research topics music therapy

REVIEW article

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

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

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

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

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

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

Introduction

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

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

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

Materials and Methods

Search strategy.

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

Inclusion Criteria

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

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

Data Extraction

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

Analysis Methods

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

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

Publication Outputs and Time Trends

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

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

Distribution by Country or Region and Institution

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

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

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

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

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

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

Distribution by Journals

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

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

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

Distribution by Authors

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

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

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

Analysis of Keywords

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

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

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

Analysis of Co-cited References

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

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

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

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

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

Global Trends in Music Therapy Research

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

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

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

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

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

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

Research Focus on the Research Frontier and Hot Topics

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

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

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

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

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

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

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

Strengths and Limitations

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

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

Conclusions

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

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

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

Author Contributions

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

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

Conflict of Interest

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

Abbreviations

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

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

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

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

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

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

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

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

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• Medical genetics
• Psychiatric disorders

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

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Introduction.

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

Scope of the article

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

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

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

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

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

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

Music engagement and well-being

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

Music engagement and internalizing problems

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

Experimental studies

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

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

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

Correlational studies

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

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

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

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

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

Music engagement and externalizing problems

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

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

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

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

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

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

Music engagement and thought disorders

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

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

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

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

Interim summary

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

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

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

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

Theoretical framework for future studies

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

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

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

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

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

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

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

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

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

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

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

Path 4: Music engagement influences brain structure and function

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

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

New approaches to studying music and mental health

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

Genetic designs

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

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

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

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

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

Neuroimaging

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

Music and reward

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

Music and brain network dynamics

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

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

Biobanks and electronic health records

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

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

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

Concluding remarks

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

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Acknowledgements

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

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

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

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

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

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

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Music’s power over our brains

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

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

• Cognition and the Brain
• Neuropsychology

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

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

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

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

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

Enhancing child development

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

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

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

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

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

Music and mental illness

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

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

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

Therapy for older adults

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

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

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

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

Further reading

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

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

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

Recommended Reading

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The Transformative Power of Music in Mental Well-Being

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

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

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

Healing Trauma and Building Resilience

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

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

Empowerment, Advocacy and Social Change

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

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

Fostering Social Connection and Support

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

Musicians and Normalizing Mental Health

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

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

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

More on Music Therapy

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

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

• Gustavson, D.E., et al. Mental health and music engagement: review, framework, and guidelines for future studies. Transl Psychiatry 11, 370 (2021). https://doi.org/10.1038/s41398-021-01483-8
• Golden, T. L., et al. (2021). The use of music in the treatment and management of serious mental illness: A global scoping review of the literature. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.649840
• Schouler-Ocak, M., et al. (2021). Racism and mental health and the role of Mental Health Professionals. European Psychiatry, 64(1). https://doi.org/10.1192/j.eurpsy.2021.2216
•  Aalbers, S., et al. (2017). Music therapy for Depression. Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.cd004517.pub3
• Dingle, G. A., et al. (2021). How do music activities affect health and well-being? A scoping review of studies examining Psychosocial Mechanisms. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.713818
• Americans for the Arts. (n.d.). A Working Guide to the Landscape of Arts for Change. Animating Democracy. http://animatingdemocracy.org/sites/default/files/Potts%20Trend%20Paper.pdf
• Stupacher, J., Mikkelsen, J., Vuust, P. (2021). Higher empathy is associated with stronger social bonding when moving together with music. Psychology of Music, 50(5), 1511–1526. https://doi.org/10.1177/03057356211050681
• Wesseldijk, L.W., Ullén, F. & Mosing, M.A. The effects of playing music on mental health outcomes. Sci Rep 9, 12606 (2019). https://doi.org/10.1038/s41598-019-49099-9

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Good Research Topics about Music Therapy

• Active Music Therapy for Parkinson’s Disease
• Effectiveness of Music Therapy for Survivors of Abuse
• Music Therapy Effectiveness for Treatment of Alzheimer’s Disease
• The Link between Ancestral Hormones and Music Therapy
• Analysis of the Effectiveness of Art and Music Therapy
• Music Therapy Usefulness for Cancer Patients
• Music Therapy Impact on Students with Emotional and Behavioral Disorders
• Healing Chronic Pain with Music Therapy
• Music Therapy Effect on the Wellness and Mood of Adolescents
• Comparing Cognitive Behavioral Therapy and Music Therapy
• Constructing Optimal Experience for the Hospitalized Newborn Through Neuro-Based Music Therapy
• Music Therapy: Considerations for the Clinical Environment
• Music Therapy for Children with Autism Spectrum Disorder
• Discussing Music Therapy: Reducing Stress, Health, and Social Care
• Music Therapy for Delinquency Involved Juveniles through Tripartite Collaboration
• Heidelberg Neuro Music Therapy Enhances Task-Negative Activity in Tinnitus Patients
• Music Therapy for Post-Traumatic Stress Disorder

Interesting Topics to Write about Music Therapy

• How Does Music Therapy Promote Positive Mental Health?
• The Relationships between Learning and Music Therapy
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• Music Therapy: How Does Music Impact Our Emotions?
• Dealing with Depression with the Help of Music Therapy
• Effectiveness of Music Therapy and Drug Therapy for Children with Autism
• The Link between Music Therapy and Personality Theory Psychology
• How Music Therapy Improves Depression Among Older Adults
• Music Therapy: The Best Way to Help Children with Mental Illness
• Interventions of Music Therapy for Stress Reduction
• Neurologic Music Therapy Training for Mobility and Stability Rehabilitation
• Nursing Theory for Music Therapy Quality Improvement Program
• The Help of Music Therapy in Pain Management
• Relationship between Hypertension and Music Therapy
• Yoga and Music Therapy as Effective Methods of Stress Management

17 Ways to Support Students Whose Behavior ...

Research topics about ebola.

Matthew Lynch

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80 Music Therapy Essay Topic Ideas & Examples

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

• Music Therapy for Schizophrenic Patients’ Quality of Life Consequently, the purpose of the project will be to review the existing literature and prepare a document with recommendations regarding MT in the discussed population, including psychiatric nurses’ acceptable role in delivering such interventions.
• Music Therapy as Experiential Activity For this reason, a technique was applied to the 10-year-old child with developmental delays to transform the lyrics of the favorite sad melody into a more positively inspiring and uplifting one.
• Art and Music Therapy Coverage by Health Insurance However, I do believe that creative sessions should be available for all patients, and I am going to prove to you that music and art are highly beneficial for human health.
• Music Therapy in Healthcare Therefore, the article suggests that music can be used for relaxation, as well as managing the health issues that may arise due to the lack of relaxation.
• Music Therapy for Children With Learning Disabilities This review includes the evidence supporting music therapy as an effective strategy for promoting auditory, communication, and socio-emotional progression in children with ASD.
• Music Therapy as a Related Service for Students With Disabilities From a neuroscientific perspective, how would music intervention improve classroom behaviors and academic outcomes of students with ADHD as a way to inform policy-makers of the importance of music therapy as a related service?
• Music Therapy: The Impact on Older Adults There is therefore the need to focus more energy to aid more understating on the role of music therapy on older residents.”The recent qualitative review of literature in the area of music and music therapy […]
• Music Therapy: Alternative to Traditional Pain Medicine The sources underline that therapists should pay attention to the subjects of music and their impact on the health of clients.
• The Role of Music Therapy as Alternative Treatment Music therapy is the use of music interventions to achieve individualized goals of healing the body, mind, and spirit. Thereafter, several developments occurred in the field of music therapy, and the ringleaders founded the American […]
• Music Therapy Effectiveness In addition to this, research has shown that stroke patients become more involved in therapy sessions once music is incorporated in the treatment program; this is the motivational aspect of music.
• Sound as an Element of Music Therapy This is one of the reasons why in the Abrams study the participants explained that they preferred the sound of rain, ocean waves and the soft strumming of a guitar as compared to the work […]
• Music Therapy Throughout the Soloist Globally, classical music in its sense has always been known to adjoin the listener to some transcendent understanding of the world order, the feeling of integrity with the Universe and enormous delight rising up from […]
• Music Therapy: Where Words Cease In spite of the fact that, as a rule, one indulges into art to find the shelter from the reality, the author of the book called The Soloist explores quite a different issue of the […]
• Active Music Therapy for Parkinson’s Disease
• Effectiveness of Music Therapy for Survivors of Abuse
• Music Therapy Effectiveness of Treatment of Alzheimer’s Disease
• The Link Between Ancestral Hormones and Music Therapy
• Analysis of the Effectiveness of Art and Music Therapy
• Music Therapy Usefulness for Cancer Patients
• Music Therapy Impact on Students With Emotional and Behavioral Disorders
• How Music Therapy Can Be Used to Reduce Pre-Operative Anxiety
• Healing Chronic Pain With Music Therapy
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“We Are Part of This Excitement:” Husband-and-Wife Cancer Researchers Come to Sylvester

Drs. Erden Atilla and Pinar Ataca Atilla join Dr. Damian Green at Sylvester Comprehensive Cancer Center to research CAR T-cell therapy.

After living, learning, teaching and conducting research in multiple locations worldwide, Erden Atilla, M.D., and Pinar Ataca Atilla, M.D., are settling in Miami.

As research assistant professors, the medical-scientist couple has joined the immunotherapy research program at Sylvester Comprehensive Cancer Center , part of the University of Miami Miller School of Medicine. They’ve come here to make breakthroughs in CAR T-cell therapy and lay down roots, create a home and raise their young son.

It’s been quite a ride for the Atillas. Erden was born in Samsun, a city on Turkey’s Black Sea coast. Pinar comes from Izmir, in western Turkey. They met as hematology fellows at Ankara University, began working together, became friends, fell in love and married.

The CAR T-Cell Breakthrough

When the Atillas worked on their fellowships, chimeric antigen receptor T-cell therapy emerged. CAR T was a breakthrough.

“The first centers were all in the U.S.,” said Erden. “It was like a dream to use these patients’ own immune cells against their leukemia. We couldn’t remain indifferent to this situation.”

They immediately began to seek training opportunities. Their search brought them first to Baylor College of Medicine in Houston and then to Fred Hutchinson Cancer Center in Seattle.

“T cells are the physiological fighters of cancer,” said Erden. “We’re just trying to enforce their power” by engineering them into CAR T cells.

Today, genetically modified CAR T cells are one of the most powerful tools for fighting cancer.

CAR T-Cell Therapy for Acute Myeloid Leukemia

After moving to Houston, the Atillas used their bone marrow transplant experience at Baylor, working with patients with treatment refractory or relapsed disease in the Center for Cell and Gene Therapy under Malcolm Brenner, M.D., Ph.D. Their research project started with acute myeloid leukemia (AML).

“AML is still one of the toughest challenges in our area,” said Erden.

The Atillas are highly skilled, dedicated and terrific partners who are willing to take some risks, such as moving across the world in the pursuit of advancing science for patients.” —Dr. Damian Green

During the COVID pandemic, the Atillas started a collaboration with University of Granada in Spain. The project involved manufacturing donor (allogeneic) CAR T-cell products for AML, “which will open the way for off-the-shelf availability of CAR T cells,” said Erden.

Thus far, CAR T-cell therapy has been more successful in treating multiple myeloma and lymphoma than AML. The Atillas are set to understand why—and to develop CAR T-cell therapy for AML. The first FDA-approved tumor target was CD19 for B cell lymphoma/leukemia. The second was B cell maturation antigen (BCMA) for multiple myeloma.

With AML, there are more challenges and unforeseen mechanisms that need to be defined.

“That’s why I call it a black hole,” Erden said. “We’re waiting for a big bang on the AML side.”

Shooting for Breakthrough Cancer Discoveries

In Miami, the Atillas work in the lab of Damian Green, M.D., chief of Sylvester’s Division of Transplantation and Cellular Therapy and assistant director of translational research.

“I started working with Dr. Green almost three years ago,” said Pinar. “I was interested in refractory disease and I was enthusiastic about learning about the relapse of these cells.”

“My goal is to build a program that allows us to work in partnership with the community to make breakthrough discoveries,” said Dr. Green. “The Atillas are highly skilled, dedicated and terrific partners who are willing to take some risks, such as moving across the world in the pursuit of advancing science for patients.”

Dr. Green came from the Fred Hutchinson Cancer Center in Seattle, where he worked with the Atillas.

“I hired the Atillas as part of my plan to develop new therapies,” he said.

According to Dr. Green, the new immunotherapy research program can accelerate the time it takes to move processes from the lab to the clinic.

“Our dream is to create the environment in the lab that facilitates rapid translation of our own discoveries to the clinic,” he said. “We’re also unique in that we bring a set of skills that will allow Sylvester to flourish by leveraging our outstanding clinicians’ skills in new ways that put us at the forefront of developing cutting-edge therapies.”

The Right Time for Miami

Erden recalls the couple’s first visit to Miami with their 5-year-old son, Eren. On the campus tour, they were excited to see new buildings being constructed.

“We are a part of this excitement,” he said.

Fittingly, outside the building housing the Atilla’s new laboratory home is a giant Banyan tree.

“These members of the Ficus family are unique because new roots constantly spring from their branches and they are always growing outward,” said Erden.

The Antillas see that kind of growth in Sylvester.

“We definitely want to be part of the growth in T-cell therapy,” Pinar said. “Our aim is to work with the physicians and the researchers at Sylvester to develop CAR T cells and new treatments.”

“And we need some roots,” added Erden.

Tags: Acute Myeloid Leukemia , cancer research , CAR T cells , Dr. Damian Green , Sylvester Comprehensive Cancer Center

Cell Therapy is Now on The Table for Metastatic Melanoma

The first cell immunotherapy for metastatic melanoma patients will soon be available to patients at Sylvester Comprehensive Cancer Center.

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A new study shows that treating cytokine release syndrome prior to teclistamab appears to slash the rate of CRS in multiple myeloma patients.

Immunotherapy Program Ready to Tackle Cancer Side Effects

A Sylvester Comprehensive Cancer Center team is working to understand and reduce immunotherapy side effects in cancer patients.

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Cognitive behavioral therapy enhances brain circuits to relieve depression

A new study led by Stanford Medicine scientists found that certain changes in neural activity predicted which patients would benefit from a type of cognitive behavioral therapy.

September 6, 2024 - By Nina Bai

Stanford Medicine researchers and their colleagues have found that choosing treatments based on the type of a patient’s depression increases the odds of success. Emily Moskal

Cognitive behavioral therapy, one of the most common treatments for depression, can teach skills for coping with everyday troubles, reinforce healthy behaviors and counter negative thoughts. But can altering thoughts and behaviors lead to lasting changes in the brain?

New research led by Stanford Medicine has found that it can — if a therapy is matched with the right patients. In a study of adults with both depression and obesity — a difficult-to-treat combination — cognitive behavioral therapy that focused on problem solving reduced depression in a third of patients. These patients also showed adaptative changes in their brain circuitry.

Moreover, these neural adaptations were apparent after just two months of therapy and could predict which patients would benefit from long-term therapy.

The findings add to evidence that choosing treatments based on the neurological underpinnings of a patient’s depression — which vary among people — increases the odds of success. 

The same concept is already standard practice in other medical specialties.

“If you had chest pain, your physician would suggest some tests — an electrocardiogram, a heart scan, maybe a blood test — to work out the cause and which treatments to consider,” said Leanne Williams , PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioral sciences, and the director of Stanford Medicine’s  Center for Precision Mental Health and Wellness .

“Yet in depression, we have no tests being used. You have this broad sense of emotional pain, but it’s a trial-and-error process to choose a treatment, because we have no tests for what is going on in the brain.”

Williams and Jun Ma, MD, PhD, professor of academic medicine and geriatrics at the University of Illinois at Chicago, are co-senior authors of the study published Sept. 4 in Science Translational Medicine. The work is part of a larger clinical trial called RAINBOW (Research Aimed at Improving Both Mood and Weight).

Leanne Williams

Problem solving

The form of cognitive behavioral therapy used in the trial, known as problem-solving therapy, is designed to improve cognitive skills used in planning, troubleshooting and tuning out irrelevant information. A therapist guides patients in identifying real-life problems — a conflict with a roommate, say — brainstorming solutions and choosing the best one.

These cognitive skills depend on a particular set of neurons that function together, known as the cognitive control circuit.

Previous work from Williams’ lab, which identified six biotypes of depression based on patterns of brain activity, estimated that a quarter of people with depression have dysfunction with their cognitive control circuits — either too much or too little activity.

The participants in the new study were adults diagnosed with both major depression and obesity, a confluence of symptoms that often indicates problems with the cognitive control circuit. Patients with this profile generally do poorly on antidepressants: They have a dismal response rate of 17%.

Of the 108 participants, 59 underwent a year-long program of problem-solving therapy in addition to their usual care, such as medications and visits to a primary care physician. The other 49 received only usual care.

They were given fMRI brain scans at the beginning of the study, then after two months, six months, 12 months and 24 months. During the brain scans, the participants completed a test that involves pressing or not pressing a button according to text on a screen — a task known to engage the cognitive control circuit. The test allowed the researchers to gauge changes in the activity of that circuit throughout the study.

“We wanted to see whether this problem-solving therapy in particular could modulate the cognitive control circuit,” said Xue Zhang , PhD, a postdoctoral scholar in psychiatry who is the lead author of the study.

With each brain scan, participants also filled out standard questionnaires that assessed their problem-solving ability and depression symptoms.  

Working smarter

As with any other depression treatment, problem-solving therapy didn’t work for everyone. But 32% of participants responded to the therapy, meaning their symptom severity decreased by half or more.

“That’s a huge improvement over the 17% response rate for antidepressants,” Zhang said.

When researchers examined the brain scans, they found that in the group receiving only usual care, a cognitive control circuit that became less active over the course of the study correlated with worsening problem-solving ability.

But in the group receiving therapy, the pattern was reversed: Decreased activity correlated with enhanced problem-solving ability. The researchers think this may be due to their brains learning, through the therapy, to process information more efficiently.

“We believe they have more efficient cognitive processing, meaning now they need fewer resources in the cognitive control circuit to do the same behavior,” Zhang said.

Before the therapy, their brains had been working harder; now, they were working smarter.

Both groups, on average, improved in their overall depression severity. But when Zhang dug deeper into the 20-item depression assessment, she found that the depression symptom most relevant to cognitive control — “feeling everything is an effort” — benefited from the more efficient cognitive processing gained from the therapy.

“We’re seeing that we can pinpoint the improvement specific to the cognitive aspect of depression, which is what drives disability because it has the biggest impact on real-world functioning,” Williams said.

Indeed, some participants reported that problem-solving therapy helped them think more clearly, allowing them to return to work, resume hobbies and manage social interactions.

Fast track to recovery

Just two months into the study, brain scans showed changes in cognitive control circuit activity in the therapy group.

“That’s important, because it tells us that there is an actual brain change going on early, and it’s in the time frame that you’d expect brain plasticity,” Williams said. “Real-world problem solving is literally changing the brain in a couple of months.”

The idea that thoughts and behaviors can modify brain circuits is not so different from how exercise — a behavior — strengthens muscles, she added.

The researchers found that these early changes signaled which patients were responding to the therapy and would likely improve on problem-solving skills and depression symptoms at six months, 12 months and even one year after the therapy ended, at 24 months. That means a brain scan could be used to predict which patients are the best candidates for problem-solving therapy.

It’s a step toward Williams’ vision of precision psychiatry — using brain activity to match patients with the therapies most likely to help them, fast-tracking them to recovery.

“It’s definitely advancing the science,” Zhang said. “But it’s also going to transform a lot of people’s lives.”

Researchers from University of Washington, University of Pittsburgh School of Medicine and The Ohio State University also contributed to the work.

The study received funding from the National Institutes of Health (grants UH2 HL132368, UH3 HL132368 and R01 HL119453).

Listen to a podcast of Leanne Williams discussing depression biotypes.

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Therapeutic use of music in neurological disorders: A concise narrative review

Medha ramaswamy.

a Department of Biotechnology, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, 632014, India

Johann Laji Philip

Vijayan priya, snigdha priyadarshini, meenakshi ramasamy, g.c. jeevitha.

b Department of Biosciences, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, 632014, India

Darin Mansor Mathkor

c Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia

Shafiul Haque

d Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102 2801, Lebanon

e Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates

Fatemeh Dabaghzadeh

f Department of Clinical Pharmacy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran

Pratik Bhattacharya

g School of Architecture, Vellore Institute of Technology, Vellore, 632014, India

Faraz Ahmad

Associated data.

The authors report there are no competing interests to declare.

Music elicits multifactorial benefits in emotional, social, cognitive, and academic aspects of human life. Music is clinically proven to reduce stress and anxiety, and improve mood and self-expression, particularly after traumatic events. Studies have also demonstrated that music promotes parasympathetic autonomic systems, suppresses hyperactivation of stress responses, and boosts immune functions. However, its ability to promote brain plasticity and signalling are only beginning to be realized. Moreover, its employment as a therapy for the treatment of specific aspects of other neurological disorders, including neurodevelopmental and neurodegenerative conditions and their comorbidities, is fast becoming an interesting field of research.

The aim of this review is to summarize some of the recent studies focused on evaluating the applications of music therapy. For this purpose, we have focused on disorders encompassing both temporal extremities of brain developmental stages, from developmental conditions of autism and attention deficit hyperactivity disorder (ADHD), to ageing-related pathologies of Parkinson's disease and dementias.

The findings of the reviewed studies indicate potent utilities of music-based interventions in beneficially affecting multiple spheres of brain functions, such as sensorimotor, auditory, communication/language, psychological/emotional, behavioural, sleep and memory and cognitive attributes of patients diagnosed with diverse neuropathologies. Nevertheless, lack of standardized protocols for music provision as well as absence of information regarding key aspects, such as cultural and musical orientations of subjects and therapists'/caregivers' attitudes, have hindered the complete realization of music's therapeutic potential for neurological conditions. Further, while some studies have undertaken assessments of core neurophysiological mechanisms underlying music therapy, this information is largely lacking for most clinical studies.

While this is not an exhaustive review of literature, we do hope that it serves as a platform to promote future research for establishing music therapy as a relevant neurotherapeutic strategy.

1. Introduction

In recent years, with the prevalence of detrimental life style changes and increased life expectancies, coupled with enhancements in medical technologies, incidences of some of the most prevalent neurological conditions have been coming to forefront. These include dysfunctions during the entire developmental spectrum, from neurodevelopmental pathologies, such as schizophrenia, autism and attention deficit hyperactivity disorder (ADHD), to age-induced neuronal deficits encompassing Parkinson's disease, dementia and neuropsychological dysfunctions. Multiple research groups and organizations have directed their efforts in diagnosis and therapy of these disorders. Music therapy has emerged as an interestingly non-pharmacological lifestyle intervention with potential multimodal benefits for these neuropathologies ( Table 1 ). The primary aim of this review is to critically analyse the relevances of music therapy in the treatment of these specific disorders and their comorbidities, citing suitable examples from recently conducted research studies. We first begin our discussion with the influences of music as a therapeutic intervention in stimulating brain plasticity and signalling. Next we attempt to clarify the beneficial roles of music therapy in traumatic brain injuries (TBI). Lastly, we assess the abilities of music therapy in providing specific, but multimodal enhancement of brain functions in neurodevelopmental and ageing-related pathologies in a disease/condition specific manner.

Music-based interventions in different nuerological disorders and their pathophysiological effects.

According to the American Music Therapy Association (AMTA), music therapy is a validated health-related discipline that utilizes music as an ameliorative regimen for addressing cognitive, social and psychological requirements. It involves employment of music for the achievement of personalized goals, including attenuation of stress-, anxiety- and depression-like behaviours, and upliftment of mood and self-expression. Indeed, the scope of music therapy is very wide, encompassing cognitive, academic, psychological, social and communicative qualities of human life [ 1 ]. Additionally, music serves as a simple distraction from distressing events, such as medical procedures. Moreover, music as a non-pharmacological agent has a long history of being used as a coping mechanism for distress and aiding in the healing process after exposure to painful and/or traumatic events [ 2 ].

Music therapy is a multidisciplinary field and requires trained therapists for administering it. Although the positive psychological effects of music therapy are well-founded, the precise underlying mechanisms remain largely obscure. In this regard, studies on rodents indicate that specific musical stimuli lead to a shift toward stimulated parasympathetic autonomic activity, diminished endocrine stress responses, and enhancement of immune functions [ 3 ]. A quadripartite model of responses to musical stimuli has been proposed by Bernatzky et al., during their exploration of music therapy as pain mitigating strategy [ 4 ]. As depicted in Fig. 1 , level 1a involves triggering poignant emotions linked to specific memories, prompting event-associated actions. Level 1b deals with primordial responses to music, rooted in early heart rhythms and associated emotions. Cognitive activation of neural circuits is dealt under level 2, while level 3 and 4 delves into stimulation of neural coherence and cellular and genetic aspects, respectively.

Clement's model of responses to musical stimuli. Clement's model is depicted as a four step scheme, arranged in decreasing levels of complexity. The first level is learned cognitive response and primal and isomorphic learned responses. The second level is circuit based approach. The third and fourth levels comprise of mechanisms at sensory, and cellular and genetic levels, respectively.

The study received an exemption from an Institutional Review Board/Ethics committee since no primary data were generated, and it did not involve human participants.

2. Music and brain plasticity

Brain plasticity, also known as neuroplasticity, is the ability of neurons and other cells of the nervous system to alter its morpho-functional characteristics in response to internal and/or external stimuli. Likewise, synaptic plasticity pertains to the capacity of the nervous system to modify synapses, the major pathways of interneuronal communication. Synaptic plasticity plays crucial roles in determining almost all aspects of higher-order brain functions, including learning and memory, execution and planning, and social and emotional behaviours.

The relationship between music and brain plasticity has been extensively studied due to the multidimensional aspects of visual, motor, and auditory cues. Favourable changes in the physiology of neurotransmitters (e.g., serotonin, dopamine, oxytocin, glutamate, etc.) involved in social and emotional aspects of behaviour, and cognitive functions of attention, imagination and creativity can be induced as a response to sensory perception of music [ 5 ]. Music also influences brain plasticity at multiple brain region levels ( Fig. 2 ), stimulating the neuronal connections between the association cortices, and aiding in the cognitive processes of multisensory perception and responses against them [ 6 ]. Such music therapy-associated brain plasticity is also observed in volume increases in the grey matter of multiple sub-regions of cerebral cortices of clinical cases of traumatic brain injury (TBI, section 3 ) upon exposure to music-based therapeutic interventions, which have been proposed to be responsible for the significant improvements in the executive, attention, and imaginative aspects of cognition in these subjects [ 7 ]. Lastly, white matter neuroplasticity has been proposed as another substrate of music-based interventions. Such plastic changes in critical brain regions such as amygdala and motor cortices, may underlie music's beneficial effects on sensory processing and feedback, communication and emotional health in an experience-dependent manner [ 8 ]. Refinement of white matter neuroplasticity in right dorsal, corpus callosum, thalamic and corticostriatal pathways may underlie music's beneficial effects on executive functions in TBI subjects [ 9 ].

Summarization of the brain region-specific effects of exposure to music. The diagram depicts region-specificity of therapeutic aspects of music as an animation of the human brain. The different parts of cortices contribute to therapeutic effects at different levels; viz. Somatosensory, visual, auditory, motor and mood. Hippocampus is involved in memory-related aspects, while cerebellum contributes to motor responses. Nucleus accumbens and amygdala participate in emotional and behavioural aspects of music therapy.

Music perception is associated with numerous beneficial effects on sensorimotor, cognitive and emotional processing. Individuals may associate “good” music with “musical chills”, which are characterized by stimulation of the responses of the autonomic nervous system, often associated with enhanced heart rate, and decreased temperature and blood volume pulse [ 10 ]. Such musical chills are associated with dopaminergic reward response regions of the hypothalamus and amygdala, activation of which signifies intense emotions and pleasure [ 11 ]. Some of the molecular and cellular players implicated in music therapy's positive impacts on brain plasticity are outlined in Fig. 3 . Additionally, readers are directed to a recent review by Chatterjee and colleagues [ 12 ], which comprehensively details the multimodal effects of music interventions on brain plasticity and rewiring with regards to diverse neuronal systems, including memory and cognition, emotional, behavioural and reward pathways, and sensorimotor, auditory, and language networks.

Proposed neurobiological mechanisms underlying music therapy. The figure shows a flowchart of mechanisms underlying neurotherapeutic aspects of music. Limbic system and prefrontal cortices relay the information to sub-regions of basal ganglia, nucleus accumbens, hippocampus, hypothalamus and VTA. This information is converted to molecular responses in form of enhanced dopamine and oxytocin signalling, resulted in stimulation of neurotrophic factors (BNDF and NGF), which finally cause enhancement in neuronal connections and their strengths.

3. Traumatic brain injury (TBI)

TBI occurs when there is damage to the brain due to a sudden, mechanical assault. Pathophysiology of TBI is characterized by primary and secondary phases of vascular, axonal and neuronal degeneration, and may be associated with adverse effects on the individual's physical, mental, emotional, and cognitive health. As one of the more recent therapies for TBI, music has shown to have promising effects. Music therapy in TBI is linked to evocation of brain activity and reformation and/or restoration of damaged resting state networks [ 13 ]. Cognitive attributes, such as executive functions of TBI subjects have also been elicited to be significantly improved via music-based interventions. In particular, rhythmic music is associated with increase in neuroplasticity and grey matter volumes [ 13 ]. Beneficial effects of neuronal plasticity mechanisms have been proposed as pathways for music therapy-based stimulation of sensorimotor, emotional and cognitive functioning of TBI subjects [ 14 ]. Particularly, deficits in attention and memory domains of cognition have been reported to be robustly attenuated by neurologic music therapy regimens [ 15 ]. Music therapy has also been linked to significant improvements in motor deficits following TBIs and spinal cord injuries (SCIs). Thompson and co-workers reported that rhythmic music-induced improvements in multiple spatio-temporal attributes of gait, including speed, symmetry and cadence [ 16 ]. A systematic analysis of primary research indicated that music-based interventions had positive impacts on gait and gait speed in clinical subjects of CNS injuries [ 17 ]. While rhythmic music may be associated with increased activation and stimulation of auditory-motor networks, more studies are warrantied to reaffirm these aspects of music therapy.

4. Ageing-related neuropathologies: Parkinson's disease and dementia

Parkinson's disease is a degenerative condition characterized by progressive loss of dopaminergic neurons in the motor-associated brain regions, culminating into severe movement dysfunctions, particularly those related to repetitive automatic muscle functions [ 18 ]. Musical stimuli have been proposed as therapeutic interventions in alleviating Parkinson's disease-associated symptoms of motor imbalance, discoordination, rigidity, and slowness [ 19 ]. Indeed, a recent systematic review of literature affirmed the effectiveness of music therapy in inducing improvements of motor functions, cognition, communication, mental health status and spatio-temporal reasoning in clinical subjects diagnosed with Parkinson's disease [ 20 ].

With regard to motor functions, singing has been observed to stimulate gait and overall motor performance in both Parkinson's disease cases and aged adults [ 20 ]. However, it should be noted that rhythmic music, in complementation with dancing, is heavily dependent on the severity of the disease and individual differences [ 21 ]. Interestingly, Boni and Cattaneo have reported that exposure to music-based therapeutic regimen developed by Helvetic Music Institute in Parkinson's disease and dementia patients resulted in significant improvements in fine and gross motor skills, emotional and memory and cognitive attributes, as well as enhanced quality of life [ 22 ]. Communication deficits are another key aspect of Parkinson's disease. In this regard, intervention-based music has beneficial effects on speech-related neural networks and pathways. Indeed, ‘ParkinSong’ as a musical intervention has been elicited to improve speech and communication in human subjects with Parkinson's disease [ 23 ]. Interestingly, group singing and writing sessions for PD subjects and their spouses has been proposed to as a tremendous strategy for emotional upliftment and stimulation of couple relationships [ 24 ]. Along similar lines, Hayes et al. [ 25 ] integrated music therapy sessions based upon melodic intonation therapy, rhythmic auditory stimulation, singing and vocal exercises, and song writing, etc. In treatment regimens for aged subjects suffering from stroke, Parkinson's disease, or dementia. Their findings indicated that music therapy resulted in significant improvements in motor functions of the patients, in addition to beneficial effects on speech and communication [ 25 ]. Mood and emotional upliftment and improvement of mental health variables are other key attribute of music therapy in Parkinson's disease [ 20 ]. Lastly, in addition to the direct impacts on motor and communicative skills, music therapy has been evidenced to serve as a cognition- and memory-enhancing strategy for Parkinson's disease subjects [ 26 ]. In conclusion, music, in combination with dance therapy appears to be a robust non-pharmacological intervention for alleviating multiple dysfunctions associated with Parkinson's disease patients, helping them regain joy from functional activity, improve body and soul integrity, and restore positive self-acceptance and autonomy.

Dementias represent progressive decline in a plethora of cognitive abilities including memory, planning, executive, and social skills. In addition to amnesia, demented individuals often elicit symptoms of confusion, mood swings, difficulties in communication, changes in personality, and hampered daily activities. Several factors have been linked to the development and progression of dementias in humans. Considering the varied pathological mechanisms, dementias can be categorized into multiple types. Some of the most prevalent dementia types include Alzheimer's disease, vascular dementia, Lewy body dementia and fronto-temporal dementia. In the absence of effective disease preventive regimens, symptomatic treatments often involve lifestyle changes, in combination with other forms of therapies, such as music-based interventions.

Indeed, music-based therapy is one of the lifestyle interventions which has been found to be particularly effective in improving patient outcomes of dementia subjects [ 27 ]. A study conducted by Moreno-Morales and co-workers confirmed music therapy's positive impacts on cognitive status, expressive states, and self-awareness, with consequential enhancement of quality of life in dementia subjects. Activation of brain areas associated with cognition, in addition to circuitry for perceiving sounds, rhythms, lyrics, and patterns were observed in these subjects [ 28 ]. Mood enhancement and attenuation of behavioural problems have also been reported to be significant facets of music therapy in dementia subjects [ 29 ]. Consequently, music has been associated with significant improvements of life quality in dementia clinical cases [ 30 ]. Further, verbal communication in demented subjects may also be beneficially affected by listening and producing music [ 31 ]. Here, it should be noted that while improvements in behavioural and emotional health has been observed in several studies, beneficial effects of music therapy on cognitive attributes of dementia subject is contested [ 32 ]. Conversely, other studies have reported significant successes of music-based interventions in retarding cognitive decline in dementia subjects [ 33 ]. Various factors may be responsible for such discrepancies, as discussed in section 8 .

5. Neurodevelopmental conditions: autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD)

ASD is a common neurodevelopmental condition that primarily affects children under the age of six, leading to difficulties in social communication and behavioural dysfunctions. ASD involves altered intrinsic brain connectivity, particularly in the fronto-temporal and cortico-subcortical regions linked to social and verbal communication skills. The positive effects of music therapy in autistic subjects have been known for a while now [ 34 ]. Children with ASD have shown enhanced pitch perception, indicating brain plasticity and reorganization influenced by genetic factors. Listening to music is regarded as a rewarding activity for individuals with ASD, activating the dopaminergic response system and contributing to emotional regulation and mood [ 35 ].

Exposure to the appropriate pitch, tone and tempo of music enhances melodic memory and brain processing in children, while engaging in music activities stimulates multiple brain regions associated with memory, emotion, pleasure, and auditory processing [ 36 ]. Music therapy's effectiveness in autism subjects stems from top-down reward-based cortical modulation related to learning non-musical behaviours like social interaction, as well as bottom-up sensorimotor integration through sound and auditory-motor processing to enhance social communication skills [ 37 ]. Neuroimaging studies indicate the potential for brain plasticity and positive impacts on communication skills in autistic subjects. By harnessing the therapeutic power of music, individuals with ASD can experience improved social interactions, attention, and sensory processing, promoting their overall well-being and development. On-going research in this area continues to enrich our understanding of music-based interventions for individuals with autism. Interestingly, research on brain regions involved in speech and music development has shown that the arcuate fascicles, crucial for these processes, appear thicker on the right hemisphere than the left in children with autism. The right hemisphere is primarily responsible for interpreting musical sounds, while the left hemisphere is associated with speech. This finding offers a potential explanation for how music increases engagement among children with autism [ 38 ].

According to the diagnostic statistical manual of mental disorders (DSM), attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly seen in children and adolescents, characterized by hyperactivity, hyperactivity, and an inability to focus [ 39 ]. ADHD is widely prevalent, and may elicit more frequently in male subjects. Thus, Venkata et al. found ADHD prevalence to be 11.33 % in an Indian community-based sample, with significantly more prevalence in males [ 40 ]. Stimulant medications are considered a primary treatment for ADHD, and their effectiveness in reducing the risk of retention among adolescents may be enhanced when combined with behavioural interventions, [ 41 ]. The relationship between music and ADHD brain is probably explained by the load theory of selective attention. According to this theory, focusing on a task involves balancing two cognitive mechanisms; early-selection, a deliberate choice of a target stimulus with a specific goal, and late-selection, involuntary attention drawn to a dominant stimulus. Cumulatively, music-based interventions result in appreciable benefits effects on self-regulation of ADHD subjects [ 42 ].

6. Mental health and mood disorders

It has been known since a long time that different types of music can activate differential emotional patterns in “normal” subjects with uncompromised mental health statuses [ 43 ]. With regards to clinical cases of mental health issues, music has been elicited to beneficially affect human behaviour and has consequently been examined for therapeutic applications against mental health conditions such as depression, stress and anxiety [ 44 ]. Meta-analyses of primary research has indicated the beneficial effects of music-based interventions, particularly in complementation of regularly practised clinical therapies, in alleviation of depression- and anxiety-like behaviour in human subjects of all ages [ 45 ]. The probable mechanisms underlying these effects seem to be modulation of the activities of brain regions associated with stress responses, as well as neoplastic changes in striatal regions, prefrontal cortex, amygdala, hippocampus and hypothalamus. Evidences from rodent models of early life stress concur with the hypothesis that music induces positive neuronal alterations, particularly with regards to hippocampal plasticity, for its effects of mitigation of behavioural and cognitive deficits [ 46 ]. Two of the most important substrates of music therapy in altering neuronal plasticity and alleviating mood disorders are dopaminergic signalling and brain-derived neurotrophic factor (BDNF). Indeed, music exposure is associated with anxiolytic consequences and fear abolishment via stimulation of BDNF signalling in anterior cingulate cortex [ 47 ]. Interestingly, Indian classical music has also been evidenced to reduce psychological stress and promote mindfulness and mitigate sleep problems, as reported by Sharma et al., who used EEG imaging in their studies on medical students [ 48 ]. Dingle and co-workers have summarized the various forms of music for their beneficial effects on emotions, arousal, social interactions, relaxation and cognition [ 49 ].

Considered by some as a neurodevelopmental disorder, schizophrenia is basically a behavioural disorder with varied aetiologies. Schizophrenia is characterized by disordered thoughts, feelings, and perceptions, and can present with acute symptoms like auditory or visual hallucinations, as well as chronic symptoms, including social withdrawal and memory issues. This condition may have significant detrimental effects on behavioural functions, such as creativity and ability to form relationships. Music therapy is widely regarded as a beneficial approach for managing various schizophrenia-related symptoms [ 50 ]. Indeed, recent evidences suggest music therapy as a very prominent component of multifactorial combinatorial therapeutic strategies against schizophrenia [ 51 ]. Such music-based interventions have been proposed to address motivational, emotional and social aspects of schizophrenics in a long-term manner. On the contrary, other studies indicate that positive impact of music therapeutic regimens may be reversible, and discontinuation may result in re-emergence and deterioration of the behavioural symptoms [ 52 ]. Moreover, duration and frequency of music-based therapeutic episodes heavily drive their effectiveness [ 53 ].

In addition to improvements of emotional and mental health statuses of clinical subjects of schizophrenia, music therapy has been found to significantly elevate their quality of life and social functioning [ 54 ]. Supplementing music-based interventions with regularly used clinical interventions has been shown to attenuate negative social and behavioural symptoms, allowing schizophrenic subjects to appreciably improve their interpersonal skills [ 55 ]. A recent meta-analysis revealed that music therapy has tremendous positive effects with regards to mitigation of social interaction deficits, anxiety-like behaviour, auditory hallucinations, and speech patterns [ 56 ]. These results are supported by magnetic resonance imaging data which indicate increased static functional connectivity between the limbic regions of the brain in schizophrenia patients [ 57 , 58 ]. Further research is however needed to gain a deeper understanding and their implications for music therapy in schizophrenia treatment. In particular, comprehensive long-term measurement of music therapy's effects must be studied in order to address all ambiguities.

7. Circadian rhythm disruptions

Circadian rhythm disruptions and sleep impairments are bi-directionally related to multiple molecular and cellular aspects of brain functional deficits in cognition, emotion, and behaviour [ 59 , 60 ]. An important aspect of music therapy interventions for chronic disorders, including neurological conditions, lies in its ability to beneficially affect circadian rhythm and sleep-wake cycle [ 61 ]. This is supported by a recent animal study which used zebrafish as a model system to assess the therapeutic effects of long-term music therapy on circadian disruption-induced cognitive and psychological impairments [ 62 ].

As reviewed recently by Sharma et al. [ 63 ], music is increasingly being recognized as an effective means of non-pharmacological intervention to ameliorate circadian disruptions, and thereby act as a neuroprotective measure targeting brain structural plasticity and other pathogenic mechanisms related to neurodegenerative states. Interestingly, the applications of music therapy for treatment of neurodegenerative disorders can be optimized by clock timing. This is in concurrence with a trial conducted by Theorell and co-workers [ 64 ], who illustrated that home-based music therapeutic intervention in dementia patients and their care-givers significantly reduced their salivary cortisol levels [ 64 ]. Further, slow “sedative” music has been noted to have beneficial effects on attributes of perceived sleep quality, duration, and latency in aged human subjects with circadian dysfunctions [ 65 ]. In concurrence, a meta-analytical study has revealed music as one of significantly effective interventional regimen for attenuating sleep dysfunctions (as assessed by the Pittsburgh Sleep Quality Index; PSQI) in both healthy subjects and those with varied medical conditions [ 66 ]. Further, music provision, in addition to other chronotherapeutic strategies, has been proposed as a means to rescue dysfunctional sleep-wake characteristics in critically ill patients suffering from delirium [ 67 ]. Lastly, in an interesting study, Ceccato and Roveran [ 68 ] proposed that group-based music therapy before evening meals may reduce pre-meal anxiety in anorexia nervosa patients, indicating its possible utility in attenuation of circadian disruptions.

8. Future prospects

Music therapy has been a profoundly sought after intervention for neurological disorders. Through the development of synchronous rhythm, motor imitation, and joint attention, music therapy is thought to support preverbal communication [ 69 ]. In patients of schizophrenia, non-verbal social communication that can be introduced by the use of music therapy can be particularly useful [ 54 ]. In the case of ASD, patients showed intact emotion recognition from music, as expressed in their behavioral ratings, and in typical brain processing of emotional music, with activation of limbic and paralimbic areas, including reward regions [ 70 ]. Patients with dementia can remember music despite having significant memory impairments, and music can help people retain episodic memories, even if the music is unrelated to the events being remembered. Additionally, music has been employed therapeutically to encourage social bonding in these patients [ 71 ]. Improvements in frontal lobe functions (cognitive flexibility, processing speed, attention, and working memory) is a relevant outcome of music-based intervention for enhancement of attention and executive functions [ 20 ]. Further, studies in ADHD patients have revealed significant decreases in cortisol levels, indicating lowered depression and stress levels. This was seen to occur in tandem with the responses from other neurophysiological factors like blood pressure, heart rate and hormones [ 72 ]. Importantly, no specific adverse effects were observed in any of the studies, and almost all patients tolerated music therapy well.

In spite of potential multimodal therapeutic aspects against different neurological disorders, there is insufficient evidence for the exact nature of music-based therapy [ 73 ]. Many studies on music therapy employed small sample sizes, which may limit the generalizability of the findings. Another drawback could be the lack of control groups which makes it difficult to establish a cause-and-effect relationship between therapy and the observed outcomes. Further, heterogeneity of the study populations is one of the top reasons for the diverse outcomes in all interventional studies. All patients with the disorders have varying degrees of impairment and symptoms. Hence, interventions may vary widely, depending on the patient's needs, the therapist's training, and the context in which the therapy is being delivered. Further, heterogeneity at the genetic level, coupled with low samples sizes, may lead to erroneous conclusions (e.g., whether experience-dependent or not) regarding the neuroplasticity-related effects induced by music exposure. Along similar lines, gender-based differences in the outcomes of music therapy for neurological conditions need to be addressed in detail. Likewise, not many studies have comprehensively analysed the impact of music on the young nervous system [ 74 ].

Other significant limitations of studies which have focussed on music therapy for neurological disorders include absence of standardized interventional protocols, disregard for cultural perspectives, and inadequacies in addressing the influences from confounders such as general environmental conditions in the hospitals/care centres, background noise, patient noise sensitivity, therapists' attitudes, etc. Further, a thorough comparison between the effects of auditory (listening), vocal (singing), motor (listening/singing coupled with dancing) and sensorimotor (instrument playing) attributes of music intervention, as well as their complementation actions, need to be assessed in a disease- and patient-specific manner. Likewise, studies should also seek to understand how patients' cultural and musical orientations shape the treatment processes. By identifying these cultural specificity issues, one could learn how to individualize the provision of music therapy in terms of patients’ cultural backgrounds and life experiences. Other key aspects of music therapy for neurological disorders which have not been optimally evaluated in a majority of studies are the underlying mechanisms and the longevity of the beneficial effects (particularly in acute clinical settings). Core neurophysiological mechanism behind the therapy and effect of music should be explored in as much as detail for a better understanding of the pathways involved; although this may be challenging under clinical and pre-clinical settings. Lastly, in order to better understand the effectiveness of the treatment course of music therapeutic regimens, future trials need to investigate their complementation with other approaches, including pharmacological and behavioural ones. Interaction of music and other therapies may have added effects on neuroplasticity enhancement and functional abilities of patients.

9. Conclusions

In conclusion, music application in neurological disorders is increasingly being regarded as a promising and diverse field for therapeutic approaches. This form of therapy has been found to be effective in varied conditions, including those affecting the developing brain such as autism and ADHD, as well as ageing-related impairments such as Parkinson's disease and dementia. Consequently, music's impact on influencing neuroplasticity in multiple brain regions/systems, developing and optimizing the mental, emotional, behavioural, sleep and cognitive functions, as well as increasing quality of life reveals its opportunity to be harnessed as a potent non-invasive and non-pharmacological treatment alternative. Nonetheless, further high-quality studies are required because the body of research on music therapy is presently insufficient. Refinement of music applying methods and better understanding of the underlying mechanisms and pathways should be the goals for future research. In this regard, we hope that the present review forms a suitable research platform outlining the pertinence of music interventions, and the need forsynchronizing and extending the experimentation on a larger scale in order to gain adequate understanding of its therapeutic potential for neurological disorders.

Ethical approval and informed consent statements

Not applicable, as no primary data were generated.

Data availability statement

Deputyship for Research & Innovation, Ministry of Education, Saudi Arabia - Project Number: ISP23-101.

CRediT authorship contribution statement

Medha Ramaswamy: Writing – review & editing, Writing – original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Johann Laji Philip: Writing – review & editing, Writing – original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Vijayan Priya: Writing – review & editing, Visualization, Validation, Methodology, Investigation, Formal analysis, Data curation. Snigdha Priyadarshini: Writing – review & editing, Writing – original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Meenakshi Ramasamy: Writing – review & editing, Writing – original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. G.C. Jeevitha: Writing – review & editing, Visualization, Validation, Methodology, Investigation, Formal analysis, Conceptualization. Darin Mansor Mathkor: Writing – review & editing, Visualization, Validation, Methodology, Investigation, Formal analysis, Conceptualization. Shafiul Haque: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Fatemeh Dabaghzadeh: Writing – review & editing, Visualization, Validation, Methodology, Investigation, Formal analysis, Conceptualization. Pratik Bhattacharya: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Faraz Ahmad: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors extend their appreciation to the Deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the Project Number ISP23-101 .