Earliest Medical References
The earliest known reference to music therapy appeared in 1789 in an unsigned article in Columbian Magazine titled “Music Physically Considered.” In the early 1800s, writings on the therapeutic value of music appeared in two medical dissertations, the first published in 1804 by students of Dr. Benjamin Rush—a physician and psychiatrist who was a strong proponent of using music to treat medical diseases—and the second by Samuel Mathews, in 1806.
Early Educational Programs and Advocates
In the 1940s, Ira Altshuler, a psychiatrist and music therapist, promoted music therapy. E. Thayer Gaston, known as “the father of music therapy,” was instrumental in moving the concept forward in terms of organization and identified the educational value of music therapy.
Organizations
The following organizations represent and support music therapists:
American Music Therapy Association: The American Music Therapy Association (AMTA) was formed in 1998. AMTA is the single largest music therapy association in the United States, representing music therapists in the United States and over 30 countries around the globe. The mission of AMTA is to advance public knowledge of the benefits of music therapy and to increase access to quality music therapy services in a rapidly changing world.
Certification Board for Music Therapists: The Certification Board for Music Therapists is a separate and distinct organization from AMTA. It was incorporated in 1983 to strengthen the credibility of the music therapy profession. Over 8000 certified music therapists hold the Music Therapist-Board Certified (MT-BC) credential.
National Association for Music Therapy: The National Association for Music Therapy (NAMT) was founded on June 2, 1950. NAMT succeeded where previous music therapy associations had failed, by creating a constitution and bylaws; developing standards for university-level educational and clinical training requirements; prioritizing research and clinical training; creating a registry, and, later, board-certification requirements; and publishing research and clinical journals. NAMT operated from 1950 to 1997 and saw the creation of a board-certification program (1985), a critically acclaimed Senate Hearing on Aging (1991), and the growth of music therapy from a few dozen practitioners to thousands.
American Association for Music Therapy: Originally called the Urban Federation of Music Therapists, the American Association for Music Therapy (AAMT) was established in 1971. Starting in 1980, AAMT published its own research and clinical journal, Music Therapy, and by 1997, AAMT had grown to 700 members. Many of the purposes of AAMT were similar to those of NAMT, but they differed in philosophy, education, and approach.
Benefits of Music Therapy
Music therapy has found a place in geriatric medicine. Recently, the National Institutes of Health announced funding for music therapy associated with pain and dementia in patients with Alzheimer disease.(1)
In 2020, the Global Council on Brain Health noted that music is a powerful way to stimulate the brain and that evidence-based medicine supports music therapy.(2) Their report showed that music therapy could effectively improve anxiety, depression, and mood disorder in older adults with dementia. Strong evidence supports specialized music-based treatment to improve movement and mobility in older adults with Parkinson’s disease and also in patients following a cerebral vascular accident (CVA) or stroke. Good evidence exists that music therapy aids recovery following a stroke, including language and speech problems.
Music therapy can increase speed of mobility, improves balance, improves motor functioning, and provides overall improvement in a patient’s quality of life.
Most patients recovering from a CVA have a loss of mobility. Music therapy improves gait, mobility, and cognitive and motor skills. Music therapy can increase speed of mobility, improves balance, improves motor functioning, and provides overall improvement in a patient’s quality of life.(3)
A randomized controlled trial in 2020(4) compared two groups of stroke patients with a mean age of 60 years: one group listened daily for three months to patient-selected music, whereas the other group listened to instrumental music and audiobooks. Progress was evaluated using psychological testing and fMRI imaging studies. The study found that listening to vocal music was more effective than instrumental music or audiobooks at recovering verbal memory. The MRI imaging showed that listening to vocal music increased gray matter volume in the left temporal areas of the brain and also increased functional connectivity in brain areas for emotional processing, language, and memory.
Ganti(5) believes that music therapy is in its infancy and, at present, is underused in stroke rehabilitation. Ganti notes that music therapy is inexpensive and provides a positive mood to both patients and caregivers.
How Does Music Therapy Work?
One of the ways that music therapy works is through its ability to stimulate the brain. Music engages multiple areas of the brain, including the auditory cortex, which is responsible for processing sound, and the limbic system, which is involved in emotions and memory. When we listen to music, our brain releases dopamine, a neurotransmitter associated with pleasure and reward. This dopamine release helps improve mood and reduce anxiety and depression.
In addition to its effects on the brain, music therapy also can have physical benefits. For example, music therapy can help to reduce pain and promote relaxation. Music can slow down heart rate, respiration, and blood pressure, leading to deep relaxation. Music therapy is particularly effective in treating chronic pain, such as that associated with arthritis or fibromyalgia.
Music therapy also can improve cognitive function. For example, music therapy helps individuals with dementia or Alzheimer disease to recall memories from their past.(6) Music often is associated with specific memories and emotions, and listening to familiar music can help to trigger these memories. Music therapy is effective in improving attention and concentration in individuals with attention deficit hyperactivity disorder.(7)
Music therapy can address social and emotional needs. For example, it can help to improve communication and social skills in individuals with an autism spectrum disorder.(8) Music therapy helps individuals who are experiencing grief or loss, because it can provide a safe and supportive outlet for expressing emotions.
There are several different approaches to music therapy. One approach is to use music as a form of relaxation or meditation. This relaxation can result from listening to calming music, playing an instrument, or singing. Another approach is to use music to help individuals express their emotions. Expressing emotions can involve writing songs or playing instruments to express feelings of sadness, anger, or happiness.
Music therapy often is combined with other forms of therapy, such as talk therapy or cognitive-behavioral therapy. This combination therapy can enhance the effectiveness of each of the therapies by providing an additional way for individuals to process their emotions and experiences.
Music therapy is a valuable and effective tool and can address a wide range of physical, emotional, cognitive, and social needs. It can provide a safe and supportive outlet for individuals to express their emotions, improve their mood, and enhance their overall well-being.
Music Therapy and Parkinson’s Disease
Most patients with Parkinson’s disease have gait and cognitive issues. Music therapy is being used as a rehabilitation modality to treat gait problems. Auditory stimulation using music therapy to improve gait mobility. When music therapy was used with standard gait therapy, it was demonstrated that the combination of music therapy and standard gait therapy benefited patients with Parkinson’s disease. The combination therapy helped to increase walking speed and stride length by synchronizing gait with musical beats. This type of therapy can also add singing to improve gait and coordination. Playing percussion instruments (e.g., piano, drums, and maracas) improves other movement issues associated with Parkinson’s disease, such as tremors. Functional MRI scans of Parkinson’s patients showed that rhythmic music induced stronger neural interconnections between auditory, executive control, and cerebellar motor areas.(9)
Music-based interventions may improve cognitive skills such as attention, processing speed, and memory by stimulating the brain’s frontal lobe.
In addition to improving gait in patients with Parkinson’s disease, music therapy incorporating singing also helped improve communication skills and reduce depression. Music-based interventions may improve cognitive skills such as attention, processing speed, and memory by stimulating the brain’s frontal lobe.(10) Other studies confirm significant improvement in motor function, balance, walking speed, freezing of gait, and mental health.(11)
A program called ParkinSong involved singing and monitored its effect on voice-related outcomes for patients with Parkinson’s disease. The results demonstrated that weekly ParkinSong sessions improved speech-related outcomes, including vocal loudness, voice-related quality of life, and anxiety associated with communication difficulties.(12)
Current Evidence and Research in Music Therapy
A 2020 study by AARP evaluated the impact of music therapy on brain health.(13) The study concluded that music is a powerful way to stimulate the brain, promote mental wellness, increase social connections, and improve cognitive skills. It recommended incorporating music to promote mental wellness, increase social connections, and stimulate cognitive skills.
The evidenced-based conclusions include the following:
Music therapy effectively improves anxiety, depression, and mood in patients with dementia. The study noted that the ability to sing, dance, listen to music, and play a musical instrument could be preserved even in patients with dementia.
Music-based treatment improves movement in patients with Parkinson’s disease and following strokes. There is also evidence that music and singing aid in recovering from post-stroke disability, including language deficits.
Music therapy’s benefits positively affect several brain functions, including hearing/listening, language, movement, attention, memory, emotion, and cognitive skills. Music therapy improves neural connectivity between the involved areas of the brain.
Music therapy promotes mental wellness. The positive effects of music include lowering blood pressure and heart rate and improving sleep quality. Paying attention to personal music preferences maximizes the beneficial effects of music on brain health.(13)
The final message of the consensus statement is that music, movement, and dance, are closely linked; therefore, music can motivate older adults to be more active, improving brain health.
In 2019, the National Institutes of Health started funding neuroscience music therapy research focusing on pain and dementia associated with Alzheimer’s disease.(14)
The American Music Therapy Association points out that evidence-based studies have shown that music therapy addresses various healthcare and educational goals. They further state that music therapy provides benefits for geriatric patients.
Advice to Caregivers of Older Adults
Caregivers for older adults with dementia must remember that patients like to select their own music. This reduces agitation, anxiety, and depression. The connection to music promotes a connection with family and friends.
Bottom Line: Music therapy in older adults is becoming accepted by the medical profession based on neuroscientific research showing the relation between the neurobiological foundations of music on the brain and how musical therapy changes brain behavior and function. Through this research, the theory and clinical practice of music therapy is changing from a social science model to a neuroscience model based on brain function and music perception. As a result, music therapy has been transformed from an adjunct modality to a central treatment modality in rehabilitation and therapy of geriatric patients.
References
Marwick C. Music therapists chime in with data on medical results. JAMA. 2000;283:731-733. https://doi.org/10.1001/jama.283.6.731-JMN0209-2-1 .
Mintzer J. Global Council on Brain Health: Consensus and recommendations for promoting brain health through music engagement. Innovation in Aging. 2020;4(Suppl 1):784. https://doi.org/10.1093/geroni/igaa057.2836 .
Raglio A, Zaliani A, Baiardi P, et al. Active music therapy approach for stroke patients in the post-acute rehabilitation. Neurol Sci. 2017;38,893-897. https://doi.org/10.1007/s10072-017-2827-7 .
Xu C, He Z, Shen Z, Huang F. Potential benefits of music therapy on stroke rehabilitation. Oxidative Medicine and Cellular Longevity, 2022. https://doi.org/10.1155/2022/9386095 .
Daniel A, Koumans H, Ganti L. Impact of music therapy on gait after stroke. Cureus. 2021;13(10). https://doi.org/10.7759/cureus.18441 .
Matziorinis AM, Koelsch S. The promise of music therapy for Alzheimer’s disease: a review. Ann NY Acad Sci. 2022;1516(1):11-17. https://doi.org/10.1111/nyas.14864 .
Zhang F, Liu K, An P, You C, Teng L, Liu Q. Music therapy for attention deficit hyperactivity disorder (ADHD) in children and adolescents. The Cochrane Database of Systematic Reviews. 2017;(5). https://doi.org/10.1002/14651858.CD010032.pub2 .
Atkinson‐Jones K, Hewitt O. Do group interventions help people with autism spectrum disorder to develop better relationships with others? A critical review of the literature. Br J Learn Disabil. 2019;47:77–90. https://doi.org/10.1111/bld.12258 .
Wolters AF, van de Weijer SC, Leentjens AF, Duits AA, Jacobs HI, Kuijf ML. Resting-state fMRI in Parkinson’s disease patients with cognitive impairment: a meta-analysis. Parkinsonism Relat Disord. 2019;62:16-27. https://doi.org/10.1016/j.parkreldis.2018.12.016 .
Devlin K, Alshaikh JT, Pantelyat A. Music therapy and music-based interventions for movement disorders. Curr Neurol Neurosci Rep. 2019;19:1-13. https://doi.org/10.1007/s11910-019-1005-0 .
Zhou Z, Zhou R, Wei W, Luan R, Li K. Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: a systematic review and meta-analysis. Clin Rehabil. 2021;35(7):937-951. https://doi.org/10.1177/0269215521990526 .
Tamplin J, Morris ME, Marigliani C, Baker FA, Vogel AP. ParkinSong: a controlled trial of singing-based therapy for Parkinson’s disease. Neurorehabil Neural Repair. 2019;33:453-463. https://doi.org/10.1177/1545968319847948 .
Denk JG. The impact of a music therapy support group on perceived stress, anxiety, and depression in long-term caregivers: a pilot study. Music Therapy Perspectives; 2023;41(1):28-36. https://doi.org/10.1093/mtp/miac019 .
Chen WG, Iversen JR, Kao MH, et al. Music and brain circuitry: strategies for strengthening evidence-based research for music-based interventions. J Neurosci. 2022;42:8498-8507. https://doi.org/10.1523/JNEUROSCI.1135-22.2022 .