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Content compiled by Evgeniya Molotkova, BS; Naomi Davis, MA; Alisa Kandel, MT-BC; Abbey Dvorak, PhD; Kate Gfeller, PhD; and Henry Hoffman, MD in February 2025

Performance of "I Am Light" used as Music Therapy (2 minutes 50 seconds)

Full Session

Definitions

Music therapy: an established healthcare profession in which certified clinicians use music interventions within a therapeutic relationship to accomplish individualized client goals and improve the health and well-being of individuals of all ages (AMTA).

• Music therapy interventions are crafted within a treatment process and may include composing, improvising, re-creating, and listening methods.  
• Due to the variety of ways that people can engage with music, and the neural interconnectivity of the auditory system within the brain, music therapists may structure music interventions to affect non-musical domain areas of functioning.  
  • These domain areas may include motor, emotion, cognition, social, sensory, and communication functioning (CBMT).

Music therapy methods: broad types of music experiences, identified by unique characteristics, processes of engagement, and therapeutic potentials and applications (Bruscia, 2014) 

• Music therapy methods include composition, improvisation, re-creative, and receptive (see section below for greater detail)

Music therapy interventions: also referred to as therapeutic music experiences, include categorization of the different ways of designing music experiences and various ways of engaging participants (Bruscia, 2014) to support or improve a situation, and/or to elicit changes in thinking, feeling, relating, and/or understanding (Dvorak, 2023; Melnyk & Morrison-Beedy, 2012).

Music therapy techniques: single interactions used to elicit an immediate response or to shape the ongoing experience of a patient, may be musical or non-musical, and can be used across interventions.

• Within any intervention, music therapists may use multiple techniques. For example, rhythmic entrainment is a music technique that may be used in any of the four methods. Validation (i.e., recognition that a person or their feelings and opinions are worthwhile) is an example of a non-music technique

Rhythmic entrainment: technique used by music therapists that refers to the phenomenon of auditory-motor coupling in which the human motor system synchronizes to an steady rhythmic auditory pulse (Sena Moore, 2022; Thaut, 2015).

Iso principle: a technique in which a music therapist matches a patient’s mood with music choice and using a gradual change in the tempo, rhythm, and content of music to move them towards a different mood or state of mind.

• “Patients listen to music which is aligned with their current emotional state (i.e., a negative one), and from there on, shift to music expressing a desired state (i.e., a positive one). The sequence of music should help the patients to integrate the internal and external experiences, and shift to a more positive perspective and experience.” (Starcke et al, 2021)

Lyric analysis: a receptive music therapy intervention, also called song analysis or song discussion, that involves the presentation of a music stimulus (live or recorded song) with a discussion of song lyrics, and other musical elements, to facilitate therapeutic discussion (Schuldt & Silverman, 2020).

 

Background

The contemporary profession of music therapy had roots in the social reforms of the Progressive Era where amateur and professional musicians played live music in hospitals and prisons to promote physical and mental wellbeing (Sevcik, 2022). Both World War I and World War II expanded clinical applications and research with veterans recovering from physical and mental traumas (Horden, 2017). Medical professionals witnessed how this affected the veterans’ healing and requested that hospitals hire professional musicians for this purpose. The growing role of musicians in the healthcare setting underscored the importance for the development of a formal college curriculum (AMTA).

The first professional music therapy organization, the National Society of Musical Therapeutics, was founded in 1903. This organization was followed by the founding of the National Association of Music in Hospitals in 1926 and the National Foundation of Music Therapy in 1941. These organizations contributed books, journals, and educational courses to the discipline. The first degree-granting programs in music therapy were founded in the late 1940s and sought to standardize the educational requirements. The contemporary American Music Therapy Association was formed in 1998 (AMTA).

 

Education and Training

To be a practicing music therapist, an individual must complete a set of educational and training guidelines to master a core set of music therapy competencies (AMTA).

• Must hold a bachelor's degree (or higher) from an accredited music therapy program
  • Course requirements in a bachelor’s degree in music therapy include:
    • Courses in music therapy theory and history
    • Participation in music theory, lessons, and ensembles
    • Courses in psychology, anatomy, research, and education
    • Required fieldwork including internship (~ 1200 clinical hours)
  • Pass the music therapy board certification exam, which allows for the use of MT-BC (Music Therapist - Board Certified) credential.
    • The MT-BC credential is required to practice as a music therapist in the U.S.
    • Individual states may have additional licensure requirements or title protections.

See also:  UIowa Music Therapy Flyer.pdf

 

Discussion

Music Therapy Methods

There are four major methods that a music therapist may integrate into their patient sessions. Depending on the context and client goals, one method may be more appropriate than another, or a combination may be the most appropriate. Within each of the four methods, there are specific interventions that employ said method. Across all methods, there are techniques that can be applied more generally. 

• Receptive (i.e., listening)
  • Receptive methods describe situations where the patient listens to music and responds either verbally or non-verbally to the stimulus (Edwards and Grocke, 2015)(Bruscia, 2014)
    • This approach is different from just listening to live/recorded music. Music selections are chosen to elicit a specific response, and receptive music therapy interventions can include movement, breathwork, relaxation, mindfulness practices, and discussion that can more effectively change a patient’s mood/state of mind.
• Re-creation
  • Reproducing already existing music (i.e., playing, singing) (Bruscia, 2014)
    • Typically directed by client preferences and familiarity with the music
  • “Recreating methods encompasses any kind of pre-composed music that the client learns to play or sing.” (Stegemann et al, 2019)
• Improvisation
  • Involves clients spontaneously making their own music in the moment through singing or playing an instrument (Bruscia, 2014)
    • “Improvisational music therapy is based on active, spontaneous music making, often in a therapist-client dyad. The method typically utilizes both non-verbal and verbal expression” (Erkkilä et al, 2008)
• Composition (i.e., songwriting)
  • Participants write songs, lyrics, instrumentals, or other components to create a musical piece (Bruscia, 2014)
    • Music therapists help their patients create their own songs. The process of creating songs may spur therapeutic discussion about a topic of interest (Aasgaard et al., 2015).
  • “The process of creating, notating and/or recording lyrics and music by the client or clients and therapist within a therapeutic relationship to address psychosocial, emotional, cognitive and communication needs of the client” (Baker et al, 2005)

 

Music Therapy Practice Settings and Applications

Music therapists may work with a variety of patient populations (from babies and small children to the elderly) in a variety of practice settings. Depending on the needs of the client, they may facilitate:

• Individual and group sessions
• In-person and telehealth
• Inpatient and outpatient

Settings (AMTA)

• Medical (e.g., hospitals, clinics, nursing homes, hospice, palliative care)
• Mental health (e.g., Acute and chronic psychiatric units, partial hospitalization; substance use disorder treatment facilities; community mental health clinics)
• Educational (e.g., schools, daycares, workplace job training facilities)
• Rehabilitation (e.g., rehabilitation hospital or unit, home health care, skilled nursing facilities)
• Correctional settings (e.g., jails, prisons, halfway houses, juvenile detention centers)
• Private practice (e.g., business owner, private practitioner, contractor)

Applications

• Pain
  • In a 2017 systematic review and meta-analysis of randomized controlled trials that assessed music therapy intervention for the treatment of chronic pain, Garza-Villareal and colleagues found that music therapy reduced self-reported symptoms of chronic pain and depression. This effect appeared to be more significant when participants were able to self-select/direct music choice (Garza-Villarreal et al, 2017).
• Anxiety
  • In a systematic review and meta-analysis of randomized controlled trials investigating the efficacy of music therapy in treating anxiety, Lu and colleagues found that music therapy (compared to a control condition) was significantly more effective in alleviating self-reported anxiety symptoms (Lu et al, 2021).
• Autism spectrum disorder
  • A 2022 Cochrane review found that there is moderate evidence to suggest that music therapy may provide global life improvement in patients with autism. This intervention was also deemed to have little associated risk (Geretsegger et al, 2022)
    • Global life improvement included significant improvement in autism-related symptoms
• Chronic obstructive pulmonary disorder
  • A recent systematic review of randomized controlled trials investigating music therapy as an intervention in patients with chronic obstructive pulmonary disease (COPD) suggested that a music therapy intervention, when compared to a control, can significantly decrease dyspnea and anxiety associated with difficulty breathing. There were also improvements in both systolic and diastolic blood pressure as well as improved self-reported sleep scores (Huang et al, 2020).
• Cognitive impairment/dementia
  • A systematic review by Lin and colleagues found that music therapy can improve cognitive function, quality of life, and neuropsychiatric symptoms associated with cognitive impairment or dementia (Lin et al, 2023).
• Depression
  • Music therapy has been investigated as an intervention to treat depression in many populations, including, but not limited to, patients with dementia, cancer, and children/adolescents
    • Cancer patients with depression: A 2023 narrative review suggested that music therapy may contribute to improvement of depression symptoms in patients with breast, lung, prostate, and colorectal cancer (Eseadi et al, 2023)
    • Children and adolescents: A systematic review of music therapy randomized controlled trials showed that “limited evidence suggests music therapy is an effective treatment for improving depression and/or anxiety symptom severity in children and adolescents.” (Belski et al, 2022)
    • Cognitive impairment: Xue and colleagues demonstrated that a “receptive music therapy intervention significantly improved cognitive function and reduced depressive symptoms in older adults with MCI.” (Xue et al, 2023)
• Multiple sclerosis
  • A systematic review of 12 studies assessing the effect of music therapy on gait abnormalities associated with multiple sclerosis demonstrated that music therapy intervention, either with a rhythmic auditory or dance strategy, resulted in a significant improvement in gait function (Kong et al, 2023).
• Parkinson’s disease
  • A systematic review of studies investigating the impact of music therapy in treating the gait difficulties associated with Parkinson’s disease found that patients had some short-term improvement in walking speed, stride length, and gait quality. Research findings are limited in the duration of these effects since most interventions occurred over a period of 1 to 3 months (Fan et al, 2023).
    • A meta-analysis of singing interventions positively affected vocal frequency range and respiratory outcomes for people with Parkinson’s disease (Alqutub et al., 2024).
• Stress
  • A systematic review of studies assessing the impact of music therapy on stress reduction found that music therapy intervention had a medium to large effect on psychological and physiological stress outcomes (de Witte et al, 2020)
• Stroke
  • Liu and colleagues found that, in a systematic review and meta-analysis of 6 studies investigating the use of music therapy as a complementary therapy for stroke patients with aphasia, there was significant improvement in functional communication and repetition/naming functions (Liu et al, 2022).

 

Music Therapists as Performers

Music therapists typically have extensive skills and experience in playing music. This is an important part of music delivery. Despite this, music therapists’ main goal is not performance or entertainment. Many of the facilitation techniques they use spur therapeutic conversation and encourage mindful behavior from patients. However, music therapists may perform outside of their job as a music therapist (Johnson, 2023).

 

The Neuroscience of Auditory Processing and How it Relates to Music Therapy

In general, sound, including music, travels through the structures of the outer and middle ear to reach the cochlea. The output of the cochlea is relayed to the inferior colliculus and eventually to the primary auditory cortex in the temporal lobe of the brain. Many, if not most, of these structures, from the cochlea to the auditory cortex, possess some degree of tonotopic organization. This means that different pitches are processed in discrete parts of these structures (Philips, 1995). Contemporary neuroscience has found that sound/hearing, like many of the senses, is processed in a variety of interconnected cortical pathways (Lesicko et al, 2022).

Music is unique in that mammals may react differently to this stimulus when compared to speech or random noise. Functional neuroimaging studies of music perception show that this stimulus increases activity in many limbic and paralimbic structures that are important in perceiving emotions and connecting them to experiences, such as the amygdala and hippocampus (Vuust et al, 2022). Music can also activate activity in sensorimotor and memory-related areas of the brain. The stimulation of these different functions helps establish a connection between music stimulus and therapeutic discussion/movement important that underlies many of the tenets of music therapy (Koelsh, 2009).

 

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