A recent narrative review published in Translational Psychiatry explores how human beings respond to music and the biological underpinnings of this response, highlighting the role of music therapy in creating effective interventions for mental health and wellness.
The author builds a convincing argument that making music therapy more accessible requires developing standardized treatments while recognizing the wide variation in how people respond to these interventions.
Study: Biological principles for music and mental health. Image Credit: Dean Drobot/Shutterstock.com
Background
The emotional, humanistic, and spiritual rewards we receive from music are well-recognized. However, the power of music goes beyond simply entertaining – music therapies have been widely used for physical recovery, such as in motor rehabilitation.
However, the relationship between music and mental health continues to be poorly understood, and the 10,000 qualified music therapists in the United States are too few for the 58 million people in the country thought to have mental health conditions.
Historical and biological perspective
The oldest known musical instruments are 40,000-year-old flutes carved from ivory and bone. Charles Darwin, who postulated the theory of evolution through natural selection, hypothesized that early humans produced musical vocalizations to communicate emotion, attract mates, and threaten rivals.
This would indicate that music is inextricably linked with language development and that there is an evolutionary pressure on music and musicality.
Tonality, or using sounds with different pitches, has universal characteristics, such as its production through vibrating the laryngeal vocal folds. However, widely varying musical traditions and cultures show striking similarities in the use of melody, harmony, and timbre.
Low-frequency tones with simple, repetitive patterns are used in lullabies around the world; similarly, sombreness is communicated through flatter melodies.
The vocal similarity theory suggests that our perception of tone is guided by vocal communication, with our brains reflexively providing context to what we hear.
Rhythm, or the pattern of sounds with temporal predictability, is also found across musical cultures. The periodicity of musical rhythms shows close correspondence with human movements, such as walking.
While many animals can, after training, react to rhythmic pulses, only humans can anticipate them and effortlessly synchronize with them. Humans also can syncopate or displace beats in a rhythm so that strong beats become weak and vice versa.
The theory of neural resonance suggests that our facility with rhythm allows us to process spoken language. Further, listening to music stimulates brain areas associated with regulating movement, such as the cortical and subcortical structures.
Brain activity in these regions increases, reacting to rhythm, even if the person does not move! This quality of music to makes us want to move is known, clinically and colloquially, as the groove.
Studies based on neuroimaging techniques have shown that listening to music activates the brain's reward centers. For example, the pleasure that music listeners experience corresponds with dopamine binding inside the nucleus accumbens.
The hypothesized opioidergic mechanism associated with this reward is supported by a study that found that treatment with opioid-receptive antagonists can reduce pleasure derived from music.
Sociality is another important aspect of listening to, enjoying, and making music, as it can facilitate interpersonal and social connections. This form of bonding can reduce feelings of isolation and improve mental health outcomes.
Interestingly, the frisson of pleasure associated with listening to music is similar to that elicited by listening to inspirational speeches, with similar mental rewards. Listening to music can trigger the release of oxytocin in the brain and thus reduce stress.
Growing evidence for mental health treatments
Receptive treatment is a type of music therapy that involves a passive approach, i.e., listening to music. A meta-analysis of more than 80 clinical trials found that receptive treatment significantly reduced anxiety for surgery patients, while another based on 32 studies found similar results for people suffering from anxiety.
The effect size was comparable to, and in some cases greater than, the estimated effectiveness of some pharmacotherapies and psychotherapies to treat anxiety. Similarly, combining music therapy with antidepressant use showed greater effectiveness in treating depression than traditional treatment.
Rhythm has been incorporated into music therapies for motor and sensory functions but is now increasingly used in mental health treatments.
A meta-analysis found that these music therapies were beneficial in improving emotional well-being, motivation, and mood compared to traditional care for individuals with Parkinson’s disease.
Listening to music has also been associated with better mental health after strokes and improved cognitive function. Researchers have hypothesized that rhythm has these therapeutic effects by disrupting maladaptive brain activity patterns such as negative ruminations.
“In sum, the biological foundations of rhythm provide insights into how music can be applied to address challenges in mental health associated with mood, cognition, and motivation.”
Dysfunctional brain reward circuitry can contribute to anxiety and mood disorders, substance use disorders, and many other mental health challenges.
Medical practitioners have reason to believe that music therapy can treat these conditions by reducing apathy, improving communication, and alleviating fatigue.
The value of the social aspect of engaging with music is borne out by studies that find improvements in non-verbal communication, self-esteem, and behavioral adaptation for children with autism.
Schizophrenia patients have also experienced improvements in social functioning and a reduction in poor social interactions and apathy through music therapy as compared to antipsychotic medication. Those with Alzheimer’s disease may also benefit.
Tailoring Approaches to Individual Musicality
One of the challenges in developing and standardizing music therapies is that people vary in their enjoyment and perception of music; this has both environmental and genetic factors and important consequences for the efficacy of these treatments.
Many people with a condition called congenital amusia are unable to dance to a rhythm or carry a tune; some feel no enjoyment when they listen to music at all.
The author suggests creating individual-level musicality profiles to identify which aspects of music, such as tonality, rhythm, reward, or sociality, can benefit each person.
Medical practitioners should also integrate individual music preferences into therapy plans while recognizing that, in some cases, preferred music may not be the most effective. Further study is also needed to fill in evidence gaps and build standardized treatments that will be accessible to more people.
A 2007 study estimated that 14% of the global disease burden comes from mental health conditions; nearly one-fourth of American adults are thought to have a mental illness, while almost 13% of adolescents struggle with suicidal thoughts.
While traditional psychotherapeutic and pharmacological treatments have been criticized for not being effective enough, music therapy provides an easy-entry, low-risk, and accessible form of intervention.
“Understanding and leveraging this fact towards better treatments and interventions in psychiatry presents an important opportunity to diversify and improve care during times of pressing need.”
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