Music is a captivating art that has varied forms ranging from instrumental, vocal, and silence. Each expression of the art invokes feelings that differ from one piece to another. For some, the art serves as a form of elegance, entertainment, enjoyment, and reflection. On the other hand, the simple art serves as a therapy to the sufferer, especially those with mental problems. Music perfectly depicts the often-uncontrollable feelings that confuse and infuriate the heart and the mind, making the person float to an imaginary world. Life then turns colorful with the sounds of the music that fill the emptiness and the opaque. For this reason, music therapy has been a transforming pacifier and healer to individuals who have been in the dark after losing someone very dear to them. [1]
1. Introduction to Music Therapy and Brain Health
The complex sounds and rhythms in the environment often make people feel relieved and supported. They put the listeners’ ideas into a beautiful painting as the sounds wave with different emotions. This also applies to the individuals who deal with immense pain, loss, and craving for the presence of the deceased. Those people’s life circumstances change after they lose someone whom they had encountered with the whole life. The artworks with vocals and sounds that feed the heart and the mind are completed. No articulacy is able to describe the feelings that drown people with uncertainty and fragility. Seemingly love is the sweetest gift of all and with it, there is happiness and joy. On the other hand, with the loss of someone so utterly dear, life turns dark and cold as if the sun does not shine anymore in the world. The heart is stunned, the breath is opened, the mind is frozen, and tears blur the vision as they rush down the cheek. Every moment feels like living in hell where imaginative blade mutilates the inner self and where memories do schismatics and sensational pain through the repetition of life events. Everything then appears bitterly sweet. The black and white world is filled with tension and disarray. [2]
2. The Neurological Basis of Music Therapy
The effects of music on human life, tastes, emotions, feelings, and subjective experiences are best known to all. Music is so much more than an entertainment activity or expression of one’s thoughts and feelings by instruments. It has an astonishing effect on the biggest mystery of human beings – the brain. The sound stimulus initiates a series of complex physiological and psychological changes in different parts of the brain. Music is, without any doubt, one of the most interesting stimuli for studying the human sub- and superconscious mind as well as understanding functions of the brain in its pathological states [3]. Music has been integrated into human culture since ancient times, primarily for religious rituals, and it is uniformly present in every human culture, regardless of social or geographical aspects [1]. Neurological studies have confirmed that music plays a key role by affecting physiological processes, hence so-called sound therapy emerged. Numerous studies have shown that listening to music has a specific impact on mental, emotional, and physical functions, and hence on health.
A great deal of research has focused on the emotional effect of music. The structure of music plays an important part in human emotional responsiveness to music, and there is a graded relationship between structural characteristics of musical sounds and emotional experiences induced by them. More recently, empirical research has looked at the neuroanatomical substrates underlying the emotional effects of music. A stimulus, such as sound, light, or touch, must be perceived to have an effect on people. Perception of a stimulus requires an awareness of the stimulus in the environment, the identification of its significance to the individual, and a willingness to respond. Understanding the biological basis of perception may shed light on the ultimate complexity of mind, consciousness, cognition, and behavior in higher animals. The goal of the present study is to examine the recovery factors in brain functions and understanding the flow of information of brain processing of music to biological and neural substrates of musical sounds as stimuli.
2.1. How Music Affects the Brain
Music activates various structures in the brain, particularly areas involved with emotions, visual imagery, and creativity. Listening to and playing certain types of music can stimulate the hypothalamus, allowing the release of more dopamine, fostering positive emotions [3]. Music enhances the activity and blood flow to the anterior cingulate cortex, stimulating feelings of happiness, joy, surprise, and sadness. On the other hand, music can activate the anterior insula, which induces combined emotions (e.g., happiness and pride). It has been proposed that folk music arouses a different pattern of brain activity compared to favorite and classical music. This difference is expressed in the activation of the right frontal hemisphere.
Furthermore, visual imagery found within abstract songs, soothing sounds, or nature music can activate the occipital cortex, enhancing the stimulation of musical sound images [1]. Electroencephalogram (EEG) studies have demonstrated that the activity of the general alpha band increases as a function of musical expression. Creative production found in rhythmic (dance music and drum) or harmonic (musical transformation and improvisation) music can generate different patterns of cortical brain activation. The brain response involved with trance rhythms is mainly based on the right frontal cortex, supporting drug and mood alteration.
2.2. Neuroplasticity and Music Therapy
Neuroplasticity is the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections. It is also referred to as brain plasticity, neural plasticity, or cortical plasticity. The terms functional plasticity and structural plasticity are often used to refer to the functional or physical changes in the brain that safeguard the quality of its performance. [4]
Neuroplasticity implies that the brain is responsive to the influences of the environment, and the brain can develop new functionalities and relearn lost capabilities. However, the extent of this reorganization does not occur in a random manner, and specific changes are determined by the parameters of activity inherent to each neural system. One type of experience is imposed by traumatic brain injuries (TBI). Regarding brain plasticity and events leading to its injury at the early stages following a TBI, there are both factors that are favorable and those considered unfavorable. Music therapy is a 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. There is evidence that music therapy improves clients’ health and functional wellbeing. Music therapy is a prospective rehabilitation approach focusing on higher-order cognitive functions. It can be applied to clients with cognitive deficits associated with various underlying aetiologies. Music and learning are inter-related as they share common neural substrates and healthy structures and processes needed for cognition and emotion. Music therapy enhances cognitive rehabilitation by stimulating and reorganizing the activity of surviving connections of damaged neural pathways involved in auditory and musical perception, social-cognitive skills, executive functions, and emotional deficits [1]. Therefore, music may have a positive impact on neuroplasticity.
3. Benefits of Music Therapy for Brain Health
There are many benefits to brain health from music therapy, beyond what we would consider “musical” health benefits. Music therapists use creative interventions that target specific areas of need in functions of the brain. These needs can include those found in cognitive function (attention, memory), functional skills (sequential movements, speech production), and emotion regulation (therapeutic response to feelings of powerlessness, isolation) [2]. By using creative composition with pre-composed familiar songs, music therapy has been shown to have a positive impact on brain health [5].
By improving cognitive functions such as attention and concentration through the practice of song recall or by improving memory retention, transfer, and recall speed through humorous parody composition, music therapy improves aspects of brain health. Many area needs found in the impairments of dementia and brain injuries, including poor attention and short-term memory loss, are positively impacted by specific music therapy interventions. Furthermore, progression in overall cognition has been noted in case studies with consistent music therapy.
3.1. Cognitive Function Improvement
The connection of musical sounds and brain functions is a major challenge of neuroscience. It has been proven that music has a psychological effect, including induction and modification of cognitive states and moods [3]. Cognitive activation leads to metabolic changes in specific cortical centers, reflected in blood flow velocity. Any improvement in blood flow through the brain during rehabilitation is a major contribution to stroke recovery. Recent studies show that rehabilitation in multidisciplinary stroke units is more successful. Music listening could improve stroke rehabilitation outcomes. Music stimulation increases blood flow in patients suffering from acute ischemic stroke, enhancing post-stroke recovery and serving as a helpful tool in neurorehabilitation.
Without any doubt, most of the respondents experienced pleasure or some other emotion while listening to some kind of music. Except for joy or contentment, they felt peace, often nostalgia, sadness, tranquility, and some others. The short and the long forms of the music description checklist yielded contrasting results—the short formal analysis revealed greater ratings of vividness, clarity, and accuracy of the perceived music form, which indicates a more analytic approach. Preferable music listening was sufficiently determined by music type and theme. The preference of the music type was congruent with the intention to enhance a specific mood. These findings suggest that a preference for a particular type of music did not depend on personal music background knowledge. Cerebrovascular accident (CVA) is a syndrome caused by a disturbance in the cerebral blood circulation.
3.2. Emotional Regulation and Stress Reduction
Music is widely used to regulate emotion and relieve stress because it is an easy and economical way to access a pleasurable experience [5]. Music is often associated with shifts in mood, memory, and cognitive function, suggesting a role in the regulation of emotions. There are several music-related contexts in which listening or making music is capable of altering emotions in a positive manner. However, the opposite is also true: some music-liking songs can evoke negative emotions such as sadness and nostalgia. Nevertheless, music is generally considered a pleasant experience. Viewing music in an “appraisal” framework, people’s individual music preferences often determine whether or not they find music pleasant. In this way, music can evoke emotional responses by either cognitive or visceral pathways.
While exposure to music is generally perceived as a pleasant experience, there exist situations where involuntary capture of attention by music gives rise to unwanted thoughts (such as music-evoked autobiographical memories) that might not be well-regulated. Under such conditions, a music-evoking cue may trigger thoughts and feelings of emotions related to distress and bring about a loss of emotional control. The ability to down-regulate negative emotional responses also derives from a possible interaction between cognition and emotion. Cognitive mechanisms include the reinterpretation of a situation in a way that alters its emotional impact. A more habitual use of this strategy could be associated with better social adjustment and well-being. Music is successful in promoting cognitive reappraisal of thoughts and feelings in negative situations [1].
4. Applications of Music Therapy in Different Populations
Music therapy is a versatile intervention that can be employed with a variety of populations, from infants to the elderly. People can hear, feel, and even move to music before they are born. For children with developmental disorders like autism specter disorder (ASD), learning disabilities, or attention-deficit hyperactivity disorder (ADHD), music therapy provides a safe and non-threatening environment. Clinicians use a combination of pitch, tempo, dynamics, and timbre to create music experiences that invite the child to explore and respond. Often using improvisation, the music therapist can adapt to the child’s needs, attentiveness, and mood [6]. “Musical conversations” create opportunities to enhance socialization, communication, emotional expression, attention, and motor movement. Back-and-forth musical interactions between a peer/therapist and child with developmental disorders parallel their verbal communication and can be a prime avenue for developing social skills. For the elderly population, people are living longer than ever before. While life expectancy rates continue to rise, aging often brings new challenges. Due to advances in medical knowledge, the population of older adults struggling with issues of aging like Alzheimer’s disease (AD), Parkinson’s disease (PD), and stroke is growing. Aging can involve cognitive deficits including impairment in attention, processing speed, semantic memory, verbal fluency, and recall. Despite an increased need for services, countries typically spend less than 1-2% of their healthcare budgets on mental health interventions for the older adults. There is a need for therapeutic interventions to provide adaptive strategies to sustain quality of life and maintaining or slowing cognitive decline due to degenerative neurologic diseases [1]. Choral singing programs have been successfully implemented in settings ranging from residential care facilities to independent communities and have positive outcomes on mental health and cognition.
4.1. Children with Developmental Disorders
Music therapy unmotivates the clients with a development disorder and positively supports the development of brain health in this population. Children with Developmental Disorder, kids with “autism spectrum disorder,” “attention deficit hyperactivity disorder,” “intellectual disability,” with “sensory processing disorder,” and kids developing with other various disorders are tough spots with the baby brain. Brain development issues have been a meaningful research topic, and many scientists and industries have proposed stimulation to solve these issues. Music, one of the ways to stimulate brain development in premature infants, as well as children with a disorder, can be one enriching subject to study and research for sci-tech fields in society [7]. Past studies on children with developmental disorders and music therapy show promising results. Children with developmental disorders show skin conductivity changes and heart rate variations distinct from the normal groups. A child with autism stated a saturation feeling, fun experiencing, and a sense of understanding when the therapist and client played a drum together. Children also sang out and improvised lyrics, made body percussion in a drum circle, and cued to the therapist how to play the drum circle. It is also said that music structure and rhythm calmed agitation better than straight speech patterns, determining music affective with human response [1].
4.2. Patients with Neurodegenerative Diseases
Music therapy is a non-pharmacological intervention that involves the planning and execution of musical experiences with a clinical trained music therapist. Individual’s responses to this type of intervention are mediated by a neurological network that addresses all possible domains of function. Due to advances in medical knowledge, the older adults struggling with issues of aging like Alzheimer’s disease, Parkinson’s disease, and stroke has grown. At the forefront of the aging demographic, there is a growing need for therapeutic interventions to provide adaptive strategies to sustain quality of life, decrease neurologic impairment, and maintain or slow cognitive decline and function due to degenerative neurologic diseases. These approaches indicate the expanding scope and efficacy of music therapy and the possible mechanisms involved, while offering insight into their potential importance [6].
A review of the neurophysiology of music is presented, particularly how music is perceived and processed by the brain, as well as how it may be employed to improve cognitive as well as motor function. Music significantly engages both sides of the brain, It typically entails the fast-paced movements of both hands and fingers, recruiting vestibular and proprioceptive input while requiring increased motor planning and spatial awareness. Engaging in these skills activates the anterior cerebellum and supplementary motor area. Music may also promote cognitive health through its emotional aspects which, through increased social engagement, can offer relief from stress [1].
5. Music Therapy Techniques and Interventions
Music therapy utilizes musical interventions to improve and maintain physical, mental, and emotional health. The primary techniques and interventions commonly used in music therapy are categorized into two different approaches: active music making and receptive music listening; a therapist-led and client-based expressive approach and a passive, media-based, listener-oriented approach [8]. Within these broad categories, a range of specific techniques are employed to promote health, heal and ease, and actively engage and support.
Active music making techniques include creating spontaneous sounds in a music therapy session (e.g., through singing, playing instruments, or vocalization) in individual or group interventions. Receptive music listening techniques are guided by the therapist and typically use precomposed texts or scores (e.g., through song discussion, lyric analysis, or imagery). The therapeutic use of music through supportive environments has shown to be useful in a range of populations characterized with symptoms of both mental and neurological disorders [6].
5.1. Active Music Making
This section focuses specifically on the technique of active music making in music therapy, daring to distinguish four distinct sub-categories of it. It explains the modalities regarding how active engagement with music is hypothesized to contribute to brain health, offering some insights into the somewhat less considered aspects of music therapy as an applied health care discipline.
In music therapy, the diagnosis and treatment planning regard the specific therapy needs and preferences of an individual client [8]. Within this context, the very first therapeutic choice to be made is whether a passive or an active musical intervention is presumed best suited for the particular client. This, among others, involves considering their medical conditions (e.g., stroke, dementia) and possible limitations (e.g., motor impairment) that might proof problematic for active music making or also possible barriers to a passive experience (e.g., stupor, agitation, certain phobias). Then there are other considerations like the type of medical professional performing the intervention, the musical genre, location, and general ambiance. Finally, the music as such may also be modified structurally, supplemented with narratives or explicit visual cues or other sensory experiences. With regards to the passive music listening interventions, these issues are all discussed in detail [6]. In contrast, active music making is much less nuanced and appears to be treated as a one-coat-fits-all category in relation to health outcomes.
5.2. Receptive Music Listening
From the start of time, music has been ever-present in human life, from ritualistic chants to passing songs, and from melodies in everyday acts to caressing notes on special occasions. Notes and rhythms have gripped humanity beyond a sweet gift and a delightful escape. This community consciousness was crystalized by Christopher Small — ethnomusicologist and senior research fellow at the Institute of Education in London — in his term “musicking.” This denotes that there is no such thing as a passive individual enjoying a concert, an isolated person tapping to the rhythm, or a private listener stuck in the room with sound. What stands is community, vibration, and A/RF; that is, rhythm and co-sharing in time [1]. This experience not only transcends the limits of the body and location but also spans time. It may engross one’s attention so much that the song keeps coming back even years later. Receptive music listening denotes musical experiences held for just appreciating the music or with other agendas but without active music making. Listening for pure pleasure is frequently seen as natural. Even in various traditions of meditation, one may have practice on listening without evaluation as part of developing attentive mindfulness. Under music therapy, listening is practiced partaking in actively designed experiences or brought-out processes through passive engagement as a, but not-the-only, testing ground for aesthetic forms of listening. Here, understanding and appreciation come to the fore [9].
6. Research Studies and Evidence Supporting Music Therapy
This section focuses on research studies and evidence that show the effectiveness of music therapy. Tackling the topic of music therapy is exciting, as it touches on many different areas of life. A lot of people have anecdotes to contribute regarding how music sparks memories and emotions or the songs they play to rev up for a race or calm the nerves. Still, addressing that topic in a scientific way is equally daunting, given how broad an area of study “music” is. What instruments, genres, types of music therapy, environment, population of subjects, etc. would be considered? Even narrowing it down to a specific kind of music therapy, like stroke patients jamming with instruments, could encompass any number of studies addressing a variety of symptoms or issues. There’s a wealth of research out there regarding music and the brain; it would be nearly impossible to write a paper considering it all.
Therefore, the examination will focus only on studies that seek to address the impact of music therapy on one aspect of brain health: the mental health of elderly patients suffering from dementia, Alzheimer’s disease, or similar disorders. Playing or listening to music is a common activity in everyday life, but it has become especially prevalent in older ages, as a soothing or reminiscing pastime. In turn, as society has tried to keep pace with an aging population, the prevalence of nursing homes and full-time elder care has skyrocketed. Many people have heard anecdotes about individuals with severe dementia relaxing or responding with understanding to music that was significant to them or that they grew up with. Even if people aren’t aware of it, a progression of ideas relating to this topic has already begun to take shape in their minds.
7. Challenges and Limitations of Music Therapy in Brain Health
Despite the promise shown by music therapy in the context of brain health, numerous studies have highlighted various challenges and limitations associated with it. A meta-narrative review by Soufineyestani, Khan, and Sufineyestani [10] provides a contemporary overview of these constraints regarding the application of music therapy for promoting brain health. Notably, the review emphasizes that music therapy studies of various intervention types adopted an unstandardized music therapy typology, which generated challenges in establishing causal effects and generalizability of results. Understanding the types of music used in music therapy facilitates the incorporation of cost-effective interventions, such as listening to recorded music, in clinical practice. It was proposed that further research is warranted to mitigate these challenges related to the standardization of music therapy typology.
8. Future Directions in Music Therapy Research and Practice
Emerging Directions: Where Will the Future Take Music Therapy? Adventures in Outside-of-the-Box Thinking
Low hanging fruit explores commonplace options mostly available but not universally practiced. Even more provocative are ideas off the beaten track requiring speculation.
8.1. Automated Music Therapy
Imagine a digital interface for MHIs and THIs. Expanded accessibility would be better than any video, DVD, or CD effort. Automatons are computer programs that perform tasks, those tried daily to filter emails so the desired ones are read. Such an interface could ask behavioral questions (What is your mood? How tired are you? What do you want to do? How was yesterday’s session?) and execute precompiled MHI/%THI playlists, perhaps personalized playlists based upon previous sessions.
MP3s based upon client need or desire could also be used to evaluate potential effects in exchange for sharing data, e.g., preblog/postblog states shared with aggregate analysis. Audio preferences (e.g., familiar, vocal, soothing) could be inputted in conjunction with fixed data points (e.g., frequency of use, duration of listening). For example, if someone with chronic anxiety hates soothing music but prefers or tolerates heavy metal at peak anxiety, a THI list could be constructed. The purpose would not solely focus on trading services for music effects data, but be as public music exposure in coffeehouses, restaurants, shopping malls, and festive recreation parks, etc.
8.2. MHI/THI
Music lenses can be viewed as alternative forms of music therapy. Prescriptive music selection includes noteworthy communal participation in creative expression (cultural) and volunteer listening to music intended for therapeutic purposes (intentionality) of various sorts (focused-audition, imagery, movement). Interested parties might form a group, e.g., 3-5 letters of interest to form pilot projects, and compile an alternative music database common across group consortiums, e.g., MHI, MHI%THI series, and even more speculative songs like “Black Magic Woman.”
9. Conclusion and Key Takeaways
The exploration of the impact of music on brain health presents fascinating evidence, offering hope to researchers and healthcare professionals alike. Building on findings over the last three decades, particularly concerning the brain’s response to sound and rhythm, there is increased optimism about the widespread healing of mental and physical ailments using music and sound. Intensive studies and trials are underway globally to assess the efficacy of music-based treatments for conditions ranging from anxiety and depression to Alzheimer’s, autism, and stroke [11].
However, although the potential for sound to heal and enhance wellness is recognized, much research remains to be done regarding the physiological and neurological mechanisms through which sound influences the body, brain, and behavior. Moreover, questions arise regarding how sound can be used effectively and safely. Despite a concerted global effort to explore this field, the music and sound healing industry is largely unregulated, leading to concerns regarding the safety and legitimacy of its practitioners [10].
References:
[1] M. Sorensen, “The Neurology of Music for Post-Traumatic-Stress Disorder Treatment: A Theoretical Approach for Social Work Implications,” 2015. [PDF]
[2] R. Oby Ebo, “The Positive Effect Music Therapy Has on People,” 2017. [PDF]
[3] S. O. N. J. A. ANTIĆ, S. A. N. D. R. A. MOROVIĆ, V. A. N. J. A. BAŠIĆ KES, I. R. I. S. ZAVOREO et al., “Enhancement of stroke recovery by music,” 2012. [PDF]
[4] S. Hegde, “Music-Based Cognitive Remediation Therapy for Patients with Traumatic Brain Injury,” 2014. ncbi.nlm.nih.gov
[5] M. Nierman, “Music and the Brain,” 2018. [PDF]
[6] A. Clements-Cortes, A. Clements-Cortes, and L. Bartel, “Are We Doing More Than We Know? Possible Mechanisms of Response to Music Therapy,” 2018. [PDF]
[7] F. Barbara Haslbeck and D. Bassler, “Music From the Very Beginning-A Neuroscience-Based Framework for Music as Therapy for Preterm Infants and Their Parents,” 2018. [PDF]
[8] L. Schneider, L. Gossé, M. Montgomery, M. Wehmeier et al., “Components of Active Music Interventions in Therapeutic Settings—Present and Future Applications,” 2022. ncbi.nlm.nih.gov
[9] S. Baylan, M. McGinlay, M. MacDonald, J. Easto et al., “Participants’ experiences of music, mindful music, and audiobook listening interventions for people recovering from stroke,” 2018. [PDF]
[10] M. Soufineyestani, A. Khan, and M. Sufineyestani, “Impacts of Music Intervention on Dementia: A Review Using Meta-Narrative Method and Agenda for Future Research,” 2021. ncbi.nlm.nih.gov
[11] K. Pisarczyk, S. Harty, and V. Kleeman, “Music Therapy in the Modern Era: Three Discussions,” 2018. [PDF]