapy on mood in neurological patients

    Although the Jadad score evaluation revealed a generally poor methodological quality of the research protocols, we found that almost all studies supported the effectiveness of musical interventions in improving mood, depression, quality of life, functional recovery, and neuromotor performances.

  21. Can Music Therapy Help People with Bipolar Disorder?

    Music therapy offers many mental health benefits, including helping to manage symptoms of anxiety and depression. Some research suggests that it might also help with bipolar disorder.

  22. Music Therapy and Music-Based Interventions in Neurology

    Synthesizes the current knowledge about how music therapy and other music-based approaches can help patients with neurological diseases ... and features a summary of available research with case examples and clinical descriptions to highlight different conceptualizations of the role of music in the care of patients with neurologic diagnoses. ...

  23. Journals and Publications, ENews, Music Therapy Matters

    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 ...

  24. Opera legend Renee Fleming teams up with Dr. Francis Collins to study

    Giants in their fields of music and science are merging their knowledge to propel advancements in body and mind. A recent international gathering of researchers, therapists and artists took stock ...

  25. Music Therapy for Posttraumatic Stress in Adults: A Theoretical Review

    There is theoretical and empirical evidence to suggest that individuals with trauma exposure and Posttraumatic Stress Disorder (PTSD), a condition characterized by enduring symptoms of distressing memory intrusions, avoidance, emotional disturbance, and hyperarousal, may derive benefits from music therapy.

  26. Addressing Yale's history of slavery

    The book, "Yale and Slavery: A History," which is available in a free digital version, was authored by Yale Professor David W. Blight with the Yale and Slavery Research Project, a group convened in 2020 to better understand the university's history — specifically its formative ties to slavery and the slave trade. The group included ...

  27. Music Therapy in the Treatment of Dementia: A Systematic Review and

    Future music therapy studies need to define a theoretical model, ... 54, 55). The investment in research in this novel therapy could lead to its implementation as a new and alternative intervention together with current cognitive-behavioral and pharmacological therapies. Data Availability Statement.