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Musical Offerings 10, no. 2 (2019): 61–80
ISSN 2330-8206 (print); ISSN 2167-3799 (online)
© 2019, Zachary J. Krauss, licensed under CC BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
* Due to the scientific content of this paper, the author has chosen to use APA
style, and the Editors have concurred.
The Effects of Music Therapy on Individuals
Suffering from Psychiatric Disorders:
A Literature Review and Look into
Future Prospects
Zachary J. Krauss
Cedarville University
usic therapy is a relatively recent development in the world of
psychology, and it is certainly a recent development in the
world of medicine. Regardless, some of the earliest references
to music therapy appeared in a 1789 article titled “Music Physically
Considered,” which discussed therapeutic value of music that was
referenced in two different medical dissertations (AMTA, 2019).
*
The value of music therapy as a legitimate form of psychotherapy has
been debated in the past few years. A quick search through the current
literature available on music therapy on PubMed yields resources that
both support and deny the efficacy of music therapy. However, upon
closer inspection, it seems that the more recent research in the field of
music therapy is finding that this form of therapy truly is a viable
treatment method for those in need. This paper argues that, while the
effectiveness of music therapy has been debated in the past, recent
literature shows that music therapy is significantly more effective in
practice than psychotherapy or psychological pharmacotherapy alone.
This paper serves as a review of recent literature (published between
2014 and 2019) on the effectiveness of music therapy in clinical settings,
with a focus on the effectiveness of music therapy to treat those with
psychiatric disorders. A narrower focus was utilized to accommodate
articles and reviews that included information about music therapy and
M
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Effects of Music Therapy
its effect on patients already taking psychiatric medications in order to
treat the symptoms of their disorder. The paper is organized by disease
states such as depression, bipolar disorder, and post-traumatic stress
disorder (PTSD).
Depression and Anxiety
The American Psychiatric Association defines depression (major
depressive disorder) as a “common and serious medical illness that
negatively affects how you feel, the way you think and how you act”
(Parekh, 2017c). Depression is mainly characterized by feeling sad or
having a depressed mood, losing interest in previously enjoyable
activities, loss of energy or increased fatigue, and even thoughts of death
or suicide. The American Psychiatric Association also defines anxiety
disorders as those disorders that differ from normal feelings of
nervousness or anxiousness and involve excessive fear and anxiety
(Parekh, 2017a). Types of anxiety disorders include generalized anxiety
disorder, social anxiety disorder, and panic disorder. Treatment for
depression and anxiety usually includes cognitive behavioral therapy as
well as other forms of psychotherapy, and sometimes antidepressants or
antianxiety medications, respectively.
In a 2018 study on anxiety and depression levels in Alzheimer’s patients
receiving several music therapy sessions lasting about one hour each,
patients were shown to experience decreasing levels of stress as well as
significantly lowered levels of depression and anxiety. During their
sessions, patients were invited to sing an introductory song before being
led in a song related to flowers. For these patients, the song on flowers
functioned to improve base cognitive levels, memory, and lyric recall,
while also strengthening the temporal link between flowers and positive
emotions associated with the season of spring. (Ortí et al., 2018).
Enzyme-Linked ImmunoSorbent Assay (ELISA) immunoassay
technique was used in order to measure the salivary levels of cortisol,
and general psychological state was measured using the Hospital
Anxiety and Depression Scale. The study showed that after music
therapy, patients’ cortisol levels decreased, which is relevant considering
recent research which has shown that cortisol is significantly associated
with increasing levels of depression (Keller et al., 2017). Not only did
the research of Ortí et al. (2018) solidify the previous research on cortisol
and its effect on patients’ depression, but it specifically showed that
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those suffering from depression within the context of another comorbid
(co-occurring) disorder can still be treated with music therapy.
In another study, Fernandes and D’silva (2019) researched the effects of
music therapy on hemodialysis patients. One of the most common
psychological disorders affecting those undergoing hemodialysis is
depression. This study utilized passive music therapy in which the
patients were exposed to music of an unspecified genre in order to affect
their global state (one accounting for all mental and emotional factors).
Using qualitative data from the Depression Anxiety Stress Scale (DASS)
tool, 40 subjects were analyzed. The therapy was shown to be effective
in decreasing general stress, anxiety, and depression levels, all
significant up to a 95% confidence interval. This research proves that
music therapy can be effective in preventing symptoms of depression
from becoming exacerbated during times of treatment, giving music
therapy a viable entrance into the medical realm rather than simply the
context of psychotherapy (Fernandes & D’silva, 2019).
One article investigating the effects of music on those with generalized
anxiety disorder found that music therapy was effective at reducing
anxiety as well as depression levels in those with the disorder. The
patients in the study experienced both receptive and active music
therapy. During the receptive portion, they listened to music without
active involvement, while the active portion involved interacting with a
music therapist to compose music/songs. This study utilized listening to
an unspecified genre of music without therapist intervention, as well as
active music therapy treatment in which the therapist guided the patient
in producing music using their voices, bodies, and/or musical
instruments. The active and passive music therapies were not directly
related in the study, but the patients likely benefited from the combined
nature of both kinds of therapy (Gutiérrez & Camarena, 2015).
The researchers acknowledge that this was a small pilot study, but they
do suggest that music therapy could effectively function as a
psychotherapeutic treatment for psychiatric care of those with
generalized anxiety disorder, even to the point of being considered
before some pharmacologic treatments (Gutiérrez & Camarena, 2015).
Another study looking at music therapy in a medical context looked at
the effects of music therapy on anxiety and depression in cancer patients.
This is very significant considering that up to 75% of cancer patients in
late stages of their illness experience either depression or anxiety
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(Jasemi, Aazami, & Zabihi, 2016). The study by Jasemi et al. (2016)
found that in the group experiencing music therapy intervention, levels
of anxiety and depression were decreased.
The study utilized a very passive form of music therapy in which patients
listened to light and peaceful music for at least 20 minutes per day
intentionally for 3 days. This therapy was implemented in a group
setting, so adherence was guaranteed in all scenarios. The study found
that there was a significant decrease in levels of depression and anxiety
in the group that experienced the intervention. While the sample size for
this study is small and future research on the effects of music therapy on
cancer patients is needed, this research is helpful for showing the clinical
relevance of music therapy for patients who are terminally ill (Jasemi et
al., 2016).
In a systematic review evaluating the effects of music therapy on pre-
and post-operative states of pediatric patients, there was a substantial
amount of research showing that music therapy is effective for relieving
fear, decreasing anxiety, and acting as an alternative for pharmacological
treatment (van der Heijden, Araghi, van Dijk, Jeekel, & Hunink, 2015).
Two studies discussed in the review found that music as an intervention
method had significant pain-reducing effects on participants, and another
study found non-statistically significant levels of pain-reducing effects.
Much of the data collected by van der Heijden et al. (2015), even that
which had to be excluded, found that post-operative music interventions
helped to reduce subjective levels of pain. Pain was measured using the
Visual Analogue Scale, the Coloured Analogue Scale, and the Facial
Pain Scale. Music therapy interventions examined in the study involved
either live music performance by a music therapist or musical creation
therapy in which the patient assisted with creation of melodies.
A study looking specifically at the neurobiology of music therapy found
that the anti-anxiety effect caused by the intervention of music is
associated with glutamic acid and GABA (Gamma-aminobutyric acid)
levels in the hippocampus (Chen, 2018). Although this study focused on
a murine (mouse) model and no in-person human trials were done, the
results were still significant. The subjects were exposed to classical and
rock music (a secondary hypothesis was that classical music by Mozart
would be more effective) for about one hour each day for 21 days.
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It was discovered in the same study that music therapy can improve
anxiety behavior, creating an easing effect on the emotional state of those
affected. Music appeared to have a regulatory effect on the levels of
glutamic acid and GABA in the hippocampus, functioning to balance the
excitatory and inhibitory function and working as a mood stabilizer
(Chen, 2018). The mice seemed to be more capable to complete a maze
that otherwise might have proven difficult in an anxious state; levels of
GABA and glutamic acid were directly measured from the hippocampus
of the mice after their death. On a more qualitative note, music by Mozart
seemed to be more effective than rock music at decreasing anxiety. This
research shows great promise for future research into music therapy’s
effect on the physiology of the brain, and for potential specifically aimed
forms of intervention.
Trauma-Related Disorders
Trauma related disorders include acute traumatic stress disorder, post-
traumatic stress disorder (PTSD), and dissociative disorders related to
trauma. These disorders’ symptoms are fairly serious, and effects on the
individual tend to be debilitating. PTSD is defined by the American
Psychiatric Association as a “psychiatric disorder that can occur in
people who have experienced or witnessed a traumatic event such as a
natural disaster, a serious accident, a terrorist act, war/combat, rape or
other violent personal assault” and was the disorder referenced most
frequently in the literature (Parekh, 2017d). The American Psychiatric
Association continues to describe the symptoms of PTSD as consisting
of intense, disturbing thoughts and feelings related to a traumatic event
that last long after that event has ended. They state that PTSD patients
often continue to experience the event through nightmares, flashbacks,
or intrusive memories, and experience symptoms such as sadness,
fear/anxiety, or anger, as well as a general detachment from reality
(Parekh, 2017d).
Treatment for PTSD often involves cognitive processing therapy, group
therapy, prolonged exposure therapy (exposing patients to flashback-
inducing stimuli in a safe environment in order to encourage healing),
and medications such as SSRIs (selective serotonin reuptake inhibitors)
and SNRIs (selective norepinephrine reuptake inhibitors). Medications
for anxiety or physical agitation are also frequently used.
One study conducted by Metzner, Verhey, Braak, and Hots (2018)
focused on the effects of music therapy on PTSD patients who had
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suffered from torture, political violence, and flight. The study showed
that patients had a “pathological perception of loudness.” Most listeners
in the study suffered from hearing loss of some sort but still reacted
positively to music therapy most of the time.
This study focused primarily on the kinds of sounds that negatively
affected those in trauma therapy, with the intent of discovering what
kinds of sounds, beats, and rhythms to avoid in music therapy. The study
also revealed the general effectiveness of the therapy. Interventions
involved in the study included passive listening to music, as well as
certain exercises involving the patients themselves learning percussion;
patients’ individual utterances of need were used in order to determine
specific implementations of music therapy. The researchers gathered
qualitative data by asking the patients questions about how their mental
state was affected, and psychoacoustic measurements ascertaining levels
of most comfortable loudness (MCL) were used to examine the effect of
harsh sounds on trauma. Metzner et al. (2018) found that once a
perception to loudness and discordant sounds was acknowledged and
accounted for, music therapy was effective for a majority of patients.
Metzner et al. (2018) also posited that patients with complex PTSD
found ways through their own personal coping to deal with unpleasant
sounds that evoke flashbacks or traumatic memories. The results of the
findings suggested that, rather than eliminating music therapy from
practice because of its potential to trigger patients, music therapy,
especially for those with PTSD, must be fine-tuned to the individual in
order to discover what kinds of sounds and beats are acceptable and truly
beneficial.
A research design pilot study by Pezzin, Larson, Lorber, McGinley, and
Dillingham (2018) performed research evaluating the effect of music
therapy on PTSD patients. The music therapy intervention in this study
focused on music instruction in order to help veterans learn how to better
cope with their trauma. Veterans were given guitar instruction in hour-
long individual lessons that lasted for at least six sessions. Along with
these individual interventions, veterans were required to attend at least
three group sessions in which they would discuss not only their music
therapy, but anything else related to their disorder and trauma.
A follow-up interview was utilized in order to determine PTSD
symptomology. Patients took a self-test known as the ‘PTSD Checklist
Civilian’ (PCLC) to measure PTSD presence and severity. The study
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showed that active music instruction in the form of music therapy
combined with group therapy discussions holds promise as a
complementary PTSD treatment method in combination with either
psychotherapy or pharmacotherapy. The results showed that this form of
treatment was extremely effective as a method of emotional expression
to decrease psychiatric symptoms in a myriad of contexts (Pezzin et al.,
2018). The researchers believe that a program such as this could be a
viable option for engaging such a vulnerable population.
One study on the effects of creative art therapies in general (including
dance, music, art, and drama therapies) found that PTSD patients had
potential to be greatly benefited by music therapy (Baker, Metcalf,
Varker, & O’Donnell, 2018). One of the randomized control trials listed
in the review found that a music therapy regimen involving
improvisation led to a significant reduction in PTSD symptoms
compared to controls. Patients were encouraged to work with the music
therapist in order to produce vocal music accompanied with an
instrumental track of their choice.
Not only did this active form of music therapy prove efficacious, but
another study listed in the review showed that passive listening to
relaxing music didn’t seem to have any significant effects on PTSD
symptoms, implying that active music therapy is necessary in order to
evoke change in PTSD patients (Baker et al., 2018). The review
concluded that music and art therapy showed promise for effectively
decreasing major symptoms of PTSD. The review examined randomized
control trials or controlled studies in which PTSD symptom severity or
diagnosis were in some way quantitatively measured. The researchers
posited that the “specialist skills and ongoing therapeutic relationship is
a key factor to reducing symptoms of PTSD,” reaffirming the
significance of the unique music therapist/patient relationship in trauma-
related treatment through musical intervention. (Baker et al., 2018, p.
649).
An article on ICU-related PTSD explored the concept of songwriting-
based music therapy as an option to reduce the negative effects of the
trauma sometimes encountered in an intensive care unit. ICU-related
PTSD is caused by the trauma and discomfort associated with medical
practices such as ventilation adjustments, lapses in anesthesia and/or
analgesia, prolonged sedation, restraint usage, prolonged time spent in
the hospital itself, and opioid-induced hallucinations (Noyes &
Schlesinger, 2017).
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In the study, Noyes and Schlesinger (2017) state that they are hopeful
music therapy could change the prognosis of ICU-related PTSD,
positively influencing those affected by ICU-related trauma. In the
article, positive effects of songwriting include mediating the isolated
world of the ICU, alleviating stress and anxiety, and enabling
communication, relaxation, and expression in patients who might
otherwise have no outlet. The study analyzed responses to qualitative
follow-up interviews as well as global state perceptions from attending
health professionals. Patients were exposed to passive/receptive music
while in the ICU and were encouraged to write lyrics and basic melodies
once in recovery or in less critical states in the hospital.
Another review study examining the effect of music therapy on the
emotions of trauma showed that music has the unique quality of touching
“multiple symptomatic clusters that [are] present in patients with trauma
and PTSD” (Landis-Shack, Heinz, & Bonn-Miller, 2017, p. 338). The
study found that, while music therapy was effective at treating all the
symptom clusters examined in the study (including arousal/reactivity,
avoidance, intrusions, and negative cognition/mood), it was most
effective at remedying negative cognition/mood.
The review posited that music therapy as a tool can directly address and
prevent/reduce certain debilitating symptoms. The primary outlook the
researchers had for music therapy in the review was the quality of music
therapy in its ability to encourage resilience. The intervention they
utilized involved patients producing music and explaining why they
wrote the lyrics that they did, or why they chose the melodies that they
did. Landis-Shack et al. (2017, p. 338–339) stated that music therapy has
a great amount of promise to “help trauma-exposed individuals harness
their ability to recover elements of normality in their life following great
adversity.”
Schizophrenia and Personality Disorders
The American Psychiatric Association defines schizophrenia as a
chronic brain disorder that, when active, is characterized by symptoms
including “delusions, hallucinations, trouble with thinking and
concentration, and lack of motivation” (Parekh, 2017e). Personality
disorders are defined as a “way of thinking, feeling and behaving that
deviates from the expectations of the culture, causes distress or problems
functioning, and lasts over time” (Robitz, 2018).
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While schizophrenia and personality disorders are substantially different
in their symptoms and manifestations, much of the literature seems to
gather the two disorders together for testing and research purposes.
Consequently, they will be examined together for the purpose of this
review. The treatments for schizophrenia and personality disorders
include antipsychotic drugs and cognitive behavioral therapy, as well as
dialectical behavior therapy.
One study looking at music therapy and schizophrenic/personality
disorder patients found that music therapy seemed to create a positive
bond between the patient and the counselor (Hannibal, Pedersen,
Hestbæk, Sørensen, & Munk-Jørgensen, 2014). This data is hopeful
because, for patients with personality disorders and schizophrenia,
psychotherapy and counseling are often rendered less effective as the
connection between counselor and patient is often unable to become
strong enough in order to enact true change. Trust is a critical factor in
counseling, especially for patients who often dissociate from the rest of
society, and this study found that patients were more liable to trust after
active music therapy sessions were implemented.
The intervention allowed patients to speak with their therapist about why
they enjoy certain forms of music, and, after more in-depth discussion,
the music therapist worked with the patients to help them improvise a
piece or set of small pieces in order to provide an emotional outlet.
Psychiatric and psychological data were collected during an
observational period by the researchers for one year, along with a year-
long follow-up observation, and the study found that 82% of patients
remained in treatment. The researchers attributed this positive result to
an alliance that “may be possible despite general severity of illness”
(Hannibal et al., 2014, p. 378). This further emphasizes the importance
of trust in the relationship and implies that music therapy creates a unique
bond that is harder to establish through other psychotherapy techniques
(Hannibal et al., 2014).
An article researching the effects of music therapy on borderline
personality disorder found similar results to those of Hannibal et al.
regarding the relationship of the therapist with the patient. This study by
Strehlow and Lindner (2016, p. 154) discussed the fact that music
therapy seemed to help “as a third element to regulate the relationship
between patient and therapist” where borderline personality patients
often have difficulty in relationships as a result of regulating their own
proximity and distance, etc.
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Findings in this qualitative study were measured by case study
comparisons conducted by the researchers. These case studies showed
that, especially with borderline personality disorder, the process of
applying music therapy is complex and involved, particularly due to the
difficulty of borderline personality disorder patients to deal with extreme
emotions and feelings. Music therapy has the ability to bring out
emotions that a patient might not have previously processed in
psychotherapy as well as the potential to heighten other emotions that
might have otherwise been muted. However, the study also found that,
when approached correctly, patients can benefit from the therapy in a
way they might not have benefitted from any other form of counseling.
The correct approach implied in this research seemed to predominantly
revolve around client comfort and the individual nature of care (Strehlow
& Lindner, 2016).
A systematic review compiled by the Cochrane Library on the effect of
music therapy on schizophrenia and similar disorders discussed the
broad data in the literature very concisely (Mossler, Chen, Heldal, &
Gold, 2014). The review surveyed randomized controlled trials and
controlled studies, searching for those which had positive and significant
data. One finding of the review was that music therapy apparently had a
very strong effect on the global state of those involved. Patients involved
in these results were given music therapy in high-dose (more than 15
sessions over the scope of the trial) format, so it is unclear if any lesser
amount of music therapy would be as effective.
Another finding of the review involved assessing the general mental state
of those involved. In doing so, it discovered that low-dose music therapy
(of less than 20 minutes in a session) didn’t seem to have significant
results; however, it was apparent that medium- and high-dose variants
were effective. The same discrepancy between high and low dosing was
observed in measurements regarding cognitive and emotional
functioning (Mossler et al., 2014).
The conclusion of the study stated that music therapy, in addition to
standard care, can help people with schizophrenia improve their global
state, negative symptoms, depression, anxiety, and social functioning
over the short- to medium-term. Music therapy seems to address
especially motivational, emotional, and relational aspects, and help
patients reconnect to both intrapersonal and social resources. The
researchers involved in the review acknowledged that, in order for the
positive effects to be realized in the patients, at least 20 sessions are
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needed, and active participation (as opposed to passive music therapy) is
essential (Mossler et al., 2014).
Important to note for the previously mentioned review is that a majority
of the examined studies included patients who were already taking either
a mood stabilizer or an antipsychotic, emphasizing the ability of music
therapy to help even those already on prescribed psychological
medications. Geretsegger et al. (2017) posited that this kind of result,
especially for those suffering from extremely hard-to-manage
schizophrenia, could be beneficial for future research into new methods
of treatment. While it doesn’t appear that being on medications for the
disorder is required for the music therapy to work, it seems that music
therapy is not hindered by the presence of most antidepressants or
antianxiety medications, nor by most mood stabilizers or antipsychotics.
Bipolar Disorder
Bipolar disorder is defined by the American Psychiatric Association as a
set of “brain disorders that cause changes in a person’s mood, energy and
ability to function…People with bipolar disorders have extreme and
intense emotional states that occur at distinct times, called mood
episodes” (Parekh, 2017b).
Bipolar is separated into three categories: Bipolar I, Bipolar II, and
Cyclothymic Disorder. Each of these distinctions imply different levels
and cycles of mood changes and swings, but the concept of emotional
and mood inconsistencies remains the same throughout. Treatment for
bipolar disorders often involves either psychotherapy or medications
such as mood stabilizers and antidepressants. Which medications or
types of psychotherapy are utilized varies based on individual
symptomatic presentation.
One study looking at the effects of music therapy on bipolar disorder
patients in a euthymic (normal mood) state found that music created
more complex negative emotions in those responding to subjectively
uplifting music (Choppin et al., 2016). Data was collected from
participants using two self-reported scales (ERS and MAThyS), along
with scales that required them to rate their music-induced emotions.
While this initially seems to imply that music therapy has a negative
effect on patients, the data found that the patients’ response to the therapy
did not differ in their subjective feelings compared to the control group.
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All patients involved in the study were taking mood stabilizers, and
almost 25% of them were taking antidepressants.
One hypothesis for these results was that patients with bipolar disorder
might respond in this way as a result of their struggle to regulate their
own positive emotions, which creates a form of distress manifested as a
negative emotion. While the data says little for the effectiveness of music
listening alone on bipolar disorder, the research group posited that
listening to music could be a beneficial tool in allowing patients to better
understand their emotions and the roots therein (Choppin et al., 2016).
A review article considering the effect of music therapy on psychiatric
patients and their already-established medical regimen found that music
therapy could be extremely beneficial in the treatment of patients
exhibiting psychotic symptoms, including bipolar patients. Results were
measured by medical professionals as they observed the continuous
effect of the participants’ medications (Stefani & Biasutti, 2016). The
article found that even patients with bipolar disorder who were taking
multiple kinds of psychological drugs could still be positively affected
by music (the positive influence on psychotic symptoms seen in patients
was not hindered by pharmacological treatment).
Broad Contexts
One systematic review done on patients undergoing treatment for
substance abuse disorders looked at the effect of music therapy on the
patients’ psychiatric symptoms and outcomes. The review examined the
effects of music therapy on many different variables, concentrating on
randomized controlled trials. Interestingly, many of the patients involved
in this extensive overview of over 40 articles were taking psychiatric
medications such as mood stabilizers, antidepressants, benzodiazepines,
and antipsychotics (Hohmann, Bradt, Stegemann, & Koelsch, 2017).
A majority of the articles viewed in the Hohmann et al. (2017) review
found that music therapy was helpful for them as a supplement to their
treatment, and it also showed in some studies that music therapy was
effective in supplying patients with more sufficient motivation and hope.
While symptoms like depression, withdrawal/craving, coping skills, and
participation could not be significantly correlated with music therapy,
the review was able to correlate music therapy and music interventions
positively with anxiety, medical symptoms, sadness, anger, and stress.
These data are helpful in the understanding of music therapy and its
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effectiveness not only in patients already undergoing other forms of
psychotherapy/pharmacotherapy, but also in examining patients
suffering from a unique comorbid condition in the form of substance
abuse disorder.
In a study examining the effects of music therapy on children and
adolescents suffering from behavioral and emotional problems, findings
demonstrated that both active and receptive music therapy had the ability
to improve outcomes such as social skills and communication in patients
with difficulties in those areas due to emotional and developmental
impediments (Porter et al., 2017). Data was collected using a Social
Skills Improvement System Rating Scales (SSIS) survey as a follow-up
after 13 weeks of the study. The data showed potential for the
effectiveness of music therapy in treating self-esteem issues and
depression in youth with certain deficits.
The data by Porter et al. (2017) also implied that music therapy would
be effective in clinical settings for children and adolescents suffering
from comorbid mood and development disorders. The research team
concluded that a substantial amount of the positive effect of music
therapy observed in the study was a result of the care and attention given
by the therapist in the music therapy relationship, again pointing to the
significance of a unique relationship created between a music therapist
and patient.
A study conducted on a group of patients with neurologic disorders
(primarily Alzheimer’s and stroke) found that music therapy could be
helpful in not only reducing “psychological and behavioral disturbances
related to neurological disorders,” but also for “promoting the functional
recovery” (Raglio et al., 2015, p. 75). The study reviewed articles that
had quantitative and qualitative responses from health professionals
related to the symptoms and severity of the examined disorders. The
article focused on mood symptoms, specifically depression and
hopelessness, which are often experienced by patients with neurological
illness.
It was found by Raglio et al. (2015) that, especially for stroke patients
with depressive symptoms, music therapy was beneficial for improving
mood and encouraging general quality of life. It was also shown that
music therapy improved all levels of anxiety to some extent. This once
again shows that, for those in comorbid situations where mental
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symptoms are paired with other disorders or illnesses, music therapy can
be effective in combination with other forms of intervention.
Brain Chemistry, Music, and Neuroscience
The mechanisms of music therapy are discussed differently in many of
the articles that were reviewed for this paper. While several theories and
ideas have been proposed to explain music therapy, it doesn’t appear that
any one particular thought system is currently dominating the field.
Recently, it seems that a focus on neurobiology and neuroplasticity is
present in the literature, and that focus will be discussed here.
In an article by Constantin (2018, p. 19), music therapy was explained in
the concept of neuroplasticity. As defined in the article, neuroplasticity
is “the ability of the brain to change throughout a person’s life span as a
consequence of sensory input, motor action, reward, or awareness.” The
article goes on to explain the many ways that music therapy fits into this
concept.
Reward circuitry in the brain focuses on research made in psychology
and neurophysiology proving that dopamine, an important
neurotransmitter, is associated with neuroplasticity and changes in the
brain. An article on reward circuitry and addiction discusses the fact that
normal neuronal activity naturally associates a “reward” circuitry to
everyday tasks such as eating, sex, or social interaction. Things like
addiction, trauma, and the reversal of these states are the focus of more
recent brain circuitry research. (Cooper, Robison, & Mazei-Robison,
2017).
One way that Constantin (2018) explains neuroplasticity and music
therapy is as a reward system. By comparing music therapy to food or
drugs in the realm of circuitry, Constantin (2018) is able to argue that
music has the potential to drastically affect neuroplasticity.
Another concept Constantin (2018) brings into music’s effect on the
brain is a theory known as ‘The Hebbian Principle,’ which basically
states that in order for strengthening of a current connection in the brain
to occur, or in order for a new connection to be made, two neurons have
to start their action potentials (or their electrical “firing”) at the same
time. Constantin (2018) presents research showing that rhythm/beat in
music is often crucial to music therapy since it is effective in linking
human behaviors to neural networks. Music therapy also linked human
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behaviors to activities such as dancing and singing, while even affecting
autonomic nervous system processes like breathing, heart rate, and sleep
cycles (Constantin, 2018).
Constantin (2018, p. 23) states that musical training clearly leads to
changes in the human brain. In a section on how neuroplasticity applies
directly to music therapy, the article argues that pairing music preferred
by a patient with the emotions they express while composing and
experiencing music creates a kind of “synchronized dopaminergic
reward that may strengthen the connections associated with related
emotional expression while suppressing connectivity associated with the
unrelated one.”
Constantin (2018, p. 24) concludes her review of research on
neuroplasticity by stating that “music is a tool that enhances
neuroplasticity in the brain. Through music therapy non-musical
behavior could change, the processes governing the change in behavior
leading to changes in the brain. The potential of music therapy to change
neural connectivity…underlie the positive effects of music therapy.”
In an article about the neurobiological foundations for music therapy, the
concepts of rhythm and neural entrainment are considered very
important factors that play into music therapy’s effect on the brain
(Thaut, McIntosh, & Hoemberg, 2015). This article focuses on research
that began in the 1990s and has continued until very recently, proving
that music and the rhythm it holds are directly related to sensory and
motor pathways in the brain. The researchers posit that, as a result of the
“entrainment” of music therapy patients with the music they are listening
to, music therapy can assist in rehabilitation both emotionally and
physiologically.
The article states that music therapy as a field has great capability to
begin shifting into a more neurologic context, meaning that it could treat
not only emotional and psychiatric disorders, but also neurologic
disorders and motor disorders. Music therapy, according to this source,
provides the ability, in a way, to “rewire” patients with movement or
speech disorders in a way that would allow them to once again find their
“rhythm” (Thaut et al., 2015).
The authors hope that this research will allow music therapists to gain a
better understanding of how music therapy can fit into the concepts of
executive and psychosocial function, attention, and memory when it
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Effects of Music Therapy
comes to psychiatric treatment. They claim that while these areas haven’t
had much success in the past as far as music therapy interventions were
involved, this new knowledge could help researchers better understand
music and rhythm in a therapeutic context in order to focus on certain
psychiatric deficits (Thaut et al., 2015).
Another current focus in the realm of music therapy is the actual
neurobiological and chemical changes that are imparted by music
therapy. A study by Keeler et al. (2015) looked specifically at the effects
of singing on two chemicals, ACTH and oxytocin. ACTH, or
adrenocorticotropic hormone, is a neurohormone that is associated with
the release of glucocorticoids like cortisol from the endocrine system.
Oxytocin is a neuropeptide that is released from the pituitary gland as a
hormone, where it colocalizes with stress hormones and helps to
suppress the HPA axis and mediate human social behavior.
While the study’s sample size was relatively small, the researchers were
able to collect significant statistical data from blood levels of ACTH and
oxytocin, showing that music therapy was effective at decreasing and
increasing the levels of these neurochemicals, respectively. This implies
that there are direct effects of music therapy on the immediate
neurochemistry of the brain and the rest of the body as a result of the
release of hormones from the brain which can affect the endocrine
system, the immune system, and the cardiovascular system (Keeler et al.,
2015). Interesting but not conclusive in this study is the fact that oxytocin
is significant in the chemistry of human bonding. Further research on
music therapy’s role in increasing oxytocin levels could help yield a
better understanding of the benefits of the relationship between the
patient and the music therapist, building on the precedent clearly set in
the literature.
Conclusion
The literature present on music therapy from roughly the past five years
clearly shows that music therapy can be effective as a treatment method
for various forms of psychiatric disorders. Whether combined with
pharmacotherapy or not, music therapy’s positive effects are evident. It
seemed apparent in the literature that active music therapy as opposed to
passive or receptive variants was the most effective, especially for the
treatment of more serious symptoms; however, many of the articles
acknowledged that more research was needed in this area before
definitive statements could be made.
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This review also discussed some of the recent theories and ideas
circulating in the actual action of music therapy in the brain. Much of the
research in the field is moving toward a focus on concepts like
neuroplasticity and brain circuitry, indicating that music can have a
significant and lasting effect on the brain, rather than just on mood or
emotional responses. At the same time, it seems that, especially for
music therapy to be applied in medical contexts, the upcoming concept
of rhythmic entrainment gives positive implications for music therapy’s
use not only for neurologic and motor disorders, but also for more
specific and debilitating aspects of serious psychiatric disorders such as
dissociation and memory loss. Brain chemistry associated with certain
neurohormones and neuropeptides has also been examined in recent
studies which seem to show promise in gaining a better understanding of
the general molecular microenvironment created by the context of music
therapy.
The results of this literature review all describe a more positive
understanding of music therapy and its effects on those suffering from
mood symptoms and psychiatric disorders. The literature points to music
therapy being implemented in many different varieties of practice
settings, implying a need for future research in those areas, and the
current research on the actual effects of music therapy on the brain also
begs for future research to be carried out.
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