Music plays a central role in identity, emotion regulation, and everyday functioning, yet in the context of substance use disorders, it may also become conditioned through repeated pairing with intoxication and later function as a cue for craving, urges to use, or emotional destabilization. Existing literature has recognized both the risks and therapeutic potential of music in recovery but has offered limited stage-sensitive guidance for clinical decision-making. This article introduces the Musical Reassociation Model (MRM), a stage-based conceptual framework that maps how the relationship between music and substance use evolves across addiction and recovery. The model describes five distinct phases: (1) the synergy phase, characterized by mutual enhancement between music and substance use; (2) acoustic erasure, marking the collapse or distortion of music's aesthetic and self-regulatory function; (3) stabilization through avoidance or substitution; (4) active tolerance through graded exposure, musical agency, and reassociation; and finally (5) integration, in which music is reclaimed as a recovery resource. Across these stages, the MRM reframes music not only as a trigger to be managed but as a dynamic domain of identity, self-regulation, and agency. The model highlights a key clinical distinction between short-term stabilization strategies based on environmental control and later-stage interventions aimed at building durable agency in the presence of problematic music cues. It also introduces the construct of Aesthetic Recovery Capital to describe the musical, social, and interpretive resources that support reintegration in the aesthetic domain. By integrating cue reactivity, identity reconstruction, recovery-oriented theory, and recovery capital, the MRM provides a theoretically grounded account of how music shifts from a substance-linked vulnerability to an integrated recovery resource. The article concludes by discussing clinical implications and illustrative vignettes, while outlining directions for future research, such as validating stage boundaries, examining digital listening environments, and developing stage-matched therapeutic interventions. Music is a powerful part of our daily lives, often helping us manage our emotions and connect with our identity. However, for people struggling with substance use disorders, music can sometimes become a “trigger”. Because certain songs or styles of music were often present during periods of substance use, hearing them later can cause intense cravings or emotional distress. We developed the Musical Reassociation Model (MRM) to help clinicians navigate this challenge. Currently, many people in recovery avoid music that reminds them of their past use, or they switch to a different style of music. While this helps in the short term, it can also lead to a sense of loss, disconnection, or difficulty using music as a positive resource in recovery. Our model provides a five-stage roadmap to move beyond mere avoidance. The process begins by stabilizing the individual’s environment and then gradually helping them rebuild their relationship with music. We describe how a person can move from feeling overwhelmed by musical triggers to regaining “musical agency”, which is the ability to choose, regulate, and reinterpret musical experiences, whether through listening, music-making, or other forms of musical participation. By using this model, therapists can help people in recovery transform music from a source of risk into a lasting tool for resilience and self-expression, identity, and social connection. This approach ensures that individuals do not have to give up the art form they love, but can instead learn to use it safely to support their long-term recovery and personal growth.
Stroke is one of the leading causes of long-term disability and is frequently associated with persistent motor, cognitive, emotional, and social sequelae that affect autonomy and quality of life. Music-based interventions have shown potential benefits in post-stroke rehabilitation, particularly through rhythmic auditory stimulation, structured instrumental practice, and active musical engagement. These approaches may support motor coordination and motivation and may also contribute to emotional regulation, social interaction, and perceived quality of life. However, evidence remains limited regarding structured music-based interventions that integrate motor activities with broader cognitive and psychosocial components into post-stroke rehabilitation. This randomized waitlist-controlled intervention study aims to evaluate the effects of a structured music-based intervention on motor function after stroke, with executive functioning and stroke-specific quality of life being examined as exploratory outcomes. A prospective, phased, randomized waitlist-controlled intervention study will include adults aged 18-70 years who have experienced a stroke at least 3 months before enrollment. The first recruitment phase will be conducted in a single outpatient neurological rehabilitation center in the Community of Madrid, Spain, with subsequent recruitment phases planned at additional outpatient neurological rehabilitation centers within the Community of Madrid until the required sample size is achieved. Two groups will be formed: an experimental group receiving standard rehabilitation care plus a structured music-based intervention consisting of 10 sessions and a waitlist group receiving only standard rehabilitation care during this period, followed by the structured music-based intervention. Assessments will be carried out at week 0 (baseline), week 5 (post-intervention), and week 10 (after group crossover), with an additional follow-up at 3 months. The primary outcome will be motor function. Upper-limb motor function will be assessed as a secondary motor outcome, while executive functioning and stroke-specific quality of life will be examined as exploratory outcomes. Analyses will follow the intention-to-treat principle, with additional analyses conducted for participants completing at least 80% of sessions. A linear mixed-effects model will be used to estimate the main effect of the intervention on the primary motor outcome, with additional secondary and exploratory models performed for upper-limb motor function, executive functioning, and stroke-specific quality of life. The model will include time, group, and the interaction between group and time as fixed effects, with time since stroke included as a covariate. Additional analyses will be conducted using intraclass correlation coefficients to explore the agreement between participant and family member reports of executive function. This protocol will evaluate a structured music-based intervention as a complement to standard rehabilitation care, with a primary focus on motor rehabilitation. Exploratory analyses will examine whether the intervention is associated with changes in executive functioning and stroke-specific quality of life. The study is expected to provide preliminary evidence on the feasibility and potential effects of this integrative music-based intervention within post-stroke rehabilitation and to contribute to the development of multidomain rehabilitation approaches. The findings may inform the design of future studies and the potential implementation of music-based interventions in post-stroke rehabilitation settings. https://osf.io/hqruw.
The medial olivocochlear (MOC) reflex enhances the signal-to-noise ratio (SNR) in the cochlea and is implicated in auditory scene analysis. Although musicians often exhibit robust MOC function, it remains unclear whether related auditory advantages stem from innate predisposition or training-induced plasticity. This study investigated the relationship between individual variations in MOC reflex function, musical perception, and speech-in-noise (SIN) performance in nonmusicians. Fifty-eight normal-hearing nonmusicians were divided into two groups on the basis of the magnitude of their MOC reflex strength, quantified via contralateral suppression of transient evoked otoacoustic emissions (cTEOAEs) measured separately in each ear. Participants with suppression values above the sample median were assigned to the high MOC function group, whereas those with values below the median comprised the low MOC function group. All participants underwent pure-tone and high-frequency audiometry, auditory efferent system evaluation, speech-in-noise (SIN) testing at 0 and -10 dB SNRs, and musical perception assessment using the Montreal Battery for Evaluation of Amusia (MBEA). The group with stronger MOC reflex activity demonstrated significantly better performance on MBEA scale and memory subtests and superior SIN perception at 0 dB SNR. Hierarchical regression confirmed MOC strength as a significant predictor of SIN performance at -10 dB SNR. Mediation analysis revealed that musical perception abilities partially mediated the relationship between MOC function and SIN performance. Variations in MOC reflex function among nonmusicians constitute a foundational biological trait that shapes auditory perception, supporting both musical abilities and speech-in-noise processing in the absence of formal musical training.
Nitrous oxide-oxygen inhalation sedation (NOIS) is the recommended first line pharmacological approach for managing dental anxiety in children. Music, owing to its psychoacoustic qualities and autonomic nervous system-influencing potential, emerges as a potential non-pharmacological agent in the management of dental anxiety. The aim of this study was to assess the efficacy of Indian instrumental music as an adjunct to nitrous oxide-oxygen Inhalation sedation. This prospective, three arm parallel- group randomized clinical trial was conducted at the Department of Pediatric and Preventive Dentistry, Yenepoya Dental College, Mangalore (CTRI/2024/04/065857). A total of 39 anxious child participants between the ages of 9 and 12 years (Mean age = 10.56 ± 1.14 years) who required restorative procedures under NOIS, as assessed by MCDASf were included in the study. They were equally distributed among the groups, i.e., Group A (Control Group), Group B (NOIS music through ambient speakers), and Group C (NOIS with music through earphones), each consisting of 13 participants. The intervention used was 'Minuet in D major' from the album 'Classicool' performed by sitar maestro Purbayan Chatterjee. Physiological responses such as systolic BP, diastolic BP, and pulse rate PR) were recorded. The earphone group (Group C) showed statistically significant change over time for all physiological parameters. p = 0.003, p = 0.011, p = 0.030, respectively, for systolic bp, diastolic bp, and PR. Intergroup comparisons revealed no statistically significant differences at baseline or post-intervention. A statistically significant between-group difference was noted during the intervention phase exclusively for PR (p = 0.014). The music intervention demonstrated high overall acceptability; 88.5% of participants reported liking the music and 84.6% indicated a desire for its continuation in future appointments (p = 1.000). The use of Indian instrumental music as an adjunct to NOIS in Earphone-delivered music demonstrated statistically significant within-group reductions in all physiological parameters, with a significant intergroup difference in pulse rate during intervention (p = 0.014). Most intergroup differences were non-significant, and these findings should be interpreted as clinically promising trends warranting larger randomized trials rather than definitive evidence of efficacy. CTRI/2024/04/065857, https://ctri.nic.in/Clinicaltrials/searchbyctri.php.
This study aimed to evaluate the impact of music therapy and white noise on preprocedural fear, anxiety, and vital signs in elderly patients undergoing colonoscopy. This was a randomized, controlled, and double-blind experimental trial. The study was conducted at a university hospital in Turkey between October 25 and November 25, 2024 and included 90 patients. Participants were randomly assigned to music therapy (n = 30), white noise (n = 30), and ambient sound (n = 30) groups using computer-generated randomization, and allocation was concealed using sealed opaque envelopes. Fear levels of the elderly patients were measured using the visual analog scale, anxiety levels were measured using the State-Trait Anxiety Inventory, and vital signs were measured using a vital signs monitor twice before and after the intervention. During the intervention, the patients were given music therapy, white noise, or ambient sound through headphones for 20 minutes prior to the colonoscopy procedure. No significant differences were found between the groups in terms of fear and state anxiety scores before the intervention (P > .05). Following the intervention, fear and state anxiety levels were significantly reduced in the music therapy and white noise groups compared to those in the control group (P < .001). ANCOVA analyses showed that this reduction was independent of baseline values. Music therapy had a stronger effect on reducing fear and anxiety than did white noise. The respiratory rate was lower in both the music therapy and white noise groups (P < .001), while no differences were found between the groups in other vital signs. Music therapy and white noise can be used as effective and safe interventions to reduce preprocedure fear and anxiety in elderly undergoing colonoscopy. Although music therapy was found to be more effective than white noise intervention in terms of psychological outcomes, further clinical studies are needed. [NCT06669338] ClinicalTrials.gov.
Music therapy has emerged as a valuable component of palliative and end-of-life care, addressing the physical, emotional, social, and spiritual needs of patients and their families. Despite growing clinical adoption, the mechanisms and breadth of psychosocial outcomes remain inconsistently synthesized. This narrative review aims to synthesize peer-reviewed evidence on music therapy's psychosocial outcomes in palliative settings, including mechanisms, populations, modalities, and evidence gaps. A systematic search was conducted in PubMed and the University of Alberta Library Primo discovery platform in May and June 2026, searching across PsycINFO, CINAHL, MEDLINE, Academic Search Complete, and additional databases. Primary search strings targeted music therapy in combination with palliative care, end-of-life care, and hospice settings. After screening for relevance and applying inclusion criteria, 33 peer-reviewed sources were included. Evidence from randomized controlled trials, systematic reviews, and qualitative studies supports consistent improvements in pain, anxiety, mood, and subjective wellbeing. Biographical approaches involving personally meaningful songs and legacy work meaningfully enhance spiritual wellbeing and existential integration in dying patients. Music therapy benefits extend to family members and informal caregivers in the pre-bereavement phase. However, most studies are small, at high risk of bias, and heavily concentrated in Western, high-income settings. The non-Western palliative music therapy literature is critically sparse in English-language indexed databases, representing a gap in the evidence base rather than evidence of absence. Music therapy is a flexible, low-risk, and clinically meaningful adjunct in palliative care. Future research should prioritize large-scale, culturally sensitive trials, standardized outcome measures, and explicit investigation of music therapy across diverse religious and cultural contexts.
Hip fractures often lead to postoperative delirium in older adults, significantly impacting recovery, hospitalization, and nursing workload. While many delirium cases are preventable, implementation of non-pharmacological strategies remains inconsistent. Music has emerged as a safe, effective, and low-cost complementary strategy to prevent delirium by targeting its underlying mechanisms. However, evidence in hip fracture patients remains limited. This study evaluated whether a nurse-led recorded music intervention could reduce the prevalence and influence the course of postoperative delirium, while ensuring practical feasibility. Secondary outcomes included postoperative pain, opioid use, and length of stay (LOS). In this quasi-experimental study, usual care was compared with the addition of a music intervention comprising twice-daily, 30-min sessions of self-selected music over 5 postoperative days. Cognitively adequate patients aged 65 or older were assessed for postoperative delirium using the Delirium Observation Scale (DOS). Differences in postoperative pain, measured by the Numerical Rating Scale, were analyzed both between groups and within the intervention group. A total of 74 participants were included across control and intervention groups. Statistical power was achieved, and confounders were balanced between groups. Music adherence was 53.13%, with missed sessions approximately equally due to patient refusal and nurse non-administration. DOS scores decreased significantly, especially on postoperative Day 2. Although delirium prevalence was halved in the intervention group, this did not reach statistical significance. No significant differences were found in LOS, opioid use, or postoperative pain between groups, however, a significant decrease in pain was observed within the intervention group. Music influenced the course of postoperative delirium by reducing its intensity and lowered postoperative pain within the intervention group. Future research should build on these findings by implementing a 30-min, once-daily music intervention during the first 3 postoperative days.
The COVID-19 pandemic has resulted in a significant increase in mental health issues, including depression, anxiety, post-traumatic stress disorder and sleep disturbances, particularly among recently hospitalised patients. Non-pharmacological interventions such as Yoga Nidra and Music Therapy offer cost-effective and accessible alternatives for improving psychological well-being and sleep quality in this population. This study aimed to investigate the effects of Yoga Nidra and Music Therapy on sleep quality, mental health and overall well-being among recently recovered, hospitalised COVID-19 patients. This three-arm, parallel-group, randomised controlled trial (RCT) enrolled 90 adults recently discharged following COVID-19 hospitalisation. Participants were randomised in a 1:1:1 ratio into Yoga Nidra, Music Therapy or standard care groups. Both interventions were delivered online via Zoom for 30 min daily over 30 days. Sleep quality, mental health and well-being were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Patient-Reported Outcomes Measurement Information System (PROMIS®) Global Health Scale and the World Health Organization Well-Being Index (WHO-5) at baseline day 0, day 15 and day 30. All outcomes were treated as exploratory. Both the Yoga Nidra and Music Therapy groups demonstrated significant improvements in PSQI, PROMIS and WHO-5 scores at day 15 and day 30 compared with the control group (p < .001 for all measures). Large effect sizes were observed across outcomes (partial η² = 0.195-0.795). Yoga Nidra showed greater improvements in overall well-being (WHO-5) and global health (PROMIS®), while Music Therapy demonstrated stronger effects on sleep quality (PSQI). No significant changes were observed in the control group. No adverse events were reported. In this exploratory RCT, Yoga Nidra and Music Therapy were associated with significant improvements in sleep quality, mental health and overall well-being among post-COVID-19 hospitalised patients compared with standard care alone. These accessible, low-cost therapies may serve as valuable adjuncts to standard care for managing post-COVID psychological distress and sleep disturbances. Larger confirmatory trials are warranted.
Music Genre Classification (MGC) plays a pivotal role in information retrieval, underpinning the organization, recommendation, and discovery of music. Current approaches predominantly depend on spectrogram-based convolutional models or handcrafted acoustic features, which inadequately capture the intricate interplay between spectral, temporal, and perceptual cues that define musical genres. To overcome these limitations, we introduce a dual-track architecture that fuses local spectro-temporal textures with global statistical descriptors through an attention-driven framework. The first track utilizes the Efficient Axis Fusion Residual Attention Network (EAFRAN), incorporating Hybrid Attention Residual Fusion (HARF) and Axis-Integrated Contextual Attention (AICA) modules to model complex time-frequency relationships. The second track employs the Residual Convolutional-Attention Embedding Network (RCAEN), leveraging streaming low-level descriptors and residual multi-head self-attention layers to encode global perceptual features. The complementary feature maps from both tracks are combined to yield an efficient and discriminative representation of musical content. Experiments conducted on the GTZAN benchmark dataset demonstrated that the proposed model attained an accuracy of 98.47 ± 0.6%, outperforming existing state-of-the-art methods. The dual-track attention-based strategy effectively bridges local and global musical features, achieving efficient classification performance and offering a potential foundation for enhanced music information retrieval systems.
To critically analyze the current evidence regarding the use of music therapy as a nonpharmacological strategy for anxiety management during third molar surgery. A critical review was conducted based on a structured search in PubMed, Scopus, and Web of Science databases. Studies evaluating music therapy during dental or surgical procedures and reporting outcomes related to anxiety, pain, or physiological parameters were included. A total of 12 studies were included, comprising several hundred patients. Most studies demonstrated that music therapy is associated with reductions in anxiety levels and improvements in physiological parameters such as heart rate and blood pressure. In addition, music exposure was frequently associated with enhanced patient relaxation, improved overall experience, and, in some cases, reduced perception of pain during dental and surgical procedures. Music therapy appears to be a promising, low-cost, and noninvasive strategy for anxiety management during third molar surgery, contributing to improved patient experience. Further well-designed clinical studies are needed to strengthen the evidence base.
Delirium and psychological stress are major clinical challenges for adult ICU patients, contributing to increased mortality and resource consumption. This study evaluated the efficacy of music therapy (MT) on delirium incidence, resource utilization, and psychological and sleep outcomes. Seven electronic databases (Medline, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM) were searched from inception to December 20, 2025. Following PRISMA guidelines, 15 randomized controlled trials (RCTs) involving 1,552 patients were included. Two researchers independently performed screening and data extraction. Risk of bias was assessed using RoB 2.0, and evidence certainty was graded using the GRADE system. Primary outcomes focused on delirium assessments; secondary outcomes included mortality and resource utilization; exploratory outcomes encompassed anxiety, depression, pain, and sleep. A total of 863 records were identified, and 15 RCTs involving 1,552 patients were finally included. Meta-analysis indicated that music therapy significantly reduced the incidence of delirium (RR = 0.49; 95% CI: 0.40-0.60; p < 0.001). Regarding resource utilization, after excluding heterogeneous outliers through sensitivity analysis, the intervention group showed a significantly shorter duration of mechanical ventilation (SMD = -0.25; p = 0.009) and ICU length of stay (MD = -1.07 days; p = 0.004). However, there was no significant difference between the two groups in terms of hospital length of stay (MD = -1.37 days; 95% CI, -4.06 to 1.33; p = 0.32). For exploratory outcomes, depression symptoms were significantly improved (SMD = -1.30; p < 0.001); objective acute sleep quality (based on the RCSQ scale) was markedly enhanced (SMD = -0.62; p < 0.001, I 2 = 0%); and anxiety was significantly relieved (SMD = -0.79; p = 0.02), with subgroup analysis suggesting a more pronounced effect in Chinese cohorts. No significant differences were observed in short-term mortality or pain scores. GRADE grading indicated high-quality evidence for delirium incidence and ICU length of stay. Music therapy is a safe, low-cost non-pharmacological intervention that significantly reduces delirium risk, restores sleep architecture, alleviates anxiety and depression, and accelerates weaning from mechanical ventilation in adult ICU patients. However, due to heterogeneity and lower certainty in some secondary outcomes, larger multicenter trials are needed before routinely integrating music therapy into standard ICU and ERAS protocols. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329297.
Shoulder pain is a common problem occurring in musicians, with impairments in motor control and poor scapular stabilization considered potential causative risk factors. Despite research highlighting the importance of scapula exercises for managing shoulder pain, there are minimal guidelines for the best exercises to apply in musicians. The aim of this study is to evaluate the effect of purpose-designed musician scapula stabilization exercises on the activation patterns of shoulder muscles. In this quasi-experimental pilot study, five task-specific exercises were designed based on upper string players' movements while playing to activate scapula musculature, and were compared with existing exercises, using surface electromyography on key stabilizing and on forearm flexor muscles. Exercises successfully activated the selected scapula stabilizing muscles, particularly the bilateral exercises. For unilateral exercises, higher activations for middle and lower trapezius occurred during exercises involving pulling actions. However, these unilateral exercises also showed effects on the contralateral muscles, indicating bilateral potential benefits. The musical-instrument-specific scapula exercises were shown in this pilot study to recruit the targeted muscles, with bilateral exercises having more effect than unilateral exercises. As this was a small pilot study, the value of unilateral exercises, and their contralateral effects, may still be apparent, but larger sample size are needed. Further research should investigate effects on pain or function.
To evaluate the feasibility, safety, and preliminary effects of individual music therapy (IMT) on electroencephalography (EEG) cortical activation in patients with minimally conscious state (MCS). This study was pilot randomized, single-blind, and blank-controlled trial. China Rehabilitation Research Center (CRRC), Beijing, China. Sixty-two MCS patients (diagnosed by Coma Recovery Scale-Revised [CRS-R]) were enrolled between March 2024 and July 2025; 43 completed the trial and were randomized. The experimental group (n = 22) received 12-week individualized music therapy (30-min sessions, five times per week) delivered by a certified music therapist. The control group (n = 21) received routine treatment and rehabilitation training without music intervention. The change in EEG spectral power (alpha band, 8-13 Hz) over right-hemisphere frontocentral regions from baseline (T1) to post-intervention (T2). The IMT group showed significantly increased alpha power over the right lateral prefrontal cortex, precentral gyrus, and central sulcus at T2 compared T1 (p < 0.05; descriptive comparison), whereas no such change was observed in the control group. No adverse events occurred in either group. IMT is feasible and safe in medically fragile MCS patients and may induce right-hemisphere cortical activation. These pilot findings are hypothesis-generating and require confirmation in larger, adequately powered trials. Chinese Clinical Trial Registry: ChiCTR2500114153, MR-11-24-014167.
Portable listening devices are widely used in daily activities, exposing users to music under highly variable ambient noise, and potentially increasing the risk of music-induced hearing loss. Previous studies show preferred listening levels (PLLs) increase in noise and vary by genre; however, these factors have typically been examined separately under laboratory conditions without synchronized real-world measurement. Fifty-one normal-hearing young adults used a custom Android application with standardized earphones. Participants listened to four music genres (ballad, dance, pop, and new age) across five everyday environments (on-campus, off-campus, library, gym, and cafeteria). The application recorded an average listening level as Z-weighted equivalent continuous sound pressure level (LZeq), peak listening level as C-weighted peak level, and simultaneous ambient noise as LZeq. Listening-level data were sampled every 1 second and transmitted to a secure server at 5-second intervals, allowing cross-validation with participant worksheets. Average and peak outcomes were analyzed using two-way repeated-measures analyses of variance (ANOVAs). Ambient noise varied across environments, with the lowest level in the library (50.40 dB SPL) and the highest in the cafeteria and gym (73.03 and 72.05 dB SPL). Across all observations, PLLs ranged from 43.0 to 99.8 dB SPL, with the lowest mean in the library-new age condition (55.14 dB SPL) and the highest mean in the gym-dance condition (74.85 dB SPL), demonstrating substantial inter-individual variability. Repeated-measures ANOVAs showed significant main effects of environment and genre on average PLLs, with no environment × genre interaction, indicating that these effects were independent. For peak levels, both main effects were significant, and an environment × genre interaction emerged, suggesting context-dependent modulation of transient peaks. In everyday listening, average listening levels increased in noisier environments and differed across music genres, whereas peak levels reflected a context-dependent interaction between environment and genre. Real-time synchronized monitoring may help characterize everyday listening exposure and inform context-aware safe-listening strategies.
Musical improvisation illustrates the brain's capacity for flexible, creative motor control, yet the causal mechanisms underlying this complex behavior remain poorly understood. We employed transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) to probe state-dependent cortical dynamics in the left dorsal premotor cortex (PMd) of professional jazz pianists (n = 3) during improvisation, sight-reading, and rest. This proof-of-concept study demonstrates the feasibility of combining perturbational neuroscience with ecologically valid musical performance. Multiple convergent analyses revealed distinct cortical signatures during improvisation: reduced local mean field power, decreased phase-locking of evoked responses, and preserved but gain-modulated early components as revealed by correlated components analysis. These findings suggest that improvisation is characterized by attenuated PMd excitability and more variable response timings, while preserving the fundamental architecture of cortical responses. This perturbational signature supports a neural efficiency model of expertise whereby expert musicians achieve creative flexibility through training-induced streamlined, optimized cortical processing. Our results establish TMS-EEG as a powerful approach for investigating the causal dynamics of creative cognition and demonstrate how the brain reconfigures its response properties to support internally driven motor performance.
Research on music making and wellbeing reports positive effects across psychological, physiological, and social dimensions. A closer look, nevertheless, reveals that most of these studies solely focus on group singing and define wellbeing in various and occasionally limited ways. This systematic review aimed at identifying the different research designs of quantitative studies in the field, structuring the musical activities, and summarizing the wellbeing outcomes. A comprehensive literature search in five databases resulted in a total of 50 papers that were included in the current review. Results showed that the majority of studies used quasi-experimental designs with active or passive control conditions. Group and individual singing were most frequently studied. As for psychological wellbeing, studies with positive or no evidence are nearly balanced, with the exception of choral studies in younger and middle-aged adults that predominantly provided positive evidence. Physiological wellbeing was measured mostly in singing activities with mixed results. Social wellbeing was primarily reported for group singing activities, with predominantly positive evidence. Taken together, this review underlines the need for including a wider range of music making activities in research on wellbeing, a careful selection of the respective research designs, and a balanced use of wellbeing measures.
Music-based interventions (MBIs) have emerged as a promising, nonpharmacologic approach to improving patient care across a variety of clinical settings. This narrative review examines the current evidence describing the mechanistic basis through which music engages biological pathways relevant to clinical pharmacy practice, and the clinical evidence supporting MBIs as adjuncts to pharmacotherapy across clinical outcomes. From this evidence, the review proposes a framework through which MBIs may be integrated into clinical practice that comprises: (1) patient selection, (2) MBI selection, and (3) outcome monitoring. The review does not constitute formal practice guidance, as pharmacy-specific clinical protocols and implementation models remain active areas of research. Additionally, the review synthesizes emerging evidence supporting MBIs as a clinical pharmacy workforce well-being strategy. Collectively, these findings highlight the potential for MBIs to serve as an innovative adjunct to traditional pharmacotherapy that aligns with the clinical pharmacist's existing responsibilities for medication optimization, deprescribing, and holistic, patient-centered care.
Guided Imagery and Music (GIM), as an emerging therapeutic approach, is widely applied in the treatment of Mood disorders (MDs). However, its efficacy and underlying neural mechanisms remain unclear at present. MDs represent one of the leading causes of disability worldwide. Conventional pharmacological treatments, which primarily target single biological pathways, are frequently limited by side effects and demonstrate inconsistent therapeutic efficacy. GIM is a multimodal psychotherapeutic intervention that utilizes music-evoked imagery to facilitate emotional and cognitive processing. By engaging cognitive and emotional processing networks, GIM is regarded as one of the approaches for neuropsychological rehabilitation in mood disorders. However, the underlying neural circuit mechanisms of this approach remain insufficiently systematized and warrant further investigation. We conducted a systematic review following PRISMA guidelines. A comprehensive literature search was performed in PubMed and Web of Science (2000-2024) to examine the neural mechanisms and clinical efficacy of GIM for MDs, with emphasis on randomized controlled trials (RCTs) and neuroimaging studies. GIM modulates four key neural circuits implicated in MDs: (1) regulates amygdala hyperactivity while enhancing prefrontal-amygdala connectivity; (2) promotes hippocampal neuroplasticity via auditory-driven theta synchronization; (3) reorganizes prefrontal network coordination by strengthening dorsolateral prefrontal connectivity and reducing ventromedial default mode network (DMN) hyperconnectivity; and (4) activates the nucleus accumbens dopaminergic reward pathway to mitigate anhedonia. Clinically, GIM demonstrates significant efficacy in alleviating depressive symptoms, improving cognitive function, and reducing somatic complaints across diverse populations. This study proposes an integrated neural circuit-targeted model for GIM in MDs, bridging multimodal neural modulation with clinical outcomes. The findings establish a neuroscientific basis for GIM as a promising non-pharmacological intervention and support its integration into standard mood disorder treatment protocols. This review presents an integrative neural circuit framework for GIM in MDs, synthesizing existing neuroimaging and clinical evidence, and laying the groundwork for future mechanistic and clinical research.
Corticobasal syndrome (CBS) is a progressive neurodegenerative condition characterized by asymmetric limb rigidity, apraxia, dystonia, and myoclonus, with no approved symptomatic or disease-modifying drug treatments. Neurologic music therapy (NMT)® employs evidence-based techniques targeting sensorimotor rehabilitation, and high-definition transcranial direct current stimulation (HD-tDCS) modulates cortical excitability. The objective was to evaluate the preliminary efficacy of active-HD-tDCS + NMT versus sham-HD-tDCS + NMT for upper-limb motor performance in individuals with CBS. In this single-center, sham-controlled, triple-masked randomized trial, 20 CBS participants received active HD-tDCS + NMT (n = 10) or sham HD-tDCS + NMT (n = 10) across six 30-minute sessions over 3 weeks. Primary outcomes included Wolf Motor Function Test (WMFT), Box and Block Test (BBT), and Purdue Pegboard Test (PPT). Secondary outcomes assessed CBS-specific function, praxis, cognition, and anxiety. Linear mixed-effects models examined the main and interaction effects of group (active vs. sham) and time (baseline, postintervention, follow-up), with sex and years since diagnosis as covariates. We found no significant main effect of group but a significant main effect of timepoint, with significant improvements from T1 to T2 and T3 on the BBT, PPT, and WMFT, along with reductions in anxiety scores. The WMFT additionally showed a significant group × time interaction, reflecting differing longitudinal patterns of change across groups. Significant within-group improvements were observed in the active HD-tDCS group (ΔM = 6.30 at T1-T2, P = 0.0002, d = 1.35; ΔM = 7.20 at T1-T3, P = 0.0001, d = 1.54), although between-group differences at individual timepoints were not statistically significant. Both NMT alone and combined NMT + HD-tDCS were feasible in CBS and were associated with improvements in selected upper-limb motor outcomes, although findings varied across assessments. The results further suggest a possible additive benefit of concurrent HD-tDCS and NMT, warranting larger controlled trials.
Playing-related musculoskeletal disorders are prevalent in musicians due to the complex and repetitive physical demands imposed over extended durations, often in awkward postures. For violinists, the position of the arm during precise movements requires good scapular control. Indeed, scapular dyskinesis and altered motor control of stabilizer muscles are often associated with pain in violinists. This study aimed to ascertain whether exercises that activated the scapular stabilizing muscles could lead to immediate changes in motor control or altered muscle patterns while playing the violin. In this quasi-experimental study, 3 instrument-specific and 3 classic scapular stabilizer exercises were taught to 12 violinists. Scapular and forearm muscle activation patterns were recorded using electromyography during these exercises (in a randomized order) and while playing their instrument before and after the intervention. Post-exercise questions allowed for subjective evaluations. The exercises successfully activated the scapular stabilizing muscles during task-specific and non-specific bilateral exercises, with a slight superiority observed for task-specific exercises. However, aside from the right lower trapezius, no immediate pre-/post-playing muscle activation pattern differences were observed. Purpose-designed exercises can recruit appropriate musculature in violinists, but immediate effects on motor control during playing were not observed. Further research should investigate whether muscle activation patterns may change after a longer training period, where strength changes can occur.