Empirically-Derived Applications of Music Therapy Across Lifespans

Abstract

Music therapy in one form or another has been a part of many cultures for thousands of years, changing many times over the centuries. This paper explores the practical applications of music therapy techniques for children, adolescents, and the elderly, highlighting the methods used and therapeutic benefits. I will start by discussing the history of music therapy and its applications throughout different cultures. Then I will discuss different types of treatments that can be applied to each age group along with their rationale. Finally, I will discuss future applications of music therapy and where additional studies are needed.

Empirically-Derived Applications of Music Therapy Across Lifespans

For eons, all humans across various cultures and backgrounds have used music as a common form of therapy and expression. One of the first groups known to heal with sound were Australians, who used an instrument called the yidaki, also known as the didgeridoo. The yidaki was believed to have assisted in healing broken bones and illnesses of every kind for at least 40,000 years (Nicholls, 2017). Traditional Chinese medicine, which is still actively used today, initially involved music rather than acupuncture or traditional medicine (Marshall, 2020). The Chinese character for ‘medicine’ combines the characters for ‘music’ and ‘grass,’ suggesting that they believed in the important role of music in regulating life harmony and improving health. The roots of music therapy can also be found in ancient Hindu mythology, Sanskrit, and local folk traditions (Gangopadhyay & Prasad, 2019). More recently, music therapy became popular in the United States in the aftermath of World War I and II (Spencer, 2013). Musicians would travel to hospitals to play music for soldiers suffering both physically and mentally during and after the two world wars. The military currently utilizes music therapy in the recovery of military service members in Army hospitals (LeDoux, 2016).

Music therapy incorporates a wide range of methods. But generally, they may be divided into two types: active and passive music therapy. Active music therapy occurs when a patient consciously takes part in creating music through improvisation, songwriting, or musical instrument playing. Improvisation music therapy involves patients’ expression of their emotions and thoughts without words through free musical improvisation techniques. Such methods may be particularly effective for patients with communication difficulties (Bruscia, 1998). Passive music therapy occurs when the patient listens to music. Music in such therapy is specially chosen for the patient and would be suitable for the client’s therapeutic goals. One of the most popular techniques for passive music therapy is guided imagery in music, which helps clients listen to music and imagine peaceful images at the same time (Bonny & Savary, 1973). Therapists commonly apply other psychosocial methods, such as cognitive-behavioral techniques, which are supposed to intensify the positive effect of music therapy.

Music therapy is effective in treating depression, anxiety, and even post-traumatic stress in the mental health profession. It offers non-verbal expression to process traumatic experiences. Listening to and actively participating in music can relieve symptoms of depression and anxiety by promoting relaxation and emotional release (Erkkilä et al., 2011). Music therapy has been found to improve the functioning of motor, communication, and cognitive responses in neurological disorders such as Parkinson’s, stroke, and dementia. For example, rhythmic sound stimulation is useful for the restoration of walking and coordination in people affected by Parkinson’s disease (Thaut, 2015). There have also been great benefits associated with music therapy for children diagnosed on the autism spectrum in terms of developing social skills, communication, and sensory regulation improvements. Music therapy is employed on a large scale, and its benefits documented in the autism spectrum are due to the inherent quality of music in that it has structured yet flexible principles, thus making it an optimal vehicle for such children (Geretsegger et al., 2014).

Music therapy aids in pain management and physical rehabilitation by alleviating pain, reducing stress, and enhancing mood. Surgical and cancer patients have described music therapy as being used to lower their pain intensity and enhance their general health-related quality of life (Cepeda et al., 2006). In end-of-life care, music therapy comforts, reduces anxiety, and supports emotional and spiritual wellness. It helps patients and their families to cope with sorrow and loss; therefore, a sense of peace is attained during furious moments (Hilliard, 2003).

Although considerable evidence showing the effectiveness of music therapy exists, skepticism about the validity of music as a mode of treatment persists, with concerns about its scientific basis and practical applications. Music is primarily used today for purposes of entertainment; hence, it is difficult to think that it can bring about such radical changes in a patient’s medical condition. The uncommon use of music therapy may also be due to the relatively recent establishment of music therapy as an educational program. The first academic program in music therapy was established in 1944 at Michigan State University, and music therapy as a profession first became accessible through the American Music Therapy Association (AMTA) in 1988, which strives to advocate for and educate music therapists (L’Etoile, 2000). 

This paper addresses the development and application of active and passive music therapy across different age groups. Specifically, I will discuss how music therapy is applied to children, adults, and geriatric populations, as well as the science that supports these applications. I will review neuropsychological and medical research that supports these practices. Finally, I will discuss the potential future of music therapy, including increasing accessibility, occupations, and the current state of research.

The Role of Music in Childhood Development

From the moment they enter the world, with ears attuned to the melodies of life, children embark on a musical journey that shapes their very existence until the cusp of adolescence. Although active music therapy intervention is limited for young children, music still plays a significant broader role in the development of their brains. The fantastical tunes that weave their way around nursery rhymes and the jaunty beats that support playground games are just a couple of simple ways music is intertwined with the very fabric of childhood. In the first two years of life alone, the brain sees quite a lot of change (Lally & Valentine-French, 2019). Branch-like structures called dendrites multiply, collecting information from other brain cells. Myelin, a fatty coating around nerve fibers, develops, improving coordination and thinking skills by strengthening neural connections. While the brain grows quickly, different areas mature at different rates. Motor areas develop before sensory areas, and the prefrontal cortex, responsible for emotions and planning, is one of the last to mature. As the prefrontal cortex develops, children gain better emotional control, planning abilities, and judgment.

Rhythmic abilities obtained through listening to music are also related to cognitive motor processing in children (Frischen et al., 2022). From a very young age, children try to recognize patterns within their physical and social surroundings, using them as a foundation for making predictions. Predictive processes are essential for both rhythm and cognitive functions, serving as bridges between them. The underlying neurological mechanisms involved in rhythm processing and cognitive development include the auditory cortex, prefrontal cortex, and cerebellum. These regions play critical roles in processing rhythmic information and supporting cognitive functions. Rhythm processing skills contribute to the development of cognitive abilities such as attention, memory, language, and executive function in children. The ability to perceive and predict rhythmic patterns serves as a foundation for the development of higher-level cognitive skills.

Frequent music exposure can enhance early language learning in kids since the brain’s music and language domains partially overlap; that is, the same brain regions are processed by music as well as speech (Peretz et al., 2015). These areas of the brain include the auditory cortex, Broca’s area, Wernicke’s area, and the motor area. The areas of the brain in the domains that deal with music and those that handle speech processes include the auditory cortex and the emotion processing areas in the frontal and temporal areas.

Music has also been shown to enhance literacy skills in young children. For example, Gordon and colleagues conducted a study in 2015 at Nashville and Stanford University in which children were exposed to different components of music such as rhythm, clapping, singing, musical notation, and instruments, suggesting that music training improves phonological awareness, particularly in rhyming skills. This aligns with previous studies showing that musicians tend to have better phonological awareness skills. However, the effectiveness of music training on rhyming skills depends on the number of training hours, with at least 40 hours needed for improvement. Gordon and colleagues’ work also explores other phonological outcomes and reading fluency but finds inconclusive results, indicating the need for further investigation. Despite limitations in study designs and consistency of outcomes, the findings suggest potential benefits of music training in improving reading-related skills, especially phonological awareness. However, more research is needed to understand the underlying mechanisms and to establish a solid link between music education and literacy skills.

Music Therapy for Adolescents

Adolescence is the time between childhood and adulthood when many teens experiment with identity and face strong emotions. Since it is a developing phase that is incomplete in itself, it is found that they are vulnerable and prone to risks that can turn out to be dangerous for them. Music or sounds also play a significant role in the lives of adolescents because they are central to the formation of their identity, emotions, and social life. When brains mature during this period of teenagers, early-maturing primary sensory and motor regions become vast bags of gray matter and lead brain development compared to the later-maturing prefrontal cortex that controls decision-making and higher-level operations like abstract reasoning (Konrad et al., 2013). The maturation of the limbic system of the brain responsible for emotions and the reward system takes place before the maturation of the prefrontal cortex, which controls decision-making and higher-level operations.

It is also at this age that teenagers are experiencing surges of hormones that can result in changes in their moods and complex emotions (Peper & Dahl, 2015). This results in a high turnout of teenagers contracting depression and other mental disorders at this age. While adolescence is a time of great confusion and conflict for teenagers, it is also an overwhelming period for expressing feelings and emotions. Thus, music is a strong medium through which teenagers can express their feelings, connect with their age-mates, and attempt to make sense of their evolving identities. From playlists on their smartphones to concert experiences shared with friends, music is present in nearly all aspects of teenagers’ lives, playing a considerable role in their mood regulation, self-perception, and social integration.

A study conducted in 2004 by the International Foundation for Music Research (IFMR) suggests that regular music lessons correlate to refinement in general education and even improvement in intelligence (Schellenberg, 2004). 144 students were randomly assigned to four groups: two received music (keyboard or voice) lessons, and two were in control groups (drama lessons or no lessons at all). Lessons were held at the Royal Conservatory of Music, with follow-up testing a year later. All groups showed increased IQ, likely influenced by starting school. However, music groups had greater increases in IQ than control groups. Teenagers who took music lessons showed larger improvements compared to controls in academic skills, as measured by the Kaufman Test of Educational Achievement (KTEA).

Emotion-regulating Improvisational Music Therapy (ERIMT) has been shown to reduce depressive symptoms in young adult students (Aalbers et al., 2020). In ERIMT sessions, individuals make music under the guidance of a therapist. Through playing different musical instruments and using their voice, participants have a vehicle to express emotions, thoughts, and experiences that, at times, cannot be expressed in simple verbal language. Through the music, the participant explores and processes feelings in the nurturing and safe environment the therapist provides. As the session goes on, the therapist might give prompts or other interventions, urging the participant to look deeper into their feelings or helping the group communicate or connect better. In this musical conversation, participants experiment, improvise, and explore different emotions, leading to release, insight, and much more perception into one’s social growth and well-being. The therapist mirrors the emotions back and guides the music-making process. The intent is to create a safe, exploratory environment for emotional growth. ERIMT can be helpful for the treatment of a wide variety of mental health conditions, including anxiety, depression, trauma, and addiction, in individual and group settings.

Depression is a major mental health issue, especially among young adults, so a study in 2020 was conducted using a multiple-case study approach with various methods, analyzing eleven female students. Results showed that nine out of eleven students experienced decreased depressive symptoms after ERIMT, lasting up to four weeks. All students reported improved emotional regulation abilities, and these results remained consistent after four weeks. This study suggests that ERIMT could help reduce depressive symptoms and improve emotional well-being among young adult students.

Music therapy has also been shown to be effective in treating students enrolled in special education programs (Rickson & McFerran, 2024). In this context, music therapy diverges from music teaching by prioritizing the development of non-musical skills and utilizing music for emotional and personal growth rather than technical improvement. Assessments by music therapists track changes in motor skills, communication, socialization, cognition, and musical responses. Various interventions are used, such as singing, songwriting, improvisation, music listening, computer-based activities, lyric analysis, and guided movement to music (American Music Therapy Association, 2021).

A meta-analysis of eleven studies found that music therapy provides significant benefits for children with behavioral or developmental disorders (Gold et al., 2004). Music therapy motivates and is theorized to help offset short attention spans often present in children with developmental delays and disabilities, enabling them to reach their potential. Music therapy is also an intervention frequently used with children diagnosed with autism spectrum disorder (ASD) and has been supported by several quantitative studies. Music therapy was revealed to be much more effective than placebo treatment or standard care alone in improving the communicative abilities of children with ASD.

It was also noted that varied music therapy approaches yield the most success in lowering aggression and hostility rates, while more fixed behavioral interventions show inconsistent results (Montello & Coons, 2003). Montello and Coons also observed enhanced attention, motivation, and reduced hostility among students with emotional, learning, and behavioral disorders post-music therapy. However, some students exhibited temporary behavioral regressions after sessions, particularly those with attention-deficit/hyperactivity disorder (ADHD), suggesting the need for more structured therapy. Rickson (2006) explored the impact of instructional and improvisational music therapy on adolescent boys with ADHD, noting a significant reduction in ADHD symptoms in the classroom.

Music Therapy for the Geriatric Population

The geriatric population comprises adults aged 75 years and older who are afflicted with various socio-economic and biological problems stemming from physical, cognitive, and emotional well-being that are oftentimes exacerbated by age-related ailments or chronic conditions. Of the available therapeutic interventions, music therapy has emerged as a very promising approach to meeting the multidimensional needs of older adults.

For instance, Parkinson’s disease (PD) is usually diagnosed in geriatric patients, and a musical strategy that could be acted upon is called rhythmic auditory stimulation. Rhythmic auditory stimulation (RAS) is the intervention providing auditory cues to enhance gait and balance in individuals suffering from Parkinson’s disease or other movement disorders through facilitation of temporal processing in the brain utilizing the application of a fixed beat, which can either be of a metronome or musical nature (Pando-Naude et al., 2021).

RAS is designed to complement, not replace, conventional drug treatments for PD. Although there is no standardized method for delivering RAS, it typically includes elements such as rhythmicity, motor synchronization, customization, and the use of gait kinematics as outcome measures. The intervention involves a healthcare professional providing auditory cues with beats per minute (bpm) adjusted to the individual’s baseline gait, measured in steps per minute (spm). Features of RAS, such as the beat tempo or rhythm complexity, can be modified from baseline, often resulting in short-term improvements in gait kinematics, including speed, cadence, and step length (Pando-Naude et. al., 2024). This therapy is generally conducted in a supervised setting, like a physical therapy clinic or hospital, and generally lasts 30 to 60 minutes, two to three times per week, for several weeks or months. Studies have demonstrated its effectiveness in decreasing both the frequency of freezing episodes and the occurrence of falls in patients.

Music therapy also offers promising avenues for addressing various symptoms experienced by stroke patients (Xu et al., 2022). For instance, engaging with lyrics and singing has been shown to enhance language comprehension and speech fluency in patients. In addition, dysphagia, or swallowing difficulties, is experienced by stroke patients, especially elderly ones. Dysphagia must be treated in a timely manner since it may cause psychological problems, such as fear of food and drinks, anxieties, and even depression disorders. It has been noted that singing in music therapy is one of the most substantial oral motor control treatments for stroke patients because the specific group showed significant changes in laryngeal elevation, laryngeal vestibule closure, respiration, and swallow function. Furthermore, music therapy aids in mitigating motor dysfunction associated with stroke by promoting functional and structural flexibility within the nervous system post-injury. Activities like playing musical instruments and following rhythmic cues can also enhance the frequency and fluency of finger movements.

Dementia stands as the leading cause of disability among the elderly worldwide (Apurv Shirsat et al., 2023). This cognitive impairment primarily manifests as memory loss, language difficulties, and executive function challenges, significantly impacting an individual’s behavior and emotions and affecting their overall well-being and quality of life. One common approach to addressing the mental and behavioral symptoms of dementia patients is through personalized music playlists in healthcare settings. Music is often integrated into daily routines as a supplementary therapy alongside pharmacological treatments, aligning with national dementia care strategies across various countries. Tailoring music selections to resonate with each individual’s preferences and personal significance enhances the therapeutic effects of music for dementia patients.

The findings of Shirlene Vianna Moreira et al. (2018) revealed that, compared to passive activities like listening to music or watching television, short sessions of group singing led by a music therapist had a more significant positive impact on the quality of life among individuals with dementia. Older adults participating in interactive music interventions, which involved personalized music selection and engaging activities such as clapping and dancing, showed greater improvements in psychological and behavioral well-being. Scott Kaiser from the Pacific Neuroscience Institute suggests that recalling music or engaging in singing may activate brain regions unaffected by neurodegenerative diseases like Alzheimer’s and dementia (Garrison, 2021). Consequently, the perception of music, associated emotions, and memory may be preserved beyond the point at which other memory and cognitive functions decline.

In a recent education systematic review, Lam et. al. (2020) conducted a review of music therapy effects among people with dementia. The critical review evaluated 82 studies investigating the benefits of music therapy for cognitive functions, behavioral and psychological symptoms, and overall quality of life in patients with this clinical condition. It was inferred from the results that while some studies showed possible improvements in memory, cognition, daily functioning, and quality of life in patients suffering from dementia, the area in which music therapy showed the most positive impact was the reduction of behavioral and psychological symptoms such as depression, anxiety, and agitation—very common symptoms for patients with Alzheimer’s and dementia. A more recent review in 2021 went a step further to establish the effectiveness of music therapy for various conditions, including dementia. Results from the review indicated that music therapy reduced mood-related symptoms, including depression and anxiety, but it also improved memory in patients with mild Alzheimer’s disease.

Conclusion

Music plays a critical role in the cognitive, emotional, and social development of human beings from early childhood through late adulthood. The influence of music on the brain and its effect on changing behavior begins from early childhood to the stage of being an adult. In younger children, music plays a crucial role in shaping neural pathways, accelerating language acquisition, and honing cognitive motor processing abilities. Nursery rhymes, rhythmic activities, and musical play create rich, engaging environments that support the rapid growth of the brain, particularly in areas associated with coordination, sensory processing, and emotion regulation.

As children grow, their ability to recognize and predict rhythmic patterns becomes intertwined with broader cognitive skills. These skills underpin essential functions such as attention, memory, language development, and executive function. Studies have shown that regular exposure to music can significantly improve phonological awareness and other literacy skills, highlighting the overlapping brain regions involved in processing music and language. However, while the benefits of music training are evident, further research is needed to fully understand the mechanisms behind these improvements and to establish stronger links between music education and academic performance.

In adolescence, music still plays an important role in emotional expression, the formation of identity, and social connections. The brain changes occurring at this time, together with the hormonal changes, mean that teenagers are well placed to pick up on, respond to, and interact with the emotional and social content of music. For this reason, music therapy has been seen to help adolescents manage some aspects of mental health, such as depression and anxiety. Techniques such as ERIMT offer safe spaces in which to explore and grow emotionally to improve regulation and general well-being.

In adulthood, especially in the elderly, music therapy has therapeutic effects on different physical, cognitive, and emotional states. In the elderly population, specifically where neurodegenerative conditions such as Parkinson’s disease are concerned, RAS can improve motor functions and decrease symptoms. Stroke patients benefit in terms of efficient recovery of speech and motor functions and from a reduction in the psychological impact of dysphagia. In patients with dementia, customized music often significantly increases their quality of life by reducing behavioral and psychological symptoms, indicating that music has long-term effects on the process of memory as well as on emotions. Moreover, there are many emerging directions for adults. 

Emerging Applications for Veterans

Today, music therapy is commonly used for patients with post-traumatic stress disorder (PTSD), particularly among veterans, often resulting from their involvement in wartime experiences. Treating this disorder is essential because individuals with PTSD are sensitive to dopamine reception, increasing their vulnerability to substance use disorders (Landis-Shack et. al., 2022). Music provides a healthier avenue for dopamine release, potentially facilitating the development of new neural pathways beneficial for PTSD recovery. Passive music therapy enables listeners to momentarily disconnect from their surroundings, offering a soothing effect on PTSD sufferers. It is commonly complemented with cognitive behavior therapy, assisting patients in identifying and challenging negative thoughts while acquiring practical self-help strategies.

Engaging in active group music therapy can foster a sense of social interaction by collectively tapping into the connection between rhythm and song lyrics. For example, a collaborative songwriting program conducted by SongwritingWith:Soldiers in 2018 with veterans suffering from PTSD yielded several positive outcomes, including a 25% decrease in depressive symptoms, a 77% rise in feelings of optimism and hope, and an 83% increase in engagement with creative activities. Moreover, connecting deeply with the lyrics of a pertinent song can help patients reinterpret trauma by expressing emotions through music.

Future Directions

Overall, the extensive body of research underscores the significant role of music therapy in enhancing various aspects of human development and health. From the tender beginnings of infancy to the challenges of old age, music acts as a potent catalyst for enhancing cognitive abilities, nurturing emotional well-being, and fostering social connections. Future research should continue to explore the mechanisms through which music exerts its effects, optimize therapeutic interventions, and expand the understanding of music’s potential to improve health outcomes.

For example, patients experiencing memory loss often exhibit an intriguing phenomenon wherein they retain the ability to recall their favorite songs from their youth despite losing memories of loved ones and fundamental life skills (Moreira et al., 2023). Why do individuals with dementia retain the ability to remember their favorite songs? This retention may be attributed to the unique way musical memory is stored and accessed in the brain. Musical memory is the form of memory entailed in musical experiences such as playing music or even listening to it (Jancke, 2008). The auditory cortex, motor cortex, and premotor cortex are different centers involved in forming musical memory. As these associated areas of the brain appear to be less affected by cognitive decline, this could elucidate why individuals with dementia are more apt to recall musical memories compared to other types of memories.

Music therapy shows great promise for the future, with technological advancements and ongoing research highlighting its numerous benefits. Wearable devices and sensors will offer real-time feedback for therapists to monitor patients’ physical responses to music and adjust therapy accordingly. Soon, personalized programs of music therapy that are tailor-made through data will be used to build the best intervention. This will make treatment highly believable and tailor-made to emotional and psychological needs.

Additionally, the use of virtual reality (VR) in music therapy could transform the field significantly. VR can provide immersive experiences that enhance therapeutic engagement, especially for patients dealing with anxiety, PTSD, or other mental health issues (Boeldt et al., 2019). VR technology is innovative and beneficial because it increases the availability of exposure therapy as well as its effectiveness as it permits individualized and controlled treatment that is easier for therapists to apply. Virtual reality (VR) technology is making significant strides in the field of music therapy, with programs like Musical Neglect Training (MNT) paving the way for innovative therapeutic approaches. A recent article in Psychology Today (Quirk, 2024) discusses how music therapy and virtual reality can aid post-stroke recovery, particularly for patients with visuospatial neglect (VSN). Visuospatial neglect (VSN) affects a person’s ability to perceive objects on one side, often resulting in mobility and safety challenges. MNT uses instruments to engage neglected areas, while VR provides immersive experiences that boost brain activity and patient involvement. Results suggest that combining these approaches can significantly aid recovery in stroke patients. Merging these treatments has shown promising preliminary outcomes toward engagement and rehabilitation.

A pivotal aspect shaping the future of music therapy lies in the heightened emphasis on interdisciplinary collaboration, marking a significant evolution in the field. I foresee music therapists teaming up with other professional groups—perhaps psychologists, neurologists, or occupational therapists—for the formulation of all-inclusive treatment plans. Collaboration in this manner helps to better manage the all-round needs of the patients. Cognitive-behavioral techniques and music therapy can be combined to enhance motor rehabilitation exercises. Such interdisciplinary synergy extends the boundaries of music therapy use and enriches its application, making this modality a very flexible therapy tool in the sphere of medical practice.

In conclusion, music therapy is expected to gain wider acceptance and integration into standard healthcare practices. With increasing research backing its efficacy across a spectrum of conditions, from neurological disorders like Parkinson’s disease and stroke to mental health challenges such as depression and autism, music therapy is poised to gain broader acceptance within the medical community and secure inclusion in insurance coverage. Greater recognition will make music therapy a common complementary treatment, improve access for all, and establish its role in comprehensive patient care. Moreover, the implementation of VR in music therapy is expected to bring great transformation to music therapy.

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