music psychology research paper

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• Published: 22 June 2021

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

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

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

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• Medical genetics
• Psychiatric disorders

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

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Introduction.

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

Scope of the article

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

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

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

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

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

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

Music engagement and well-being

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

Music engagement and internalizing problems

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

Experimental studies

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

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

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

Correlational studies

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

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

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

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

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

Music engagement and externalizing problems

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

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

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

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

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

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

Music engagement and thought disorders

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

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

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

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

Interim summary

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

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

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

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

Theoretical framework for future studies

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

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

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

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

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

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

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

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

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

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

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

Path 4: Music engagement influences brain structure and function

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

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

New approaches to studying music and mental health

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

Genetic designs

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

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

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

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

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

Neuroimaging

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

Music and reward

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

Music and brain network dynamics

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

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

Biobanks and electronic health records

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

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

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

Concluding remarks

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

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Acknowledgements

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

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

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EDITORIAL article

Editorial: the impact of music on human development and well-being.

• 1 Department of Culture, Communication and Media, University College London, London, United Kingdom
• 2 Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
• 3 School of Humanities and Communication Arts, Western Sydney University, Penrith, NSW, Australia
• 4 Melbourne Conservatorium of Music, University of Melbourne, Melbourne, VIC, Australia

Editorial on the Research Topic The Impact of Music on Human Development and Well-Being

Music is one of the most universal ways of expression and communication for humankind and is present in the everyday lives of people of all ages and from all cultures around the world ( Mehr et al., 2019 ). Hence, it seems more appropriate to talk about musics (plural) rather than in the singular ( Goble, 2015 ). Furthermore, research by anthropologists as well as ethnomusicologists suggests that music has been a characteristic of the human condition for millennia (cf. Blacking, 1976 ; Brown, 1999 ; Mithen, 2005 ; Dissanayake, 2012 ; Higham et al., 2012 ; Cross, 2016 ). Nevertheless, whilst the potential for musical behavior is a characteristic of all human beings, its realization is shaped by the environment and the experiences of individuals, often within groups ( North and Hargreaves, 2008 ; Welch and McPherson, 2018 ). Listening to music, singing, playing (informally, formally), creating (exploring, composing, improvising), whether individually and collectively, are common activities for the vast majority of people. Music represents an enjoyable activity in and of itself, but its influence goes beyond simple amusement.

These activities not only allow the expression of personal inner states and feelings, but also can bring about many positive effects in those who engage in them. There is an increasing body of empirical and experimental studies concerning the wider benefits of musical activity, and research in the sciences associated with music suggests that there are many dimensions of human life—including physical, social, educational, psychological (cognitive and emotional)—which can be affected positively by successful engagement in music ( Biasutti and Concina, 2013 ). Learning in and through music is something that can happen formally (such as part of structured lessons in school), as well as in other-than-formal situations, such as in the home with family and friends, often non-sequentially and not necessarily intentional, and where participation in music learning is voluntary, rather than mandated, such as in a community setting (cf. Green, 2002 ; Folkestad, 2006 ; Saether, 2016 ; Welch and McPherson, 2018 ).

Such benefits are evidenced across the lifespan, including early childhood ( Gerry et al., 2012 ; Williams et al., 2015 ; Linnavalli et al., 2018 ), adolescence ( McFerran et al., 2018 ), and older adulthood ( Lindblad and de Boise, 2020 ). Within these lifespan perspectives, research into music's contribution to health and well-being provides evidence of physical and psychological impacts ( MacDonald et al., 2013 ; Fancourt and Finn, 2019 ; van den Elzen et al., 2019 ). Benefits are also reported in terms of young people's educational outcomes ( Guhn et al., 2019 ), and successful musical activity can enhance an individual's sense of social inclusion ( Welch et al., 2014 ) and social cohesion ( Elvers et al., 2017 ).

This special issue provides a collection of 21, new research articles that deepen and develop our understanding of the ways and means that music can impact positively on human development and well-being. The collection draws on the work of 88 researchers from 17 different countries across the world, with each article offering an illustration of how music can relate to other important aspects of human functioning. In addition, the articles collectively illustrate a wide range of contemporary research approaches. These provide evidence of how different research aims concerning the wider benefits of music require sensitive and appropriate methodologies.

In terms of childhood and adolescence, for example, Putkinen et al. demonstrate how musical training is likely to foster enhanced sound encoding in 9 to 15-year-olds and thus be related to reading skills. A separate Finnish study by Saarikallio et al. provides evidence of how musical listening influences adolescents' perceived sense of agency and emotional well-being, whilst demonstrating how this impact is particularly nuanced by context and individuality. Aspects of mental health are the focus for an Australian study by Stewart et al. of young people with tendencies to depression. The article explores how, despite existing literature on the positive use of music for mood regulation, music listening can be double-edged and could actually sustain or intensify a negative mood.

A Portuguese study by Martins et al. shifts the center of attention from mental to physical benefits in their study of how learning music can support children's coordination. They provide empirical data on how a sustained, 24-week programme of Orff-based music education, which included the playing of simple tuned percussion instruments, significantly enhanced the manual dexterity and bimanual coordination in participant 8-year-olds compared to their active control (sports) and passive control peers. A related study by Loui et al. in the USA offers insights into the neurological impact of sustained musical instrument practice. Eight-year-old children who play one or more musical instruments for at least 0.5 h per week had higher scores on verbal ability and intellectual ability, and these correlated with greater measurable connections between particular regions of the brain related to both auditory-motor and bi-hemispheric connectivity.

Younger, pre-school children can also benefit from musical activities, with associations being reported between informal musical experiences in the home and specific aspects of language development. A UK-led study by Politimou et al. found that rhythm perception and production were the best predictors of young children's phonological awareness, whilst melody perception was the best predictor of grammar acquisition, a novel association not previously observed in developmental research. In another pre-school study, Barrett et al. explored the beliefs and values held by Australian early childhood and care practitioners concerning the value of music in young children's learning. Despite having limited formal qualifications and experience of personal music learning, practitioners tended overall to have positive attitudes to music, although this was biased toward music as a recreational and fun activity, with limited support for the notion of how music might be used to support wider aspects of children's learning and development.

Engaging in music to support a positive sense of personal agency is an integral feature of several articles in the collection. In addition to the Saarikallio team's research mentioned above, Moors et al. provide a novel example of how engaging in collective beatboxing can be life-enhancing for throat cancer patients in the UK who have undergone laryngectomy, both in terms of supporting their voice rehabilitation and alaryngeal phonation, as well as patients' sense of social inclusion and emotional well-being.

One potential reason for these positive findings is examined in an Australian study by Krause et al. . They apply the lens of self-determination theory to examine musical participation and well-being in a large group of 17 to 85-year-olds. Respondents to an online questionnaire signaled the importance of active music making in their lives in meeting three basic psychological needs embracing a sense of competency, relatedness and autonomy.

The use of public performance in music therapy is the subject of a US study by Vaudreuil et al. concerning the social transformation and reintegration of US military service members. Two example case studies are reported of service members who received music therapy as part of their treatment for post-traumatic stress disorder, traumatic brain injury, and other psychological health concerns. The participants wrote, learned, and refined songs over multiple music therapy sessions and created song introductions to share with audiences. Subsequent interviews provide positive evidence of the beneficial psychological effects of this programme of audience-focused musical activity.

Relatedly, McFerran et al. in Australia examined the ways in which music and trauma have been reported in selected music therapy literature from the past 10 years. The team's critical interpretive synthesis of 36 related articles led them to identify four different ways in which music has been used beneficially to support those who have experienced trauma. These approaches embrace the use of music for stabilizing (the modulation of physiological processes) and entrainment (the synchronization of music and movement), as well as for expressive and performative purposes—the fostering of emotional and social well-being.

The therapeutic potential of music is also explored in a detailed case study by Fachner et al. . Their research focuses on the nature of critical moments in a guided imagery and music session between a music therapist and a client, and evidences how these moments relate to underlying neurological function in the mechanics of music therapy.

At the other end of the age span, and also related to therapy, an Australian study by Brancatisano et al. reports on a new Music, Mind, and Movement programme for people in their eighties with mild to moderate dementia. Participants involved in the programme tended to show an improvement in aspects of cognition, particularly verbal fluency and attention. Similarly, Wilson and MacDonald report on a 10-week group music programme for young Scottish adults with learning difficulties. The research data suggest that participants enjoyed the programme and tended to sustain participation, with benefits evidenced in increased social engagement, interaction and communication.

The role of technology in facilitating access to music and supporting a sense of agency in older people is the focus for a major literature review by Creech , now based in Canada. Although this is a relatively under-researched field, the available evidence suggests that that older people, even those with complex needs, are capable of engaging with and using technology in a variety of ways that support their musical perception, learning and participation and wider quality of life.

Related to the particular needs of the young, children's general behavior can also improve through music, as exampled in an innovative, school-based, intensive 3-month orchestral programme in Italy with 8 to 10-year-olds. Fasano et al. report that the programme was particularly beneficial in reducing hyperactivity, inattention and impulsivity, whilst enhancing inhibitory control. These benefits are in line with research findings concerning successful music education with specific cases of young people with ADHD whose behavior is characterized by these same disruptive symptoms (hyperactivity, inattention, and impulsivity).

Extra-musical benefits are also reported in a study of college students (Bachelors and Masters) and amateur musicians in a joint Swiss-UK study. Antonini Philippe et al. suggest that, whilst music making can offer some health protective effects, there is a need for greater health awareness and promotion among advanced music students. Compared to the amateur musicians, the college music students evaluated their overall quality of life and general and physical health more negatively, as did females in terms of their psychological health. Somewhat paradoxically, the college students who had taken part in judged performances reported higher psychological health ratings. This may have been because this sub-group were slightly older and more experienced musicians.

Music appears to be a common accompaniment to exercise, whether in the gym, park or street. Nikol et al. in South East Asia explore the potential physical benefits of synchronous exercise to music, especially in hot and humid conditions. Their randomized cross-over study (2019) reports that “time-to-exhaustion” under the synchronous music condition was 2/3 longer compared to the no-music condition for the same participants. In addition, perceived exertion was significantly lower, by an average of 22% during the synchronous condition.

Comparisons between music and sport are often evidenced in the body of existing Frontiers research literature related to performance and group behaviors. Our new collection contains a contribution to this literature in a study by Habe et al. . The authors investigated elite musicians and top athletes in Slovenia in terms of their perceptions of flow in performance and satisfaction with life. The questionnaire data analyses suggest that the experience of flow appears to influence satisfaction with life in these high-functioning individuals, albeit with some variations related to discipline, participant sex and whether considering team or individual performance.

A more formal link between music and movement is the focus of an exploratory case study by Cirelli and Trehub . They investigated a 19-month-old infant's dance-like, motorically-complex responses to familiar and unfamiliar songs, presented at different speeds. Movements were faster for the more familiar items at their original tempo. The child had been observed previously as moving to music at the age of 6 months.

Finally, a novel UK-based study by Waddington-Jones et al. evaluated the impact of two professional composers who were tasked, individually, to lead a 4-month programme of group composing in two separate and diverse community settings—one with a choral group and the other in a residential home, both funded as part of a music programme for the Hull City of Culture in 2017. In addition to the two composers, the participants were older adults, with the residential group being joined by schoolchildren from a local Primary school to collaborate in a final performance. Qualitative data analyses provide evidence of multi-dimensional psychological benefits arising from the successful, group-focused music-making activities.

In summary, these studies demonstrate that engaging in musical activity can have a positive impact on health and well-being in a variety of ways and in a diverse range of contexts across the lifespan. Musical activities, whether focused on listening, being creative or re-creative, individual or collective, are infused with the potential to be therapeutic, developmental, enriching, and educational, with the caveat provided that such musical experiences are perceived to be engaging, meaningful and successful by those who participate.

Collectively, these studies also celebrate the multiplicity of ways in which music can be experienced. Reading across the articles might raise a question as to whether or not any particular type of musical experience is seen to be more beneficial compared with another. The answer, at least in part, is that the empirical evidence suggests that musical engagement comes in myriad forms along a continuum of more or less overt activity, embracing learning, performing, composing and improvising, as well as listening and appreciating. Furthermore, given the multidimensional neurological processing of musical experience, it seems reasonable to hypothesize that it is perhaps the level of emotional engagement in the activity that drives its degree of health and well-being efficacy as much as the activity's overt musical features. And therein are opportunities for further research!

Author Contributions

The editorial was drafted by GW and approved by the topic Co-editors. All authors listed have made a substantial, direct and intellectual contribution to the Edited Collection, and have approved this editorial for publication.

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.

Acknowledgments

We are very grateful to all the contributing authors and their participants for their positive engagement with this Frontiers Research Topic, and also for the Frontiers staff for their commitment and support in bringing this topic to press.

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Welch, G. F., Himonides, E., Saunders, J., Papageorgi, I., and Sarazin, M. (2014). Singing and social inclusion. Front. Psychol. 5:803. doi: 10.3389/fpsyg.2014.00803

Williams, K. E., Barrett, M. S., Welch, G. F., Abad, V., and Broughton, M. (2015). Associations between early shared music activities in the home and later child outcomes: findings from the longitudinal study of Australian Children. Early Childhood Res. Q. 31, 113–124. doi: 10.1016/j.ecresq.2015.01.004

Keywords: music, wider benefits, lifespan, health, well-being

Citation: Welch GF, Biasutti M, MacRitchie J, McPherson GE and Himonides E (2020) Editorial: The Impact of Music on Human Development and Well-Being. Front. Psychol. 11:1246. doi: 10.3389/fpsyg.2020.01246

Received: 12 January 2020; Accepted: 13 May 2020; Published: 17 June 2020.

Reviewed by:

Copyright © 2020 Welch, Biasutti, MacRitchie, McPherson and Himonides. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Graham F. Welch, graham.welch@ucl.ac.uk ; Michele Biasutti, michele.biasutti@unipd.it

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

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• Description
• Aims and Scope
• Editorial Board
• Abstracting / Indexing
• Submission Guidelines

Psychology of Music publishes peer-reviewed papers directed at increasing the scientific understanding of any psychological aspect of music. These include studies on listening, performing, creating, memorising, analysing, describing, learning, and teaching, as well as applied social, developmental, attitudinal and therapeutic studies. Special emphasis is placed on studies, which address the interface between music psychology and music education.

"Without doubt, Psychology of Music is the pre-eminent journal in the field. Its reputation as the source of some of the most sophisticated and elegant research in music psychology has long been unparalleled." Professor Robert Walker

"... absorbing, well-researched and tidily presented, frequently thought-provoking and stimulating. The range of topics and educational levels covered is wide and varied. Journals like this serve an admirable purpose to make readily available reliable up-to-date research to support and encourage all musicians and teachers in their joint pursuits." Colin Touchin

"It is my considered opinion that Psychology of Music is now the premier journal of its kind in the world." Edward P. Asmus

Psychology of Music and SEMPRE provide an international forum for researchers working in the fields of psychology of music and music education, to encourage the exchange of ideas and to disseminate research findings.

View the institutional subscription rates : An institutional subscription to Psychology of Music includes a subscription to Research Studies in Music Education (two issues a year, also published by SAGE on behalf of SEMPRE). Subscriptions are available in the usual three ways: combined print and online, print only and e-access only. Please contact the customer services department to subscribe. Individual subscribers can purchase the journals separately in print only. If you are interested in becoming a member of SEMPRE and receiving a subscription to Psychology of Music as part of your membership dues please contact the SEMPRE membership secretary at: [email protected] This journal accepts supplementary materials, e.g. audio/video files, datasets, additional images etc. For more information please see our guidelines

All issues of Psychology of Music are available to browse online . Psychology of Music provides collections of free to access articles from the archive, centred around key topics and themes. The collections are collated by individuals across the field, and include an introduction to the topic or theme. Read them here .

This journal is a member of the Committee on Publication Ethics (COPE)

Published by the Society for Education, Music and Psychology Research (SEMPRE), the journal aims to increase the scientific understanding of all psychological aspects of music and music education. This includes studies on listening, performing, creating, memorizing, analyzing, describing, learning and teaching as well as applied social, developmental, attitudinal and therapeutic studies.

Submissions may be: theoretical critical papers or original empirical investigations containing systematic qualitative or quantitative analyses of relevant data; short research reports and notes which substantailly confirm or extend existing knowledge but which do not justify a full-length paper; or reviews of books, DVDs, CD Roms or online materials. Special emphasis is placed on studies carried out in naturalistic settings, especially those which address the interface between music psychology and music education.

Psychology of Music provides collections of free to access articles from the archive, centred around key topics and themes. The collections are collated by individuals across the field, and include an introduction to the topic or theme. Read them here .

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Manuscript Submission Guidelines: Psychology of Music

This Journal is a member of the  Committee on Publication Ethics .

Please read the guidelines below then visit the Journal’s submission site http://mc.manuscriptcentral.com/pom to upload your manuscript. Please note that manuscripts not conforming to these guidelines may be returned.

Only manuscripts of sufficient quality that meet the aims and scope of Psychology of Music will be reviewed.

There are no fees payable to submit or publish in this Journal. Open Access options are available - see section 3.3 below.

As part of the submission process you will be required to warrant that you are submitting your original work, that you have the rights in the work, and that you have obtained and can supply all necessary permissions for the reproduction of any copyright works not owned by you, that you are submitting the work for first publication in the Journal and that it is not being considered for publication elsewhere and has not already been published elsewhere. Please see our guidelines on prior publication and note that  Psychology of Music  may accept submissions of papers that have been posted on pre-print servers; please alert the Editorial Office when submitting (contact details are at the end of these guidelines) and include the DOI for the preprint in the designated field in the manuscript submission system. Authors should not post an updated version of their paper on the preprint server while it is being peer reviewed for possible publication in the journal. If the article is accepted for publication, the author may re-use their work according to the journal's author archiving policy. If your paper is accepted, you must include a link on your preprint to the final version of your paper.

• What do we publish? 1.1 Aims & Scope 1.2 Article types 1.3 Writing your paper
• Editorial policies 2.1 Peer review policy 2.2 Authorship 2.3 Acknowledgements 2.4 Funding 2.5 Declaration of conflicting interests 2.6 Research ethics and participant consent 2.7 Redundant publication 2.8 Editor/Assistant Editor Submissions 2.9 Research Data
• Publishing policies 3.1 Publication ethics 3.2 Contributor's publishing agreement 3.3 Open access and author archiving
• Preparing your manuscript 4.1 Formatting 4.2 Artwork, figures and other graphics 4.3 Supplemental material 4.4 Reference style 4.5 English language editing services
• Submitting your manuscript 5.1 ORCID 5.2 Information required for completing your submission 5.3 Permissions
• On acceptance and publication 6.1 Sage Production 6.2 Online First publication 6.3 Access to your published article 6.4 Promoting your article
• Further information

1. What do we publish?

1.1 Aims & Scope

Before submitting your manuscript to Psychology of Music , please ensure you have read the  Aims & Scope .

1.2 Article Types

Psychology of Music  publishes research articles of typically 4,000-6,000 words and shorter research notes.  Other types of format (e.g. theoretical critical papers, position papers, discussions, and reviews) are also welcomed providing they make a novel contribution to the field. The journal also publishes book reviews. Concise contributions are particularly welcome to facilitate timely publication.  Space is reserved for short and timely research articles (max. 3,000 words) that are identified as meriting more rapid publication which will be fast-tracked through the review process; the editorial board will identify such articles at submission, or authors may wish to flag them in their cover letter.

1.3 Writing your paper

The Sage Author Gateway has some general advice and on  how to get published , plus links to further resources. Sage Author Services also offers authors a variety of ways to improve and enhance their article including English language editing, plagiarism detection, and video abstract and infographic preparation.

1.3.1 Make your article discoverable

When writing up your paper, think about how you can make it discoverable. The title, keywords and abstract are key to ensuring readers find your article through search engines such as Google. For information and guidance on how best to title your article, write your abstract and select your keywords, have a look at this page on the Gateway:  How to Help Readers Find Your Article Online .

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2. Editorial policies

2.1 Peer review policy

Sage does not permit the use of author-suggested (recommended) reviewers at any stage of the submission process, be that through the web-based submission system or other communication. Reviewers should be experts in their fields and should be able to provide an objective assessment of the manuscript. Our policy is that reviewers should not be assigned to a paper if:

•  The reviewer is based at the same institution as any of the co-authors

•  The reviewer is based at the funding body of the paper

•  The author has recommended the reviewer

•  The reviewer has provided a personal (e.g. Gmail/Yahoo/Hotmail) email account and an institutional email account cannot be found after performing a basic Google search (name, department and institution). 

2.2 Authorship

All parties who have made a substantive contribution to the article should be listed as authors. Principal authorship, authorship order, and other publication credits should be based on the relative scientific or professional contributions of the individuals involved, regardless of their status. A student is usually listed as principal author on any multiple-authored publication that substantially derives from the student’s dissertation or thesis.

Please note that AI chatbots, for example ChatGPT, should not be listed as authors. For more information see the policy on Use of ChatGPT and generative AI tools .

2.3 Acknowledgements

All contributors who do not meet the criteria for authorship should be listed in an Acknowledgements section. Examples of those who might be acknowledged include a person who provided purely technical help, or a department chair who provided only general support.

Please supply any personal acknowledgements separately to the main text to facilitate anonymous peer review.

2.3.1 Third party submissions

Where an individual who is not listed as an author submits a manuscript on behalf of the author(s), a statement must be included in the Acknowledgements section of the manuscript and in the accompanying cover letter. The statements must:

• Disclose this type of editorial assistance – including the individual’s name, company and level of input
• Identify any entities that paid for this assistance
• Confirm that the listed authors have authorized the submission of their manuscript via third party and approved any statements or declarations, e.g. conflicting interests, funding, etc.

Where appropriate, Sage reserves the right to deny consideration to manuscripts submitted by a third party rather than by the authors themselves .

2.4 Funding

Psychology of Music requires all authors to acknowledge their funding in a consistent fashion under a separate heading. Please visit the Funding Acknowledgements  page on the Sage Journal Author Gateway to confirm the format of the acknowledgment text in the event of funding, or state that: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 

2.5 Declaration of conflicting interests

Psychology of Music encourages authors to include a declaration of any conflicting interests and recommends you review the good practice guidelines on the  Sage Journal Author Gateway .

2.6 Research ethics and participant consent

Psychology of Music requires that any manuscripts involving human subjects or participants must include the following statements:

Ethical approval statement

Upon submission, authors will be asked to state the relevant ethics committee or institutional review board provided (or waived) approval. Please ensure that you have provided the full name and institution of the review committee, in addition to the approval number. Where exemption from ethics approval has been granted by an appropriate body, this should be specified and the reason for exemption should be provided. Manuscripts should include statements that provide a clear explanation as to why ethics approval and/or informed consent was not sought for a given study in a specific country or region.

Informed consent

Authors are required to state in the methods section whether participants provided informed consent (for inclusion, collection/use of data or samples, and/or publication, as applicable) and whether the consent was written or verbal.

2.7 Redundant publication

The Editors of Psychology of Music ask authors to declare if any data reported in their submission have been published previously wholly or in part. For example: the reanalysis of a previously published dataset by a different set of authors would need to be declared. The publication of multiple articles using the same dataset with somewhat related outcomes could be considered inappropriate. Within the cover letter and methods section, authors should declare if datasets or participants reported in their submission overlap with any prior published work to help a thorough Editorial assessment of the study.

2.8 Editor/Assistant Editor Submissions

In the interest of transparency, the journal’s policy on submissions by journal board members or Editors or Assistant Editors with a role in administering the peer review process or their families or associates, is as follows:

• Board members and Editors take no part in the review process of their own submissions, those of their family member or their associates and have no access to Editorial information concerning such submissions.
• No preference or favour is given in the decision or peer review process dependent on the author’s relationship to the journal.
• Papers are processed consecutively irrespective of the author’s relationship to the journal. That is, the journal does not ‘expedite’ papers at the expense of others as journal resources are distributed evenly.

2.9 Research Data

The journal is committed to facilitating openness, transparency and reproducibility of research, and has the following research data sharing policy. For more information, including FAQs please visit the Sage Research Data policy pages .

Subject to appropriate ethical and legal considerations, authors are encouraged to:

• share your research data in a relevant public data repository
• include a data availability statement linking to your data. If it is not possible to share your data, we encourage you to consider using the statement to explain why it cannot be shared.
• cite this data in your research

3. Publishing Policies

3.1 Publication ethics

Sage is committed to upholding the integrity of the academic record. We encourage authors to refer to the Committee on Publication Ethics’ International Standards for Authors  and view the Publication Ethics page on the  Sage Author Gateway .

3.1.1 Plagiarism

Psychology of Music and Sage take issues of copyright infringement, plagiarism or other breaches of best practice in publication very seriously. We seek to protect the rights of our authors and we always investigate claims of plagiarism or misuse of published articles. Equally, we seek to protect the reputation of the journal against malpractice. Submitted articles may be checked with duplication-checking software. Where an article, for example, is found to have plagiarised other work or included third-party copyright material without permission or with insufficient acknowledgement, or where the authorship of the article is contested, we reserve the right to take action including, but not limited to: publishing an erratum or corrigendum (correction); retracting the article; taking up the matter with the head of department or dean of the author's institution and/or relevant academic bodies or societies; or taking appropriate legal action.

3.1.2 Prior publication

If material has been previously published it is not generally acceptable for publication in a Sage journal. However, there are certain circumstances where previously published material can be considered for publication. Please refer to the guidance on the Sage Author Gateway  or if in doubt, contact the Editor at the address given below.

3.2 Contributor's publishing agreement

Before publication, Sage requires the author as the rights holder to sign a Journal Contributor’s Publishing Agreement. Sage’s Journal Contributor’s Publishing Agreement is an exclusive licence agreement which means that the author retains copyright in the work but grants Sage the sole and exclusive right and licence to publish for the full legal term of copyright. Exceptions may exist where an assignment of copyright is required or preferred by a proprietor other than Sage. In this case copyright in the work will be assigned from the author to the society. For more information please visit the  Sage Author Gateway .

3.3 Open access and author archiving

Psychology of Music offers optional open access publishing via the Sage Choice programme and Open Access agreements, where authors can publish open access either discounted or free of charge depending on the agreement with Sage. Find out if your institution is participating by visiting Open Access Agreements at Sage . For more information on Open Access publishing options at Sage please visit Sage Open Access . For information on funding body compliance, and depositing your article in repositories, please visit Sage’s Author Archiving and Re-Use Guidelines and Publishing Policies .

4. Preparing your manuscript for submission

4.1 Formatting

The preferred format for your manuscript is Word. You do not need to follow a template, but please ensure your heading levels are clear, and the sections clearly defined.

4.2 Artwork, figures and other graphics

For guidance on the preparation of illustrations, pictures and graphs in electronic format, please visit Sage’s Manuscript Submission Guidelines .   

Figures supplied in colour will appear in colour online regardless of whether or not these illustrations are reproduced in colour in the printed version. For specifically requested colour reproduction in print, you will receive information regarding the costs from Sage after receipt of your accepted article.

4.3 Supplemental material

This journal is able to host additional materials online (e.g. datasets, podcasts, videos, images etc) alongside the full-text of the article. For more information please refer to our  guidelines on submitting supplemental files .

4.4 Reference style

Psychology of Music adheres to the APA reference style. View the APA guidelines to ensure your manuscript conforms to this reference style.

4.5 English language editing services

Authors seeking assistance with English language editing, translation, or figure and manuscript formatting to fit the journal’s specifications should consider using Sage Language Services. Visit Sage Language Services  on our Journal Author Gateway for further information.

5. Submitting your manuscript

Psychology of Music is hosted on Sage Track, a web based online submission and peer review system powered by ScholarOne™ Manuscripts. Visit http://mc.manuscriptcentral.com/pom to login and submit your article online.

IMPORTANT: Please check whether you already have an account in the system before trying to create a new one. If you have reviewed or authored for the journal in the past year it is likely that you will have had an account created.  For further guidance on submitting your manuscript online please visit ScholarOne Online Help .

As part of our commitment to ensuring an ethical, transparent and fair peer review process Sage is a supporting member of ORCID, the Open Researcher and Contributor ID . ORCID provides a unique and persistent digital identifier that distinguishes researchers from every other researcher, even those who share the same name, and, through integration in key research workflows such as manuscript and grant submission, supports automated linkages between researchers and their professional activities, ensuring that their work is recognized. 

The collection of ORCID IDs from corresponding authors is now part of the submission process of this journal. If you already have an ORCID ID you will be asked to associate that to your submission during the online submission process. We also strongly encourage all co-authors to link their ORCID ID to their accounts in our online peer review platforms. It takes seconds to do: click the link when prompted, sign into your ORCID account and our systems are automatically updated. Your ORCID ID will become part of your accepted publication’s metadata, making your work attributable to you and only you. Your ORCID ID is published with your article so that fellow researchers reading your work can link to your ORCID profile and from there link to your other publications.

If you do not already have an ORCID ID please follow this link to create one or visit our ORCID homepage to learn more.  

5.2 Information required for completing your submission

You will be asked to provide contact details and academic affiliations for all co-authors via the submission system and identify who is to be the corresponding author. These details must match what appears on your manuscript. The affiliation listed in the manuscript should be the institution where the research was conducted. If an author has moved to a new institution since completing the research, the new affiliation can be included in a manuscript note at the end of the paper. At this stage please ensure you have included all the required statements and declarations and uploaded any additional supplementary files (including reporting guidelines where relevant).

5.3 Permissions

Please also ensure that you have obtained any necessary permission from copyright holders for reproducing any illustrations, tables, figures or lengthy quotations previously published elsewhere. For further information including guidance on fair dealing for criticism and review, please see the Copyright and Permissions page on the  Sage Author Gateway .

6. On acceptance and publication

6.1 Sage Production

Your Sage Production Editor will keep you informed as to your article’s progress throughout the production process. Proofs will be sent by PDF to the corresponding author via our editing portal Sage Edit or by email, and corrections should be made directly or notified to us promptly.  Authors are reminded to check their proofs carefully to confirm that all author information, including names, affiliations, sequence and contact details are correct, and that Funding and Conflict of Interest statements, if any, are accurate.

6.2 Online First publication

Online First allows final articles (completed and approved articles awaiting assignment to a future issue) to be published online prior to their inclusion in a journal issue, which significantly reduces the lead time between submission and publication. Visit the Sage Journals help page  for more details, including how to cite Online First articles.

6.3 Access to your published article

Sage provides authors with online access to their final article.

6.4 Promoting your article

Publication is not the end of the process! You can help disseminate your paper and ensure it is as widely read and cited as possible. The Sage Author Gateway has numerous resources to help you promote your work. Visit the Promote Your Article  page on the Gateway for tips and advice.

7. Further information

Any correspondence, queries or additional requests for information on the manuscript submission process should be sent to the Psychology of Music editorial office as follows:

Alexandra Lamont ( [email protected] )

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• Open access
• Published: 21 March 2023

Changing positive and negative affects through music experiences: a study with university students

• José Salvador Blasco-Magraner 1 ,
• Gloria Bernabé-Valero 2 ,
• Pablo Marín-Liébana 1 &
• Ana María Botella-Nicolás 1  

BMC Psychology volume  11 , Article number:  76 ( 2023 ) Cite this article

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Currently, there are few empirical studies that demonstrate the effects of music on specific emotions, especially in the educational context. For this reason, this study was carried out to examine the impact of music to identify affective changes after exposure to three musical stimuli.

The participants were 71 university students engaged in a music education course and none of them were musicians. Changes in the affective state of non-musical student teachers were studied after listening to three pieces of music. An inter-subject repeated measures ANOVA test was carried out using the Positive and Negative Affect Schedule (PANAS) to measure their affective state.

The results revealed that: (i) the three musical experiences were beneficial in increasing positive affects and reducing negative affects, with significant differences between the interaction of Music Experiences × Moment (pre-post); (ii) listening to Mahler’s sad fifth symphony reduced more negative affects than the other experimental conditions; (iii) performing the blues had the highest positive effects.

Conclusions

These findings provide applied keys aspects for music education and research, as they show empirical evidence on how music can modify specific affects of personal experience.

Peer Review reports

Introduction

The studies published on the benefits of music have been on the increase in the last two decades [ 1 , 2 , 3 ] and have branched out into different areas of research such as psychology [ 4 , 5 , 6 , 7 , 8 ], education [ 1 , 9 , 10 ] and health [ 11 , 12 ] providing ways of using music as a resource for people’s improvement.

The publication in 1996 of the famous report “Education Hides a Treasure” submitted to the UNESCO by the International Commission was an important landmark in the educational field. This report pointed out the four basic pillars of twenty-first century education: learning to know, learning to do, learning to live together, and learning to be [ 13 ]. The two last ones clearly refer to emotional education. This document posed a challenge to Education in terms of both academically and emotionally development at all levels from kindergarten to university. In this regard, there has been a notable increase in the number of studies that have shown the strong impact of music on the emotions in the different stages of education and our lives. For example, from childhood to adolescence, involving primary, secondary and university education, music is especially relevant for its beneficial effects on developing students’ emotional intelligence and prosocial skills [ 1 , 14 ]. In adults, music benefits emotional self-regulation [ 15 ], while in old age it helps to maintain emotional welfare and to experience and express spirituality [ 16 ]. This underlines the importance of providing empirical evidence on the emotional influence of music.

Influence of music on positive affects

Numerous studies have used the Positive and Negative Affect Schedule (PANAS) to evaluate the emotional impact of music [ 17 ]. This scale is valid and effective for measuring the influence of positive and negative effects of music on listeners and performers [ 10 , 18 , 19 ]. Thus, for example, empirical evidence shows that exposure to a musical stimulus favours the increase of positive affects [ 20 , 21 ] found a significant increase in three positive affects in secondary school students after listening to music, and the same results has been found after listening to diverse musical styles. These results are consistent with Schubert [ 22 ], who demonstrated that music seems to improve or maintain well-being by means of positive valence emotions (e. g. happiness, joy and calm). Other research studied extreme metal fans aged between 18 and 34 years old and found statements of physiological excitement together with increased positive affects [ 21 ]. Positive outcomes after listening to sad music have also been found [ 23 ], who played Samuel Barbers’ Adagio for Strings , described by the BBC as the world’s saddest piece of classical music, to 20 advanced music students and 20 advanced psychology students with no musical background and subsequently found that the music only had positive affects on both groups.

Several experimental designs that used sad music on university students noticed that they experienced both sadness and positive affects [ 24 , 25 ] and also found that music labeled as “happy” increased positive affects while the one labeled as “sad” reduced both positive and negative affects [ 26 ]. For other authors the strongest and most pleasant responses to sad music are associated with empathy [ 27 ]. Moreover, listening to sad music had benefits since attributes of empathy were intensified [ 27 , 28 ]. In relation to musical performances, empirical evidence found a significant increase in positive affects [ 29 ]. Thus, music induces listeners to experience positive affects, which could turn music into an instrument for personal development.

Following on from Fredrickson’s ‘broaden‐and‐build’ framework of positive emotions [ 30 ], positive affects cause changes in cognitive activities which, in turn, can cause behaviour changes. They can also expand the possibilities for action and improve physical resources. According to Fredrickson [ 30 ], positive affects trigger three sequential effects: (1) amplification of the scope for thought and action; (2) construction of personal resources to deal with difficult simplifications; (3) personal transformation by making one more creative, with a better understanding of situations, better able to face up to difficulties and better socially integrated. This leads to an “upward spiral” in which even more positive affects are experienced. A resource such as music that can increase positive affects, can therefore be considered as a step forward in personal transformation. Thus, music teachers could have a powerful tool to help students enhance their personal development.

Influence of music on negative affects

There is a great deal of controversy as regards the influence of music on negative affects. Blasco and Calatrava [ 20 ] found a significant reduction of five negative affects in secondary school students after listening to Arturo Marquez’s typically happy Danzón N O 2. Different results were found in an experiment in which the change in participants ‘affects was assessed after listening the happy "Eye of the Tiger" by Survivor and the sad "Everybody Hurts" by REM [ 26 ]. They found that the happy piece only increased the positive affects but did not reduce the negative ones, while the sad piece reduced both positive and negative affects. However, neither of these findings agree with Miller and Au [ 31 ], who carried out an experiment to compare the influence of sad and happy music on undergraduates ‘mood arousal and found that listening to both types had no significant changes on negative affects. Shulte [ 32 ] conducted a study with 30 university students to examine the impact that nostalgic music has on affects, and found that after listening to different songs, negative affects decreased. Matsumoto [ 33 ] found that sad music reduced sad feelings in deeply sad university students, while Vuoskoski and Eerola [ 34 ] showed that sad music could produce changes in memory and emotional judgements related to emotions and that experiencing music-induced sadness is intrinsically more pleasant than sad memories. It therefore seems that reducing negative affects has mostly been studied with sad and nostalgic musical stimuli. In this way, if music can reduce negative affects, it can also be involved in educational and psychological interventions focused on improving the emotional-affective sphere. Thus, for example, one study examined the effects of a wide range of music activities and found that it would be necessary to specify exactly what types of music activity lead to what types of outcomes [ 2 ]. Moore [ 3 ] also found that certain music experiences and characteristics had both desirable and undesirable effects on the neural activation patterns involved in emotion regulation. Furthermore, recent research on university students shows that music could be used to assess mood congruence effects, since these effects are reactions to the emotions evoked by music [ 35 ].

These studies demonstrate that emotional experience can be actively driven by music. Moreover, they synthesize the efforts to find ways in which music can enhance affective emotional experience by increasing positive affects and reducing the negative ones (e. g. hostility, nervousness and irritability). Although negative emotions have a great value for personal development and are necessary for psychological adjustment, coping with them and self-regulation capacities are issues that have concerned psychology. For example, Emotional Intelligence [ 36 ], which has currently been established in the educational field, constitutes a fundamental conceptual framework to increase well-being when facing negative emotions, providing keys for greater control and management of emotional reactions. It also establishes how to decrease the intensity and frequency of negative emotional states [ 37 ], providing techniques such as mindfulness meditation that have proven their effectiveness in reducing negative emotional experiences and increasing the positive ones [ 38 ]. The purpose of this research is to find whether music can be part of the varied set of resources that can be used by a teacher to modify students’ emotional experience.

Thus, although empirical evidence of the effects of music on the emotional sphere is still incipient. It seems that they can increase positive effects, but it is not clear their impact on the negative ones, since diverse and contradictory results (no change and reduction of negative affects after listening to music) were found. In addition, the effects of the type of musical piece (e.g. happy or sad music) need further investigation as different effects were found. Moreover, previous studies do not compare between the effects of listening to versus performing music. Such an approach could provide keys to highlight the importance of performing within music education. Therefore, this study aims to contribute to this scientific field, providing experimental evidence on the effects of listening to music as compared to performing music, as well as determining the effects of different types of music on positive and negative affects.

To this end, the effects of three different types of music experiences were compared: (1) listening to a sad piece, (2) listening to an epic and solemn piece, and (3) performing of a rhythm and a blues piece, to determine whether positive and negative affects were modified after exposure to these experimental situations. In particular, two hypotheses guided this study: (1) After exposure to each musical experience (listening to a sad piece; listening to a solemn piece and playing a blues), all participants will improve their emotional experience, increasing their positive affects and reducing their negative ones; and (2) the music performance will induce a greater change as compared to the listening conditions.

Participants

A total of 71 students were involved in this study, 6 men and 65 women between the ages of 20 and 40, who were studying a Teaching Grade. These students were enrolled in the "Music Education" program as part of their university degree’s syllabus. None of them had special music studies from conservatories, academies or were self-taught; thus, all had similar musical knowledge. None of them had previously listened to music in an instructional context nor had performed music with their fellow students. In addition, none of them had listening before to the musical pieces selected for this experiment.

All signed an informed consent form before participating and no payment was given for taking part in the study. As the experiment was carried out in the context of a university course, they were assured that their participation and responses would be anonymous and would have no impact on their qualifications. The research was approved by the ethical committee at the Universidad Católica de Valencia San Vicente Mártir: UCV2017- 18-28 code.

Questionnaire

To assess emotional states, the Positive and Negative Affective States scales (PANAS), was administered [ 39 ]. In particular, the Spanish version of the scale [ 17 ], whose study shows a high degree of internal consistency; in males 0.89 in positive affects and 0.91 in negative affects; in women 0.87 in positive affects and 0.89 in negative affects. In this study, good reliability level in each experimental condition was obtained (0.836–0.913 for positive affects and 0.805–0.917 for negative affects (see Table 1 for more information on Cronbach’s α for each experimental condition).

The PANAS consists of 20 items which describe different dimensions of emotional experience. Participants must answer them regarding to their current affective state. The scale is composed of 20 items; 10 positive affects (PA) and 10 negative affects (NA). Answers are graded in a 5-options (Likert scale), with reversed items, ranging from extremely (1) to very slightly or not at all (5).

Musical pieces

The musical pieces choice stemmed from the analysis of some of the music elements that most influence the perception of emotions: mode, melody and intervals. Within the melody, range and melodic direction were distinguished. The range or amplitude of the melodic line is commonly divided into wide or narrow, while the melodic direction is often classified as ascending or descending. Chang and Hoffman [ 10 ] associated narrow amplitude melodies with sadness, while Schimmark and Grob [ 40 ] related melodic amplitude with highly activated emotions. Regarding the melodic direction, Gerardi and Gerken [ 41 ] found a relationship between ascending direction and happiness and heroism, and between descending direction and sadness.

In relation to the mode, Tizón [ 42 ] stated that the major one is completely happy, while the minor one represents sadness. Thompson and Robitaille [ 43 ] considered that, in order to cause emotions such as happiness, solemnity or joy, composers use tonal melodies, while to obtain negative emotions, they use atonality and chromaticism.

In this research, the selected pieces (“Adagietto” from Gustav Mahler's Fifth Symphony, MML; and “Titans” from Alexander The Great from Vangelis, VML) are representative examples of the melodic, intervallic and modal characteristics previously exposed. Mahler's and Vangelis's pieces completely differ in modes and melodic amplitude (sad vs. heroism). Likewise, Mahler's piece is much more chromatic than Vangelis' one, which has a broader melody made up of third, fourth and fifth intervals, often representative of heroism. Those features justify the fact that they have been used as soundtracks in two films belonging to the epic genre (Alexander The Great, 2004) and drama (Death in Venice, 1971).

The musical piece that was performed by the students was chosen in order to be easy to learn in a few sessions, since they were not musicians. So, three musical pieces were used for the experimental conditions, the first two musical pieces were recordings in a CD, while the third one was performed by the subjects.

The three chosen pieces are described below:

Condition 1 (MML): “Adagietto” from Gustav Mahler’s Fifth Symphony (9:01 min), performed by the Berlin Philharmonic conducted by Claudio Abbado [ 44 ]. This is a sad, melancholic and dramatic piece that Luchino Visconti used in the film Death in Venice, made in 1971 and based on the book by Thomas Mann.

Condition 2 (VML): “Titans Theme” from Alexander the Great (3:59 min), directed by Oliver Stone and premiered in 2004, whose music was composed, produced and performed by Vangelis [ 45 ]. It has a markedly epic character with large doses of heroism and solemnity.

Condition 3 (BP): “Rhythm’s Blues” composed and played by Ana Bort (4:00 min). This is a popular African-American piece of music with an insistent rhythm and harmonically sustained by tonal degrees. This piece was performed by the participants using percussion instruments (carillons and a range of xylophones and metallophones).

The sample was divided into two groups (N 1  = 36 and N 2  = 35) that participated separately in all the phases of the study. The first two conditions (MML and VML) were carried out in each group's classroom, while the performance (BP) was developed in the musical instruments room. This room had 52 percussion instruments, including different types of chimes, xylophones and metallophones (soprano, alto and bass). It is a large space where there are only chairs and musical instruments and stands. The first group was distributed as follows: 6 chimes (3 soprano and 3 alto), 5 soprano xylophones, 5 alto xylophones, 5 bass xylophones, 5 soprano metallophones, 5 alto metallophones and 5 bass metallophones. The distribution of the second group was similar, but with one less alto metallophone.

Prior to the experiment, participants received two practical lessons in order to learn how to collectively perform the music score (third experimental condition). After the two practical lessons, during the next three sessions (leaving two weeks between each session), the experiment was carried out. In each session, an experimental condition was applied and PANAS was on-line administered online beforehand and afterwards (Pre-Post design). All participants were exposed to the three experimental conditions and completed the scale before and after listening to music.

In each of these three sessions, a different music condition was applied: MML in the first one, VML in the second one and BP in the third one.

As conditions VML and MML were listening to pieces of music, the instructions received by the subjects were: “You are going to listen to a musical piece, you ought to listen actively, avoiding distractions. You can close your eyes if you feel like to”. For the BP condition, they were said to play the musical sheet all together.

The aim of the study was to examine the effect of the music experience variable (with three levels: MML, VML and BP) in the Positive and Negative Affects subscales from the PANAS scale. The variable Moment was also studied to control biases and to analyze differences between the Pre and Post conditions.

The experiment was designed as a two-way repeated measure (RM) ANOVA with two dependent variables: Positive Affects and Negative Affects, one for each PANAS’ subscales.

The two repeated measures used in the experiment were the variables Musical Experience (ME), with three levels (MML, VML and BP) and the variable Moment, with two levels (PRE and POST). All participants were exposed to the three experimental conditions.

The design did not include a control group, similar to many other studies in the field of music psychology [ 27 , 30 ]. The control was carried out from the intra-subject pre-post measurement of all the participants. The rationale for this design lies in the complexity of the control condition (or placebo) design in psychology [ 46 ]. While placebos in pharmacological trials are sugar pills, in psychology it is difficult to establish an equivalent period of time similar to the musical pieces (e. g. 9 min) without activity, so that cognitive activity occurred during this period of time (e. g. daydreaming, reading a story, etc.) could bias and limit the generalization of results.

Additionally, one of the goals of this study was to compare the effects of listening to music compared to performance on affects. For this reason, two music listening experiences (MML and VML) and a musical performance experience (BP) were designed. In order to control potential biases, participants did not know the musical pieces in the experimental conditions and they had a low level of musical performance competence (musicians were excluded).

It was used SPSS statistics v.26 for the statistical analyzes.

Two ANOVA were performed. The first one, analyzed two dependent variables at the same time: Positive Affects (PA) and Negative Affects (NA).

In the second ANOVA, the 20 items of the PANAS scale were taken as dependent variables. The rest of the experimental design was similar to the first one, a two-way RM ANOVA with variables Musical Experience (ME) and Moment as repeated measures.

Examination of frequency distributions, histograms, and tests of homogeneity of variance and normality for the criterion measures indicated that the assumptions for the use of parametric statistics were met. Normality was met in all tests except for one, but the ANOVA is robust against this assumption violation. All the analyses presented were performed with the significance level (alpha) set at 0.05, two-tailed tests. Means and standard deviations for the 6 experimental conditions for both subscales, Positive Affects and Negative Affects, are presented in Table 1 .

Mauchly’s test of sphericity was statistically significant for Musical Experience and Musical Experience*Moment focusing on NA as the dependent variable ( p  < 0.05). The test only was significant for Musical Experience for PA as dependent variable ( p  < 0.05). The rest of the W’s Mauchly were not significant ( p  > 0.05), so we assumed sphericity for the non-mentioned variables and worked with the assumed sphericity univariate solution. For the variables which the W’s Mauchly was significant, the univariate solution was also taken, but choosing the corrected Greenhouse–Geisser epsilon approximation due to its conservativeness.

A significant principal effect of the Musical Experience variable F(1.710,119.691) = 22.505, p  < 0.05, η 2  = 0.243; the Moment variable F(1,70) = 45.291, p  < 0.05, η 2  = 0.393; and the Musical Experience*Moment interaction F(2,140) = 32.502, p  < 0.05, η 2  = 0.317 were found for PA.

Statistically significance was found for Moment F(1, 70) = 70.729, p  < 0.05, η 2  = 0.503 and Musical Experience*Moment interaction F(1.822, 127.555) = 8.594, p  < 0.05, η 2  = 0.109, but not for Musical Experience F(1.593, 111.540) = 2.713, p  < 0.05, η 2  = 0.037, for the other dependent variable, NA.

Table 2 shows pairwise comparisons between Musical Experience levels. Bonferroni’s correction was applied in order to control type I error. We only interpret the results for the Positive Affects because the Musical Experience effect was not statistically significant for Negative Affects. Results show that condition VML presents a significant higher punctuation in Positive Affects than the other two conditions ( p  < 0.05). It also shows that the musical condition MML is significantly above BP in Positive Affects ( p  < 0.05).

As regards Moment variable (Table 3 ), all but one Pre-Post differences were statistically significant ( p  < 0.05) for all the three conditions for both Positive and Negative Affects dependent variables. The Pre-Post difference found in Positive Affects for the VML Musical Experience did not reach the statistical level ( p  = 0.319).

Focusing on these statistically significant differences, we observe that conditions MML and BP, for PA, decreased from Pre to Post condition, indicating that positive emotions increased significantly between pre and post measures. On the other hand, for NA, all conditions increased from Pre to Post conditions, indicating that negative affects were decreased between pre and post conditions. Once again, one should bear in mind that items were reversed, thus, a higher scores in NA means a decrease in affects.

In order to measure the interaction effect, significant differences between simple effects were analysed.

The simple effect of Moment (level2-level1) in the first Music Experience condition (MML) in PA was compared with the simple effect of Moment (level2-level1) in the second Musical Experience condition (VML). Music Experience conditions 2–3 (VML-BP) and 1–3 (MML-BP) were compared in the same way. Thus, taking into account PA and NA variables, a total of 6 comparisons, 3 per dependent variable, were made.

The results of these comparisons are shown in Table 4 . Comparisons for PA range from T1 to T3 and comparisons for NA range from T4 to T6. All of them are significant ( p  < 0.05) which means that there are statistically significant differences between all the Musical Experience conditions when comparing the Moment (pre/post) simple effects.

In Table 5 , we can look at the differences’ values. As we said before the differences between Pre and Post conditions are significant when comparing the three musical conditions. The biggest difference for positive affects is between MML and BP (T3 = 8.443), and between VML and MML (T4 = − 6.887) for negative affects.

In this second part, the results obtained from the second two-way RM ANOVA with the 20 items as dependent variables are considered. Results of the descriptive analysis of each item: Interested, Excited, Strong, Enthusiastic, Proud, Alert, Inspired, Determined, Attentive, Active, Distressed, Upset, Guilty, Afraid, Hostile, Irritable, Ashamed, Nervous, Jittery, Scared ; in each musical condition: MML, VML and BP; and for the PRE and POST measurements, can be found in the Additional file 1 (Appendix A).

As regards the ANOVA test that compares the three experimental conditions in each mood, Mauchly’s Sphericity Test indicates that sphericity cannot be assumed for the musical experience in most of the variables of the items of effects, except for Interested, Alert, Inspired, Active and Irritable . For these items, the highest observed power index among Greenhouse–Geisser, Huynh–Feldt and Lower-bound epsilon corrections was taken for each variable. For the interaction Musical Experience*Moment, sphericity was not assumed for Distressed, Guilty, Hostile and Scared . For these items, the same above-cited criterion was followed.

Musical experience has a principal effect on all the positive affects, but only has it for 5 negative affects ( Nervous, Jittery, Scared, Hostile and Upset ) ( p  < 0.05). For more detail see Table S1 from Additional file 1 : Appendix B.

The principal effect of Moment is also statistically significant ( p  < 0.05) for all (positive and negative), but two items: Guilty ( p  = 0.073) and Hostile ( p  = 0.123). All the differences between Pre and Post for positive affects are positive, which means that scores in conditions Pre were significantly higher than in condition Post. The other way around occurs for negative affects, all the differences Pre-Post are negative, meaning that the Post condition is significantly higher than the Pre condition. For more detail, see Table S2 from Additional file 1 : Appendix B. In this way, Pre-post changes (Moment) improve affective states; the positive affects increase while the negative are reduced, except for Guilty ( p  = 0.073) and Hostile ( p  = 0.123).

Comparing the proportion of variance explained by the musical experienced and Moment (Tables s1 and s2 from the Additional file 1 : Appendix B), it is observed that most of the η 2 scores in musical experience are below 0.170, except Active and Alert , which are higher. On the other hand, the η 2 scores for Moment are close to 0.300. From these results we can state that, taking only one of the variables at a time, the proportion of the dependent variable’s variance explained by Moment is higher than the proportion of the dependent variable’s variance explained by Musical Experience.

The effect of interaction, shown in Table S3 from the Additional file 1 : Appendix B is significant in 7 positive moods ( Interested, Excited, Enthusiastic, Alert, Determined, Active and Proud ) and 4 negative moods ( Hostile , Irritable, Nervous , and Jittery ).

The pairwise comparisons of Musical Experience’s levels show a wide variety of patterns. Looking at Positive Affects, there is only one item ( Active ) which present significant differences between the three musical conditions. Items Concentrated and Decided do not present any significant difference between any musical conditions. The rest of the Positive items show at least one significant difference between conditions VML and BP. All differences are positive when comparing VML-MML, VML-BP MML-BP, except for Alert and Proud. So, in general, scores are higher for the first two conditions in relation to the third one, meaning that third musical condition presents the biggest increase for Positive Affects (remember items where reversed). For more detail see Additional file 1 : Appendix C.

As regard pairwise comparisons of Musical Experience’s for negative affects, only the items which had a significant principal effect of the variable Musical Experience are shown here. There is a significant difference between conditions VML and MML in item Nervous ; between VML and BP for Scared ( p  < 0.05). For Jittery ; all three conditions differed significantly from each other ( p  < 0.05). Conditions MML and BP differed significantly for Hostile ( p  < 0.05) and conditions VML and BP almost differed significantly for Upset item, but null hypothesis cannot be rejected as p  = 0.056. For more detail see Additional file 1 : Appendix C. All differences were negative when comparing VML-MML, VML-BP MML-BP, except for Nervous and Jittery . So, in general, scores are lower for the first and second condition in relation to the third one.

Positive effects increased significantly during the post phase of all the music experiences, showing that exposure to any of the three music stimuli improved positive affectivity. There were also significant differences between the three experiences in this phase, according to the following order of improvements in positive affectivity: (1) the rhythm and blues performance (BP), (2) listening to Mahler (MML) and (3) listening to Vangelis (VML). As regards the effects of the musical experience x Moment interaction , all the comparisons were significant, with bigger differences in the interpretation of the blues (BP) than in listening to Mahler (MML) and Vangelis (VML). However, the comparison between both experiences, although significant, was smaller. These results indicate that performing music is significantly effective in increasing positive effects. We will explain these results in greater detail below as regards the specific affective states.

As regards Negative Affects, the comparison of the simple effects showed that these decreased after the musical experiences, although in this first analysis the VML musical experience did not differ from the other two. However, the results of the effects of the interaction between musical experiencie x Moment showed that all the comparisons were significant, with a larger difference between MML and VML than the one between BP and each of the other experiences. Listening to Mahler (MML) was more effective in reducing negative affects, compared to both listening to Vangelis and interpreting the blues (BP). These results agree with previous studies [ 26 , 32 ], in which listening to sad music helped to reduce negative affectivity. In this study, it was the most effective condition, although exposure to all three musical experiences reduced negative affects.

The analysis of the specific affective states shows that most items that belong to Positive Affect scale are the most sensitive ones to the PRE-POST change, the different musical conditions and the interpretation of both effects. However, some items of the Negative Affect scale did not differ in the different music conditions or in the music experience × Moment interaction . For example, there were two items (Guilty and Hostile) that did not obtain significance. These results are consistent with the fact that music has certain limits as regards its impact on people’s affects and does not influence all equally. For example, Guilty has profound psychological implications that cannot be affected by simple exposure to certain musical experiences. This means we should be cautious in inferring that music alone can have therapeutical effects on complex emotional states whose treatment should include empirically validated methods. Also, emotional experiences are widely diverse so that any instrument used to measure them is limited as regards the affective/emotional state under study. These results suggest the importance of reviewing the items that compose the PANAS scale in musical studies to adapt it in order to include affective states more sensitive to musical experiences and eliminate the least relevant items.

The analysis of the results in the specific affective states, allows us to delve deeper into each experimental condition. Thus, regarding the results obtained in the complete scale of PANAS, listening to Mahler (MML), causes desirable changes by raising two positive affects ( Inspired and Attentive ) and reducing 10 negative affects ( Distressed, Upset, Afraid, Hostile, Irritable, Ashamed, Nervous, Jittery, and Scared ). This shows that this music condition had a greater effect on the negative affects than the other ones. These results agree with previous studies [ 26 , 32 ], which found that sad music could effectively reduce negative affects, although other studies came to the opposite conclusion. For instance, Miller and Au [ 31 ] found that sad music did not significantly change negative affects. Some authors [ 47 , 48 ] have argued that adults prefer to listen to sad music to regulate their feelings after a negative psychological experience in order to feel better. Taruffi and Koelsch [ 49 ] concluded that sad music could induce listeners to a wide range of positive effects, after a study with 772 participants. In order to contribute to this debate. It would be interesting to control personality variables that might explain these differences on the specific emotions evoked by sad music. In this study, it has been shown that a sad piece of music can be more effective in reducing negative affects than in increasing positive ones. Although the results come from undergraduate students, similar outcomes could be obtained from children and adolescents, although further research is required. In fact, Borella et al. [ 50 ] studied the influence of age on the effects of music and found that the emotional effects influenced cognitive performance (working memory) in such a way that the type of music (Mozart vs. Albinoni) had a stronger influence on young people than on adults. Kawakami and Hatahira [ 28 ], in a study on 84 primary schoolchildren, also found that exposure to sad music pleased them and their level of empathy correlated with their taste for sad music.

Listening to Vangelis (VML) increased 3 positive affects ( Excited, Inspired and Attentive ) and reduced 8 negative affects ( Distressed, Upset, Afraid, Irritable, Ashamed, Nervous, Jittery , and Scared ). Surprisingly, two positive affects were reduced in this experimental condition ( Alert and Attentive ). It could be explained due to the characteristic ostinato rhythm of this piece of music. It was found a similar effect in the study by Campbell et al., [ 26 ] in which sad music reduced both positive and negative affects. This musical condition also managed to modify negative affects more than positive ones.

Performing the blues (BP) increased all 10 positive affects, indicating that performing is more effective in increasing positive affects than listening. These results agree with the study by Dunbar et al. [ 29 ], who found that music performance significantly increased positive affects.

Performing the blues (BP) reduced 6 negative affects, although it was more effective in increasing positive affective states. Vigorous rhythmic music was also found to be positively associated with the use of all the forms of regulating emotions, which suggests that this type of music is especially useful for emotion modulation [ 51 ]. It was found an exception, since Jittery increased after the blues performance. It could be explained by the negative experience that is sometimes associated with music performance. Therefore, it should be taken into account that music performance could increase some negative effects. For example, Dimsdale et al. [ 52 ] found that a strong negative emotional response to a certain type of music in adolescents was related to risk behaviour, indicating that research into the repertory of music experiences needs to be broadened to diverse styles in different age groups to identify all the types of emotional response and their psychological consequences. However, this result should be taken with caution and further research should focus on whether the effect of increased agitation is usual after music performances.

To sum up, this study contributes to the scientific field on the following points: (1) all the musical experiences had significant effects on improving emotional states, increasing positive affects and decreasing the negative ones, which shows the importance of musical experiences on improving the affective sphere; (2) the specific affects that increased, decreased or did not change for each musical experience were identified, providing specific and useful keys for the design of future interventions; and (3) the differences between various types of musical experiences were analyzed, finding more improvements in the performing conditions than in the listening ones.

Limitations and future directions

Limitations.

The sample, made up of university students with a very homogeneous profile in terms of age and sociodemographic characteristics, could limit the generalization of the results. In addition, the low percentage of men in the sample could also affect the generalizability of the results, although no previous studies have reported gender-based differential effects on the positive and negative affects after musical experiences.

Besides, the choice of the pieces of music was based on theoretical criteria and students’ music preferences were not taken into account. This will be included in future research, since the specific choice of the pieces could affect the positive or negative valence of participants’ emotions. However, the goal of using pieces of music not chosen by participants was to elicit new musical experiences for them. Furthermore, no participant was a musician and none of them had previous knowledge of any of the pieces, which may lead to a bias in the results.

In relation to this, the huge amount of available pieces of music, all of them influenced by their cultural and historical context, make it difficult to generalize that certain music parameters correlate with specific emotions. It would be necessary a cross-cultural approach to reach that conclusion.

Future directions

It is recommended to introduce the variables of music preferences and music history to control their effect on the results and to be able to compare the different musical parameters of the pieces together with participants’ preferences.

Likewise, it would be interesting to identify the affects with a greater or lesser degree of influence by music, to adjust the psychological evaluation instrument to the characteristics of the experiment, including items of emotions that can be modified after exposure to a music experience.

The PANAS manual [ 39 ] indicates that a wide variety of affective states (60) and eight different temporal instructions were included in its construction, showing its great versatility. In further research, this instrument should be adapted to for a more specific application to music studies. For instance, by including other emotional states that could be related with the influence of music (e.g. Tranquility , Gratitude , Elevation ), in order to measure more exactly the effects of music on people’s affective experiences.

Accordingly, it would be interesting to evaluate participants' affective traits to establish a baseline and control personality variables, helping to delve into the different levels of the hierarchical structure of affectivity and its relationship with the various music parameters.

Finally, it is recommended that the psychology of music include objective psychophysiological measurements together with self-report evaluations, so that conclusions arising from the experiments have greater robustness and can increase the impact of the contribution to the scientific community.

This study have shown how different music experiences, such as listening and performing, influence the changes in positive and negative affects in student teachers. The results show that the three musical experiences studied are effective in improving the affects by comparing the emotional states before and after the music experiences. It was also showed that there are differences between the effects obtained in each of the music experiences. Besides, improving both types of affects will depend largely on the selected music for the purpose. Although further evidence is required, the results support the importance of music in education, since it provides tools to increase positive affects and to decrease the negative ones, which is important for emotional intelligence development [ 53 , 54 ].

The three music experiences studied are more effective in reducing negative emotional states than in increasing the positive ones. This finding provides useful clues for music teachers to provide strategies that favor emotional regulation. For instance, in order to reduce hostility, irritability and nervousness, students could be exposed to musical auditions of both sad and solemn pieces, choosing musical pieces with similar characteristics to those described in this study. These auditions will be a resource for stress management in the classroom, as well as a tool that students can adopt and generalize to other contexts. Moreover, it is highly likely that students have not heard this type of music before and this experience could increase their repertoire of musical preferences, enhancing their emotional regulation.

The blues performance had a greater impact on participants' positive affects than listening to the other two pieces so, if any teacher wants to increase them (e.g., enthusiasm, interest, etc.), students could be asked to perform simple pieces such as Rhythm's Blues. In this way, musical performance could increase students' resources, contributing to higher levels of motivation, concentration and interest, which promotes learning [ 55 , 56 , 57 , 58 ]. Likewise, it could be very useful for elementary and secondary music teachers, who will be able to contribute to socio-emotional improvement and personal development of their students. Particularly, musical experiences could be a valuable resource for secondary teachers, since music is important in adolescents' lives and can be an interesting tool for meeting their emotional needs [ 59 ]. This is supported by Kokotsaki and Hallam [ 60 ], who consider that performing music helps students feel like active agents of a group, develop a strong sense of belonging, gain popularity, make "like-minded" relationships, improve their social skills and foster a strong sense of self-esteem and satisfaction.

This study shows that experiencing with various unknown musical pieces can have positive effects on emotions. According to this finding, university professors of Teaching grade in music education should encourage future teachers to experience various musical styles, rhythms and tonalities, avoiding prejudices. Thereby, future music teachers will be able to use a diversity of musical experiences that broaden the emotional effects and fulfill the socio-emotional function of music education. In relation to Fredrickson's 'broaden‐and‐build' framework of positive emotions [ 30 ], music can become a mean of widening other positive emotional states, constructing personal resources and transforming people, and contribute to an upward spiral of positive emotions. Taking into account the underlying psychological mechanisms of the impact of music on the emotional states it will be possible to use it to improve emotional area and other aspects of the personal sphere, as Chang et al., [ 10 ] maintain. Therefore, music education is an important resource to improve the emotional development of students.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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We should like to express our gratitude to the Valencia University student teachers for their disinterested and valuable contribution to this study.

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José Salvador Blasco-Magraner, Pablo Marín-Liébana & Ana María Botella-Nicolás

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Blasco-Magraner, J.S., Bernabé-Valero, G., Marín-Liébana, P. et al. Changing positive and negative affects through music experiences: a study with university students. BMC Psychol 11 , 76 (2023). https://doi.org/10.1186/s40359-023-01110-9

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Effects of music therapy on depression: A meta-analysis of randomized controlled trials

Qishou tang.

1 Bengbu Medical University, Bengbu, Anhui, China

Zhaohui Huang

2 Anhui Provincial Center for Women and Child Health, Hefei, Anhui, China

3 National Drug Clinical Trial Institution, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China

Associated Data

All relevant data are within the manuscript and its Supporting Information files.

We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect.

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model.

A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P <0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P <0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P <0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P <0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P <0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods.

Conclusions

A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.

Introduction

Depression was reported to be a common mental disorders and affected more than 300 million people worldwide, and long-lasting depression with moderate or severe intensity may result in serious health problems [ 1 ]. Depression has become the leading causes of disability worldwide according to the recent World Health Organization (WHO) report. Even worse, depression was closely associated with suicide and became the second leading cause of death, and nearly 800 000 die of depression every year worldwide [ 1 , 2 ]. Although it is known that treatments for depression, more than 3/4 of people in low and middle-income income countries receive no treatment due to a lack of medical resources and the social stigma of mental disorders [ 3 ]. Considering the continuously increased disease burden of depression, a convenient effective therapeutic measures was needed at community level.

Music-based interventions is an important nonpharmacological intervention used in the treatment of psychiatric and behavioral disorders, and the obvious curative effect on depression has been observed. Prior meta-analyses have reported an obvious effect of music therapy on improving depression [ 4 , 5 ]. Today, it is widely accepted that the music-based interventions are divided into two major categories, namely music therapy and music medicine. According to the American Music Therapy Association (AMTA), “music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” [ 6 ]. Therefore, music therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals, and includes the triad of music, clients and qualified music therapists. While, music medicine is defined as mainly listening to prerecorded music provided by medical personnel or rarely listening to live music. In other words, music medicine aims to use music like medicines. It is often managed by a medical professional other than a music therapist, and it doesn’t need a therapeutic relationship with the patients. Therefore, the essential difference between music therapy and music medicine is about whether a therapeutic relationship is developed between a trained music therapist and the client [ 7 – 9 ]. In the context of the clear distinction between these two major categories, it is clear that to evaluate the effects of music therapy and other music-based intervention studies on depression can be misleading. While, the distinction was not always clear in most of prior papers, and no meta-analysis comparing the effects of music therapy and music medicine was conducted. Just a few studies made a comparison of music-based interventions on psychological outcomes between music therapy and music medicine. We aimed to (1) compare the effect between music therapy and music medicine on depression; (2) compare the effect between different specific methods used in music therapy; (3) compare the effect of music-based interventions on depression among different population [ 7 , 8 ].

Materials and methods

Search strategy and selection criteria.

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies assessing the effectiveness of music therapy on depression from inception to May 2020. The combination of “depress*” and “music*” was used to search potential papers from these databases. Besides searching for electronic databases, we also searched potential papers from the reference lists of included papers, relevant reviews, and previous meta-analyses. The criteria for selecting the papers were as follows:(1) randomised or quasi-randomised controlled trials; (2) music therapy at a hospital or community, whereas the control group not receiving any type of music therapy; (3) depression rating scale was used. The exclusive criteria were as follows: (1) non-human studies; (2) studies with a very small sample size (n<20); (3) studies not providing usable data (including sample size, mean, standard deviation, etc.); (4) reviews, letters, protocols, etc. Two authors independently (YPJ, HZH) searched and screened the relevant papers. EndNote X7 software was utilized to delete the duplicates. The titles and abstracts of all searched papers were checked for eligibility. The relevant papers were selected, and then the full-text papers were subsequently assessed by the same two authors. In the last, a panel meeting was convened for resolving the disagreements about the inclusion of the papers.

Data extraction

We developed a data abstraction form to extract the useful data: (1) the characteristics of papers (authors, publish year, country); (2) the characteristics of participators (sample size, mean age, sex ratio, pre-treatment diagnosis, study period); (3) study design (random allocation, allocation concealment, masking, selection process of participators, loss to follow-up); (4) music therapy process (music therapy method, music therapy period, music therapy frequency, minutes per session, and the treatment measures in the control group); (5) outcome measures (depression score). Two authors independently (TQS, ZH) abstracted the data, and disagreements were resolved by discussing with the third author (YPJ).

Assessment of risk of bias in included studies

Two authors independently (TQS, ZH) assessed the risk of bias of included studies using Cochrane Collaboration’s risk of bias assessment tool, and disagreements were resolved by discussing with the third author (YPJ) [ 10 ].

Music therapy and music medicine

Music Therapy is defined as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Music medicine is defined as mainly listening to prerecorded music provided by medical personnel or rarely listening to live music. In other words, music medicine aims to use music like medicines.

Music therapy mainly divided into active music therapy and receptive music therapy. Active music therapy, including improvisational, re-creative, and compositional, is defined as playing musical instruments, singing, improvisation, and lyrics of adaptation. Receptive music therapy, including music-assisted relaxation, music and imagery, guided imagery and music, lyrics analysis, and so on, is defined as music listening, lyrics analysis, and drawing with musing. In other words, in active methods participants are making music, and in receptive music therapy participants are receiving music [ 6 , 7 , 9 , 11 – 13 ].

Evaluation of depression

Depression was evaluated by the common psychological scales, including Beck Depression Inventory (BDI), Children’s Depression Inventory (CDI), Center for Epidemiologic Studies Depression (CES-D), Cornell Scale (CS), Depression Mood Self-Report Inventory for Adolescence (DMSRIA), Geriatric Depression Scale-15 (GDS-15); Geriatric Depression Scale-30 (GDS-30), Hospital Anxiety and Depression Scale (HADS), Hamilton Rating Scale for Depression (HRSD/HAMD), Montgomery-sberg Depression Rating Scale (MADRS), Patient Reported Outcomes Measurement Information System (PROMIS), Self-Rating Depression Scale (SDS), Short Version of Profile of Mood States (SV-POMS).

Statistical analysis

The pooled effect were estimated by using the standardized mean differences (SMDs) and its 95% confidence interval (95% CI) due to the different depression rate scales were used in the included papers. Heterogeneity between studies was assessed by I-square ( I 2 ) and Q-statistic (P<0.10), and a high I 2 (>50%) was recognized as heterogeneity and a random-effect model was used [ 14 – 16 ]. We performed subgroup analyses and meta-regression analyses to study the potential heterogeneity between studies. The subgroup variables included music intervention categories (music therapy and music medicine), music therapy methods (active music therapy, receptive music therapy), specific receptive music therapy methods (music-assisted relaxation, music and imagery, and guided imagery and music (Bonny Method), specific active music therapy methods (recreative music therapy and improvisational music therapy), music therapy mode (group therapy, individual therapy), music therapy period (weeks) (2–4, 5–12, ≥13), music therapy frequency (once weekly, twice weekly, ≥3 times weekly), total music therapy sessions (1–4, 5–8, 9–12, 13–16, >16), time per session (minutes) (15–40, 41–60, >60), inpatient settings (secure [locked] unit at a mental health facility versus outpatient settings), sample size (20–50, ≥50 and <100, ≥100), female predominance(>80%) (no, yes), mean age (years) (<50, 50–65, >65), country having music therapy profession (no, yes), pre-treatment diagnosis (mental health, depression, severe mental disease/psychiatric disorder). We also performed sensitivity analyses to test the robustness of the results by re-estimating the pooled effects using fixed effect model, using trim and fill analysis, excluding the paper without information on music therapy, excluding the papers with more high biases, excluding the papers with small sample size (20< n<30), excluding the papers using an infrequently used scale, excluding the studies focused on the people with a severe mental disease. We investigated the publication biases by a funnel plot as well as Egger’s linear regression test [ 17 ]. The analyses were performed using Stata, version 11.0. All P-values were two-sided. A P-value of less than 0.05 was considered to be statistically significant.

Characteristics of the eligible studies

Fig 1 depicts the study profile, and a total of 55 RCTs were included in our meta-analysis [ 18 – 72 ]. Of the 55 studies, 10 studies from America, 22 studies from Europe, 22 studies from Asia, and 1 study from Australia. The mean age of the participators ranged from 12 to 86; the sample size ranged from 20 to 242. A total of 16 different scales were used to evaluate the depression level of the participators. A total of 25 studies were conducted in impatient setting and 28 studies were in outpatients setting; 32 used a certified music therapist, 15 not used a certified music therapist (for example researcher, nurse), and 10 not reported relevent information. A total of 16 different depression rating scales were used in the included studies, and HADS, GDS, and BDI were the most frequently used scales ( Table 1 ).

PRISMA diagram showing the different steps of systematic review, starting from literature search to study selection and exclusion. At each step, the reasons for exclusion are indicated. Doi: 10.1371/journal.pone.0052562.g001.

Note: BDI = Beck Depression Inventory; CDI = Children’s Depression Inventory; CDSS = depression scale for schizophrenia; CES-D = Center for Epidemiologic Studies Depression; CS = Cornell Scale; DMSRIA = Depression Mood Self-Report Inventory for Adolescence; EPDS = Edinburgh Postnatal Depression Scale; GDS-15 = Geriatric Depression Scale-15; GDS-30 = Geriatric Depression Scale-30; HADS = Hospital Anxiety and Depression Scale; HRSD (HAMD) = Hamilton Rating Scale for Depression; MADRS = Montgomery-sberg Depression Rating Scale; PROMIS = Patient Reported Outcomes Measurement Information System; SDS = Self-Rating Depression Scale; State-Trait Depression Questionnaire = ST/DEP; SV-POMS = short version of Profile of Mood States; NA = not available.

Of the 55 studies, only 2 studies had high risks of selection bias, and almost all of the included studies had high risks of performance bias ( Fig 2 ).

The overall effects of music therapy

Of the included 55 studies, 39 studies evaluated the music therapy, 17 evaluated the music medicine. Using a random-effects model, music therapy was associated with a significant reduction in depressive symptoms with a moderate-sized mean effect (SMD = −0.66; 95% CI = -0.86 to -0.46; P <0.001), with a high heterogeneity across studies ( I 2 = 83%, P <0.001); while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P <0.001) ( Fig 3 ).

Twenty studies evaluated the active music therapy using a random-effects model, and a moderate-sized mean effect (SMD = −0.57; 95% CI = -0.90 to -0.25; P <0.001) was observed with a high heterogeneity across studies ( I 2 = 86.3%, P <0.001). Fourteen studies evaluated the receptive music therapy using a random-effects model, and a moderate-sized mean effect (SMD = −0.73; 95% CI = -1.01 to -0.44; P <0.001) was observed with a high heterogeneity across studies ( I 2 = 76.3%, P <0.001). Five studies evaluated the combined effect of active and receptive music therapy using a random-effects model, and a moderate-sized mean effect (SMD = −0.88; 95% CI = -1.32 to -0.44; P <0.001) was observed with a high heterogeneity across studies ( I 2 = 70.5%, P <0.001) ( Fig 4 ).

Among specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P <0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P <0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P <0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), and music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively ( Fig 5 ).

Sub-group analyses and meta-regression analyses

We performed sub-group analyses and meta-regression analyses to study the homogeneity. We found that music therapy yielded a superior effect on reducing depression in the studies with a small sample size (20–50), with a mean age of 50–65 years old, with medium intervention frequency (<3 times weekly), with more minutes per session (>60 minutes). We also found that music therapy exhibited a superior effect on reducing depression among people with severe mental disease /psychiatric disorder and depression compared with mental health people. While, whether the country have the music therapy profession, whether the study used group therapy or individual therapy, whether the study was in the outpatients setting or the inpatient setting, and whether the study used a certified music therapist all did not exhibit a remarkable different effect ( Table 2 ). Table 2 also presents the subgroup analysis of music medicine on reducing depression.

In the subgroup analysis by total session, music therapy and music medicine both exhibited a stronger effects of short (1–4 sessions) and medium length (5–12 sessions) compared with long intervention periods (>13sessions) ( Fig 6 ). Meta-regression demonstrated that total music intervention session was significantly associated with the homogeneity between studies ( P = 0.004) ( Table 3 ).

A, evaluating the effect of music therapy; B, evaluating the effect of music medicine.

Sensitivity analyses

We performed sensitivity analyses and found that re-estimating the pooled effects using fixed effect model, using trim and fill analysis, excluding the paper without information regarding music therapy, excluding the papers with more high biases, excluding the papers with small sample size (20< n<30), excluding the studies focused on the people with a severe mental disease, and excluding the papers using an infrequently used scale yielded the similar results, which indicated that the primary results was robust ( Table 4 ).

Evaluation of publication bias

We assessed publication bias using Egger’s linear regression test and funnel plot, and the results are presented in Fig 7 . For the main result, the observed asymmetry indicated that either the absence of papers with negative results or publication bias.

A, evaluating the publication bias of music therapy; B, evaluating the publication bias of music medicine; BDI = Beck Depression Inventory; CDI = Children’s Depression Inventory; CDSS = depression scale for schizophrenia; CES-D = Center for Epidemiologic Studies Depression; CS = Cornell Scale; DMSRIA = Depression Mood Self-Report Inventory for Adolescence; EPDS = Edinburgh Postnatal Depression Scale; GDS-15 = Geriatric Depression Scale-15; GDS-30 = Geriatric Depression Scale-30; HADS = Hospital Anxiety and Depression Scale; HRSD (HAMD) = Hamilton Rating Scale for Depression; MADRS = Montgomery-sberg Depression Rating Scale; PROMIS = Patient Reported Outcomes Measurement Information System; SDS = Self-Rating Depression Scale; State-Trait Depression Questionnaire = ST/DEP; SV-POMS = short version of Profile of Mood Stat.

Our present meta-analysis exhibited a different effect of music therapy and music medicine on reducing depression. Different music therapy methods also exhibited a different effect, and the recreative music therapy and guided imagery and music yielded a superior effect on reducing depression compared with other music therapy methods. Furthermore, music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods. The strength of this meta-analysis was the stable and high-quality result. Firstly, the sensitivity analyses performed in this meta-analysis yielded similar results, which indicated that the primary results were robust. Secondly, considering the insufficient statistical power of small sample size, we excluded studies with a very small sample size (n<20).

Some prior reviews have evaluated the effects of music therapy for reducing depression. These reviews found a significant effectiveness of music therapy on reducing depression among older adults with depressive symptoms, people with dementia, puerpera, and people with cancers [ 4 , 5 , 73 – 76 ]. However, these reviews did not differentiate music therapy from music medicine. Another paper reviewed the effectiveness of music interventions in treating depression. The authors included 26 studies and found a signifiant reduction in depression in the music intervention group compared with the control group. The authors made a clear distinction on the definition of music therapy and music medicine; however, they did not include all relevant data from the most recent trials and did not conduct a meta-analysis [ 77 ]. A recent meta-analysis compared the effects of music therapy and music medicine for reducing depression in people with cancer with seven RCTs; the authors found a moderately strong, positive impact of music intervention on depression, but found no difference between music therapy and music medicine [ 78 ]. However, our present meta-analysis exhibited a different effect of music therapy and music medicine on reducing depression, and the music medicine yielded a superior effect on reducing depression compared with music therapy. The different effect of music therapy and music medicine might be explained by the different participators, and nine studies used music therapy to reduce the depression among people with severe mental disease /psychiatric disorder, while no study used music medicine. Furthermore, the studies evaluating music therapy used more clinical diagnostic scale for depressive symptoms.

A meta-analysis by Li et al. [ 74 ] suggested that medium-term music therapy (6–12 weeks) was significantly associated with improved depression in people with dementia, but not short-term music therapy (3 or 4 weeks). On the contrary, our present meta-analysis found a stronger effect of short-term (1–4 weeks) and medium-term (5–12 weeks) music therapy on reducing depression compared with long-term (≥13 weeks) music therapy. Consistent with the prior meta-analysis by Li et al., no significant effect on depression was observed for the follow-up of one or three months after music therapy was completed in our present meta-analysis. Only five studies analyzed the therapeutic effect for the follow-up periods after music therapy intervention therapy was completed, and the rather limited sample size may have resulted in this insignificant difference. Therefore, whether the therapeutic effect was maintained in reducing depression when music therapy was discontinued should be explored in further studies. In our present meta-analysis, meta-regression results demonstrated that no variables (including period, frequency, method, populations, and so on) were significantly associated with the effect of music therapy. Because meta-regression does not provide sufficient statistical power to detect small associations, the non-significant results do not completely exclude the potential effects of the analyzed variables. Therefore, meta-regression results should be interpreted with caution.

Our meta-analysis has limitations. First, the included studies rarely used masked methodology due to the nature of music therapy, therefore the performance bias and the detection bias was common in music intervention study. Second, a total of 13 different scales were used to evaluate the depression level of the participators, which may account for the high heterogeneity among the trials. Third, more than half of those included studies had small sample sizes (<50), therefore the result should be explicated with caution.

Our present meta-analysis of 55 RCTs revealed a different effect of music therapy and music medicine, and different music therapy methods also exhibited a different effect. The results of subgroup analyses revealed that the characters of music therapy were associated with the therapeutic effect, for example specific music therapy methods, short and medium-term therapy, and therapy with more time per session may yield stronger therapeutic effect. Therefore, our present meta-analysis could provide suggestion for clinicians and policymakers to design therapeutic schedule of appropriate lengths to reduce depression.

Supporting information

S1 checklist, funding statement.

The Key Project of University Humanities and Social Science Research in Anhui Province (SK2017A0191) was granted by Education Department of Anhui Province; the Research Project of Anhui Province Social Science Innovation Development (2018XF155) was granted by Anhui Provincial Federation of Social Sciences; the Ministry of Education Humanities and Social Sciences Research Youth fund Project (17YJC840033) was granted by Ministry of Education of the People’s Republic of China. These funders had a role in study design, text editing, interpretation of results, decision to publish and preparation of the manuscript.

Data Availability

• PLoS One. 2020; 15(11): e0240862.

Decision Letter 0

PONE-D-20-17706

Effects of music therapy on depression: a meta-analysis of randomized controlled trials

Dear Dr. Ye,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

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Sukru Torun

Academic Editor

Additional Editor Comments:

Dear Author,

Thank you for your valuable submission. I think it would be appropriate to emphasize the main problem first. Various musical interventions are used in medical settings to improve the patient's well-being, and of course, there are many publications on this subject. However, it is important to properly differentiate between these interventions for some important reasons I have pointed out below.

The music therapy definition you made, as "Music therapy was defined as music therapy provided by a qualified music teacher, psychological therapist, or nurse" is not universally accepted specific definition for music therapy. Moreover, the specific methods used in receptive music therapy include music-assisted relaxation, music and imagery, and Guided Imagery and Music (Bonny Method). Each of these may have different levels of effects on depression. It is not clear that which receptive music therapy studies in your review have used which of these methods. So, the majority of studies that you accepted as the receptive music therapy seems to be music medicine studies indeed. Similar critiques may also be apply to some of the studies you describe as active music therapy. Today, it is widely accepted that these music-based interventions should be divided into two major categories, namely music therapy (MT) and music medicine (MM). MM mainly based on patients' pre-recorded or rarely listening to live music and the direct effects of the music they listen to. In other words, MM aims to use music like medicines. It often managed by a medical professional other than a music therapist, and not needed a therapeutic relationship with the patients. Conversely, music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed music therapist who has completed an approved music therapy program. So, music therapy is a relational, interaction based form of therapy within a therapeutic relationship between the therapist and the client, and includes the triad of the music, the client and the music therapist. Since music therapy interventions is an evidence-based procedure using special music therapy methods of interventions and a more pragmatic approach than other music-based interventions, their effect levels and results are also different.

In the context of the above mentioned explanations, it is clear that to evaluate the effects of music therapy and other music based intervention studies together on depression can be misleading. The subjects I have mentioned so far have never been addressed in the introduction and discussion sections of your manuscript. I think that will be perceived as a major deficiency at least by the readers who are closer to the subject. In this sense, I think that an attentive revision considering the following views will be valuable and needed:

- The universally accepted definitions of music therapy (including active and receptive music therapy) and music medicine should be taken into account.

- It should be clarified that how many studies in your review did included a certified music therapist.

- Analyses, results and discussion should be submitted to the readers in accordance with all this distinctions and definitions. (The way to this seems to be to compare the effects of music medicine and music therapy on depression in parallel with the possible differences of music interventions used, and to discuss their possible implications on the results.)

- Another important point is that you did not mention nor discuss any of important reviews on same subject (for example please see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858. {"type":"entrez-nucleotide","attrs":{"text":"CD004517","term_id":"30321255","term_text":"CD004517"}} CD004517 .pub3/epdf/full or https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01109/full or https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858. {"type":"entrez-nucleotide","attrs":{"text":"CD006911","term_id":"30323649","term_text":"CD006911"}} CD006911 .pub3/full)

I am aware that such a major revision will, in a sense, be a challenging way that may require a new analysis of your data. However, I believe you would appreciate that a study aimed at shedding light on potential music-based interventions in an important public health problem such as depression should not be misleading.

Thank you for your effort in advance.

Besides, according to the statistical reviewer who only reviewed the statistical approach used in this paper, there are two caveats:

1. The authors state that they excluded studies with fewer than 20 participants in one place in the paper (page 4), but fewer than 30 participants in another place in the paper (Table 4). This needs to be corrected for consistency.

2. The authors mention stronger effects of short and medium length vs. long music therapy periods in their results but there is no accompanying figure. I think it would be beneficial to show these findings in a figure (Forest plot).

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Research in Anhui Province (SK2017A0191), Research Project of Anhui Province Social Science

Innovation Development (2018XF155), Ministry of Education Humanities and Social Sciences

Research Youth fund Project (17YJC840033)."

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: No

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Reviewer #2: Yes

4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Thank you for conducting this research and submitting it for publication consideration.

I recognize that English may not be the primary language of the authors. There are a few instances where the language could be improved, but that is mostly a copy-editing issue. There is also a lot of passive voice in the paper. I recommend making the voice active. This will enhance the readability of the paper.

I have a few comments that I hope will improve the paper.

1. Not all countries have an established music therapy profession. I recognize that this creates challenges for the authors! I'm wondering if the authors might consider including this as a factor in the analysis? For example, if a nurse provides "music therapy" in a country that does not have music therapy as a profession, is the effect equivalent as when a qualified music therapist in a country that has music therapy as a profession provides it? This might provide some incentive for occupational regulation and establishing professional music therapy associations.

2. please fix the "short title" (oxygen)

3. Music therapy with fewer minutes might yield superior effects. This may be misleading. Is there a minimum number of minutes? How many minutes might be optimal for therapeutic outcome? I believe it does make sense that longer sessions may result in less impact - quantity/duration does not always result in enhanced outcome.

4. I believe a stronger case needs to be made for the study. There are existing meta-analyses of MT for depression (Aalbers et al., 2017 Cochrane Review). What makes the current study unique and different? What are the gaps in the literature that warrant this study? Have there been a lot of recent additions to the literature that warrant a new meta-analysis?

5. A stronger discussion of the limitation of this study. Many studies did not evaluate a group with major depression/major depressive disorder (music therapy for chronic pain is important, but the variance of the populations under study does constitute a limitation). So, this study is not exclusive to adults with a major mental health condition. Might effects be different for people who are depressed versus people who are not depressed?

6. Instead of "blinding/blinded" please use "masking/masked."

7. Is there a citation that supports your classification of active versus receptive? (I would think Bruscia would be a good place to start with that...)

8. One item that I am not seeing is group therapy versus individual therapy. Did the authors screen for that? If so, is there an optimal group size? Are effects stronger when in a group format versus an individual format? This would have serious implications for clinical practice.

9. What about inpatient settings (such as a secure [locked] unit at a mental health facility) versus outpatient settings?

10. One item that I believe is missing is the dose. Not necessarily the duration (number of minutes) of each session, but the total number of sessions a participant has received. Gold has done some work in this area. Is there is a certain number of sessions that are needed to reach a therapeutic outcome? The number of sessions/week is good, but the number of total sessions is important.

11. Table 1 has the mean age. I recommend including the SD as well.

Thank you for taking the time to consider these suggestions. While receiving critical feedback can be difficult, please understand that my intentions are to improve the paper and ensure it has maximum impact. This is an important addition to the literature and I am grateful to the authors for their scholarship. I wish you the best!

Reviewer #2: This article addresses an important topic that is of interest to music therapists, psychiatrists and teachers and metal health practitioners. The statistics look promising. However, the major concern is that the definition of music therapy is theoretically and practically incorrect and misleading:

"7 Music therapy was defined as music therapy provided by a qualified music teacher, psychological

8 therapist, or nurse. " The study is missing several research studies that I am aware of and this makes its content suspicious. Also missing is a more depth-ful analysis of what active and passive music therapy is, and if it is indeed performed by those in other professions who have no training in 'musuc therapy;'-than the contents and findings are misleading and irrelevant.

Reviewer #3: I only reviewed the statistical approach used in this paper, which appeared appropriate for the research question under study. There are two caveats:

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Reviewer #1: No

Reviewer #3: No

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Author response to Decision Letter 0

29 Sep 2020

Response to Reviewers

Dear Editors and Reviewers:

Thank you for your letter and for the reviewers’ comments concerning our manuscript entitled " Effects of music therapy on depression: a meta-analysis of randomized controlled trials (PONE-D-20-17706)".

Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made revision which we hope meet with approval. All the revised portions were marked in red font in the new document. The main corrections in the paper and the responds to the reviewer’s comments are as flowing:

Response：We have studied comments carefully and revised the manuscript extensively according to the reviewer’s comments.

Firstly, We have amended the music therapy definition mainly based on the World Federation of Music Therapy (WFMT) and The American Music Therapy Association (AMTA), WFMT defines music therapy as “the professional use of music and its elements as an intervention inmedical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social,communicative, emotional, intellectual, and spiritual health and wellbeing”. AMTA defines music therapy as “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”. [American Music Therapy Association (2020). Definition and Quotes about Music Therapy. Available online at: https://www.musictherapy.org/about/quotes/ (Accessed Sep 13, 2020).][van der Steen, J. T., et al. (2017). "Music-based therapeutic interventions for people with dementia." Cochrane Database Syst Rev 5: {"type":"entrez-nucleotide","attrs":{"text":"CD003477","term_id":"30320215","term_text":"CD003477"}} CD003477 .]

Secondly, we have re-studed all included papers carefully and added the specific intervention methods of each paper in table 1 (Table 1. Characteristics of clinical trials included in this meta-analysis). Two main types of music therapy were distinguished in our present study - receptive (or passive) and active music therapy. The specific methods used in receptive music therapy in our included papers including music-assisted relaxation, music and imagery, and guided imagery and music (Bonny Method), while the specific methods used in active music therapy included recreative music therapy, improvisational music therapy, song writing, and so on.

Thirdly, we have added some contents regarding the distinction between music therapy and music medicine in introduction and discussion sections of our manuscript.

The following contents are added in introduction section, “Today, it is widely accepted that the music-based interventions should be divided into two major categories, namely music therapy and music medicine. According to the American Music Therapy Association (AMTA), “music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”. Therefore, music therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individualst, and includes the triad of the music, the client and the qualified music therapist. [American Music Therapy Association (2020). Definition and Quotes about Music Therapy. Available online at: https://www.musictherapy.org/about/quotes/ (Accessed Sep 13, 2020).] While, music medicine is defined as mainly listening to prerecorded music provided by medical personnel or rarely listening to live music. In other words, music medicine aims to use music like medicines. It often managed by a medical professional other than a music therapist, and not needed a therapeutic relationship with the patients. Therefore, the essential difference of music therapy and music medicine is whether a therapeutic relationship is developed between a trained music therapist and the client.

[Bradt, J., et al. (2015). "The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: a mixed methods study." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23(5): 1261-1271.

[Yinger, O. S. and L. Gooding (2014). "Music therapy and music medicine for children and adolescents." Child and adolescent psychiatric clinics of North America 23(3): 535-553.]

【Tony Wigram．Inge Nyggard Pedersen＆Lars Ole Bonde，A Compmhensire Guide to Music Therapy．London and Philadelphia：Jessica Kingsley Publishen．2002：143．】

In the context of the clear distinction between these two major cagerories, it is clear that to evaluate the effects of music therapy and other music based intervention studies together on depression can be misleading. While, the distinction was not always clear in most of prior papers, and we found that no meta-analysis comparing the effects of music therapy and music medicine was conducted. Just a few studies made a comparison of music-based interventions on psychological outcomes between music therapy and music medicine. We aimed to (1) compare the effect between music therapy and music medicine on depression; (2) compare the effect between different specific methods used inmusic therapy on depression; (3) compare the effect of music-based interventions on depression among different population.

[Bradt, J., et al. (2015). "The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: a mixed methods study." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23(5): 1261-1271.[Yinger, O. S. and L. Gooding (2014). "Music therapy and music medicine for children and adolescents." Child and adolescent psychiatric clinics of North America 23(3): 535-553.]

The last, we have made a new analysis of our data. 1) including three new papers and re-analying of our data, 2) adding the comparison of music therapy and music medicine, 3) adding the comparison of impatient setting and outpatients setting, 4) adding the comparison of depressed people and not depressed people, 5）adding the comparison of countries have having music therapy profession and not, 6) adding the comparison of group therapy and individual therapy, 7) added the comparison of different intervention dose, and so on.

Response: (1)We have amended the of definitions of music therapy. The revised difinitons of music therapy was “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”. [American Music Therapy Association (2020). Definition and Quotes about Music Therapy. Available online at: https://www.musictherapy.org/about/quotes/ (Accessed Sep 13, 2020).]

We have added some contents on the distinction between music therapy (MT) and music medicine (MM) in introduction and discussion sections of our manuscript.

We have added the analysis of the comparion of music therapy (MT) and music medicine (MM) in Methord and Results sections

Response: we have re-studed all included papers carefully and added a new varible (Intervenor or therapist) into table 1, and the corresponding description was addded in the results section. Of 55 studies, 32 used a certified music therapist, 15 not used a certified music therapist (for example researcher, nurse), and 10 not reported relevent information.

Response: We have divided music-based interventions into two major categories, namely music therapy and music medicine according to the difinition. With respect to specific methods used in music therapy, we also have divided music therapy into receptive (or passive) and active music therapy. The specific methods used in receptive music therapy in our included papers including music-assisted relaxation, music and imagery, and guided imagery and music (Bonny Method), and the specific methods used in active music therapy included recreative music therapy and improvisational music therapy.

We have added some sub-group analyses by different music intervention categories, different music therapy categories, and specific music therapy methords.

The the above mentioned content have been added to Intruduction Analyses, results and discussion section.

Response: we are very sorry for not mentioning these important reviews. We have studied these reviews carefully and discussed these reviews in Discussion sections.

Some prior reviews have evaluated the effects of music therapy for reducing depression. Aalbers and colleagues included nine studies in their review; they concluded that music therapy provides short-term benefificial effects for people with depression, and suggested that high-quality trials with large sample size were needed. However, this review was limited to studies of individuals with a diagnosis of depression, and did not differentiate music therapy from music medicine. Another paper reviewed the effectiveness of music interventions in treating depression. The authors included 26 studies and found a signifiant reduction in depression in the music intervention group compared with the controp group. The authors made a clear distincition on the definition of music therapy and music medicine; however, they did not include all relevant data from the most recent trials and did not conduct a meta-analysis. A recent meta-analysis compared the effects of music therapy and music medicine for reducing depression in people with cancer with seven RCTs; the authors found a moderately strong, positive impact of music intervention on depression , but found no difference between music therapy and music medicine.

【Aalbers, S., et al. (2017). "Music therapy for depression." Cochrane Database Syst Rev 11: {"type":"entrez-nucleotide","attrs":{"text":"CD004517","term_id":"30321255","term_text":"CD004517"}} CD004517 .】

【Leubner, D. and T. Hinterberger (2017). "Reviewing the Effectiveness of Music Interventions in Treating Depression." Front Psychol 8: 1109.】

【Bradt, J., et al. (2016). "Music interventions for improving psychological and physical outcomes in cancer patients." Cochrane Database Syst Rev(8): {"type":"entrez-nucleotide","attrs":{"text":"CD006911","term_id":"30323649","term_text":"CD006911"}} CD006911 .】

To date, many new trials focued on music therapy and depression in differnt poupulation (such as people with cancer, people with dementia, people with chronic disease, and so on ) have been performed, but they have not yet been systematically reviewed.

Response: Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches. We have studied comments carefully and have made revision according to the comments.

Response: We are sorry for making this mistake. In the Methord section, we defined exclusive criteria as studies with a very small sample size (n<20),while in table 4 we performed the sensitivity analyses by excluding the papers with smale sample size ( 20< n<30). We have amended the table 4.

Response: We have added these findings with a forest plot (figure 6) according to the comment.

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Response: We have adjusted these content according to the comment.

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Response: We would like to update our funding statement as follows: The funders had a role in study design, text editing, interpretation of results, decision to publish and preparation of the manuscript.

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Response: We have checked the refer to Figure 5 and found that the refer to figure 5 was a mistake, and we have amended it.

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Response: Thinks very much for your comment.

Response: Thinks very much for your comment. Our manuscript have been edited for proper English language, grammar, punctuation, spelling, and overall style by one qualified native English speaking editors.

Response: This suggestion is valuable and we have tried to judge if the countries in our inluded papers have an established music therapy profession by checking the author's work address, literature review, visiting the important website about music therapy, and consulting to some famous music therapist via emails. The following table showed that four countries may be not have a music therapy profession. We have added the comparison of the country having music therapy profession and not.

https://erikdalton.com/find-a-certified-therapist/

https://www.musictherapy.org/about/listserv/

Table 1. The information on the music therapy profession in the inluded papers

Country Country having music therapy profession

Korea Korean Music Therapy Association

South Korea Korean Music Therapy Association

UK British Association for Music Therapy

Australia Australian Music Therapy Association

Canada Canadian Association of Music Therapists

China Chinese Professional Music Therapist Association

Taiwan China Chinese Professional Music Therapist Association

Denmark Dansk forbund for musikterapie

Finland Finnish Society for Music Therapy

Hong Kong China Hong Kong Music Therapy and Counseling Association

Serbia Music Therapists of Serbia organize workshops

Switzerland Swiss Association of Music Therapy

USA The American Music Therapy Association

Singapore The Association for Music Therapy (Singapore)

Brazil Uniao Braileira Das Associacoes De Musicoterapia

Germany YES

Northern Ireland YES

Spanish YES

Venezuela No

2.please fix the "short title" (oxygen)

Response: We’re sorry for making this mistake, and we have corrected this mistake.

Music therapy with fewer minutes might yield superior effects. This may be misleading. Is there a minimum number of minutes? How many minutes might be optimal for therapeutic outcome? I believe it does make sense that longer sessions may result in less impact - quantity/duration does not always result in enhanced outcome.

Response: In 33 included trials, intervention time each session was different, the mimimum time was 15 minutes in only one study (Burrai et al., 2019b), followed by 20 minuters in four studies (Chirico et al., 2020; Guétin et al., 2009; Hanser et al., 1994; Sigurdardóttir et al., 2019). In our subgroup analysis by time per session (minutes), we divided time per session into three groups, namely 15-40, 41-60, >60, and this presentation might be unclear.

In order to respond this comment, we have re-divided the time per session into four groups, namely 15-40, 41-60, 61-120, to explore the optimal minuter per session for therapeutic outcome.

I believe a stronger case needs to be made for the study. There are existing meta-analyses of MT for depression (Aalbers et al., 2017 Cochrane Review). What makes the current study unique and different? What are the gaps in the literature that warrant this study? Have there been a lot of recent additions to the literature that warrant a new meta-analysis?

Response: Some prior reviews have evaluated the effects of music therapy for reducing depression. Aalbers and colleagues (Aalbers et al., 2017）included nine studies in their review; they concluded that music therapy provides short-term benefificial effects for people with depression, and suggested that high-quality trials with large sample size were needed. However, this review was limited to studies of individuals with a diagnosis of depression, and did not differentiate music therapy from music medicine.

Another paper reviewed the effectiveness of music interventions in treating depression. The authors (Leubner D., 2017) included 26 studies and found a signifiant reduction in depression in the music intervention group compared with the controp group. The authors made a clear distincition on the definition of music therapy and music medicine; however, they did not include all relevant data from the most recent trials and did not conduct a meta-analysis. A recent meta-analysis (Bradt et al., 2016) compared the effects of music therapy and music medicine for reducing depression with seven RCTs; the authors found a moderately strong, positive impact of music intervention on depression , but found no difference between music therapy and music medicine. However, this review was limited to studies of individuals with a diagnosis of cancer.

Figure 1 presents the number of published paper ( search from Pubmed) focued on music therapy and depression from 1983 to 2020, the published paper was in the rapidly growing stage during the past five years. While, the above mentioned reviews all included papers published before 2017. To date, many new trials focued on music therapy and depression in differnt poupulation (such as people with cancer, people with dementia, people with chronic disease, and so on ) have been performed, but they have not yet been systematically reviewed.

While, no meta-analysis compared the the difference of music therapy on depression in differnt poupulation (such as people with depression, people with dementia, people with chronic disease, health people, and so on ) have been performed.

Figure 1 The pubished papers from 1983 to 2020 focused on music therapy and depression (searched from Pubmed)

In our persent meta-analysis, we aimed to (1) compare the effect between music therapy and music medicine on depression; (2) compare the effect between different specific methods used inmusic therapy on depression; (3) compare the effect of music-based interventions on depression among different population.

We have added the above content to Intruduction and Dissussion sections.

5.A stronger discussion of the limitation of this study. Many studies did not evaluate a group with major depression/major depressive disorder (music therapy for chronic pain is important, but the variance of the populations under study does constitute a limitation). So, this study is not exclusive to adults with a major mental health condition. Might effects be different for people who are depressed versus people who are not depressed?

Response: This is a very important comment. According to this comment, we have made some revision.

Firstly, we have added a sensitivity analysis by excluding the studes focused on the people with a major mental health condition.

Secondly, we have re-grouped the populations into three groups, namely mental health, severe mental disease /psychiatric disorder, and depression and we have added the subgroup analysis (table 2 in revised manuscript)..

Thirdly, we have added the analysis of the difference between people who are depressed versus people who are not depressed accordingly (table 2 in revised manuscript).

6.Instead of "blinding/blinded" please use "masking/masked."

Response: We have replaced "blinding/blinded" with "masking/masked" according to this comment.

Response: In active methods (improvisational, re-creative, compositional), participants are ‘making music’ , and in receptive music therapy (music-assisted relaxation, music and imagery, guided imagery and music, lyrics analysis ), participants are ‘receiving’ (e.g. listening to) music (Bruscia 2014; Wheeler 2015).

We have amended the difinition and added the citation to the Result section according to this commment.

[Bruscia KE. Defining Music Therapy. 3rd Edition.University Park, Illinois, USA: Barcelona Publishers, 2014.]

[Wheeler BL. Music Therapy Handbook. New York, New York, USA: Guilford Publications, 2015.]

Response: Of the 55 studies, 38 used group therapy, 17 used individual therapy, and 2 not reported. We have added the comparison of group therapy versus individual therapy according to this comment (table 2 in revised manuscript).

Response: Of 55 studies, a total of 25 studies were conducted in impatient setting,28 studies were in outpatients setting setting, and 2 studies not repoted the setting. We have added the subgroup analysis by inpatient settings (secure [locked] unit at a mental health facility versus outpatient settings) according to this comment (table 2 in revised manuscript).

Response: We have added the subgroup analysis by total sessions a participant has received according to this comment.

Response: We have added the SD in table 1

Response: Thanks very much for your important comments, these comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our researches.

Response: (1) We have amendded the difinition of music therapy. According to the American Music Therapy Association (AMTA), “music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”.. [American Music Therapy Association (2020). Definition and Quotes about Music Therapy. Available online at: https://www.musictherapy.org/about/quotes/ (Accessed Sep 13, 2020).]

(2)We are very sorry for missing several research studies in our present meta-analysis. According to this comment, we have performed more extensive electronic search using the following terms: depression or mood disorders or affective disorders and music. We also performed manual search for the reference of all relevent reviews. In order to ensure the study quality of included papers, we excluded the studies with a very small sample size (n<20), we also excluded the non-english papers due to our language barrier. We included 23 new papers and deleted 1 old paper, in the last a total of 55 paper were included in our present analysis. The following are the new included papers and some excluded papers:

New-included papers

1)Albornoz Y. The effects of group improvisational music therapy on depression in adolescents and adults with substance abuse: a randomised controlled trial. Nordic Journal of Music Therapy 2011;20(3):208–24.

2)Hendricks CB, Robinson B, Bradley B, Davis K. Using music techniques to treat adolescent depression. Journal of Humanistic Counseling, Education and Development 1999; 38:39–46. （unavaliable）

3)Hendricks CB. A study of the use of music therapy techniques in a group for the treatment of adolescent depression. Dissertation Abstracts International 2001;62(2-A):472.

4)Radulovic R. The using of music therapy in treatment of depressive disorders. Summary of Master Thesis. Belgrade: Faculty of Medicine University of Belgrade, 1996.

5)Zerhusen JD, Boyle K, Wilson W. Out of the darkness: group cognitive therapy for depressed elderly. Journal of Military Nursing Research 1995;1:28–32. PUBMED: 1941727]

6)Chen SC, Yeh ML, Chang HJ, Lin MF. Music, heart rate variability, and symptom clusters: a comparative study. Support Care Cancer. 2020;28(1):351-360. doi:10.1007/s00520-019-04817-x

7)Chang, M. Y., Chen, C. H., and Huang, K. F. (2008). Effects of music therapy on psychological health of women during pregnancy. J. Clin. Nurs. 17, 2580–2587. doi: 10.1111/j.1365-2702.2007.02064.x

8)Chen XJ, Hannibal N, Gold C. Randomized Trial of Group Music Therapy With Chinese Prisoners: Impact on Anxiety, Depression, and Self-Esteem. Int J Offender Ther Comp Criminol. 2016;60(9):1064-1081. doi:10.1177/0306624X15572795

9)Esfandiari, N., and Mansouri, S. (2014). The effect of listening to light and heavy music on reducing the symptoms of depression among female students. Arts Psychother. 41, 211–213. doi: 0.1016/j.aip.2014.02.001

10)Fancourt, D., Perkins, R., Ascenso, S., Carvalho, L. A., Steptoe, A., and Williamon, A. (2016). Effects of group drumming interventions on anxiety, depression, social resilience and inflammatory immune response among mental health service users. PLoS ONE 11:e0151136. doi: 10.1371/journal.pone.0151136

11)Giovagnoli AR, Manfredi V, Parente A, Schifano L, Oliveri S, Avanzini G. Cognitive training in Alzheimer's disease: a controlled randomized study. Neurol Sci. 2017;38(8):1485-1493. doi:10.1007/s10072-017-3003-9

12)Harmat, L., Takács, J., and Bodizs, R. (2008). Music improves sleep quality in students. J. Adv. Nurs. 62, 327–335. doi: 10.1111/j.1365-2648.2008.04602.x

13)Liao J, Wu Y, Zhao Y, et al. Progressive Muscle Relaxation Combined with Chinese Medicine Five-Element Music on Depression for Cancer Patients: A Randomized Controlled Trial. Chin J Integr Med. 2018;24(5):343-347. doi:10.1007/s11655-017-2956-0

14)Lu, S. F., Lo, C. H. K., Sung, H. C., Hsieh, T. C., Yu, S. C., and Chang, S. C. (2013). Effects of group music intervention on psychiatric symptoms and depression in patient with schizophrenia. Complement. Ther. Med. 21, 682–688. doi: 10.1016/j.ctim.2013.09.002

15)Mahendran R, Gandhi M, Moorakonda RB, et al. Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care. Trials. 2018;19(1):615. Published 2018 Nov 9. doi:10.1186/s13063-018-2988-6

16)Nwebube C, Glover V, Stewart L. Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study. BMC Complement Altern Med. 2017;17(1):256. Published 2017 May 8. doi:10.1186/s12906-017-1759-3

17)Porter S, McConnell T, McLaughlin K, et al. Music therapy for children and adolescents with behavioural and emotional problems: a randomised controlled trial. J Child Psychol Psychiatry. 2017;58(5):586-594. doi:10.1111/jcpp.12656

18)Raglio A, Giovanazzi E, Pain D, et al. Active music therapy approach in amyotrophic lateral sclerosis: a randomized-controlled trial. Int J Rehabil Res. 2016;39(4):365-367. doi:10.1097/MRR.0000000000000187

19)Torres E, Pedersen IN, Pérez-Fernández JI. Randomized Trial of a Group Music and Imagery Method (GrpMI) for Women with Fibromyalgia. J Music Ther. 2018;55(2):186-220. doi:10.1093/jmt/thy005

20)Verrusio, W., Andreozzi, P., Marigliano, B., Renzi, A., Gianturco, V., Pecci, M. T., et al. (2014). Exercise training and music therapy in elderly with depressive syndrome: a pilot study. Complement. Ther. Med. 22, 614–620. doi: 10.1016/j.ctim.2014.05.012

21)Wang, J. , Wang, H. and Zhang, D. (2011) Impact of group music therapy on the depression mood of college students. Health, 3, 151-155

22)Yap AF, Kwan YH, Tan CS, Ibrahim S, Ang SB. Rhythm-centred music making in community living elderly: a randomized pilot study. BMC Complement Altern Med. 2017 Jun 14;17(1):311. doi: 10.1186/s12906-017-1825-x. PMID: 28615007; PMCID: PMC5470187.

23)Koelsch, S., Offermanns, K., and Franzke, P. (2010). Music in the treatment of affective disorders: an exploratory investigation of a new method for music-therapeutic research. Music Percept. Interdisc. J. 27, 307–316. doi: 10.1525/mp.2010.27.4.307

Excluded papers：

24)Bally, K., Campbell, D., Chesnick, K., and Tranmer, J. E. (2003). Effects of patient controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit. Care Nurse 23, 50–58. （not provide useable data）

25)Atiwannapat P, Thaipisuttikul P, Poopityastaporn P, Katekaew W. Active versus receptive group music therapy for major depressive disorder - a pilot study. Complementary Therapies in Medicine 2016;26:141–5. (sample size<20)

26)Garrido S, Stevens CJ, Chang E, Dunne L, Perz J. Music and Dementia: Individual Differences in Response to Personalized Playlists. J Alzheimers Dis. 2018;64(3):933-941. doi:10.3233/JAD-180084 （not randomised or quasi-randomised controlled trials）

27)Sánchez A, Maseda A, Marante-Moar MP, de Labra C, Lorenzo-López L, Millán-Calenti JC. Comparing the Effects of Multisensory Stimulation and Individualized Music Sessions on Elderly People with Severe Dementia: A Randomized Controlled Trial. J Alzheimers Dis. 2016;52(1):303-315. doi:10.3233/JAD-151150 （the control group also received music intervention）

28)Mondanaro JF, Homel P, Lonner B, Shepp J, Lichtensztein M, Loewy JV. Music Therapy Increases Comfort and Reduces Pain in Patients Recovering From Spine Surgery. Am J Orthop (Belle Mead NJ). 2017;46(1):E13-E22. (No full text available)

29)Castillo-Pérez, S., Gómez-Pérez, V., Velasco, M. C., Pérez-Campos, E., and Mayoral, M. A. (2010). Effects of music therapy on depression compared with psychotherapy. Arts Psychother. 37, 387–390. doi: 0.1016/j.aip.2010.07.001 （not provide useable data)

30)Alcântara-Silva TR, de Freitas-Junior R, Freitas NMA, et al. Music Therapy Reduces Radiotherapy-Induced Fatigue in Patients With Breast or Gynecological Cancer: A Randomized Trial. Integr Cancer Ther. 2018;17(3):628-635. doi:10.1177/1534735418757349（not provide useable data)

31)Cheung CWC, Yee AWW, Chan PS, et al. The impact of music therapy on pain and stress reduction during oocyte retrieval - a randomized controlled trial. Reprod Biomed Online. 2018;37(2):145-152. doi:10.1016/j.rbmo.2018.04.049（not provide useable data)

32)Pezzin LE, Larson ER, Lorber W, McGinley EL, Dillingham TR. Music-instruction intervention for treatment of post-traumatic stress disorder: a randomized pilot study. BMC Psychol. 2018;6(1):60. Published 2018 Dec 19. doi:10.1186/s40359-018-0274-8 (the control group also received music intervention)

33)Silverman, M. J. (2011). Effects of music therapy on change and depression on clients in detoxification. J. Addict. Nurs. 22, 185–192. doi: 10.3109/10884602.2011.616606 （the control group also received music intervention）

34)Särkämö T, Laitinen S, Numminen A, Kurki M, Johnson JK, Rantanen P. Clinical and Demographic Factors Associated with the Cognitive and Emotional Efficacy of Regular Musical Activities in Dementia. J Alzheimers Dis. 2016;49(3):767-81. doi: 10.3233/JAD-150453. PMID: 26519435.

35)Tuinmann G, Preissler P, Böhmer H, Suling A, Bokemeyer C. The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study. Psychooncology. 2017 Mar;26(3):377-384. doi: 10.1002/pon.4142. Epub 2016 May 5. PMID: 27146798.（not provide useable data)

36)Hsu, W. C., and Lai, H. L. (2004). Effects of music on major depression in psychiatric inpatients. Arch. Psychiat. Nurs. 18, 193–199. doi: 10.1016/j.apnu.2004.07.007（not provide useable data)

（3）We have added some new analyses of our data. 1) including three new papers and re-analying of our data, 2) adding the comparison of music therapy and music medicine (figure 3 in revised manuscript) , 3) adding some subgroup analyses by country having music therapy profession, intervention settings, therapy mode, specific music therapy methord, intervenor /therapist, and total intervention session (table 2 in revised manuscript) .

Response: We are sorry for making this mistake. In the Methord section, we defined exclusive criteria as studies with a very small sample size (n<20),while in table4 we performed the sensitivity analyses by excluding the papers with smale sample size ( 20< n<30). We have amended the table 4.

Response: We have added these findings with a forest plot (figure 6 in revised manuscript) according to the comment.

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• The Graduate School >
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• Novel global study using investigators as participants finds shared acoustic relationships among the world’s languages and music

Novel global study using investigators as participants finds shared acoustic relationships among the world’s languages and music

By Bert Gambini

Release Date: May 15, 2024

BUFFALO, N.Y. – A University at Buffalo psychologist is part of a global research team that has identified specific acoustic relationships that distinguish speech, song and instrumental music across cultures.

The study published in the journal Science Advances , which involved experts in ethnomusicology, music psychology, linguistics and evolutionary biology, compared instrumental melodies along with songs, lyrics and speech in 55 languages. The findings provide an international perspective supporting ideas about how the world’s music and languages evolved into their current states.

“There are many ways to look at the acoustic features of singing versus speaking, but we found the same three significant features across all the cultures we examined that distinguish song from speech,” said Peter Pfordresher, PhD , a professor of psychology in the UB College of Arts and Sciences, and one of the 75 contributors to a unique project that involved the researchers assuming the dual roles of investigator and participant.

The three features are:

• Singing tends to be slower than speaking across all the cultures studied.
• People tend to produce more stable pitches when singing as opposed to speaking.
• Overall, singing pitch is higher than spoken pitch.

The exact evolutionary pressures responsible for shaping human behaviors are difficult to identify, but the new paper provides insights regarding the shared, cross-cultural similarities and differences in language and music − both of which are found in highly diverse forms across every human culture.

Pfordresher says the leading theory, advanced by the paper’s senior author, Patrick Savage, PhD, senior research fellow at the University of Auckland, New Zealand, is that music evolved to promote social bonding .

“When people make music, and this is the case around the world, they tend to do so collectively. They synchronize and harmonize with each other,” says Pfordresher. “The features we found that distinguish music from speech fit well with that theory.”

Think about tempo as a mechanism to encourage music’s social aspects. Being in sync becomes more difficult as tempo increases. When the tempo slows, the rhythm becomes predictable and easier to follow. Music becomes a more social enterprise.

It’s the same with pitch stability, according to Pfordresher.

“It’s much easier to match a stable pitch with someone else, to be in sync with the collective, than is the case when a pitch is wavering,” he says.

Similarly, it’s possible that the higher pitches found in singing happen as a byproduct of songs being produced at a slower rate.

“Slower production rates require a greater volume of air in the lungs,” explains Pfordresher. “Greater air pressure in the vocal system increases pitch.”

Conversational speech, in contrast, is not synchronized. Conversations generally alternate between people.

“I would speculate that conversational speech is faster than song because people want to hold on to the stage. They don’t want to provide false cues that they’ve finished, in essence handing the conversation off to another speaker,” says Pfordresher. “Pausing in a conversation or speaking slowly often indicates that it’s another person’s turn to speak.”

The study’s novel structure, with its investigators as participants, is part of the increasingly global nature of music cognition research. Savage and Yuto Ozaki, PhD, the lead author from Keio University in Japan, recruited researchers from Asia, Africa, the Americas, Europe and the Pacific, who spoke languages that included Yoruba, Mandarin, Hindi, Hebrew, Arabic, Ukrainian, Russian, Balinese, Cherokee, Kannada, Spanish, Aynu, English and dozens more .

“First, we used this structure to counteract the unfortunate tradition of extractive research in cross-cultural musical studies in which researchers from the developed world collect, or extract, data from a culture in the developing world, and use the data to promote their own success,” says Pfordresher.

The second reason has more to do with the validity of the data.

“Our analyses require annotation of syllable and note onsets in songs and speech from around the world,” says Pfordresher. “No single investigator knows all of these languages. By having each investigator participate and thus check their own annotations, we add additional validity to our study.”

Each investigator-participant chose a song of national significance from their culture. Pfordresher selected “America the Beautiful.” Savage chose “Scarborough Fair.” Ozaki sang the Japanese folk song “Ōmori Jinku.”

Participants sang the song first; performed an instrumental version next on an instrument of their choice; and then recited the lyrics. They also provided an explanation for their choice as a free-form speech condition of the study. All four conditions were recorded and then segmented.

To avoid the possibility of bias creeping into the data, Pfordresher explained that not all investigators were involved in generating the study’s initial set of hypotheses. All of the authors looked at the data, but did so to make sure there were no differences between the initial group and those others.

“We do hope to follow up this study with other research that has authors from around the world sample data from within their cultures,” says Pfordresher.

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