Dialogues in Music Therapy and Social Neuroscience: An Interdisciplinary Approach to Clinical Progress
In his book “Musicophilia: Tales of Music and the Brain”, the neurologist Oliver Sacks stated that music can “calm us, animate us, comfort us, thrill us, or serve to organize and synchronize us at work or play– it may be especially powerful and have great therapeutic potential for patients with a variety of neurological conditions.”
Our relationship with music starts in the womb: In the last trimester of fetal life, babies are able to hear external sounds, including musical stimuli. Once born, they will respond differently to those familiar sounds compared to novel ones. For instance, in investigations of prenatal auditory learning using electroencephalography (EEG), extensive prenatal exposure to a melody induced changes in newborn neural signal that lasted several months and correlated with the amount of prenatal exposure. This implies a memory of distinctive, low-level elements constituting speech and music that may form the basis of language learning in the first years of life. Indeed, prenatal music exposure has been show to induce long-term physiological and neural effects (Partanen et al., 2013).
Music has been a relevant stimulus for our species for a very long time (Cross, 2001) and there’s plenty of evidence about the beneficial effect of music on well-being (for an overview, see: Chanda & Levitin, 2013). For instance, Menon & Levitin (2005) investigated the neural correlates of musical pleasure showing enhanced activation in a network of areas, including the nucleus accumbens, the ventral tegmental area, the hypothalamus, and orbitofrontal cortex, when participants listened to classical music compared to scrambled music. The authors suggested that musical reward is dependent on similar neural networks as other reinforcing stimuli because these brain structures are known to be part of a brain reward system which is involved in processing pleasure and positively valenced emotions (Berridge & Kringelbach, 2015).
“The emotional power of music and its profound effect on the brain suggests that it can be wielded as a therapeutic tool to probe the neural basis of psychiatric disorders. “
The emotional power of music and its profound effect on the brain suggests that it can be wielded as a therapeutic tool to probe the neural basis of psychiatric disorders. In the last two decades, music therapy has been gradually recognized as a useful option for the treatment of several complex neuropsychiatric diseases, such as schizophrenia, dementia, autism spectrum disorder, anxiety, depression and Parkinson’s disease (Mossler et al., 2011; Vink et al., 2003; Gold et al., 2006; Bradt & Dileo, 2009; Maratos et al., 2008; de Dreu et al., 2012).
Music therapy describes the clinical use of music interventions to accomplish individualized goals within a therapeutic setting. It has also been defined as a psychological therapy that aims to create an interpersonal relationship between the client and the therapist to relieve symptoms and determine positive changes (for an overview, see Witusik et al., 2019). Major depressive disorder is the most studied medical condition in the context of music therapy (Maratos, 2011), the effectiveness of which was demonstrated, through a randomised controlled trial, by Erkkilä and colleagues (2011).
“The possibility of analyzing coupled activities of two or more brain regions from different brains represents a remarkable opportunity for the advancement of knowledge on social and therapeutic interactions involving musical stimuli.”
Neuroscience methods, such as fMRI and EEG, offer exciting and noninvasive ways to examine the physiological effects of music therapy interventions. One EEG study revealed how a music therapy rehabilitation program improved fine and gross motor skills in stroke patients (Altenmüller et al., 2009). The authors found that motor improvement has been accompanied by greater inter-regional brain communication and increased brain activity of motor regions (Altenmüller et al., 2009). Recently, the brain activity of an interacting couple during a music therapeutic intervention was measured via EEG hyperscanning (Fachner et al., 2019), which is a relatively new methodology to study the neural substrates of social interactions. The hyperscanning technique allows us to measure brain activity (either through EEG or fMRI) from two or more individuals simultaneously (Ayrolles et al., 2020). The possibility of analyzing coupled activities of two or more brain regions from different brains represents a remarkable opportunity for the advancement of knowledge on social and therapeutic interactions involving musical stimuli. Fachner and colleagues (2019) had a client, therapist, and two external individuals rate moments in a therapy session by importance and emotional-relevance. By pairing this detailed audio-visual data with coupled EEG hyperscanning, they showed that the EEG time-course of both the therapist’s and client’s brain activity was aligned in the frontal part of the brain during emotionally-relevant moments compared to moments of non-interest. The implementation of this methodology provides a great opportunity to study authentic therapeutic relationships and explore the neural mechanisms underlying therapeutic interactions.
Altogether, the evidence illustrates how music therapy and neuroscience can inform each other. Decades of research have shown that neuroscience methods can provide insight into individuals’ interactions and social events, including precise and time-relevant measurements of ongoing cognitive processes. Pairing such with behavioural, physiological, or questionnaire measures provides a more powerful means to investigate the neural mechanisms underlying therapeutic processes.
A critical, ongoing experimental challenge for the field of music therapy research is to create dynamic conditions for the study of the music therapeutical impact on clinical settings without sacrificing well-controlled laboratory conditions. In other words, research in the field of music therapy needs to account for a social and real-time neuroscientific approach (Schilbach et al., 2013) allowing the study of authentic therapeutic relationships.
Written by Filippo Pasqualitto. Illustrated by Sumana Shrestha.
Edited by Zoe Guttman, Sean Noah, and Desislava Nesheva.
What applications do you think music therapy might have in the future? Tell us in the comments below!
Interested in supporting Knowing Neurons? Become a Patron today and help us deliver our mission of making neuroscience accessible to everyone.
References
Aalbers S, Fusar‐Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A, Crawford M, Chen XJ, Gold C. (2017). Music therapy for depression. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub3.
Altenmüller E, Marco-Pallares J, Münte TF, Schneider S. (2009). Neural reorganization underlies improvement in stroke-induced motor dysfunction by music-supported therapy. Ann N Y Acad Sci. 2009 Jul;1169:395-405. doi: 10.1111/j.1749-6632.2009.04580.x. PMID: 19673814.
Ayrolles, A., Brun, F., Chen, P., Djalovski, A., Beauxis, Y., Delorme, R., Bourgeron, T., Dikker, S., & Dumas, G. (2021). HyPyP: a Hyperscanning Python Pipeline for inter-brain connectivity analysis. Social cognitive and affective neuroscience, 16(1-2), 72–83. https://doi.org/10.1093/scan/nsaa141
Berridge KC, Kringelbach ML (May 2015). “Pleasure systems in the brain”. Neuron. 86 (3): 646–664. doi:10.1016/j.neuron.2015.02.018. PMC 4425246. PMID 25950633.
Bradt J, Dileo C. Music for stress and anxiety reduction in coro- nary heart disease patients. Cochrane Database Syst Rev. 2009;2: CD006577.
Cross, I., 2001. Music, cognition, culture, and evolution. Ann. N. Y. Acad.Sci. 930, 28–42.
de Dreu MJ, van der Wilk AS, Poppe E, Kwakkel G, van Wegen EE. Rehabilitation, exercise therapy and music in patients with Parkinson’s diseases: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism Relat Disord. 2012;18 Suppl 1:S114–S119.
Erkkilä J, Punkanen M, Fachner J, Ala-Ruona E, Pöntiö I, Tervaniemi M, Vanhala M, Gold C: Individual music therapy for depression: randomised controlled trial. Br J Psychiatry 2011; 199:132-9
Fachner JC, Maidhof C, Grocke D, Nygaard Pedersen I, Trondalen G, Tucek G, Bonde LO. (2019). “Telling me not to worry…” Hyperscanning and Neural Dynamics of Emotion Processing During Guided Imagery and Music. Front Psychol.10:1561. doi: 10.3389/fpsyg.2019.01561. PMID: 31402880; PMCID: PMC6673756.
Geretsegger, M., Elefant, C., Mössler, K. A., & Gold, C. (2014). Music therapy for people with autism spectrum disorder. The Cochrane database of systematic reviews, 2014(6), CD004381. https://doi.org/10.1002/14651858.CD004381.pub3
Gold C, Wigram T, Elefant C. Music therapy for autistic spectrum disorder. Cochrane Database Syst Rev. 2006;2:CD004381.
Hohmann L, Bradt J, Stegemann T, Koelsch S. (2017). Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review. PLoS One. 2017 Nov 15;12(11):e0187363. doi: 10.1371/journal.pone.0187363.
Krueger J. Affordances and the musically extended mind. Front Psychol. 2014 Jan 6;4:1003. doi: 10.3389/fpsyg.2013.01003. PMID: 24432008; PMCID: PMC3880934.
Levitin, D. J., and Tirovolas, A. K. (2009). Current advances in the cognitive neuroscience of music. Ann. N. Y. Acad. Sci. 1156, 211–231. doi: 10.1111/j. 1749-6632.2009.04417.x
Maratos A, Crawford MJ, Procter S. Music therapy for depression: it seems to work, but how? Br J Psychiatry. 2011; 199:92-3
Meltzoff A.N. & Moore M.K, (1977). Imitation of facial and manual gestures by human neonates. Science, 198, 75-78.
Menon, V., & Levitin, D. J. (2005). The rewards of music listening: response and physiological connectivity of the mesolimbic system. Neuroimage, 28(1), 175-184.
Montague PR, Berns GS, Cohen JD, McClure SM, Pagnoni G, Dhamala M, Wiest MC, Karpov I, King RD, Apple N, Fisher RE. (2002). Hyperscanning: simultaneous fMRI during linked social interactions. Neuroimage. 2002 Aug;16(4):1159-64. doi: 10.1006/nimg.2002.1150.
Mössler K, Chen X, Heldal TO, Gold C. (2017). Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD004025. doi: 10.1002/14651858.CD004025.pub3.
Notterman, D. A., & Mitchell, C. (2015). Epigenetics and Understanding the Impact of Social Determinants of Health. Pediatric clinics of North America, 62(5), 1227–1240. https://doi.org/10.1016/j.pcl.2015.05.012
Partanen, E., Kujala, T., Tervaniemi, M., & Huotilainen, M. (2013). Prenatal music exposure induces long-term neural effects. PloS one, 8(10), e78946. https://doi.org/10.1371/journal.pone.0078946
Sacks, Oliver. Musicophilia: Tales of Music and the Brain. New York: Alfred A. Knopf, 2007.
Schilbach L., Timmermans B., Reddy V., Costall A., Bente G., Schlicht T., Vogeley K., Toward a second-person neuroscience.Behavioral and Brain Sciences · July 2013
Vink AC, Birks JS, Bruinsma MS, Scholten RJ. Music therapy for people with dementia. Cochrane Database Syst Rev. 2003;4: CD003477.
