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Music Therapy

Music therapy

Common Names

  • Music listening
  • Experiential music
  • Singing therapy
  • Movement music therapy
  • Rhythmic drumming
  • Music reminiscence
  • Guided song-writing
  • Music-assisted relaxation
  • Lyric analysis
  • Guided Imagery with Music (GIM)

For Patients & Caregivers

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Cross-cultural beliefs have long held that music has a healing effect on mind and body. Music can promote relaxation and distract from pain associated with many illnesses. It can also relieve anxiety and distress. Music therapy emerged as a formal discipline in the US in the 1940s, as methods of increased effectiveness became clearer.

Currently, there are close to 8,000 trained therapists in the US alone, with thousands more worldwide. Passive forms of therapy may be used to reduce stress before procedures or ease transition from sedation. More active forms are used for rehabilitation, enrichment, and simple enjoyment. Patients may listen to, play, and even write their own music with guidance from a professionally trained music therapist. Often this process evolves to give meaning and voice to complex emotions that patients may struggle to otherwise articulate. It can also strengthen and enhance communications and support from loved ones. Patient state, physical surroundings, instrument choices, the desire to self-select or create music, and cultural backgrounds are among the considerations that may direct therapy.

A majority of NCI-designated cancer centers now offer music therapy as part of their supportive care programs. In addition, cancer guidelines recommend music therapy for anxiety, stress reduction, depression, and mood disorders. Music therapists also work with other populations, such as specials needs and mental health patients.

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Music therapy helps improve social, emotional, and quality of life aspects in patients with cancer, heart disease, Alzheimer’s disease, and dementia. It has also shown benefit in hospitalized children, patients undergoing difficult treatment, and those with terminal illnesses by improving symptoms of anxiety, depression, stress, fatigue, and perceived pain. Other studies have shown it can reduce blood pressure in listeners, and help improve coordination, mobility, and endurance in patients with stroke, multiple sclerosis, and Parkinson’s disease. It may also have positive effects on the nervous system and immune function.

There are many mechanisms by which these effects occur. Selecting the right music can induce either calmness or stimulation, and provide meaning and pleasure. It can offer a welcome distraction or shift perception, induce feel-good chemicals in the brain, spark positive associations and memories, or help patients process and communicate difficult emotions. The rhythm of music can help guide and improve movement coordination. Music can also impart a calming environment to reduce the stress of loved ones and caregivers.

Several forms of music therapy are also used in rehabilitation. For example, singing therapy can improve breathing and lung function. In addition, music can improve adherence to exercise regimens because it is more enjoyable, making it an important component in health-challenged populations.

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  • Anxiety
    Several clinical trials have shown that music therapy can help reduce anxiety including distress related to surgery and other procedures. Current cancer guidelines recommend music therapy for anxiety.
  • Depression
    Several studies have shown that music can help reduce depression. Current cancer guidelines recommend music therapy for depression and mood disorders.
  • Pain
    Several clinical trials have shown that music therapy can help reduce pain or pain perception. However, more studies are needed.
  • Stress
    This use is supported by clinical trials. Current cancer guidelines recommend music therapy for stress reduction.
  • Cancer-related symptoms
    Cancer guidelines and a number of studies support music therapy for cancer patients to reduce anxiety, depression, and mood disturbances.
  • Family and caregiver support
    Music therapy can help reduce stress and enhance communications for loved ones and caregivers.
  • Improving exercise adherence
    Studies show that carefully selected music is integral to improving exercise adherence in health-challenged populations and in rehabilitation regimens.
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Music therapy is safe, but should be provided by a qualified therapist. Because music therapy is noninvasive, free of side effects, and has shown effectiveness, it is a part of standard supportive care in major cancer hospitals and other institutions. It is also recommended in cancer supportive care guidelines.

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A professional music therapist holds a degree in music therapy from a college or university program approved by the American Music Therapy Association (AMTA). Graduates may then apply for the national credential of Music Therapist – Board Certified (MT-BC).

Currently, close to 8,000 therapists are board-certified in the US. Therapists may also obtain post-graduate specialty certifications in Hospice and Palliative Music Therapy (HPMT), Neurologic Music Therapy (NMT), and Nordoff-Robbins Music Therapy (NRMT). Some states require additional licensure for music therapists who include psychotherapy in their scope of practice. Qualified therapists are listed in the AMTA’s National Music Therapy Registry. International organizations include the World Federation of Music Therapy and the International Society for Music Education.

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Many major hospitals offer some form of music therapy for rehabilitation and supportive care. In addition, a majority of NCI-designated cancer centers now offer music therapy as part of their supportive care programs. Therapists are skilled at employing evidence-based techniques for symptom management in clinical, intensive care, and hospice settings.

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For Healthcare Professionals

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Cross-cultural beliefs have long held that music has a healing effect on mind and body. Music can promote relaxation, distract from pain associated with many illnesses, and relieve distress. Music therapy emerged as a formal discipline in the United States in the 1940s, as methods of increased effectiveness became clearer. Currently, close to 8,000 trained music therapists work in clinical settings in the US alone, with thousands more worldwide. Patients passively or actively listen to music, or engage in playing or even writing their own music, with guidance from a professionally trained therapist.

Goals of therapy can include reducing stress before procedures or easing transition from sedation, reducing feelings of isolation, or bringing pleasure into what can often be a sterile setting. This process may evolve to give meaning and voice to complex emotions that patients might struggle to otherwise articulate. It can also strengthen and enrich communications and support from loved ones. Patient demeanor, physical surroundings, instrument availability, the desire to self-select or write music, applied interpretations, and cultural backgrounds are among the considerations that may direct therapy.

Studies have shown that music can reduce perioperative anxiety, pain, and stress (1) (2) (3) (4) (5) (6). Both active and passive distraction-based music therapy were effective for pediatric patients and their caregivers (7). Music was superior to standard care for anxiety among intensive care unit patients receiving acute ventilatory support (8). In addition, it enhanced pulmonary rehabilitation (9) and improved respiratory function in patients with asthma (10). In hemodialysis patients, self-selected music was effective for fistula puncture-related pain (11).

Music helps improve social and emotional aspects in patients with Alzheimer’s disease (12) (13) (14) and quality of life in patients with dementia (15) and stroke (16). Positive effects of group music therapy were experienced by elderly individuals with mild to moderate dementia (17). Music interventions also reduced anxiety among older adults in an urban emergency department (18), in full-term pregnant women (19), and in women with fibromyalgia (20). However, improvisational music therapy did not reduce symptoms in children with autism spectrum disorder (21) (22).

Music therapy helps to alleviate symptoms associated with cancer and its treatments as well. Data suggest it helps reduce breathing problems and improves quality of life in terminal cancer patients (23) (24) (25). In those undergoing radiation therapy simulation, music therapy lowered anxiety and distress (26). For autologous stem cell transplantation (ASCT) recipients, it reduced narcotic medication use (27) and pain perception (28), and improved mood, coping, and social integration (29) (30). Another study among ASCT patients found acute rather than long-term benefits (31).

Reductions in pain and/or anxiety have also been demonstrated in pediatric (32) (33) and breast (34) (35) cancer patients, women undergoing colposcopy (36) (37), and those receiving chemotherapy (38) and radiation therapy (39). Conclusions from systematic reviews however, question the clinical significance of music therapy for treating pain (40) and also point to poor methodology in trials (41).

Music also enhances the effects of exercise (42) (43) and may enhance cellular immunity (44). For specific health-challenged populations, careful music selection rather than just exercise performance is an important consideration to improve recovery and long-term adherence to lifestyle changes and physical activity guidelines (43) (45) (46) (47) (48) (49).

Current oncology societies recommend music therapy for anxiety, stress reduction, depression and mood disorders (50) (51). Because it is noninvasive, free of side effects, and has shown effectiveness, music therapy is integrated into standard supportive care at major cancer hospitals.

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The effects of music on mood disorders have in part been attributed to the therapeutic framework and interaction that offers patients opportunities for new aesthetic, physical, and relational experiences (52). This can be particularly important as patients who are hospitalized or undergoing treatment may experience increased isolation and limited communication.

Music selection and delivery method are important considerations in periprocedural settings to induce relaxation and decrease anxiety. For example, slow-rhythm music for women undergoing colposcopy reduced anxiety and pain perception (36) (37).

In other therapeutic settings, the intimate nature of music that is written or offered translates to a deeply personal and transporting experience. Listening to preferential music appears to shift the autonomic balance towards parasympathetic activity (53). Background, experiences, and traditions that have meaning to the patient as well as cherished songs or intriguing sounds can engage the brain’s reward circuitry (54), and guide therapy to energize someone who feels lethargic, evoke pleasant sensations and autobiographical memory (55), or calm agitation and distressed mood.

The principle of entrainment, a method used with live music, has been shown to be effective among agitated patients (56). It seeks to musically emulate an existing pattern of body processes to meet a person where they are, effectively offering a bridge by which one can organically move into a less distressed state. In rehabilitation, mechanisms for neurobiological and cognitive effects of singing therapy include neuroplastic reorganization, mirror neuron system activation, multimodal integration, and both shared and distinct features fundamental to music and language (57). Among studies of singing lessons for lung conditions, Parkinson’s disease, and multiple sclerosis, participants had improved breathing, breath control, physical functioning, and mood, and also described it as fun and good exercise (58). Rhythmic movements with a percussion intervention was shown to activate the prefrontal cortex in older adults with mild cognitive impairment (59).

During high-intensity exercise, music promotes ergogenic and psychological benefits but may not reduce perceptions of exertion beyond the anaerobic threshold (42). Animal studies suggest music exposure enhances lymphocyte function in the brain to reverse stress-induced immune suppression (60). In humans, drumming has also been shown to enhance cellular immunity by increasing lymphocyte activated natural killer cell activity (44).

Plus and Minus IconIcon showing a plus/minus toggle, indicating that the surrounding element can be opened and closed.

Music therapy is safe, but should be provided by a qualified therapist. Because music therapy is noninvasive, free of side effects, and has shown effectiveness, it is a part of standard supportive care in major cancer hospitals and other institutions. It is also recommended in cancer supportive care guidelines.

Plus and Minus IconIcon showing a plus/minus toggle, indicating that the surrounding element can be opened and closed.

Music therapist practitioners employ evidence-based techniques for symptom management in clinical, intensive care, and hospice settings. A professional music therapist holds a degree in music therapy from a college or university program approved by the American Music Therapy Association (AMTA). Graduates may then apply for the national credential of Music Therapist – Board Certified (MT-BC).

Currently, close to 8,000 therapists are board-certified in the US. Therapists may also obtain post-graduate specialty certifications in Hospice and Palliative Music Therapy (HPMT), Neurologic Music Therapy (NMT), and Nordoff-Robbins Music Therapy (NRMT). Some states require additional licensure for music therapists who include psychotherapy in their scope of practice. Qualified therapists are listed in the AMTA’s National Music Therapy Registry. International organizations include the World Federation of Music Therapy and the International Society for Music Education.

A skilled music therapist is integral to achieving patient-centered therapeutic directions, offer and assess options for engagement, and encourage patient confidence in expression. For example, a therapist may help a patient write their own music to enjoy experimentation and discovery, take them to a place of understanding about themselves, or provide a means by which they may more easily communicate with loved ones and caregivers.

Many major hospitals offer some form of music therapy for rehabilitation and supportive care. In addition, a majority of NCI-designated cancer centers now offer music therapy as part of their supportive care programs (61). A recent report suggests variable access to music therapy in hospice settings (62). Music therapists also work with other populations, such as specials needs and mental health patients.

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  1. Gallagher LM, Gardner V, Bates D, et al. Impact of Music Therapy on Hospitalized Patients Post-Elective Orthopaedic Surgery: A Randomized Controlled Trial. Orthop Nurs. Mar/Apr 2018;37(2):124-133.

  2. Good M, Anderson GC, Stanton-Hicks M, et al. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs. Jun 2002;3(2):61-70.

  3. Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev. Jun 6 2013(6):Cd006908.

  4. Salamon E, Bernstein SR, Kim SA, et al. The effects of auditory perception and musical preference on anxiety in naive human subjects. Med Sci Monit. Sep 2003;9(9):Cr396-399.

  5. Allen K, Golden LH, Izzo JL, Jr., et al. Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Psychosom Med. May-Jun 2001;63(3):487-492.

  6. Canga B, Azoulay R, Raskin J, et al. AIR: Advances in Respiration - Music therapy in the treatment of chronic pulmonary disease. Respir Med. Dec 2015;109(12):1532-1539.

  7. Sliwka A, Nowobilski R, Polczyk R, et al. Mild asthmatics benefit from music therapy. J Asthma. May 2012;49(4):401-408.

  8. Shabandokht-Zarmi H, Bagheri-Nesami M, Shorofi SA, et al. The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients. Complement Ther Clin Pract. Nov 2017;29:53-57.

  9. Brotons M, Marti P. Music therapy with Alzheimer’s patients and their family caregivers: a pilot project. J Music Ther. Summer 2003;40(2):138-150.

  10. Quoniam N, Ergis AM, Fossati P, et al. Implicit and explicit emotional memory for melodies in Alzheimer’s disease and depression. Ann N Y Acad Sci. Nov 2003;999:381-384.

  11. Suzuki M, Kanamori M, Watanabe M, et al. Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia. Nurs Health Sci. Mar 2004;6(1):11-18.

  12. Belland L, Rivera-Reyes L, Hwang U. Using music to reduce anxiety among older adults in the emergency department: a randomized pilot study. J Integr Med. Nov 2017;15(6):450-455.

  13. Garcia Gonzalez J, Ventura Miranda MI, Requena Mullor M, et al. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. J Matern Fetal Neonatal Med. Apr 2018;31(8):1058-1065.

  14. Torres E, Pedersen IN, Perez-Fernandez JI. Randomized Trial of a Group Music and Imagery Method (GrpMI) for Women with Fibromyalgia. J Music Ther. Jun 7 2018;55(2):186-220.

  15. Ramirez R, Planas J, Escude N, et al. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients. Front Psychol. 2018;9:254.

  16. Rossetti A, Chadha M, Torres BN, et al. The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy. Int J Radiat Oncol Biol Phys. Sep 1 2017;99(1):103-110.

  17. Bates D, Bolwell B, Majhail NS, et al. Music Therapy for Symptom Management After Autologous Stem Cell Transplantation: Results From a Randomized Study. Biol Blood Marrow Transplant. Sep 2017;23(9):1567-1572.

  18. Tuinmann G, Preissler P, Bohmer H, et al. The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study. Psychooncology. Mar 2017;26(3):377-384.

  19. Ratcliff CG, Prinsloo S, Richardson M, et al. Music therapy for patients who have undergone hematopoietic stem cell transplant. Evid Based Complement Alternat Med. 2014;2014:742941.

  20. Barrera ME, Rykov MH, Doyle SL. The effects of interactive music therapy on hospitalized children with cancer: a pilot study. Psychooncology. Sep-Oct 2002;11(5):379-388.

  21. Nguyen TN, Nilsson S, Hellstrom AL, et al. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. J Pediatr Oncol Nurs. May-Jun 2010;27(3):146-155.

  22. Bulfone T, Quattrin R, Zanotti R, et al. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holist Nurs Pract. Jul-Aug 2009;23(4):238-242.

  23. Chan YM, Lee PW, Ng TY, et al. The use of music to reduce anxiety for patients undergoing colposcopy: a randomized trial. Gynecol Oncol. Oct 2003;91(1):213-217.

  24. Galaal K, Bryant A, Deane KH, et al. Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database Syst Rev. Dec 7 2011(12):Cd006013.

  25. Smith M, Casey L, Johnson D, et al. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncol Nurs Forum. Jun 2001;28(5):855-862.

  26. Cepeda MS, Carr DB, Lau J, et al. Music for pain relief. Cochrane Database Syst Rev. Apr 19 2006(2):Cd004843.

  27. Bradt J, Dileo C, Grocke D, et al. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev. Aug 10 2011(8):Cd006911.

  28. Karageorghis CI, Priest DL. Music in the exercise domain: a review and synthesis (Part I). Int Rev Sport Exerc Psychol. Mar 2012;5(1):44-66.

  29. Bittman BB, Berk LS, Felten DL, et al. Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Altern Ther Health Med. Jan 2001;7(1):38-47.

  30. Lee AL, Dolmage TE, Rhim M, et al. The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD. Chest. May 2018;153(5):1134-1141.

  31. Clark IN, Baker FA, Taylor NF. Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. J Music Ther. Winter 2016;53(4):364-397.

  32. Killingback C, Tsofliou F, Clark C. Older people’s adherence to community-based group exercise programmes: a multiple-case study. BMC Public Health. Jan 25 2017;17(1):115.

  33. Rocha PA, Slade SC, McClelland J, et al. Dance is more than therapy: Qualitative analysis on therapeutic dancing classes for Parkinson’s. Complement Ther Med. Oct 2017;34:1-9.

  34. Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. Sep 1 2018;36(25):2647-2655.

  35. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. May 6 2017;67(3):194-232.

  36. Maratos A, Crawford MJ, Procter S. Music therapy for depression: it seems to work, but how? Br J Psychiatry. Aug 2011;199(2):92-93.

  37. Jia T, Ogawa Y, Miura M, et al. Music Attenuated a Decrease in Parasympathetic Nervous System Activity after Exercise. PLoS One. 2016;11(2):e0148648.

  38. Belfi AM, Karlan B, Tranel D. Music evokes vivid autobiographical memories. Memory. Aug 2016;24(7):979-989.

  39. Cadwalader A, Orellano S, Tanguay C, et al. The Effects of a Single Session of Music Therapy on the Agitated Behaviors of Patients Receiving Hospice Care. J Palliat Med. Aug 2016;19(8):870-873.

  40. Merrett DL, Peretz I, Wilson SJ. Neurobiological, cognitive, and emotional mechanisms in melodic intonation therapy. Front Hum Neurosci. 2014;8:401.

  41. Goldenberg RB. Singing Lessons for Respiratory Health: A Literature Review. J Voice. Jan 2018;32(1):85-94.

  42. Singhal G, Jaehne EJ, Corrigan F, et al. Cellular and molecular mechanisms of immunomodulation in the brain through environmental enrichment. Front Cell Neurosci. 2014;8:97.

  43. Dain AS, Bradley EH, Hurzeler R, et al. Massage, Music, and Art Therapy in Hospice: Results of a National Survey. J Pain Symptom Manage. Jun 2015;49(6):1035-1041.

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