research paper on how music affects your mood

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Published: 21 March 2023

Changing positive and negative affects through music experiences: a study with university students

José Salvador Blasco-Magraner 1 ,
Gloria Bernabé-Valero 2 ,
Pablo Marín-Liébana 1 &
Ana María Botella-Nicolás 1

BMC Psychology volume 11 , Article number: 76 ( 2023 ) Cite this article

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Currently, there are few empirical studies that demonstrate the effects of music on specific emotions, especially in the educational context. For this reason, this study was carried out to examine the impact of music to identify affective changes after exposure to three musical stimuli.

The participants were 71 university students engaged in a music education course and none of them were musicians. Changes in the affective state of non-musical student teachers were studied after listening to three pieces of music. An inter-subject repeated measures ANOVA test was carried out using the Positive and Negative Affect Schedule (PANAS) to measure their affective state.

The results revealed that: (i) the three musical experiences were beneficial in increasing positive affects and reducing negative affects, with significant differences between the interaction of Music Experiences × Moment (pre-post); (ii) listening to Mahler’s sad fifth symphony reduced more negative affects than the other experimental conditions; (iii) performing the blues had the highest positive effects.

Conclusions

These findings provide applied keys aspects for music education and research, as they show empirical evidence on how music can modify specific affects of personal experience.

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Introduction

The studies published on the benefits of music have been on the increase in the last two decades [ 1 , 2 , 3 ] and have branched out into different areas of research such as psychology [ 4 , 5 , 6 , 7 , 8 ], education [ 1 , 9 , 10 ] and health [ 11 , 12 ] providing ways of using music as a resource for people’s improvement.

The publication in 1996 of the famous report “Education Hides a Treasure” submitted to the UNESCO by the International Commission was an important landmark in the educational field. This report pointed out the four basic pillars of twenty-first century education: learning to know, learning to do, learning to live together, and learning to be [ 13 ]. The two last ones clearly refer to emotional education. This document posed a challenge to Education in terms of both academically and emotionally development at all levels from kindergarten to university. In this regard, there has been a notable increase in the number of studies that have shown the strong impact of music on the emotions in the different stages of education and our lives. For example, from childhood to adolescence, involving primary, secondary and university education, music is especially relevant for its beneficial effects on developing students’ emotional intelligence and prosocial skills [ 1 , 14 ]. In adults, music benefits emotional self-regulation [ 15 ], while in old age it helps to maintain emotional welfare and to experience and express spirituality [ 16 ]. This underlines the importance of providing empirical evidence on the emotional influence of music.

Influence of music on positive affects

Numerous studies have used the Positive and Negative Affect Schedule (PANAS) to evaluate the emotional impact of music [ 17 ]. This scale is valid and effective for measuring the influence of positive and negative effects of music on listeners and performers [ 10 , 18 , 19 ]. Thus, for example, empirical evidence shows that exposure to a musical stimulus favours the increase of positive affects [ 20 , 21 ] found a significant increase in three positive affects in secondary school students after listening to music, and the same results has been found after listening to diverse musical styles. These results are consistent with Schubert [ 22 ], who demonstrated that music seems to improve or maintain well-being by means of positive valence emotions (e. g. happiness, joy and calm). Other research studied extreme metal fans aged between 18 and 34 years old and found statements of physiological excitement together with increased positive affects [ 21 ]. Positive outcomes after listening to sad music have also been found [ 23 ], who played Samuel Barbers’ Adagio for Strings , described by the BBC as the world’s saddest piece of classical music, to 20 advanced music students and 20 advanced psychology students with no musical background and subsequently found that the music only had positive affects on both groups.

Several experimental designs that used sad music on university students noticed that they experienced both sadness and positive affects [ 24 , 25 ] and also found that music labeled as “happy” increased positive affects while the one labeled as “sad” reduced both positive and negative affects [ 26 ]. For other authors the strongest and most pleasant responses to sad music are associated with empathy [ 27 ]. Moreover, listening to sad music had benefits since attributes of empathy were intensified [ 27 , 28 ]. In relation to musical performances, empirical evidence found a significant increase in positive affects [ 29 ]. Thus, music induces listeners to experience positive affects, which could turn music into an instrument for personal development.

Following on from Fredrickson’s ‘broaden‐and‐build’ framework of positive emotions [ 30 ], positive affects cause changes in cognitive activities which, in turn, can cause behaviour changes. They can also expand the possibilities for action and improve physical resources. According to Fredrickson [ 30 ], positive affects trigger three sequential effects: (1) amplification of the scope for thought and action; (2) construction of personal resources to deal with difficult simplifications; (3) personal transformation by making one more creative, with a better understanding of situations, better able to face up to difficulties and better socially integrated. This leads to an “upward spiral” in which even more positive affects are experienced. A resource such as music that can increase positive affects, can therefore be considered as a step forward in personal transformation. Thus, music teachers could have a powerful tool to help students enhance their personal development.

Influence of music on negative affects

There is a great deal of controversy as regards the influence of music on negative affects. Blasco and Calatrava [ 20 ] found a significant reduction of five negative affects in secondary school students after listening to Arturo Marquez’s typically happy Danzón N O 2. Different results were found in an experiment in which the change in participants ‘affects was assessed after listening the happy "Eye of the Tiger" by Survivor and the sad "Everybody Hurts" by REM [ 26 ]. They found that the happy piece only increased the positive affects but did not reduce the negative ones, while the sad piece reduced both positive and negative affects. However, neither of these findings agree with Miller and Au [ 31 ], who carried out an experiment to compare the influence of sad and happy music on undergraduates ‘mood arousal and found that listening to both types had no significant changes on negative affects. Shulte [ 32 ] conducted a study with 30 university students to examine the impact that nostalgic music has on affects, and found that after listening to different songs, negative affects decreased. Matsumoto [ 33 ] found that sad music reduced sad feelings in deeply sad university students, while Vuoskoski and Eerola [ 34 ] showed that sad music could produce changes in memory and emotional judgements related to emotions and that experiencing music-induced sadness is intrinsically more pleasant than sad memories. It therefore seems that reducing negative affects has mostly been studied with sad and nostalgic musical stimuli. In this way, if music can reduce negative affects, it can also be involved in educational and psychological interventions focused on improving the emotional-affective sphere. Thus, for example, one study examined the effects of a wide range of music activities and found that it would be necessary to specify exactly what types of music activity lead to what types of outcomes [ 2 ]. Moore [ 3 ] also found that certain music experiences and characteristics had both desirable and undesirable effects on the neural activation patterns involved in emotion regulation. Furthermore, recent research on university students shows that music could be used to assess mood congruence effects, since these effects are reactions to the emotions evoked by music [ 35 ].

These studies demonstrate that emotional experience can be actively driven by music. Moreover, they synthesize the efforts to find ways in which music can enhance affective emotional experience by increasing positive affects and reducing the negative ones (e. g. hostility, nervousness and irritability). Although negative emotions have a great value for personal development and are necessary for psychological adjustment, coping with them and self-regulation capacities are issues that have concerned psychology. For example, Emotional Intelligence [ 36 ], which has currently been established in the educational field, constitutes a fundamental conceptual framework to increase well-being when facing negative emotions, providing keys for greater control and management of emotional reactions. It also establishes how to decrease the intensity and frequency of negative emotional states [ 37 ], providing techniques such as mindfulness meditation that have proven their effectiveness in reducing negative emotional experiences and increasing the positive ones [ 38 ]. The purpose of this research is to find whether music can be part of the varied set of resources that can be used by a teacher to modify students’ emotional experience.

Thus, although empirical evidence of the effects of music on the emotional sphere is still incipient. It seems that they can increase positive effects, but it is not clear their impact on the negative ones, since diverse and contradictory results (no change and reduction of negative affects after listening to music) were found. In addition, the effects of the type of musical piece (e.g. happy or sad music) need further investigation as different effects were found. Moreover, previous studies do not compare between the effects of listening to versus performing music. Such an approach could provide keys to highlight the importance of performing within music education. Therefore, this study aims to contribute to this scientific field, providing experimental evidence on the effects of listening to music as compared to performing music, as well as determining the effects of different types of music on positive and negative affects.

To this end, the effects of three different types of music experiences were compared: (1) listening to a sad piece, (2) listening to an epic and solemn piece, and (3) performing of a rhythm and a blues piece, to determine whether positive and negative affects were modified after exposure to these experimental situations. In particular, two hypotheses guided this study: (1) After exposure to each musical experience (listening to a sad piece; listening to a solemn piece and playing a blues), all participants will improve their emotional experience, increasing their positive affects and reducing their negative ones; and (2) the music performance will induce a greater change as compared to the listening conditions.

Participants

A total of 71 students were involved in this study, 6 men and 65 women between the ages of 20 and 40, who were studying a Teaching Grade. These students were enrolled in the "Music Education" program as part of their university degree’s syllabus. None of them had special music studies from conservatories, academies or were self-taught; thus, all had similar musical knowledge. None of them had previously listened to music in an instructional context nor had performed music with their fellow students. In addition, none of them had listening before to the musical pieces selected for this experiment.

All signed an informed consent form before participating and no payment was given for taking part in the study. As the experiment was carried out in the context of a university course, they were assured that their participation and responses would be anonymous and would have no impact on their qualifications. The research was approved by the ethical committee at the Universidad Católica de Valencia San Vicente Mártir: UCV2017- 18-28 code.

Questionnaire

To assess emotional states, the Positive and Negative Affective States scales (PANAS), was administered [ 39 ]. In particular, the Spanish version of the scale [ 17 ], whose study shows a high degree of internal consistency; in males 0.89 in positive affects and 0.91 in negative affects; in women 0.87 in positive affects and 0.89 in negative affects. In this study, good reliability level in each experimental condition was obtained (0.836–0.913 for positive affects and 0.805–0.917 for negative affects (see Table 1 for more information on Cronbach’s α for each experimental condition).

The PANAS consists of 20 items which describe different dimensions of emotional experience. Participants must answer them regarding to their current affective state. The scale is composed of 20 items; 10 positive affects (PA) and 10 negative affects (NA). Answers are graded in a 5-options (Likert scale), with reversed items, ranging from extremely (1) to very slightly or not at all (5).

Musical pieces

The musical pieces choice stemmed from the analysis of some of the music elements that most influence the perception of emotions: mode, melody and intervals. Within the melody, range and melodic direction were distinguished. The range or amplitude of the melodic line is commonly divided into wide or narrow, while the melodic direction is often classified as ascending or descending. Chang and Hoffman [ 10 ] associated narrow amplitude melodies with sadness, while Schimmark and Grob [ 40 ] related melodic amplitude with highly activated emotions. Regarding the melodic direction, Gerardi and Gerken [ 41 ] found a relationship between ascending direction and happiness and heroism, and between descending direction and sadness.

In relation to the mode, Tizón [ 42 ] stated that the major one is completely happy, while the minor one represents sadness. Thompson and Robitaille [ 43 ] considered that, in order to cause emotions such as happiness, solemnity or joy, composers use tonal melodies, while to obtain negative emotions, they use atonality and chromaticism.

In this research, the selected pieces (“Adagietto” from Gustav Mahler's Fifth Symphony, MML; and “Titans” from Alexander The Great from Vangelis, VML) are representative examples of the melodic, intervallic and modal characteristics previously exposed. Mahler's and Vangelis's pieces completely differ in modes and melodic amplitude (sad vs. heroism). Likewise, Mahler's piece is much more chromatic than Vangelis' one, which has a broader melody made up of third, fourth and fifth intervals, often representative of heroism. Those features justify the fact that they have been used as soundtracks in two films belonging to the epic genre (Alexander The Great, 2004) and drama (Death in Venice, 1971).

The musical piece that was performed by the students was chosen in order to be easy to learn in a few sessions, since they were not musicians. So, three musical pieces were used for the experimental conditions, the first two musical pieces were recordings in a CD, while the third one was performed by the subjects.

The three chosen pieces are described below:

Condition 1 (MML): “Adagietto” from Gustav Mahler’s Fifth Symphony (9:01 min), performed by the Berlin Philharmonic conducted by Claudio Abbado [ 44 ]. This is a sad, melancholic and dramatic piece that Luchino Visconti used in the film Death in Venice, made in 1971 and based on the book by Thomas Mann.

Condition 2 (VML): “Titans Theme” from Alexander the Great (3:59 min), directed by Oliver Stone and premiered in 2004, whose music was composed, produced and performed by Vangelis [ 45 ]. It has a markedly epic character with large doses of heroism and solemnity.

Condition 3 (BP): “Rhythm’s Blues” composed and played by Ana Bort (4:00 min). This is a popular African-American piece of music with an insistent rhythm and harmonically sustained by tonal degrees. This piece was performed by the participants using percussion instruments (carillons and a range of xylophones and metallophones).

The sample was divided into two groups (N 1 = 36 and N 2 = 35) that participated separately in all the phases of the study. The first two conditions (MML and VML) were carried out in each group's classroom, while the performance (BP) was developed in the musical instruments room. This room had 52 percussion instruments, including different types of chimes, xylophones and metallophones (soprano, alto and bass). It is a large space where there are only chairs and musical instruments and stands. The first group was distributed as follows: 6 chimes (3 soprano and 3 alto), 5 soprano xylophones, 5 alto xylophones, 5 bass xylophones, 5 soprano metallophones, 5 alto metallophones and 5 bass metallophones. The distribution of the second group was similar, but with one less alto metallophone.

Prior to the experiment, participants received two practical lessons in order to learn how to collectively perform the music score (third experimental condition). After the two practical lessons, during the next three sessions (leaving two weeks between each session), the experiment was carried out. In each session, an experimental condition was applied and PANAS was on-line administered online beforehand and afterwards (Pre-Post design). All participants were exposed to the three experimental conditions and completed the scale before and after listening to music.

In each of these three sessions, a different music condition was applied: MML in the first one, VML in the second one and BP in the third one.

As conditions VML and MML were listening to pieces of music, the instructions received by the subjects were: “You are going to listen to a musical piece, you ought to listen actively, avoiding distractions. You can close your eyes if you feel like to”. For the BP condition, they were said to play the musical sheet all together.

The aim of the study was to examine the effect of the music experience variable (with three levels: MML, VML and BP) in the Positive and Negative Affects subscales from the PANAS scale. The variable Moment was also studied to control biases and to analyze differences between the Pre and Post conditions.

The experiment was designed as a two-way repeated measure (RM) ANOVA with two dependent variables: Positive Affects and Negative Affects, one for each PANAS’ subscales.

The two repeated measures used in the experiment were the variables Musical Experience (ME), with three levels (MML, VML and BP) and the variable Moment, with two levels (PRE and POST). All participants were exposed to the three experimental conditions.

The design did not include a control group, similar to many other studies in the field of music psychology [ 27 , 30 ]. The control was carried out from the intra-subject pre-post measurement of all the participants. The rationale for this design lies in the complexity of the control condition (or placebo) design in psychology [ 46 ]. While placebos in pharmacological trials are sugar pills, in psychology it is difficult to establish an equivalent period of time similar to the musical pieces (e. g. 9 min) without activity, so that cognitive activity occurred during this period of time (e. g. daydreaming, reading a story, etc.) could bias and limit the generalization of results.

Additionally, one of the goals of this study was to compare the effects of listening to music compared to performance on affects. For this reason, two music listening experiences (MML and VML) and a musical performance experience (BP) were designed. In order to control potential biases, participants did not know the musical pieces in the experimental conditions and they had a low level of musical performance competence (musicians were excluded).

It was used SPSS statistics v.26 for the statistical analyzes.

Two ANOVA were performed. The first one, analyzed two dependent variables at the same time: Positive Affects (PA) and Negative Affects (NA).

In the second ANOVA, the 20 items of the PANAS scale were taken as dependent variables. The rest of the experimental design was similar to the first one, a two-way RM ANOVA with variables Musical Experience (ME) and Moment as repeated measures.

Examination of frequency distributions, histograms, and tests of homogeneity of variance and normality for the criterion measures indicated that the assumptions for the use of parametric statistics were met. Normality was met in all tests except for one, but the ANOVA is robust against this assumption violation. All the analyses presented were performed with the significance level (alpha) set at 0.05, two-tailed tests. Means and standard deviations for the 6 experimental conditions for both subscales, Positive Affects and Negative Affects, are presented in Table 1 .

Mauchly’s test of sphericity was statistically significant for Musical Experience and Musical Experience*Moment focusing on NA as the dependent variable ( p < 0.05). The test only was significant for Musical Experience for PA as dependent variable ( p < 0.05). The rest of the W’s Mauchly were not significant ( p > 0.05), so we assumed sphericity for the non-mentioned variables and worked with the assumed sphericity univariate solution. For the variables which the W’s Mauchly was significant, the univariate solution was also taken, but choosing the corrected Greenhouse–Geisser epsilon approximation due to its conservativeness.

A significant principal effect of the Musical Experience variable F(1.710,119.691) = 22.505, p < 0.05, η 2 = 0.243; the Moment variable F(1,70) = 45.291, p < 0.05, η 2 = 0.393; and the Musical Experience*Moment interaction F(2,140) = 32.502, p < 0.05, η 2 = 0.317 were found for PA.

Statistically significance was found for Moment F(1, 70) = 70.729, p < 0.05, η 2 = 0.503 and Musical Experience*Moment interaction F(1.822, 127.555) = 8.594, p < 0.05, η 2 = 0.109, but not for Musical Experience F(1.593, 111.540) = 2.713, p < 0.05, η 2 = 0.037, for the other dependent variable, NA.

Table 2 shows pairwise comparisons between Musical Experience levels. Bonferroni’s correction was applied in order to control type I error. We only interpret the results for the Positive Affects because the Musical Experience effect was not statistically significant for Negative Affects. Results show that condition VML presents a significant higher punctuation in Positive Affects than the other two conditions ( p < 0.05). It also shows that the musical condition MML is significantly above BP in Positive Affects ( p < 0.05).

As regards Moment variable (Table 3 ), all but one Pre-Post differences were statistically significant ( p < 0.05) for all the three conditions for both Positive and Negative Affects dependent variables. The Pre-Post difference found in Positive Affects for the VML Musical Experience did not reach the statistical level ( p = 0.319).

Focusing on these statistically significant differences, we observe that conditions MML and BP, for PA, decreased from Pre to Post condition, indicating that positive emotions increased significantly between pre and post measures. On the other hand, for NA, all conditions increased from Pre to Post conditions, indicating that negative affects were decreased between pre and post conditions. Once again, one should bear in mind that items were reversed, thus, a higher scores in NA means a decrease in affects.

In order to measure the interaction effect, significant differences between simple effects were analysed.

The simple effect of Moment (level2-level1) in the first Music Experience condition (MML) in PA was compared with the simple effect of Moment (level2-level1) in the second Musical Experience condition (VML). Music Experience conditions 2–3 (VML-BP) and 1–3 (MML-BP) were compared in the same way. Thus, taking into account PA and NA variables, a total of 6 comparisons, 3 per dependent variable, were made.

The results of these comparisons are shown in Table 4 . Comparisons for PA range from T1 to T3 and comparisons for NA range from T4 to T6. All of them are significant ( p < 0.05) which means that there are statistically significant differences between all the Musical Experience conditions when comparing the Moment (pre/post) simple effects.

In Table 5 , we can look at the differences’ values. As we said before the differences between Pre and Post conditions are significant when comparing the three musical conditions. The biggest difference for positive affects is between MML and BP (T3 = 8.443), and between VML and MML (T4 = − 6.887) for negative affects.

In this second part, the results obtained from the second two-way RM ANOVA with the 20 items as dependent variables are considered. Results of the descriptive analysis of each item: Interested, Excited, Strong, Enthusiastic, Proud, Alert, Inspired, Determined, Attentive, Active, Distressed, Upset, Guilty, Afraid, Hostile, Irritable, Ashamed, Nervous, Jittery, Scared ; in each musical condition: MML, VML and BP; and for the PRE and POST measurements, can be found in the Additional file 1 (Appendix A).

As regards the ANOVA test that compares the three experimental conditions in each mood, Mauchly’s Sphericity Test indicates that sphericity cannot be assumed for the musical experience in most of the variables of the items of effects, except for Interested, Alert, Inspired, Active and Irritable . For these items, the highest observed power index among Greenhouse–Geisser, Huynh–Feldt and Lower-bound epsilon corrections was taken for each variable. For the interaction Musical Experience*Moment, sphericity was not assumed for Distressed, Guilty, Hostile and Scared . For these items, the same above-cited criterion was followed.

Musical experience has a principal effect on all the positive affects, but only has it for 5 negative affects ( Nervous, Jittery, Scared, Hostile and Upset ) ( p < 0.05). For more detail see Table S1 from Additional file 1 : Appendix B.

The principal effect of Moment is also statistically significant ( p < 0.05) for all (positive and negative), but two items: Guilty ( p = 0.073) and Hostile ( p = 0.123). All the differences between Pre and Post for positive affects are positive, which means that scores in conditions Pre were significantly higher than in condition Post. The other way around occurs for negative affects, all the differences Pre-Post are negative, meaning that the Post condition is significantly higher than the Pre condition. For more detail, see Table S2 from Additional file 1 : Appendix B. In this way, Pre-post changes (Moment) improve affective states; the positive affects increase while the negative are reduced, except for Guilty ( p = 0.073) and Hostile ( p = 0.123).

Comparing the proportion of variance explained by the musical experienced and Moment (Tables s1 and s2 from the Additional file 1 : Appendix B), it is observed that most of the η 2 scores in musical experience are below 0.170, except Active and Alert , which are higher. On the other hand, the η 2 scores for Moment are close to 0.300. From these results we can state that, taking only one of the variables at a time, the proportion of the dependent variable’s variance explained by Moment is higher than the proportion of the dependent variable’s variance explained by Musical Experience.

The effect of interaction, shown in Table S3 from the Additional file 1 : Appendix B is significant in 7 positive moods ( Interested, Excited, Enthusiastic, Alert, Determined, Active and Proud ) and 4 negative moods ( Hostile , Irritable, Nervous , and Jittery ).

The pairwise comparisons of Musical Experience’s levels show a wide variety of patterns. Looking at Positive Affects, there is only one item ( Active ) which present significant differences between the three musical conditions. Items Concentrated and Decided do not present any significant difference between any musical conditions. The rest of the Positive items show at least one significant difference between conditions VML and BP. All differences are positive when comparing VML-MML, VML-BP MML-BP, except for Alert and Proud. So, in general, scores are higher for the first two conditions in relation to the third one, meaning that third musical condition presents the biggest increase for Positive Affects (remember items where reversed). For more detail see Additional file 1 : Appendix C.

As regard pairwise comparisons of Musical Experience’s for negative affects, only the items which had a significant principal effect of the variable Musical Experience are shown here. There is a significant difference between conditions VML and MML in item Nervous ; between VML and BP for Scared ( p < 0.05). For Jittery ; all three conditions differed significantly from each other ( p < 0.05). Conditions MML and BP differed significantly for Hostile ( p < 0.05) and conditions VML and BP almost differed significantly for Upset item, but null hypothesis cannot be rejected as p = 0.056. For more detail see Additional file 1 : Appendix C. All differences were negative when comparing VML-MML, VML-BP MML-BP, except for Nervous and Jittery . So, in general, scores are lower for the first and second condition in relation to the third one.

Positive effects increased significantly during the post phase of all the music experiences, showing that exposure to any of the three music stimuli improved positive affectivity. There were also significant differences between the three experiences in this phase, according to the following order of improvements in positive affectivity: (1) the rhythm and blues performance (BP), (2) listening to Mahler (MML) and (3) listening to Vangelis (VML). As regards the effects of the musical experience x Moment interaction , all the comparisons were significant, with bigger differences in the interpretation of the blues (BP) than in listening to Mahler (MML) and Vangelis (VML). However, the comparison between both experiences, although significant, was smaller. These results indicate that performing music is significantly effective in increasing positive effects. We will explain these results in greater detail below as regards the specific affective states.

As regards Negative Affects, the comparison of the simple effects showed that these decreased after the musical experiences, although in this first analysis the VML musical experience did not differ from the other two. However, the results of the effects of the interaction between musical experiencie x Moment showed that all the comparisons were significant, with a larger difference between MML and VML than the one between BP and each of the other experiences. Listening to Mahler (MML) was more effective in reducing negative affects, compared to both listening to Vangelis and interpreting the blues (BP). These results agree with previous studies [ 26 , 32 ], in which listening to sad music helped to reduce negative affectivity. In this study, it was the most effective condition, although exposure to all three musical experiences reduced negative affects.

The analysis of the specific affective states shows that most items that belong to Positive Affect scale are the most sensitive ones to the PRE-POST change, the different musical conditions and the interpretation of both effects. However, some items of the Negative Affect scale did not differ in the different music conditions or in the music experience × Moment interaction . For example, there were two items (Guilty and Hostile) that did not obtain significance. These results are consistent with the fact that music has certain limits as regards its impact on people’s affects and does not influence all equally. For example, Guilty has profound psychological implications that cannot be affected by simple exposure to certain musical experiences. This means we should be cautious in inferring that music alone can have therapeutical effects on complex emotional states whose treatment should include empirically validated methods. Also, emotional experiences are widely diverse so that any instrument used to measure them is limited as regards the affective/emotional state under study. These results suggest the importance of reviewing the items that compose the PANAS scale in musical studies to adapt it in order to include affective states more sensitive to musical experiences and eliminate the least relevant items.

The analysis of the results in the specific affective states, allows us to delve deeper into each experimental condition. Thus, regarding the results obtained in the complete scale of PANAS, listening to Mahler (MML), causes desirable changes by raising two positive affects ( Inspired and Attentive ) and reducing 10 negative affects ( Distressed, Upset, Afraid, Hostile, Irritable, Ashamed, Nervous, Jittery, and Scared ). This shows that this music condition had a greater effect on the negative affects than the other ones. These results agree with previous studies [ 26 , 32 ], which found that sad music could effectively reduce negative affects, although other studies came to the opposite conclusion. For instance, Miller and Au [ 31 ] found that sad music did not significantly change negative affects. Some authors [ 47 , 48 ] have argued that adults prefer to listen to sad music to regulate their feelings after a negative psychological experience in order to feel better. Taruffi and Koelsch [ 49 ] concluded that sad music could induce listeners to a wide range of positive effects, after a study with 772 participants. In order to contribute to this debate. It would be interesting to control personality variables that might explain these differences on the specific emotions evoked by sad music. In this study, it has been shown that a sad piece of music can be more effective in reducing negative affects than in increasing positive ones. Although the results come from undergraduate students, similar outcomes could be obtained from children and adolescents, although further research is required. In fact, Borella et al. [ 50 ] studied the influence of age on the effects of music and found that the emotional effects influenced cognitive performance (working memory) in such a way that the type of music (Mozart vs. Albinoni) had a stronger influence on young people than on adults. Kawakami and Hatahira [ 28 ], in a study on 84 primary schoolchildren, also found that exposure to sad music pleased them and their level of empathy correlated with their taste for sad music.

Listening to Vangelis (VML) increased 3 positive affects ( Excited, Inspired and Attentive ) and reduced 8 negative affects ( Distressed, Upset, Afraid, Irritable, Ashamed, Nervous, Jittery , and Scared ). Surprisingly, two positive affects were reduced in this experimental condition ( Alert and Attentive ). It could be explained due to the characteristic ostinato rhythm of this piece of music. It was found a similar effect in the study by Campbell et al., [ 26 ] in which sad music reduced both positive and negative affects. This musical condition also managed to modify negative affects more than positive ones.

Performing the blues (BP) increased all 10 positive affects, indicating that performing is more effective in increasing positive affects than listening. These results agree with the study by Dunbar et al. [ 29 ], who found that music performance significantly increased positive affects.

Performing the blues (BP) reduced 6 negative affects, although it was more effective in increasing positive affective states. Vigorous rhythmic music was also found to be positively associated with the use of all the forms of regulating emotions, which suggests that this type of music is especially useful for emotion modulation [ 51 ]. It was found an exception, since Jittery increased after the blues performance. It could be explained by the negative experience that is sometimes associated with music performance. Therefore, it should be taken into account that music performance could increase some negative effects. For example, Dimsdale et al. [ 52 ] found that a strong negative emotional response to a certain type of music in adolescents was related to risk behaviour, indicating that research into the repertory of music experiences needs to be broadened to diverse styles in different age groups to identify all the types of emotional response and their psychological consequences. However, this result should be taken with caution and further research should focus on whether the effect of increased agitation is usual after music performances.

To sum up, this study contributes to the scientific field on the following points: (1) all the musical experiences had significant effects on improving emotional states, increasing positive affects and decreasing the negative ones, which shows the importance of musical experiences on improving the affective sphere; (2) the specific affects that increased, decreased or did not change for each musical experience were identified, providing specific and useful keys for the design of future interventions; and (3) the differences between various types of musical experiences were analyzed, finding more improvements in the performing conditions than in the listening ones.

Limitations and future directions

Limitations.

The sample, made up of university students with a very homogeneous profile in terms of age and sociodemographic characteristics, could limit the generalization of the results. In addition, the low percentage of men in the sample could also affect the generalizability of the results, although no previous studies have reported gender-based differential effects on the positive and negative affects after musical experiences.

Besides, the choice of the pieces of music was based on theoretical criteria and students’ music preferences were not taken into account. This will be included in future research, since the specific choice of the pieces could affect the positive or negative valence of participants’ emotions. However, the goal of using pieces of music not chosen by participants was to elicit new musical experiences for them. Furthermore, no participant was a musician and none of them had previous knowledge of any of the pieces, which may lead to a bias in the results.

In relation to this, the huge amount of available pieces of music, all of them influenced by their cultural and historical context, make it difficult to generalize that certain music parameters correlate with specific emotions. It would be necessary a cross-cultural approach to reach that conclusion.

Future directions

It is recommended to introduce the variables of music preferences and music history to control their effect on the results and to be able to compare the different musical parameters of the pieces together with participants’ preferences.

Likewise, it would be interesting to identify the affects with a greater or lesser degree of influence by music, to adjust the psychological evaluation instrument to the characteristics of the experiment, including items of emotions that can be modified after exposure to a music experience.

The PANAS manual [ 39 ] indicates that a wide variety of affective states (60) and eight different temporal instructions were included in its construction, showing its great versatility. In further research, this instrument should be adapted to for a more specific application to music studies. For instance, by including other emotional states that could be related with the influence of music (e.g. Tranquility , Gratitude , Elevation ), in order to measure more exactly the effects of music on people’s affective experiences.

Accordingly, it would be interesting to evaluate participants' affective traits to establish a baseline and control personality variables, helping to delve into the different levels of the hierarchical structure of affectivity and its relationship with the various music parameters.

Finally, it is recommended that the psychology of music include objective psychophysiological measurements together with self-report evaluations, so that conclusions arising from the experiments have greater robustness and can increase the impact of the contribution to the scientific community.

This study have shown how different music experiences, such as listening and performing, influence the changes in positive and negative affects in student teachers. The results show that the three musical experiences studied are effective in improving the affects by comparing the emotional states before and after the music experiences. It was also showed that there are differences between the effects obtained in each of the music experiences. Besides, improving both types of affects will depend largely on the selected music for the purpose. Although further evidence is required, the results support the importance of music in education, since it provides tools to increase positive affects and to decrease the negative ones, which is important for emotional intelligence development [ 53 , 54 ].

The three music experiences studied are more effective in reducing negative emotional states than in increasing the positive ones. This finding provides useful clues for music teachers to provide strategies that favor emotional regulation. For instance, in order to reduce hostility, irritability and nervousness, students could be exposed to musical auditions of both sad and solemn pieces, choosing musical pieces with similar characteristics to those described in this study. These auditions will be a resource for stress management in the classroom, as well as a tool that students can adopt and generalize to other contexts. Moreover, it is highly likely that students have not heard this type of music before and this experience could increase their repertoire of musical preferences, enhancing their emotional regulation.

The blues performance had a greater impact on participants' positive affects than listening to the other two pieces so, if any teacher wants to increase them (e.g., enthusiasm, interest, etc.), students could be asked to perform simple pieces such as Rhythm's Blues. In this way, musical performance could increase students' resources, contributing to higher levels of motivation, concentration and interest, which promotes learning [ 55 , 56 , 57 , 58 ]. Likewise, it could be very useful for elementary and secondary music teachers, who will be able to contribute to socio-emotional improvement and personal development of their students. Particularly, musical experiences could be a valuable resource for secondary teachers, since music is important in adolescents' lives and can be an interesting tool for meeting their emotional needs [ 59 ]. This is supported by Kokotsaki and Hallam [ 60 ], who consider that performing music helps students feel like active agents of a group, develop a strong sense of belonging, gain popularity, make "like-minded" relationships, improve their social skills and foster a strong sense of self-esteem and satisfaction.

This study shows that experiencing with various unknown musical pieces can have positive effects on emotions. According to this finding, university professors of Teaching grade in music education should encourage future teachers to experience various musical styles, rhythms and tonalities, avoiding prejudices. Thereby, future music teachers will be able to use a diversity of musical experiences that broaden the emotional effects and fulfill the socio-emotional function of music education. In relation to Fredrickson's 'broaden‐and‐build' framework of positive emotions [ 30 ], music can become a mean of widening other positive emotional states, constructing personal resources and transforming people, and contribute to an upward spiral of positive emotions. Taking into account the underlying psychological mechanisms of the impact of music on the emotional states it will be possible to use it to improve emotional area and other aspects of the personal sphere, as Chang et al., [ 10 ] maintain. Therefore, music education is an important resource to improve the emotional development of students.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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We should like to express our gratitude to the Valencia University student teachers for their disinterested and valuable contribution to this study.

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Blasco-Magraner, J.S., Bernabé-Valero, G., Marín-Liébana, P. et al. Changing positive and negative affects through music experiences: a study with university students. BMC Psychol 11 , 76 (2023). https://doi.org/10.1186/s40359-023-01110-9

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research paper on how music affects your mood

The Transformative Power of Music in Mental Well-Being

August 01, 2023
Healthy living for mental well-being, Patients and Families, Treatment

Music has always held a special place in our lives, forming an integral part of human culture for centuries. Whether we passively listen to our favorite songs or actively engage in music-making by singing or playing instruments, music can have a profound influence on our socio-emotional development and overall well-being.

Recent research suggests that music engagement not only shapes our personal and cultural identities but also plays a role in mood regulation. 1 A 2022 review and meta-analysis of music therapy found an overall beneficial effect on stress-related outcomes. Moreover, music can be used to help in addressing serious mental health and substance use disorders. 2 In addition to its healing potential, music can magnify the message of diversity and inclusion by introducing people to new cultures and amplifying the voice of marginalized communities, thereby enhancing our understanding and appreciation for diverse communities.

Healing Trauma and Building Resilience

Many historically excluded groups, such as racial/ethnic and sexual minorities and people with disabilities, face systemic injustices and traumatic experiences that can deeply impact their mental health. Research supports the idea that discrimination, a type of trauma, increases risk for mental health issues such as anxiety and depression. 3

Music therapy has shown promise in providing a safe and supportive environment for healing trauma and building resilience while decreasing anxiety levels and improving the functioning of depressed individuals. 4 Music therapy is an evidence-based therapeutic intervention using music to accomplish health and education goals, such as improving mental wellness, reducing stress and alleviating pain. Music therapy is offered in settings such as schools and hospitals. 1 Research supports that engaging in music-making activities, such as drumming circles, songwriting, or group singing, can facilitate emotional release, promote self-reflection, and create a sense of community. 5

Empowerment, Advocacy and Social Change

Music has a rich history of being used as a tool for social advocacy and change. Artists from marginalized communities often use music to shed light on social issues (.pdf) , challenge injustices, and inspire collective action. By addressing topics such as racial inequality, gender discrimination, and LGBTQ+ rights, music becomes a powerful medium for advocating for social justice and promoting inclusivity. Through music, individuals can express their unique experiences, struggles, and triumphs, forging connections with others who share similar backgrounds. Research has shown that exposure to diverse musical genres and artists can broaden perspectives, challenge stereotypes, and foster empathy among listeners especially when dancing together. 7

Genres such as hip-hop, reggae, jazz, blues, rhythm & blues and folk have historically served as platforms for marginalized voices, enabling them to reclaim their narratives and challenge societal norms. The impact of socially conscious music has been observed in movements such as civil rights, feminism, and LGBTQ+ rights, where songs have played a pivotal role in mobilizing communities and effecting change. Music artists who engage in activism can reach new supporters and help their fans feel more connected to issues and motivated to participate. 6

Fostering Social Connection and Support

Music can also serve as a catalyst for social connection and support, breaking down barriers and bridging divides. Emerging evidence indicates that music has the potential to enhance prosocial behavior, promote social connectedness, and develop emotional competence. 2 Communities can leverage music’s innate ability to connect people and foster a sense of belonging through music programs, choirs, and music education initiatives. These activities can create inclusive spaces where people from diverse backgrounds can come together, collaborate, and build relationships based on shared musical interests. These experiences promote social cohesion, combat loneliness, and provide a support network that can positively impact overall well-being.

Musicians and Normalizing Mental Health

Considering the healing effects of music, it may seem paradoxical that musicians may be at a higher risk of mental health disorders. 8 A recent survey of 1,500 independent musicians found that 73% have symptoms of mental illness. This could be due in part to the physical and psychological challenges of the profession. Researchers at the Max Planck Institute for Empirical Aesthetics in Germany found that musically active people have, on average, a higher genetic risk for depression and bipolar disorder.

Commendably, many artists such as Adele, Alanis Morrisette, Ariana Grande, Billie Eilish, Kendrick Lamar, Kid Cudi and Demi Lovato have spoken out about their mental health battles, from postpartum depression to suicidal ideation. Having high-profile artists and celebrities share their lived experiences has opened the conversation about the importance of mental wellness. This can help battle the stigma associated with seeking treatment and support.

Dr. Regina James (APA’s Chief of the Division of Diversity and Health Equity and Deputy Medical Director) notes “Share your story…share your song and let's help each other normalize the conversation around mental wellness through the influence of music. My go-to artist for relaxation is jazz saxophonist, “Grover Washington Jr” …what’s yours?” Submit to [email protected] to get featured!

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The effects of different types of music on mood, tension, and mental clarity

Affiliation.

1 Institute of HeartMath, Boulder Creek, Calif., USA.
PMID: 9439023

This study investigated the impact of different types of music on tension, mood, and mental clarity. A total of 144 subjects completed a psychological profile before and after listening for 15 minutes to four types of music (grunge rock, classical, New Age, and designer). With grunge rock music, significant increases were found in hostility, sadness, tension, and fatigue, and significant reductions were observed in caring, relaxation, mental clarity, and vigor. In contrast, after listening to the designer music (music designed to have specific effects on the listener), significant increases in caring, relaxation, mental clarity, and vigor were measured; significant decreases were found in hostility, fatigue, sadness, and tension. The results for New Age and classical music were mixed. Feeling shifts among subjects were observed with all types of music. Designer music was most effective in increasing positive feelings and decreasing negative feelings. Results suggest that designer music may be useful in the treatment of tension, mental distraction, and negative moods.

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Impact of Music on Mood: Empirical Investigation

Research on Humanities and Social Sciences. ISSN (Paper) 2224-5766 ISSN (Online) 2225-0484 (Online)

5 Pages Posted: 30 Nov 2015 Last revised: 30 Dec 2015

Nawaz Ahmad

RTS (Research, Trainings, and Solutions); Mehran University of Engineering & Technology

Afsheen Rana

Iqra university.

Date Written: November 29, 2015

The research entitled Effect of Music on Mood. This research was initiated by collecting primary data through questionnaire filled in by volunteers. This primary data was further processed, analyzed and evaluated to obtain certain interesting outcomes. For instance, the purpose of this research is to examine the listener’s response to music. This research also indicated that people get inspired by listening to music. Music is a source that can get them into the other mood. People think that music has strong impact on their mood and behavior. This research found that people are pretty much interested in listening to music and they believe music influence them in positive and negative both ways. In the light of this research it can be safely concluded that specific music has specific impact on mood and people take interest and feel good after listening to music.

Keywords: Music, Mood

JEL Classification: C90

Suggested Citation: Suggested Citation

Nawaz Ahmad (Contact Author)

Rts (research, trainings, and solutions) ( email ).

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How Music Can Influence Thoughts

The power of listening to motivational music..

Posted July 25, 2024 | Reviewed by Gary Drevitch

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Music can make us feel better about ourselves.
Empowering music evokes more positive and motivating thoughts.
Listening to empowering songs enhances self-esteem.

Image by Karolina Grabowska from Pixabay

Music can be used as a tool for emotional empowerment, such as enhanced mood and motivation . Music has an immediate effect on us. It has a unique power to elicit moments of intense emotional reactions, such as tears, chills and thrills, or goosebumps. The simple act of listening to a favorite song can alter our mood, triggering old memories.

Emotions typically occur with evaluations of events that tell us how significant the events are in relation to our goals. For example, happiness tells us we are doing well, and fear warns us of danger, even though the beliefs involved may not be accurate.

Likewise, our thought process can be influenced systematically by music. Inspiring music can instantly shift one’s mood from sadness toward a more hopeful feeling. On the other hand, sad-sounding music may arouse more calm or depressive thoughts. Evidence has shown that people who had listened to happy music evaluated themselves more positively than people who had listened to sad music (Elvers 2017). Interestingly, the changes in self-evaluation were more noticeable in listeners who reported low self-esteem .

Evidence has shown that empowering music strongly influences thought content (Koelsch, 2019). For example, empowering music—music that sounds energetic, triumphant, and strong—can make listeners feel more inspired, and less afraid.

The use of music by athletes prior to important competitions clearly demonstrate its potential to empower. The use of music in sports and exercise is a near-universal practice to enhance motivation, mood, and positive self-evaluation (Ballmann, 2021). For example, the Maori battle cries known as haka are regularly performed by New Zealand teams prior to international athletic competitions to put the performers in the right mindset. The music, and the accompanying movements, serve as a display of power and confidence and also allow the players to get into the right mindset prior to competitions.

Similarly, listening to music during exercise may positively impact psychological (i.e., mood, motivation) and physiological (i.e., rate of perceived exertion, arousal) changes. It is easier to forget about pain or fatigue when a song you enjoy is distracting you. A lack of enjoyment is frequently cited as a barrier to exercise, but music may help to shift this negative feeling toward a more positive mindset. Music (self-selected) can inspire you to exercise longer or work harder during your exercise routine.

The exact mechanisms through which music influences thoughts are not known. One possibility is that the empowering music has a strong potential to stimulate visual imagery (e.g., scenes of nature, or a sense of achievement). Another possibility is that the listener empathizes and identifies with a singer expressing positive self-view (Elvers, 2016).

In summary, listening to empowering music could be an effective strategy to enhance low self-confidence as well as trigger positive thoughts that contribute to psychological health. Moreover, in everyday life, empowering music can potentially be motivating to engage in tasks, and to reduce distraction by negative thoughts when concentrating on tasks. Furthermore, preferred music has a greater ability to divert attentional focus away from the discomfort of exercise toward the external music stimuli.

Ballmann, C.G.; Favre, M.L.; Phillips, M.T.; Rogers, R.R.; Pederson, J.A.; Williams, T.D. (2021). Effect of Pre-Exercise Music on Bench Press Power, Velocity, and Repetition Volume. Percept. Mot. Ski.128 , 1183–1196.

Elvers P., Steffens J. (2017). The sound of success: investigating cognitive and behavioral effects of motivational music in sports. Front. Psychol. 8:2026.

Koelsch S., Bashevkin T., Kristensen J., Tvedt J., Jentschke S. (2019). Heroic music stimulates empowering thoughts during mind-wandering. Scientific Reports , 9(1), 10317.

Shahram Heshmat, Ph.D., is an associate professor emeritus of health economics of addiction at the University of Illinois at Springfield.

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24 July 2024

Don’t fade away: memory for music persists with age

Bianca Nogrady

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A young girl and her grandmother play a piano duet together.

Musical memory might be resistant to age-related cognitive declines because it stirs emotions and becomes more encoded in memory. Credit: SDI Productions/Getty

The ability to remember and recognize a musical theme does not seem to be affected by age, unlike many other forms of memory.

“You’ll hear anecdotes all the time of how people with severe Alzheimer’s can’t speak, can’t recognize people, but will sing the songs of their childhood or play the piano,” says Sarah Sauvé, a feminist music scientist now at the University of Lincoln in the United Kingdom.

Past research has shown that many aspects of memory are affected by ageing, such as recall tasks that require real-time processing , whereas recognition tasks that rely on well-known information and automatic processes are not. The effect of age on the ability to recall music has also been investigated, but Sauvé was interested in exploring this effect in a real-world setting such as a concert.

In her study 1 , published today in PLoS ONE , she tested how well a group of roughly 90 healthy adults, ranging in age from 18 to 86 years, were able to recognize familiar and unfamiliar musical themes at a live concert. Participants were recruited at a performance of the Newfoundland Symphony Orchestra in St John’s, Canada. Another 31 people watched a recording of the concert in a laboratory.

The study focused on three pieces of music played at the concert: Eine kleine Nachtmusik by Mozart, which the researchers assumed most participants were familiar with, and two specially commissioned experimental pieces. One of these was tonal and easy to listen to; the other was more atonal and didn’t conform to the typical melodic norms of Western classical music. A short melodic phrase from each of the three pieces was played three times at the beginning of that piece, and participants then logged whenever they recognized that theme in the piece.

The melodic phrase from the Eine kleine Nachtmusik was equally well recognized across all ages and musical backgrounds, with no loss of recognition as age increased. All participants were less confident in recognizing the theme in the unfamiliar tonal piece, and even less confident with the unfamiliar atonal piece. This pattern, too, did not vary with age. The study also found no age-related difference in the results between the participants at the concert and those in the lab.

Steffen Herff, a cognitive neuroscientist at the University of Sydney, Australia, says the reason musical memory seems to be resistant to age-related cognitive declines might have to do with the emotions that music stirs in people, which makes it more encoded in memory. “We know from general memory research that, effectively, the amygdala — or emotional processing — operates a little bit like an importance stamp,” he says.

Music also tends to follow certain rules, so “it’s relatively easy to have a pretty good guess of what happened in-between,” Herff says.

The study collected limited data on some participants’ cognitive health, and so did not provide detailed insights into how cognitive impairments or neurodegenerative diseases affect memory recall. But Herff says there is great interest in using music as a form of ‘cognitive scaffolding’ — that is, as a memory aid for other information — in individuals with neurogenerative conditions such as dementia.

Nature 632 , 19 (2024)

doi: https://doi.org/10.1038/d41586-024-02369-7

Sauvé, S. A. et al. PLoS ONE 19 , e0305969 (2024).

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v.5(1); 2015 Mar 22

Effects of music and music therapy on mood in neurological patients

Correspondence to: Alfredo Raglio, MT, PhD, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via S. Boezio 24, 27100 Pavia, Italy. [email protected]

Telephone: +39-0382-593797 Fax: +39-0382-593797

Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson’s Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.

Core tip: We conducted a search on PubMed and PsychInfo databases identifying 25 Randomized Controlled Trials or Clinical Controlled Trials regarding the effects of Music Therapy and other musical interventions on mood disorders in neurological patients. Although the Jadad score evaluation revealed a generally poor methodological quality of the research protocols, we found that almost all studies supported the effectiveness of musical interventions in improving mood, depression, quality of life, functional recovery, and neuromotor performances. Therefore Music Therapy and other musical approaches seem to be effective, inexpensive and non-invasive, being that no adverse side-effects were observed.

INTRODUCTION

Neurology and psychiatry.

Neurological diseases are often associated with several behavioral and psychological symptoms that are usually overlooked by neurologists because require diagnostic methods that differ from those used for classical somatic symptoms and are more suitable to the field of psychiatry. On the other hand, psychiatrists do not seem to give an adequate attention to these symptoms considering them as a consequence of a cerebral damage and more pertinent to neurologists. This clinical attitude is historically based on the obsolete and reductive distinction between “organic” and “functional” behavioral disorders introduced by the phrenologist George Combe in 19 th century. According to Combe, cerebral diseases were respectively classified depending on the presence or the absence of cerebral lesions and from that time on this terminology has been used to indicate that some behavioral disorders are linked to a neurological damage while others are not. However, the reductionism of Combe’s distinction clearly emerges from the clinical observation given that a wide range of nervous system’s illnesses with different etiology shows both neurological and psychiatric symptoms. Emotional and behavioral disturbances with a polymorphic symptomatology are often connected to neurological disorders such as Multiple Sclerosis (MS)[ 1 - 3 ], Parkinson’s Disease (PD)[ 4 ], stroke[ 5 ], dementia[ 6 ], traumatic brain injury[ 7 ], epilepsy[ 8 , 9 ], Amyotrophic Lateral Sclerosis (ALS) and others Motor Neuron Diseases (MND)[ 10 , 11 ], pain syndromes (like headaches) and can be observed even with or without “organic” neurological diseases, thus miming in some cases an idiopathic psychiatric disorder.

Most common psychiatric disorders in neurology are depression, anxiety, maniacal states, and thought and perception disorders. Other psychiatric syndromes that can be seen in persons with neurological disorders are alexithymia, worry, and locus of control[ 12 ]. For example, mood disorders are often associated with acute or chronic cerebrovascular pathologies where the most common complications is certainly depression, usually defined post-stroke depression (PSD). The frequency of this syndrome is variable accordingly to different studies with a mean of 40% of the cases[ 13 ] and data obtained by numerous studies seem to indicate the presence of multiple etiological factors, both structural-endogenous and environmental-external, that may change depending on the early or late onset of the depressive disorder. In addition, a bidirectional association between depression and neurological disorder may be possible being that depressive syndromes may be considered as a risk factor for certain neurological disorders. As sustained by two recent meta-analysis, depressive syndromes, particularly major depressive disorder (MDD), are associated with a significantly increased risk of stroke[ 14 , 15 ]. On the other hand, lower rates of depression in equally impaired orthopedic patients suggest that PSD may even result from a stroke-specific neurobiological change and not only from a consequence of the psychological distress or the related impairments[ 16 - 18 ].

The second most common neurodegenerative disorder is represented by PD, with a prevalence of 1% of the elderly worldwide population. About 30% of PD patients show clinically significant depressive syndromes and, again, it appears to be also an increased risk for depressed patients to develop PD[ 19 - 23 ].

As far as regard MS, depressive syndromes are psychiatric most common disorders associated to the illness. Among individuals with MS, relative to the general population, lifetime prevalence rates are elevated for MDD (36%-54%), bipolar disorder (13%), anxiety disorders (35.7%), adjustment disorders (22%), and psychotic disorders (2%-3%). Suicide may be at least twice as common[ 1 ].

Many reports of depression and its correlation with numerous variables in clinical samples of people with MS have been published. The few population-based studies have reported a high prevalence of depression, despite using different methods of data collection. The lifetime risk of major depression in people with MS has been estimated to be as high as 50% compared to 10% to 15% in the general population[ 24 , 25 ].

In a recent cross-sectional, population-based study conducted in Stockholm county, the authors reported a prevalence rate of depression of 19% [Beck Depression Inventory (BDI) > 13] among patients suffering of MS. It’s interesting to note how depressive symptoms were associated with worse self-reported functioning, with poor memory function and with weak sense of coherence (SOC) (referring to ‘‘general resistance resources’’ - capacities that facilitate coping with stressors). Moreover, the authors suggested to incorporate depressive symptoms or mental health as a standard parameter for assessment and follow-up in clinical MS management[ 26 ].

Data from the United Kingdom MS Register, those obtained directly from MS patients, confirmed a high rate of anxiety and depression: over half of the respondents (54.1%) reported anxiety and 46.9% reported a variable level of depression[ 27 ]. From this registry data were recently examined about the positive relationships between physical disability, anxiety and depression[ 28 ].

Other reports confirmed the need to recognize and treat, having widely effective treatments, several emotional disorders which may worsen functioning and quality of life, decrease treatment adherence, and increase risk of suicide[ 1 ].

The prevalence of depressive disorders is higher in MS patients than patients with other chronic disease, suggesting a possible direct effect of the illness on the pathogenesis of the depressive syndromes in addition to the reactive disorder. Some evidences suggested that depression in MS is largely biologically mediated by some of the same processes involved in the immunopathogenesis of this neurologic disease. In particular, the increase in proinflammatory cytokines, the activation of the hypothalamic-pituitary-adrenal axis, and the reduction in neurotrophic factors. Notwithstanding, depression and mood disorders still remain under-diagnosed and under-treated in neurological patients claiming for a bio-psychosocial model be used[ 29 - 32 ].

Music therapy

In last decades, a growing body of evidence in the use of musical intervention in clinical setting have been seen, concerning singing, music listening, musical improvisation, and other musical activities, as long as more structured music therapy (MT) treatments. Given that music engages a variety of brain areas involved in emotion, motivation, cognition, and motor functions, musical interventions have been used to increase socialization and cognitive, emotional, and neuromotor functioning[ 33 - 38 ]. Although the debate on what the boundaries of MT is still going on, different approaches of musical intervention are actually available referring to three principal domains: relational approaches, rehabilitative approaches and music listening.

Relational approaches refer to psychological models and involve both active and receptive techniques[ 39 , 40 ]. The former consist of different musical activities such as free or structured musical improvisation by means of simple musical instruments, singing, songwriting etc . that allow patient and therapist to directly interact building a musical relationship[ 41 ]. In receptive approaches music imagery and music listening are used to induce psychological beneficial effects and even to evoke and process emotions and thoughts[ 40 ].

Rehabilitative approaches, such as Neurologic Music Therapy (NMT)[ 42 ] refer to neuroscientific models and use primarily the potential of musical stimuli to activate perception and production areas in the human brain, providing a series of therapeutic applications to sensory, cognitive, and motor dysfunctions resulting from neurological disorders. Using directive approach based on a series of exercises, NMT may be used, for example, to improve gait and movements in post-stroke and PD patients[ 43 - 47 ] and language in persons with aphasia[ 48 , 49 ].

On the other hand, simple music listening interventions don’t require neither a specifically trained therapist nor a direct therapeutic relationship with the patient being that beneficial effects are induced by the content of the musical stimuli and by the activity of listening itself. For these reasons, this practice is sometimes defined with the term “Music Medicine” rather than “MT”[ 41 , 50 , 51 ]. Notwithstanding, listening interventions seem to be quite common in clinical literature, usually based on self-selected or other-selected music proposed individually[ 52 , 53 ] or in group, as in the case of background music[ 54 , 55 ].

As far as regard neurological disorders, MT may promote functional recovery and also improve social and psychological outcomes such as socialization, motivation, mood, and depression[ 56 ]. Literature in this field shows that most of the musical interventions are currently used in clinical practice, being that the majority of the interventions are based on a combination of rehabilitative and relational techniques. Also music listening seems to be a common practice in neurological rehabilitation. Due to the possible side effects of pharmacological treatment of depressive syndromes following neurological disease, music and MT may represent a valid support in reducing depressive symptoms, improving mood and adherence to treatment while contributing to the functional recovery at the same time.

PubMed and PsychInfo databases were considered for articles to include in the current narrative review. The research has been conducted by three independent reviewers using the following search terms: (“Music” OR “MT”) AND (name of pathology) AND (“Mood” OR “Depression”). Names of pathologies where used alone or in combination with “OR” Boolean operator and included: “Stroke”, “Parkinson”, “Dementia”, “Epilepsy”, “ALS”, “MS”, “Cerebral palsy”, “Neurological disease”, and “Acquired brain injury”.

We included only Randomized Controlled Trials (RCTs) or Clinical Controlled Trials (CCTs) studies in English language published in peer-reviewed journals between 1 st January 1997 and 31 st May 2014. Importantly, we considered only trials including outcomes concerning mood or depression where experimental conditions were clearly stated and consisted only or primarily of musical activities.

Assessments of methodological quality of selected studies have been provided using Jadad score[ 57 ]. Jadad scale is based on 7 items that evaluate three main characteristics of a clinical trial: the random assignment, the double-blinding of assessments, and the flow of participants. Scoring ranges from a minimum of 0 to a maximum of 5 points where a score of 3 indicates a good quality study. Being that 2 points on 5 are scored for double-blinding and none of the included studies had double-blinding assessment, the maximum possible score was 3. Even if it doesn’t take into account allocation concealment and has been criticized for placing too much emphasis on blinding[ 58 ], Jadad scale represents a simple, easy and common way to evaluate the methodological quality of a clinical trial with good validity and reliability[ 59 ]. Due to the heterogeneity of the outcomes, no meta-analysis was carried out.

DESCRIPTION OF SELECTED STUDIES

A total of 464 records resulted from the search of which 301 from PubMed and 163 from PsychInfo. Twenty-five articles that met the inclusion criteria have been found and were included in the current review. Most of the selected studies are related to dementia (44%) and stroke (36%) while others regard MS, ALS/motor neuron disease, PD, Chronic quadriplegia, and acquired brain dysfunctions (20%). Fourteen studies (56%) employed a relational approach including both active and receptive techniques, six studies (24%) adopted a rehabilitative approach, and five (20%) concerned music listening interventions. Activities were conducted by trained music therapists in the most part of the experimental interventions. As far as regard the methodological quality of included studies, our analysis showed that only nine on twenty-five (36%) of the included studies received a Jadad score of 3 and thus can be considered of good quality. Five studies (20%) had a Jadad score of 2, three studies (12%) a score 1, and eight studies (32%) were evaluated with a score of 0. Results of the methodological assessment pointed out a general poor rigor in research protocols.

In the following subsections, results are presented through a subdivision of the selected studies by pathology (Table (Table1, 1 , Table Table2, 2 , Table Table3 3 ).

Characteristics of the included studies concerning effects on dementia


Ashida[ ]	CCT (0)	20	Dementia	Playing percussion instruments and listening to live songs performed by the therapist	Music therapist	Five daily session of about 40 min each in a single week	CSDD	Significant reduction of depressive symptoms ( < 0.05)
Choi et al[ ]	CCT (1)	20	Dementia	Singing songs, analysis of libretto, making musical instruments, playing instruments, song drawing, and song writing	Music therapist	50 min, 3 times 1 wk for 5 wk (15 sessions)	MMSE, GDS, GQoL, NPI-Q	Positive trends for GDS and GQoL in music group. Improvements in BPDS ( = 0.004) and caregiver distress ( = 0.003)
Guètin et al[ ]	RCT (3)	30	Dementia (Alzheimer’s type)	Weekly sessions of individual, self selected music listening. Control group underwent reading sessions	Not specified therapist	Once 1 wk for 18 mo for 20 min	HRSD, GDS	Significant improvements in anxiety and depression ( < 0.01) in the music therapy group
Raglio et al[ ]	RCT (3)	20	Dementia	Active-intersubjective approach, based on sonorous-musical improvisation. Control group took part in educational and occupational activities without music	Music therapist	2 times a week for 15 wk for 30 min	ECG Holter, MMSE, ADAS-Cog test, NPI, ADL, IADL	Significant improvement of depression symptoms ( = 0.02) and increase of HRV ( = 0.013)
Cooke et al[ ]	RCT (3)	47	Dementia	Musician-led familiar song singing and music listening. Control group participated in reading sessions	Musicians	3 mornings 1 wk for 8 wk for 40 min	DQOL, GDS, MMSE	Not significant effects on GDS and QOL. Positive trends in music group at sub-analysis
Fischer-Terworth et al[ ]	CCT (0)	49	Dementia	Singing in group with the therapist, playing elementary musical instruments and listening to biographically relevant music. Control group participated in a nonspecific occupational therapy	Not specified	Once 1 wk for 6 mo for 45 min	NPI, ICEA-D, MMST, GDS	Depression decreased in both groups ( < 0.05). Improvements of NPI and ICEA-D ( < 0.01) in favor of music group No effects on mood. Improvements ( < 0.05) for MPI, MPD, attentional matrices
Ceccato et al[ ]	RCT (3)	50	Dementia	Cognitive and sensorial exercises associated with musical stimuli	Music therapist	2 times 1 wk for 12 wk for 45 min	NPI, MPD, ADL, SVAM, GMP, MMSE, CMAI, GDS	No effects on mood. Improvements (P < 0.05) for MPI, MPD, attentional matrices, ADL, SVAM, and GMP
Janata[ ]	RCT (3)	38	Dementia	Preferred music listening. Control group was incidentally exposed to the music programming in the course of daily life	Music therapist	Every day for 12 wk from 21 to 65 min	NPI, CMAI, CSDD, MMSE	Reduction of CSDD, NPI, and CMAI score in both groups ( < 0.0001)
Clemént et al[ ]	RCT (2)	14	Dementia (Alzheimer’s type)	Listening to music and playing hand-drums over recorded music. Control group underwent cooking activities. Both groups alternated receptive and productive phases	Psychologist with no musical experience	2 times 1 wk for 4 wk for 1 h	BEHAVE-AD, PSMS, SIB. EFE, Discourse contents and STAI-A	Short time effects of emotional indices ( < 0.05) and longer term effects of mood ( < 0.05) up to 4 wk after the end of the treatment
Narme et al[ ]	RCT (2)	48	Dementia	Listening to music, singing and playing percussion instruments. Control group took part in cooking activities. Both groups alternated receptive and productive phases	Psychologist with no musical experience	2 times 1 wk for 4 wk for 1 h	SIB, NPI, CMAI, MMST, EFE, Discourse contents and STAI-A	Both group improved in emotional state, NPI score, and professional caregiver distress at different evaluation periods ( < 0.05)
Chu et al[ ]	RCT (3)	104	Dementia	Song choice, music-prompted reminiscence, singing, music listening, and instrument playing	Music therapist	Two sessions per week for 6 wk for 30 min	C-CSDD, salivary cortisol, MMSE	Short time effects on depression ( < 0.001) and long time effects on cognition at 1 mo follow-up ( = 0.039)

ADAS-Cog: Alzheimer's Disease Assessment Scale-Cognitive Subscale; ADL: Activities of daily living; BEHAVE-AD: Behavioral Pathology in Alzheimer’s Disease Scale; CCT: Controlled Clinical Trial; CMAI: Cohen-Mansfield Agitation Inventory; CSDD: Cornell Scale for Depression in Dementia; C-CSDD: Chinese Cornell Scale for Depression in Dementia; DQOL: Dementia Quality of Life; ECG Holter: Electrocardiography Holter; GDS: Geriatric Depression Scale; GMP: Good Manufacturing Practice; GQoL: Geriatric Quality of Life; HRSD: Hamilton Rating Scale for Depression; IADL: Instrumental Activities of Dailiy Living; ICEA-D: Inventory to Asses Communication, Emotional Expression and Activity in Dementia; MMSE: Mini-Mental State Examination; NPI: Neuropsychiatric Inventory; NPI-Q: Neuropsychiatric Inventory Questionnaire; RCT: Randomized Controlled Trial; SVAM: Metacognition Assessment Scale.

Characteristics of the included studies concerning effects on stroke

		)
Purdie et al[ ]	RCT (0)	40	Stroke	Playing familiar or improvised music with the therapist by means of percussion instruments, synthesizers, or voice	Music therapist	Once a week for 12 sessions lasting 30-40 min each	FAST, HADS, MBRS, NRS	Positive trends in communication skills, behavior and psychological state in treatment group (not significant result)
Nayak et al[ ]	RCT (0)	18	Stroke or TBI	Singing, playing instruments, composing, improvising, listening	Music therapist	2 or 3 sessions a week during the hospitalization up to a maximum of 10 sessions	Face Scale, VAS, SIP, questionnaire	Positive trends in mood and significant improvements in social interaction ( < 0.02) and involvement in therapy ( < 0.01) in experimental group
Jeong et al[ ]	RCT (2)	33	Stroke	Rhythmic motor activity with music based on Rhythmic Auditory Stimulation (RAS) theory (Neurologic Music Therapy)	Instructors	One weekly session of 2 h for 8 wk	ROM, POMS, SS-QOL, exit interview	Improvement in mood states and interpersonal relationship, flexibility, and range of joint motion ( < 0.05)
Särkämö et al[ ]	RCT (3)	60	Stroke	Treatment group underwent preferred-music listening.A second group received self-selected audio book listening while a third control group had no listening material	Music therapists	Every day for 2 mo for 1 h (at minimum)	RBMT, WMS-R, BDAE, CERAD, Token test, BVRT, MBEA, FAB, POMS, SAQUOL-39	Improvements in depression ( = 0.024) and positive trends in confused mood with cognitive recovery (verbal memory and focused attention) in music listening group
Forsblom et al[ ]	RCT(3)	39	Stroke	Preferred music listening. Control group underwent audio-book listening	Music therapist	Every day for 2 mo for 1 h (at minimum)	Analysis of patient’s interviews	Improved mood, better relaxation, increased motor activity in music listening group ( < 0.0001)
Kim et al[ ]	CCT (0)	18	Stroke	Hello song and sharing of events in their lives (5 m), planned musical activities (30 m) and sharing feelings and goodbye song (5 m)	Not specified therapist	Twice a week for 4 wk for 40 min	BAI, BDI, questionnaire of satisfaction	Improvement in depression ( = 0.048) and positive trends for anxiety
Jun et al[ ]	RCT (2)	40	Stroke	Stretching exercises while listening to music, singing and/or playing songs on percussion instruments, and final verbalization	Researchers and music therapist	Three times per week for 8 wk for 60 min	ROM, K-MBI, K-POMS-B, CES-D	Improvements in mood states ( = 0.04) and increase in the degree of shoulder ( = 0.03) and elbow ( = 0.04) joint flexion
Chen et al[ ]	CCT (0)	19	Stroke	Self-selected individual listening in two different conditions: pleasant music and unpleasant music. A white noise condition acted as control	Not specified	1 session for each condition, separated by no more than 1 wk	VAS, HR, GSR, SCT, LBT, PST, visual task	Improvement of mood ( = 0.03) and arousal ( < 0.001) under pleasant music condition
Van Vugt et al[ ]	RCT (1)	28	Stroke	Play fingers exercises and children’s song on the piano	Music therapist	10 therapy sessions for 3/4 times a week for 30 min	9HPT, Finger tapping measurements, POMS	Reduction of depression ( = 0.002) and fatigue ( = 0.02) and improvement in the synchronization tapping ( < 0.05)

Characteristics of the included studies concerning effects on other neurological disorders

		)
Pacchetti et al[ ]	RCT (2)	32	Parkinson’s Disease	Relaxing music, choral singing, breathing/voice exercises, rhythmic movements, collective improvisation, body expression to music. Control group underwent specific motor exercises	Music therapist	Once a week for 3 mo for 2 h,	HM, MS, PDQL, UPDRS	Improvement in emotional ( < 0.0001) and motor ( < 0.034) functions, activities of daily living, and quality of life ( < 0.0001)
Schmid et al[ ]	RCT (0)	20	Multiple Sclerosis	Active role of both patient and music therapist on playing instruments or singing (Nordoff-Robbins approach)	Music therapist	3 blocks of individual sessions (8 to 10 sessions per block) over the course of 1 yr	BDI, HADS, SESA, HAQUAMS, MSFC	Not significant differences between groups but medium effect size on depression ( = 0.63), self esteem ( = 0.54), and anxiety ( = 0.63)
Thaut et al[ ]	CCT (0)	54	Acquired brain dysfunctions	Group improvisation, singing, synchronization, attention, and memory exercises with music (Neurologic Music Therapy). Control group spent an equal amount of time resting	Music therapist	4 group sessions on different days for 30 min each	WAIS-III, AVLT, TMT-B, BSI-18, MAACL, SEQ	Improvements on depression ( = 0.02), anxiety ( = 0.04), sensation seeking ( < 0.01), and executive functions (mental flexibility) ( < 0.01)
Horne-Thompson et al[ ]	CCT	21	ALS/Motor neuron disease	Music relaxation, playing/singing familiar songs, and music and imagery. A second group received a listening intervention of self-selected music while a third control group underwent activities such as reading or watching TV	Music therapist	3 d per week for 30 min each condition	HADS, ESAS, HR, oxygen saturation levels	No effect was found on depression, anxiety, heart rate, and oxygenation levels between groups
Tamplin et al[ ]	RCT (3)	24	Chronic Quadriplegia	Oral motor and respiratory exercises and therapeutic singing (Neurologic Music Therapy). Control group received group music appreciation and relaxation	Not specified	3 times weekly for 12 wk for 1 h	Standard respiratory function testing, EMG, PVP, POMS, AQoL	Both groups improved in mood ( = 0.002). The singing group showed positive effects on arousal ( = 0.006), speech intensity ( = 0.028), and maximum phonation length ( = 0.007)

HM: Happiness Measure; MS; Motor Subscale; PDQL: Parkinson's Disease Quality of Life Questionnaire; UPDRS: Unified Parkinson’s Disease Rating Scale; BDI: Beck Depression Inventory; HADS: Hospital Anxiety and Depression Scale; SESA: Self-Acceptance Scale; HAQUAMS: Hamburg Quality of Life Questionnaire in Multiple Sclerosis; MSFC: Multiple Sclerosis Functional Composite; WAIS-III: Wechsler Adult Intelligence Scale-III; AVLT: Auditory Verbal Learning Test; TMT-B: Trial Making Test Part B; BSI-18: Brief Symptoms Inventory-18; MAACL: Multiple Affect Adjective Check List; SEQ: Self Efficacy Questionnaire; HADS: Hospital Anxiety and Depression Scale; ESAS: Edmonton Symptom Assessment System; HR: Heart Rate; EMG: Electromyogram; PVP: Perceptual Voice Profile; POMS: Profile of Mood State; AQoL: Assessment of Quality of Life.

Effects on dementia

Eleven studies assessed the effects of music and MT on dementia[ 60 - 70 ]. Eight studies employed a relational approach[ 60 - 61 , 63 - 65 , 68 - 70 ] based either on active or receptive techniques or a combination of both of them. Two studies concerned music listening interventions[ 62 , 67 ] and one study adopted a rehabilitative approach[ 66 ]. In most cases the results show a positive effect on mood, depression, and anxiety. Two studies revealed no significant effect of musical intervention[ 64 , 66 ] while in three studies both experimental and control group improved emotional and behavioral functioning in the same way[ 65 , 67 , 69 ]. Characteristics of the studies and main results have been summarized in Table Table1 1 .

Effects on stroke

Nine studies assessed the effects of music or MT on post-stroke patients[ 71 - 79 ]. Four of them were based on a relational approach[ 71 , 72 , 76 , 77 ], three regarded music listening interventions[ 74 , 75 , 78 ], and two used a rehabilitative approach[ 73 , 79 ]. All studies show a positive effect of music or MT on mood in patients with Stroke. For a synthesis of studies and results please see Table Table2 2 .

Effects on other neurological disorder

Five studies concerning other neurological disorders such as MS, ALS/motor neuron disease, PD, Chronic quadriplegia, and Acquired Brain dysfunctions, have been found[ 80 - 84 ]. Three studies concerned a rehabilitative approach[ 80 , 82 , 84 ] and two studies adopted a relational approach using an active technique[ 81 ] or both active and receptive techniques depending on what the therapist deemed appropriate in consultation with the patient[ 83 ]. All studies but one[ 83 ] reported positive effects of music and MT on outcomes as mood, depression, anxiety, and quality of life. Characteristics of the studies and main results have been summarized in Table Table3 3 .

In the last few decades, the development of neuroscience demonstrated that the brain isn't a static structure only influenced by genetic determinants but it is a plastic organ that continuously reorganizes synaptic connections under the influence of inner and outer factors such as genetic programs, environmental stimulation, learning and expertise[ 85 - 87 ].

Neurological illnesses that provoke behavioral disturbances might originate from both endogenous and external causal factors thus determining, depending on the circumstances, a more “structural” or a more “environmental” etiology. The mutual interaction between these factors occurs in the brain and gives rise to a variety of psychiatric disorders that can be distributed upon a continuum, on one end of which are behavioral disturbances clearly linked to neuroanatomic and neurochemical alterations while on the opposite those more associated to the environment.

Synaptic functions and neuroanatomic structures are proper “organic” factors that determine those alterations that are usually treated by neuropsychiatry and biological psychiatry. Behavioral disorders resulting from these factors include psychiatric syndromes that are linked to alterations of the neural transmission caused by receptor’s abnormalities and by modifications of the synaptic concentrations of one or more neurotransmitters. Given that neurotransmitters regulate the neural impulse transmission processes into neurotransmitter systems, with a widespread projection in the brain, the whole emotional, motivational, and affective state of the person will be altered[ 88 , 89 ].

External causal factors related to the environment may promote and characterize those behavioral disorders that are commonly counted accordingly to a bio-psychosocial model and interfere with the cognitive and emotional state of the person thus inducing an important change in the quality of the inter-individual relationships. These disorders may be considered as a reaction to the physical disability and the psycho-social difficulties produced by the disease but also as an adjustment disorder if we consider the impact of the diagnosis on patient’s life, or the weight of a chronic illness and all the other factors that may affect patient’s quality of life[ 90 - 92 ].

Depressive syndromes in chronic neurological illness are common and disabling. Their etiology is complex and may be multifactorial. Good history taking and detailed examination of physical and mental state (including cognitive function) will usually reveal the diagnosis and the formulation.

Providing a correct diagnosis of an emotional disorder and starting an appropriate treatment may help physicians to increases in function and quality of life of their neurological patients[ 93 ].

The current review showed how MT and musical interventions can improve mood and psychological well-being in neurological patients. These clinical results are in accordance with the literature that highlights the effects that music listening and music making have on brain structures of emotion regulation[ 36 ], on various neurochemical systems[ 38 ], and on neural plasticity[ 94 , 95 ]. However, the strength of this review’s findings is limited due to a generally poor methodological quality of the studies and the restricted size of samples. Moreover, the heterogeneity of the outcomes prevented any meta-analysis. Notwithstanding, the analysis of the 25 RCTs or CCTs included in this work points out a positive effect of interventions with music on psychosocial outcomes such as mood, depression, and quality of life when compared to standard care or other treatments.

Music-based activities can represent a valid and without side effects intervention for reducing psychological and behavioral disturbances related to neurological disorders and also for promoting the functional recovery. Specifically, the most significant results of the music interventions on the psychological side can be identified in the aspects more closely related to mood, especially in the reduction of the depressive and anxiety's component, and in the improvement of the emotional expression, communication and interpersonal skills, self esteem and quality of life. As revealed in advance, the efficacy of music and MT interventions could be explained by different points of view. From the neurochemistry point of view we know that music can activate limbic and paralimbic structures, such as the amygdala, the hippocampus, the nucleus accumbens, etc. that function abnormally in patients with a high depressive component. At the psychological level music can engage several social functions, can increase communication and social cohesion and can promote empathetic relationships, especially in the active MT approaches. Finally, from the rehabilitative point of view, making music can involve and influence motor areas functioning and regulation. This effect appears to be connected to the pleasure and thereby can positively affect the mood and consequently the rehabilitative process[ 36 - 38 ].

In conclusion, a more methodological rigor and a clearer definition of music approaches are needed to improve the quality of MT research and to focus on the specific role of music-based interventions in psychological symptoms in the field of neurology.

P- Reviewer: Boehm K, Mishra J S- Editor: Ji FF L- Editor: A E- Editor: Lu YJ

Conflict-of-interest: The Authors have not any competing interests to declare and no funding was received for this research.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Peer-review started: September 28, 2014

First decision: December 17, 2014

Article in press: February 11, 2015

COMMENTS

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