1.(MeSH)The use of music as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders.
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Music Therapy (n.) [MeSH]
Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health. Music therapists primarily help clients improve their health across various domains (e.g., cognitive functioning, motor skills, emotional and affective development, behavior and social skills, and quality of life) by using music experiences (e.g., free improvisation, singing, songwriting, listening to and discussing music, moving to music) to achieve treatment goals and objectives. It is considered both an art and a science, with a qualitative and quantitative research literature base incorporating areas such as clinical therapy, biomusicology, musical acoustics, music theory, psychoacoustics, embodied music cognition, aesthetics of music, and comparative musicology. Referrals to music therapy services may be made by other health care professionals such as physicians, psychologists, physical therapists, and occupational therapists. Clients can also choose to pursue music therapy services without a referral (i.e., self-referral).
Music therapists are found in nearly every area of the helping professions. Some commonly found practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence/orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke victims. Music therapy is also used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities.
The Turco-Persian psychologist and music theorist al-Farabi (872–950), known as "Alpharabius" in Europe, dealt with music therapy in his treatise Meanings of the Intellect, where he discussed the therapeutic effects of music on the soul. Robert Burton wrote in the 17th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia.
Music has been used as a healing force for centuries. Music therapy goes back to biblical times, when David played the harp to rid King Saul of a bad spirit. As early as 400 B.C., Hippocrates, Greek father of medicine, played music for his mental patients. Aristotle described music as a force that purified the emotions. In the thirteenth century, Arab hospitals contained music-rooms for the benefit of the patients. In the United States, Native American medicine men often employed chants and dances as a method of healing patients. Music therapy as we know it began in the aftermath of World Wars I and II. Musicians would travel to hospitals, particularly in the United Kingdom, and play music for soldiers suffering from war-related emotional and physical trauma.
Approaches used in music therapy that have emerged from the field of education include Orff-Schulwerk (Orff), Dalcroze Eurhythmics, and Kodaly. Two models that developed directly out of music therapy are Nordoff-Robbins and the Bonny Method of Guided Imagery and Music.
Music therapists may work with individuals who have behavioral-emotional disorders. To meet the needs of this population, music therapists have taken current psychological theories and used them as a basis for different types of music therapy. Different models include behavioral therapy, cognitive behavioral therapy, and psychodynamic therapy.
One therapy model based on neuroscience, called "neurological music therapy" (NMT), is "based on a neuroscience model of music perception and production, and the influence of music on functional changes in non-musical brain and behavior functions." In other words, NMT studies how the brain is without music, how the brain is with music, measures the differences, and uses these differences to cause changes in the brain through music that will eventually affect the client non-musically. As one researcher, Dr. Thaut, said: "The brain that engages in music is changed by engaging in music." NMT trains motor responses (i.e. tapping foot or fingers, head movement, etc.) to better help clients develop motor skills that help "entrain the timing of muscle activation patterns".
Two common approaches are used when conducting music therapy with children: either as a one-on-one session or in a group setting. When a therapist meets with a child for the first time, customarily the therapist and child develop goals to be met during the duration of their sessions. Music therapy can help children with communication, attention, motivation, and behavioral problems. Therapy rooms should have a wide range of different instruments from different places. They should also be colorful, and have different textures. The therapist should either play a piano or guitar to keep everything grounded and in rhythm. The most important thing, though, is to have high quality and well-maintained instruments. As some children will be able to handle an instrument while others cannot, the child should be given an instrument adapted to them. All these elements help the experience and outcome of the music therapy go better and have more successes for the child. In fact according to Daniel Levitin, it started inside the womb, surrounded by amniotic fluid, the fetus hears sounds. It hears the mother’s heartbeat, at times speed up, at other times slow down, not only that but other music, conversations, and environmental noises. Alexandra Lamont of Keele University in the UK discovered the fetus hears music. She found that, a year after they are born, children recognize and prefer music they were exposed to in the womb. The auditory system of the fetus is fully functional about twenty weeks after conception.
According to the Mayo Health Clinic , out of every 100,000 adolescents, two to three thousand will have mood disorders, out of which 8-10 will commit suicide. Two prevalent mood disorders in the adolescent population are clinical depression and bipolar disorder.
On average American adolescents listens to approximately 4.5 hours of music per day and are responsible for 70% of pop music sales. Now with the invention of new technologies, such as the iPod and digital downloads, access to music has become easier than ever. As children make the transition into adolescence they become less likely to sit and watch TV, an activity associated with family, and spend more of their leisure time listening to music, an activity associated with friends.
Adolescents have identified many benefits of listening to music, including emotional, social, and daily life benefits, along with the formation of one’s own identity. Music can provide a sense of independence and individuality, which in turn contributes to one’s own self discovery and sense of identity. Music also offers adolescents with relatable messages that allow him/her to take comfort in knowing that others feel the same way they do. It can also serve as a creative outlet to release or control emotions and find ways of coping with difficult situations. Music can improve one's mood by reducing stress and lowering anxiety levels, which can help counteract or prevent depression. Music education programs provide adolescents with a safe place to express themselves and learn life skills such as self-discipline, diligence, and patience. These school programs also promote confidence and self esteem. Ethnomusicologist Alan Merriam (1964) once stated that music is a “universal behavior;” it is something that everyone can identify with. Among adolescents, music is a unifying force, bringing people of different backgrounds, age groups, and social groups together.
Adolescents may listen to music for its therapeutic qualities, but that does not mean every adolescent needs music therapy. Many adolescents may go through a period of teenage angst, characterized by intense feelings of strife, caused by the development of their brains and bodies. Some adolescents can also develop more serious mood disorders such as major clinical depression and bipolar disorder. Adolescents diagnosed with a mood disorder may be referred to a music therapist based on observations by the diagnosing physician, therapist, or school counselor/teacher. When a music therapist gets a referral it is important to first assess the patient and create goals and objectives for him/her before beginning the actual music therapy. According to the American Music Therapy Association Standards of Clinical Practice assessments should include the “general categories of psychological, cognitive, communicative, social, and physiological functioning focusing on the client’s needs and strengths…and will also determine the client’s response to music, music skills, and musical preferences”  The result of the assessment is used to create an individualized music therapy intervention plan.
There are many different music therapy assessment tools, but one particularly suited to adolescents is the “Music Therapy Assessment for Emotionally Disturbed Children.”,. The term “emotionally disturbed children” refers to a diverse group of diagnoses including behavioral disorders, schizophrenia, affective/mood disorders, autism, anxiety disorders, and attachment disorders. This assessment concentrates not only on the facts of developmental skills but on the quality, content, and development of these affective behaviors. This music therapy assessment tool consists of seven main areas. The assessment starts with an interview with the patient regarding his/her, and their family’s, previous background in music. Next, the music therapist is to assess developmental appropriateness of the patient’s social and emotional functioning while in the music therapy setting, and then assess the patient’s ability to organize his/her musical experience. An important part of the assessment is to follow the changes in musical behaviors exhibited by the patient over the course of the session, and find any possible meanings in these variations. While interpreting the patient’s musical behavior, the music therapist must consider family history, current behavioral problems, affective developmental levels, and the patient’s current diagnosis. Last, the music therapist must investigate musical responses characteristic of the patient’s particular pathology.
Another assessment tool for adolescents is the Beech Brook Music Therapy Assessment . This assessment measures the patient’s behavioral and social functioning, emotional responsiveness, language and communication skills, and musical skills. Beech Brook, a child oriented treatment facility in Cleveland, Ohio, designed this assessment to help evaluate children beginning music therapy and then throughout the music therapy process, and focuses more on the reasons for referral than the previously mentioned assessment. This assessment uses a quantitative numbered scoring system in which the total score indicates an overall trend of behavior exhibited by a client. Both of these assessment tools help the music therapist plan the client’s treatment process and also establish credibility though accountability.
There are many different music therapy techniques used with adolescents. The music therapy model is based on various theoretical backgrounds such as psychodynamic, behavioral, and humanistic approaches. Techniques can be classified as active vs. receptive and improvisational vs. structured. The most common techniques in use with adolescents are musical improvisation, the use of precomposed songs or music, receptive listening to music, verbal discussion about the music, and the use of creative media outlets incorporated into the music therapy. Research also showed that improvisation and the use of other media were the two techniques most often used by the music therapists. The overall research showed that adolescents in music therapy “change more when discipline-specific music therapy techniques, such as improvisation and verbal reflection of the music, are used.” The results of this study showed that music therapists should put careful thought and deliberation into their choice of technique with each individual client. In the end, those choices can effect the positive or negative outcomes of music therapy treatment.
To those unfamiliar with music therapy the idea may seem a little strange, but music therapy has been found to be as effective as traditional forms of therapy. In a meta-analysis of the effects of music therapy for children and adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at 10 previous studies conducted between 1970 and 1998 to examine the overall efficacy of music therapy on children and adolescents with psychopathology, which can be broken down into three distinct categories: behavioral disorders, emotional disorders, and developmental disorders. The results of the meta-analysis found that “music therapy with these clients has a highly significant, medium to large effect on clinically relevant outcomes.” More specifically, music therapy was most effective on subjects with mixed diagnoses. Another important result was that “the effects of music therapy are more enduring when more sessions are provided.” 
Music therapists work with these adolescents on increasing emotional and cognitive stability, identifying contributing factors of current distress, and initiating changes to alleviate that distress. Music therapy may also focus on improving quality of life and building self-esteem, a sense self-worth, and confidence. Improvements in these areas can be measured by a number of tests, including qualitative questionnaires like Beck’s Depression Inventory, State and Trait Anxiety Inventory, and Relationship Change Scale. Effects of music therapy can also be observed in the patient’s demeanor, body language, and changes in awareness of mood.
Group meetings and one-one sessions are two main methods for music therapy. Group music therapy can include group discussions concerning moods and emotions in/to music, songwriting, and musical improvisation. Groups emphasizing mood recognition and awareness, group cohesion, and improvement in self-esteem can be effective in working with adolescents. Group therapy, however, is not always the best choice for the client. Ongoing one-on-one music therapy has also been shown to be effective. One-on-one music therapy provides a non-invasive, non-judgmental environment, encouraging clients to show capacities that may be hidden in group situations.
Though more research needs to be done of the effect of music therapy on adolescents with mood disorders, most research has been finding positive effects.
Music has been shown to affect portions of the brain. Part of this therapy is the ability of music to affect emotions and social interactions. Research by Nayak et al. showed that music therapy is associated with a decrease in depression, improved mood, and a reduction in state anxiety. Both descriptive and experimental studies have documented effects of music on quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization. Additionally, Nayak et al. found that music therapy had a positive effect on social and behavioral outcomes and showed some encouraging trends with respect to mood.
More recent research suggests that music can increase patient's motivation and positive emotions. Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly. Therefore, it is hypothesized that music therapy helps stroke victims recover faster and with more success by increasing the patient's positive emotions and motivation, allowing them to be more successful and driven to participate in traditional therapies.
Recent studies have examined the effect of music therapy on stroke patients, when combined with traditional therapy. One study found the incorporation of music with therapeutic upper extremity exercises gave patients more positive emotional effects than exercise alone. In another study, Nayak et al. found that rehabilitation staff rated participants in the music therapy group were more actively involved and cooperative in therapy than those in the control group. Their findings gave preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation.
Current research shows that when music therapy is used in conjunction with traditional therapy, it improves rates of recovery and emotional and social deficits resulting from stroke. A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. Thirty-three stroke survivors were randomized into one of two groups: the experimental group, which combined rhythmic music and specialized rehabilitation movement for eight weeks; and a control group that sought and received traditional therapy. The results of this study showed that participants in the experimental group gained not only more flexibility and wider range of motion, but an increased frequency and quality of social interactions and positive mood.
Music has proven useful in the recovery of motor skills. Rhythmical auditory stimulation in a musical context in combination with traditional gait therapy improved the ability of stroke patients to walk. The study consisted of two treatment conditions, one which received traditional gait therapy and another which received the gait therapy in combination with the rhythmical auditory stimulation. During the rhythmical auditory stimulation, stimulation was played back measure by measure, and was initiated by the patient's heel-strikes. Each condition received fifteen sessions of therapy. The results revealed that the rhythmical auditory stimulation group showed more improvement in stride length, symmetry deviation, walking speed and rollover path length (all indicators for improved walking gait) than the group that received traditional therapy alone.
Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods. In this experiment, researchers recruited stroke patients without prior musical experience and trained half of them in an intensive step by step training program that occurred fifteen times over three weeks, in addition to traditional treatment. These participants were trained to use both fine and gross motor movements by learning how to use the piano and drums. The other half of the patients received only traditional treatment over the course of the three weeks. Three-dimensional movement analysis and clinical motor tests showed participants who received the additional music therapy had significantly better speed, precision, and smoothness of movements as compared to the control subjects. Participants who received music therapy also showed a significant improvement in every-day motor activities as compared to the control group. Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca's aphasia. In this study, thirty novel phrases were taught in three conditions: unrehearsed, rehearsed verbal production (repetition), or rehearsed verbal production with melody (MIT). Results showed that phrases taught in the MIT condition had superior production, and that compared to rehearsal, effects of MIT lasted longer.
Another study examined the incorporation of music with therapeutic upper extremity exercises on pain perception in stroke victims. Over the course of eight weeks, stroke victims participated in upper extremity exercises (of the hand, wrist, and shoulder joints) in conjunction with one of the three conditions: song, karaoke accompaniment, and no music. Patients participated in each condition once, according to a randomized order, and rated their perceived pain immediately after the session. Results showed that although there was no significant difference in pain rating across the conditions, video observations revealed more positive affect and verbal responses while performing upper extremity exercises with both music and karaoke accompaniment. Nayak et al. examined the combination of music therapy with traditional stroke rehabilitation and also found that the addition of music therapy improved mood and social interaction. Participants who had suffered traumatic brain injury or stroke were placed in one of two conditions: standard rehabilitation or standard rehabilitation along with music therapy. Participants received three treatments per week for up to ten treatments. Therapists found that participants who received music therapy in conjunction with traditional methods had improved social interaction and mood.
According to a 2009 Cochrane review of 23 clinical trials, it was found that some music may reduce heart rate, respiratory rate, and blood pressure in patients with coronary heart disease. Benefits included a decrease in blood pressure, heart rate, and levels of anxiety in heart patients. However, the effect was not consistent across studies, according to Joke Bradt, PhD, and Cheryl Dileo, PhD, both of Temple University in Philadelphia. Music did not appear to have much effect on patients' psychological distress. "The quality of the evidence is not strong and the clinical significance unclear", the reviewers cautioned. In 11 studies patients were having cardiac surgery and procedures, in nine they were MI patients, and in three cardiac rehabilitation patients. The 1,461 participants were largely white (average 85%) and male (67%). In most studies, patients listened to one 30-minute music session. Only two used a trained music therapist instead of prerecorded music.
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Research suggests that listening to Mozart's piano sonata K448 can reduce the number of seizures in people with epilepsy. This has been called the "Mozart effect." However, in recent times, the validity of the "Mozart Effect" and the studies upon which the theory is based have been questioned, due to reasons such as the limitations in the original study and the failure to replicate the effects of Mozart's music in subsequent studies.
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Music therapist, music researcher, and composer Enrico Curreri clinically explored theories and concepts developed by the American composer John Cage. For example, in various music therapy sessions with a patient diagnosed with depression and anxiety disorder, Curreri performed Cage's seminal composition of silence 4′33″ and utilized aleatoric/chance procedures, as well as investigated experimental and microtonal music.
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In Australia in 1949, music therapy (not clinical music therapy as understood today) was started through concerts organized by the Australian Red Cross along with a Red Cross Music Therapy Committee Key Australian body, AMTA, [http://www.austmta.org.au/about/our-history/ Australian Music Therapy Association, founded on 1975.
Music therapy has existed in its common current form in the United States since around 1944, when the first undergraduate degree program in the world was founded at Michigan State University and the first graduate degree program at the University of Kansas. The American Music Therapy Association (AMTA) was founded in 1998 as a merger between the National Association for Music Therapy (NAMT, founded in 1950) and the American Association for Music Therapy (AAMT, founded in 1971). Numerous other national organizations exist, such as the Institute for Music and Neurologic Function, Nordoff-Robbins Center For Music Therapy, and the Association for Music and Imagery. A music therapist may use ideas or concepts from different disciplines such as speech/language, physical therapy, medicine, nursing, education, etc.
A music therapy degree candidate can earn an undergraduate, masters or doctoral degree in music therapy. Many AMTA approved programs offer equivalency and certificate degrees in music therapy for students that have completed a degree in a related field. Some practicing music therapists have held PhDs in non-music-therapy (but related) areas, but more recently Temple University has founded a PhD program specifically in music therapy. A music therapist will typically practice in a manner that incorporates music therapy techniques with broader clinical practices such as psychotherapy, rehabilitation, and other practices depending on client needs. Music therapy services rendered within the context of a social service, educational, or health care agency can be reimbursable by insurance and sources of funding for individuals with certain needs. Music therapy services have been identified as reimbursable under Medicaid, Medicare, private insurance plans and other services such as state departments and government programs.
A degree in music therapy requires proficiency in guitar, piano, voice, music theory, music history, reading music, improvisation, as well as varying levels of skill in assessment, documentation, and other counseling and health care skills depending on the focus of the particular university's program. To become board certified, a music therapist must complete a music therapy degree from an accredited AMTA program at a college or university, successfully complete a music therapy internship, and pass the Board Certification Examination in Music Therapy. The credential, Music Therapist-Board Certified (MT-BC) is granted by The Certification Board for Music Therapists (CBMT), upon successful passage of the Board Certification Examination. A music therapist may also hold the designations CMT (Certified Music Therapist), ACMT (Advanced Certified Music Therapist), or RMT (Registered Music Therapist)—initials which were previously conferred by the now-defunct AAMT and NAMT, and which will remain legitimate until 2020. To maintain the credential, either 100 units of continuing education must be completed every five years, or the board exam must be retaken near the end of the five year cycle. The units claimed for credit fall under the purview of The Certification Board for Music Therapists to assure continued competence in music therapy. Many states recognize the professional status of Music Therapists. As of June, 2011, the State of Nevada recognized and has provided legislation adding Music Therapy as an obtainable license in the state which can now be obtained through the state board of health.
Live music was used in hospitals after both of the World Wars, as part of the regime for some recovering soldiers. Clinical music therapy in Britain as it is understood today was pioneered in the 60s and 70s by French cellist Juliette Alvin, whose influence on the current generation of British music therapy lecturers remains strong. Mary Priestley, one of Juliette Alvin's students, came to discover/create "analytical music therapy". Analytical music therapy is a form of music therapy which together with the Nordoff-Robbins School of Music Therapy, form the two central forms of music therapy used today. Mary Priestley's books Music Therapy in Action, first published by Constable and company ©1975 (ISBN 0-09-459900-9) and Essays on Analytical Music Therapy, Barcelona Publishers ©1994 (ISBN 0-9624080-2-6) form part of the core course work for students of analytical music therapy all over the world.
The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s. It is grounded in the belief that everyone can respond to music, no matter how ill or disabled. The unique qualities of music as therapy can enhance communication, support change, and enable people to live more resourcefully and creatively. Nordoff-Robbins now run music therapy sessions throughout the UK, US, South Africa, Australia and Germany. Its headquarters are in London where it also provides training and further education programs, including the only PhD course in music therapy available in the UK. Music therapists, many of whom work with an improvisatory model (see Clinical improvisation), are active particularly in the fields of child and adult learning disability, but also in psychiatry and forensic psychiatry, geriatrics, palliative care and other areas.
Practitioners are registered with the Health Professions Council and from 2007 new registrants must normally hold a master's degree in music therapy. There are masters level programs in music therapy in Bristol, Cambridge, Cardiff, Edinburgh and London, and there are therapists throughout the UK. The professional body in the UK is the Association of Professional Music Therapists while the British Society for Music Therapy is a charity providing information about music therapy.
In 2002, the World Congress of Music Therapy was held in Oxford, on the theme of Dialogue and Debate. In November 2006, Dr. Michael J. Crawford and his colleagues again found that music therapy helped the outcomes of schizophrenic patients. In 2009, he and his team were researching the usefulness of improvisational music in helping patients with agitation and also those with dementia.
Research has shown that in many parts of Africa during male and female circumcision, bone setting, or traditional surgery and bloodletting, lyrical music related to endurance has been used to reduce anticipated pain, therapeutically. In 1999, the first program for music therapy in Africa opened in Pretoria, South Africa. Research has shown that in Tanzania patients can receive palliative care for life-threatening illnesses directly after the diagnosis of these illnesses. This is different from many Western countries, because they reserve palliative care for patients who have an incurable illness. Music is also viewed differently between Africa and Western countries. In Western countries and a majority of other countries throughout the world, music is traditionally seen and used for entertainment purposes. Whereas in many African cultures, music is used in recounting stories, celebrating life events, or sending messages.
In a study done in 2003, 20 Scottish patients and 24 Kenyan patients, all having advanced cancers, were asked questions of their experiences, needs and available services. It was found that the Scottish patients and their caregivers thought the emotional pain of facing death was the prime concern. Whereas, in the Kenyan patients and their caregivers, they were most worried about physical pain and financial problems.
In Tanzania, music has strong associations with faith and lifestyle. For instance, Taraab music of Zanzibar is associated with Moslem recreational music. Christian churches are associated with European hymns. Weddings are interestingly enough associated with brass bands and drums are associated with traditional celebrations. Finally, clubs and bars are associated with dance music.
Tanzanian people varied in the type of music to be used in different circumstances, such as for pain. In a study taken by 17 Tanzanian palliative care participants, two people said they would not use music for patients in pain because of the belief that it could raise the patient's blood pressure and make it worse. The rest of the participants agreed that music would help decrease pain in patients, but they did not know if certain forms of music were better than others in decreasing pain. In this same study, four participants believed that the most helpful form of music would be one that the patient chose as their favorite. Another person believed that music videos could be beneficial because it would use both sound and vision as a distraction for patients. The final 12 participants believed that joyful, up-beat songs would help the patients more, especially if they were having difficulties with loneliness and depression or despair.
In Tanzanian cultures, music without lyrics does not have a lot of meaning, due to most music in Tanzania being used to bring about a message.
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Ethnomusicology is the study of music in its cultural context, or the anthropology of music.
But to leave all declamatory speeches in praise of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against  despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in  Philostratus, when Apollonius was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban,  Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith  Bodine, that are troubled with St. Vitus's Bedlam dance. 
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