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On the Neural Mechanisms of Music

Therapy in Mental Health Care: Literature

Review and Clinical Implications
ALEXANDER W.LEGGE, MMT Columbia Comprehensive Epilepsy Center

ABSTRACT: This article reviews literature from various disciplines in contexts can lead to a contagious effect; consider the slow,
order to provide a conceptual framework for the neural mechanisms soft voice of a violin and emotions linked to slow, soft speech.
of music therapy in mental health treatment. Literature on the neuro- Fourth, music can lead to new mental imagery. Fifth, music
biology of music-mediated emotion reveals distinct roles of several
anatomical structures and neurotransmitters, many of which are also
can also conjure episodic memories, or old mental imagery.
implicated in mental health disorders. Musics impact on these neu- Sixth, features of musical syntax can mediate emotions through
ral correlates is dependent upon several factors, such as harmonic musical expectancy, such as a chord progression without har-
structure, autobiographical relevance, the presence of multimodal monic resolution. Finally, the presence of music can directly
stimuli, and level of music training. Music is also capable of activat- affect personal/therapeutic goals of any listener, such as the
ing specific neural networks through either music listening or active sound of sedative music helping someone fall asleep.
music-making, with distinct networks involved in different types of
Juslin and Vstfjlls (2008) model provides a psychological
musical experiences. This article explores the neurobiological basis
of music-induced emotion associated with each of the four types of foundation for music-induced emotions. However, it does not
music therapy experiencesreceptive, re-creative, improvisational, account for emotional processes that uniquely affect active
and compositional. Clinical implications for music therapists in men- music-making or the interpersonal emotional possibilities of
tal health settings are discussed. Music is also a known modulator group/dyad music therapy. Nor does it explain (or attempt to
of the neurochemistry of trust and social affiliation, highlighting its explain) the connections between music-induced emotions
ability to help establish therapeutic connections. Relevant literature and non-musical components of therapeutic practice, such as
is examined regarding the neural mechanisms of effective music ther-
verbal processing and the client-therapist relationship.
apy and psychotherapy interventions in mental health treatment.
Similarly, the neurobiology literature is primarily focused on
emotional mechanisms during music listening, although some
investigators have also explored active music-making. Chanda
Introduction and Levitin (2013) summarize evidence that demonstrates
How can music therapy contribute to emotional health how music can influence neurochemistry in four ways. First,
from a neurobiological perspective? Musics role in mediating music listening has been shown to affect neurotransmission
emotions has been investigated for decades by researchers in in the brains reward pathways. Second, music can influence
psychology, neuroscience, and music therapy, among other hormonal levels via the hypothalamic-pituitary axis. Listening
disciplines. However, many questions remain largely unan- to relaxing music, for instance, has been shown to decrease
sweredparticularly those related to the potential of music blood levels of cortisola marker for stress. There is also evi-
to promote healthy emotion regulation. This is especially rel- dence for decreased cortisol following music therapy inter-
evant to music therapists in mental health settings. ventions, such as Guided Imagery and Music (Burns, 1999;
Psychology researchers have already provided models to McKinney, Antoni, Kumar, Tims, & McCabe, 1997). Third,
help understand the connection between music and emotions. Chanda and Levitin cite drum circle studies that have shown
Juslin and Vstfjll (2008) describe seven ways in which musi- increased immunological measures among participantssuch
cal stimuli can induce emotions. First, musical elements can as increased natural killer T-cells and 5-DHA-to-cortisol ratio
trigger brainstem reflexes related to survival mechanisms. For (Bittman etal., 2001). Fourth and finally, the authors describe
instance, a fast tempo or a surprisingly loud sound might cause evidence of musics impact on hormones related to social affili-
arousal. Second, music that is repeatedly paired with positive ation (to be addressed further herein). Although their literature
or negative stimuli can be classically conditioned to induce review does not focus specifically on music-induced emotions
emotions. Third, features of music that mimic other emotional or mental health treatment settings, the biological mechanisms
they discuss have applications in both of these realms.
Within the body of music therapy literature, researchers
have repeatedly demonstrated that music-based interventions
Alexander Legge recently earned his MMT from Loyola University in New Orleans,
completing his internship at Beth Abraham nursing home and rehabilitation center can affect emotional patterns in individuals receiving men-
in New York City. He is currently coordinating research at Columbia Universitys tal health treatment (Bensimon, Amir, & Wolf, 2008; Bloch,
Comprehensive Epilepsy Center and will be beginning medical school in the fall.
E-mail: alexlegge@gmail.com
Reshef, Vadas, Haliba, & Ziv, 2010; Carr etal., 2012; Cevasco,
the American Music Therapy Association 2015. All rights reserved. Kennedy, & Generally, 2005; Hammer, 1996; Kerr, Walsh, &
For permissions, please e-mail: journals.permissions@oup.com Marshall, 2001). But what mechanisms of music-induced
Advance Access publication June 26, 2015
emotions are most responsible for the efficacy of music ther-
Music Therapy Perspectives, 33(2), 2015, 128141 apy interventions? How do these mechanisms differ between

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On The Neural Mechanisms of Music Therapy in Mental Health Care 129

different music therapy interventions? And how can the neuro- substructures. Two subsections of the PFC are especially rel-
biological effects of music influence the client-therapist rela- evant in emotion: the medial PFC (mPFC) and the dorsolateral
tionship? These questions reflect gaps in the scientific litera- PFC (dlPFC).
ture, none of which can be answered easily and all of which The mPFC appears to be particularly active during emo-
demand an interdisciplinary approach. tion processing. Activation in the mPFC has been found in a
Sena Moore (2013) began tackling several of these ques- large variety of emotional contexts, independent of emotional
tions in a systematic review of the neuroscience of music- valence and regardless of whether an emotion is coupled with
based emotion regulation, most of which examines studies cognitive tasks (Phan, Wager, Taylor, & Liberzon, 2002). The
of receptive music experiences. Akey finding was that listen- mPFC is also part of a larger default mode network, which
ing to pleasurable or happy-sounding music activated brain includes parts of the temporal, parietal, and cingulate cortices.
areas involved in the cognitive control of emotion regulation The default mode network is important for introspective emo-
(the anterior cingulate cortex, orbitofrontal cortex, and lateral tional processes, as evidenced by its activation during self-
prefrontal cortex) while deactivating the amygdala. Interested referential tasks and deactivation during externally oriented
readers are encouraged to refer to Sena Moores article for tasks (Raichle etal., 2001). Reduced gray matter in the mPFC
more information and music therapy implications. has also been linked to mood disorders and disturbances of
The purpose of the present article is to examine literature the reward system (Soares & Mann, 1997).
from various disciplines in order to provide a conceptual The dorsolateral part of the PFC (dlPFC) appears to serve
framework for the neural mechanisms of music therapy in different functions than the mPFC. In particular, the dlPFC
mental health. To establish such a conceptual framework, has been implicated in cognitive tasks related to emo-
this article will examine neural mechanisms of music- tional perception, such as moral decision-making (Greene,
induced emotion within each of the four major types of Sommerville, Nystrom, Darley, & Cohen, 2001). Note the
music therapy experiencesreceptive, re-creative, improvi- distinction between the dlPFC (more active during cogni-
sational, and compositional (Bruscia, 1998)in addition to tive-emotional perception in response to external stimuli)
their clinical implications for different music therapy inter- and the mPFC (more active during internal emotional
ventions. The focus on mental health is especially important processing).
because both music and mental health are closely linked Amygdala. The amygdala, a bilateral structure of the limbic
to emotion. Several mental health disorders are character- system located within the temporal lobes, is strongly associ-
ized by deficits in emotion processing, emotion perception, ated with fear and processing of unpleasant emotional stimuli
and emotion regulation (Atherton, Nevels, & Moore, 2015; (Phan etal., 2002). This includes aversive, unpleasant, and/or
Fulford, Peckham, Johnson, & Johnson, 2014; Maat et al., fearful musical stimuli. The amygdala is activated in response
2015). In particular, emotion regulation has been implicated to unpleasant music listening and deactivated in response to
as a cornerstone of mental health (Berking & Wupperman, pleasant music listening (Chanda & Levitin, 2013; Koelsch,
2012; Gross & Muoz, 1995). This article will also exam- Fritz, von Cramon, Mller, & Friederici, 2006). Damage to
ine neurobiological processes involved during the develop- the amygdala can also lead to impaired recognition of fearful
ment of the client-therapist relationship and how music can music (Koelsch, 2009). Nearby structures are also related, fur-
contribute to these processes. Through a more complete bio- ther underlining the central role of the amygdala; in particular,
logical understanding of music-based interventions and the connections to the subgenual and pregenual anterior cingulate
therapeutic relationship, music therapists working in mental cortex have been implicated in both regulation and intensifi-
health settings will be better equipped to plan client-oriented cation of negative emotional responses, although their exact
objectives and interventions, measure the efficacy of music roles are unclear (Drevets, 2000; Holzschneider & Mulert,
therapy sessions, and advocate for the importance of music 2011; Lanius, Bluhm, Lanius, & Pain, 2006). In mental health
therapy in an ever-changing system of mental health care. research, hyperactivity of the amygdala has been implicated
Table 1 summarizes possible neural mechanisms of music in depression, bipolar disorder, and post-traumatic stress dis-
therapy for a variety of specific mental health goal areas, all order (PTSD) (Drevets, 2000; Lanius etal., 2006; Zhang etal.,
of which will be discussed herein. However, before this can 2011). In depression in particular, increased metabolism and
be accomplished, a brief overview of the neurobiology of blood flow in the amygdala are correlated with the severity of
emotion is necessary. depression (Drevets, 2000).
Sena Moores (2013) systematic literature review revealed
a broader musical theme for the amygdala: it seems to play
Neurobiology of Emotion
a key role in processing musical stimuli containing fea-
Several neuroanatomical structures and neurotransmitters tures consistent with a potential threatespecially musical
have been implicated in specific aspects of emotion. These stimuli that are unpleasant, new, surprising, or complicated.
neural correlates are closely tied to mental health because Moreover, she provides an important clinical suggestion
their functions are often most apparent in instances of dys- based on her findings: music therapists trying to establish cli-
function. Consult Figure1 to locate several specific neuroana- ent comfort might want to avoid music with these features,
tomical structures. Aglossary of key neurobiological terms is thereby ensuring minimal amygdala-based activity. On the
also available. other hand, some music therapy interventions may be most
Prefrontal cortex. The prefrontal cortex (PFC) plays key effective when client emotions are intensified; these may be
roles in emotional processing and emotion perception. The instances when amygdala activity is more desirable (Sena
PFC is part of the frontal lobe and can be divided into different Moore, 2013).
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130 Music Therapy Perspectives (2015), Vol. 33

Evidence-Suggested Neural Mechanisms Involved in Music Therapy (MT) and Implications for Mental Health Treatment

Goal Areas and Components of MT Possible Neurobiological

Interventions Mechanisms in MT Implications for Mental Health Treatment
Establishing client comfort early in Emotionally positive music leads to Sad and unpleasant music may be
therapeutic process deactivation of amygdala (Chanda & contraindicated during early stages of MT
Levitin, 2013; Koelsch etal., 2006) Negative emotional valence of music is
not solely dependent on dissonance
May be especially important to use
emotionally positive music in populations
with hyperactive amygdala activity: PTSD,
depression, and bipolar disorder
Developing trust in client-therapist Music and speech mediate oxytocin, Hormonal changes are most subject to
relationship cortisol, and vasopressin (Bittman changes from auditory communication,
etal., 2001; Burns, 1999; Burns underlining crucial roles of music and verbal
etal., 2001; Nilsson, 2009; Seltzer processing
etal., 2010)
Selecting appropriate instruments/roles Musicians and non-musicians invoke Group cohesion may be more easily
during group music-making activities similar neural strategies for simple accomplished when client roles reflect level
musical tasks but different neural of music training
strategies for challenging musical
tasks (Zarate & Zatorre, 2008)
Accessing client emotions through Emotions from multisensory stimuli Pairing music with concrete referents helps
referential MT interventions mediated by limbic system and enhance emotion processing
dlPFC (Baumgartner etal., 2006;
Eldar etal., 2007)
Increasing reminiscence through Specific harmonic changes in Some harmonic changes may be more
autobiographically relevant music autobiographically relevant music important than others in music-induced
activate music memory network memories
consisting of left mPFC, left Music memory network may be less
ventrolateral PFC, and left lingual functional in some clients
gyrus (Janata, 2009)
Inducing musical pleasure Preferred music activates reward Music can act as an alternative source
system: release of dopamine in of reward system activation for clients in
ventral striatum leads to release substance abuse rehabilitation
of endogenous opioids, resulting
in pleasure sensation (Chanda &
Levitin, 2013; Koelsch etal., 2006;
Salimpoor etal., 2011)
Processing self-concept through Activation in mPFC and deactivation Self-reflective improvisation is probably most
improvisation of dlPFC (Limb & Braun, 2008) effective when clients are familiar with some
structural features of the music
Changing behavioral patterns Music-induced dopamine Client-preferred music is effective at inducing
activity leads to stronger synaptic dopamine activity (Salimpoor etal., 2011),
connections, reinforcing new and thus can support neuroplasticity and
behaviors (Stegemller, 2014) learning
Compositional interventions Widespread neural networks Widespread neural activity underlines
involved. Several neural strategies high cognitive demand of compositional
are possible (Shah etal., 2013) interventions
Improving social functioning Music and speech mediate increases Could be especially valuable for treatment of
in baseline oxytocin levels (Dai social isolation symptoms in schizophrenia
etal., 2012; Nilsson, 2009) and PTSD

Some literature suggests that the amygdala is a mediator of to increase negative-valence emotions, while direct stimula-
positive emotions as well, particularly in the case of a positive tion of the left amygdala has been shown to increase emotions
stimulus leading to increased arousal (Davis & Whalen, 2001). of both positive and negative valence (Lanteaume etal., 2007).
Furthermore, the left and right amygdalae may have different Frontal alpha asymmetry. Another interesting neuroanatom-
roles. Direct stimulation of the right amygdala has been shown ical feature of emotional perception is an apparent difference
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On The Neural Mechanisms of Music Therapy in Mental Health Care 131

Figure1. Approximate locations of relevant neuroanatomical areas (side view of right hemisphere). Key: ACC: anterior cingulate cortex; Amy:
amygdala; HC: hippocampus; HT: hypothalamus; NAc: nucleus accumbens; PFC: prefrontal cortex (medial aspect shown in figure); Pit: pituitary
gland; SN: substantia nigra; Figure adapted from clker.com (free public domain clip art)

between right and left frontal lobe activity in response to dif- of pleasuremay be a predictor of addiction (Wong et al.,
ferent types of emotional stimuli. Specifically, electroencepha- 2013). Low serotonin levels are also a marker for depression
lography (EEG) recordings show more left frontal alpha activ- (Zipursky, Meyer, & Verhoeff, 2007).
ity upon exposure to positive emotional stimuli and more right Oxytocin and vasopressin. Although their roles are less
frontal alpha activity upon exposure negative emotional stim- understood, recent research has implicated two neuroen-
uli (Deldin & Chiu, 2005). This also applies to musical stim- docrine hormonesoxytocin and vasopressinin social
uli, which lead to such asymmetrical alpha activity accord- affiliation and trust. Both hormones are synthesized in the
ing to emotional valence of the music (Schmidt & Trainor, hypothalamus, released into the bloodstream from the pos-
2001). Additionally, individuals with depression often exhibit terior pituitary gland, and serve other important roles as well;
a baseline pattern of asymmetrical activity (right > left). In vasopressin is an antidiuretic and increases blood pressure,
other words, less left-sided frontal activity compared to right- while oxytocin causes uterine dilation during birth and milk
sided frontal activity indicates hyper-reactivity in response ejection during nursing. In non-human studies, oxytocin and
to negative emotional stimuli. Such asymmetrical activation vasopressin have been shown to act as neuromodulators that
is a marker for depression. Because the asymmetry is mostly link social affiliation to reward pathways. In human research,
detectable in the alpha frequency band of EEG data, it is variations in a vasopressin receptor gene have been associ-
known as frontal alpha asymmetry (FAA) (Deldin & Chiu, ated with interpersonal skills, pair-bonding, and empathy.
2005). Note that the left/positive and right/negative patterns of Oxytocin, meanwhile, has been shown to facilitate empathy,
emotional valence in FAA are not necessarily related to similar eye contact, generosity, and face memory; it is also associated
valence relationships found in the left and right amygdalae. with reduced amygdala activation after a threatening stimulus.
Reward system structures and neurotransmitters. The Additionally, studies in neuroeconomics have demonstrated
reward system represents another well-studied neural circuit increases in financial trust toward investors and generosity
involving specific structures and neurotransmitters. The neu- toward peers following intranasal administration of oxytocin
rotransmitter dopamine is believed to mediate reward-seeking (Kosfeld, Heinrichs, Zak, Fischbacher, & Fehr, 2005; Zak,
behaviors. In the nucleus accumbens, a substructure of the Stanton, & Ahmadi, 2007).
ventral striatum of the basal ganglia, the neurotransmitter Oxytocin and vasopressin also have important implications
dopamine leads to the release of endogenous opioids. The in mental health disorders and treatment. For instance, higher
release of these opioids results in the sensation of pleasure. oxytocin levels are associated with treatment response in
Dysfunction of this reward circuitry has been repeatedly social anxiety disorder (Insel, 2010). Individuals with Williams
implicated in addiction (Sweet, Amlung, & MacKillop, 2013; syndrome, often characterized by unusually trusting behaviors
Wong, Brasic, Gean, & Nandi, 2013). Low levels of seroto- toward strangers, have higher levels of both oxytocin and vas-
ninanother neurotransmitter associated with the sensation
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opressin compared to controls (Dai etal., 2012). And a 2008
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132 Music Therapy Perspectives (2015), Vol. 33

study revealed larger variability in oxytocin levels among a contributes to receptive music-induced emotions, but that
group of depressed women (Cyranowski et al., 2008). Low other factors are also involved.
oxytocin and/or reduced sensitivity to oxytocin may also be Results from Green et al. (2008) raise the possibility of
involved in symptoms of social isolation common in schizo- non-harmonic factors affecting neurobiological responses to
phrenia and PTSD (Keri, Kiss, & Kelemen, 2009; Olff et al., receptive music. But what are these factors? And how can they
2014). impact music therapy? James, Britz, Vuilleumier, Hauert, and
Michel (2008) investigated the effects of musical training on
Neural Mechanisms Underlying Common processing perceived harmonic incongruities. Specifically,
Music Therapy Experiences they compared EEG responses of trained pianists versus non-
musicians upon hearing deceptive cadences. Their results
Receptive Music Experiences revealed a characteristic response in right-sided limbic regions
As mentioned above, most neurobiological investigations that was evident only in the trained musicians. This implies
of music-induced emotions have explored music listening that trained musicians respond differently to musical grammar.
experiences. Their findings are broad and will not be exhaus- In music therapy, this may mean that clients and therapists
tively discussed here. However, several studies have immedi- have different emotional responses to music because of differ-
ate implications for music therapists in mental health settings. ences in training. This is particularly relevant when consider-
Emotion responses to music listening. Many neuroimaging ing irregular limbic system responses in mental health disor-
studies have compared emotional responses to different musi- ders such as depression, bipolar disorder, and PTSD (Drevets,
cal stimuli. For instance, Koelsch et al. (2006) performed a 2000; Lanius et al., 2006; Zhang et al., 2011). One might
functional magnetic resonance imaging (fMRI) study in which suspect even more drastic differences between therapists and
normal adult participants heard pleasant excerpts of classi- clients with these disorders who lack musical training. This
cal music and electronically modified unpleasant versions underlines the importance of meeting clients at their unique
of the same excerpts. The unpleasant excerpts led to activation emotional and musical levels.
in the amygdala; this is consistent with the amygdalas role Emotion responses to multimodal stimuli. Another non-
in processing fear and novel unpleasant stimuli. Similarly, the music factor influencing music-induced emotions is the pres-
pleasant music excerpts resulted in activation of the ventral ence of additional stimuli. For instance, Eldar, Ganor, Admon,
striatum (part of the reward system), as would be predicted Bleich, and Hendler (2007) conducted an MRI study in which
in instances of reward-based pleasure. Interestingly, another participants without music training were exposed to combina-
brain region was also activated during the pleasant excerpts: tions of emotionally neutral film clips and/or three different
the Rolandic operculum, a part of the motor cortex that nor- kinds of simultaneous musical clips: positive commercial
mally controls the larynx. It is possible that this finding rep- pop music, negative music from horror soundtracks, and
resented participants desire to sing along with the pleasant monotonic neutral music. Behavioral tests indicated that
excerpts. If so, it could help explain a common occurrence in the music (and not the film clips) established the participants
music therapy sessionsthe tendency of some clients to sing emotional responses. But amygdala activation in the com-
or hum during receptive interventions. bined music-film condition was significantly greater than in
In another fMRI study (Green et al., 2008), researchers film-only or music-only conditions.
compared non-musicians responses to minor and major In a similar investigation, Baumgartner, Esslen, and Jncke
piano melodies. Participants reported that the minor melodies (2006) examined the capacity of music to enhance responses
were sadder than the major melodies. Furthermore, the minor to emotional images. Participants viewed pictures of differ-
melodies yielded more neural activation in two limbic sys- ent faceswith or without simultaneous music stimulus
tem structures (parahippocampal gyrus and ventral anterior and were asked to identify the facial emotions. An fMRI
cingulate cortex), as well as part of the mPFC. Although the contrast of the two conditions revealed more limbic system
amygdala was not specifically activated, activation in related activation with music present. Furthermore, the picture-only
limbic structures suggests that emotional processing of minor condition yielded more activation in the dlPFC; recall that
modes may be similar to processing of unpleasant and/or fear- the dlPFC is typically involved in more externally driven
ful stimuli. Interestingly, the same study also included another cognitive-emotionaltasks.
condition to determine whether the minor mode activations Considered together, the results of Baumgartner et al.
were related to dissonance; the researchers examined subject (2006) and Eldar etal. (2007) demonstrate two closely related
responses to chromatic melodies, hypothesizing that the same qualities of music-induced emotion. First, music can enhance
structures as the minor mode would be activated to a greater emotional responses related to other types of cognitive stim-
extent. This was the case with the mPFC, indicating high sen- uli. Second, it appears that music alone does not stimulate
sitivity to harmonic changes. Chromatic-induced activation in emotional processing centers as much as a combination of
limbic structures was also expectedly higher than the major music and concrete cognitive stimuli. Although the studies
melodies. However, chromatic melodies induced less activity mentioned here apply largely to visual stimuli, one might
in limbic structures than the minor melodies. In other words, expect other types of concrete cognitive stimuli to elicit simi-
brain structures involved in negative emotions were activated lar responses when coupled with music. This would suggest
more after minor melodies than chromatic melodies. Despite that music therapy interventions with concrete non-musical
being less dissonant than the chromatic melodies, the minor referents can activate limbic structures (leading to stronger
melodies resulted in a more emotionally negative neural emotional responses) more than non-referential music
response. These findings suggest that harmonic dissonance experiences.
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On The Neural Mechanisms of Music Therapy in Mental Health Care 133

The benefits of referential music therapy interventions Neurotransmission in music-induced pleasure. In addi-
could be especially important in mental health treatment. For tion to limbic structures and the mPFC, neurotransmission in
instance, music therapists could use concrete referents and the reward system plays a key role in emotional responses to
music to help access positive emotions in clients suffering music listening. Salimpoor, Benovoy, Larcher, Dagher, and
from a depressive episode after losing a loved one. Similarly, Zatorre (2011), in an investigation of normal participants
referential music therapy interventions may be helpful in listening to self-chosen music, found that music-induced
accessing emotions during PTSD treatment or assisting in chills corresponded to release of dopamine in the ventral
cognitive restructuring. Pairing concrete referents with music striatum. Listening to preferred music has also been shown
might also help eliminate phobias or promote rehabilitation of to increase blood serotonin levels (Evers & Suhr, 2000). In
sensory integration pathways in clients with dissociative PTSD other words, music-induced pleasure appears to utilize iden-
subtypes. tical mechanisms as other types of pleasure. These mecha-
Music listening, emotion, and memory. Music listening can nisms are especially relevant for clinical work in addiction
also induce emotions via elicitation of autobiographical mem- and depression, disorders that are respectively characterized
ories. Janata (2009) examined the neural mechanisms behind by abnormal dopamine and serotonin neurotransmission. It
this in a population of undergraduate students. Inside an fMRI is possible that music-based changes in neurotransmission
scanner, students heard Billboard Top 100 clips from their ado- particularly those resulting from music-induced pleasureare
lescence (when they were 719years old) and then rated each the primary vehicle for successful music therapy treatment in
clip according to arousal, familiarity, and autobiographical these populations. This would support Baker, Gleadhill, and
associations. For clips with strong self-reported autobiographi- Dingles (2007) study of group music therapy for patients in a
cal associations, participants completed a series of follow-up substance abuse rehabilitation treatment program. Their music
questions regarding the vividness of music-induced memories. therapy sessions featured a cognitive behavioral approach to
Several neuroanatomical areas were associated with reported therapy and included lyric analysis, song parody, instrumen-
positive affect, particularly in the left hemisphere. The intensity tal improvisation, and song listening/singing interventions.
of autobiographical associations was also related to activity Patient questionnaires indicated moderate to high levels of
in the left mPFC and left ventrolateral PFC. Taking the results emotion during sessions, especially pleasure-related emo-
one step further, Janata analyzed neural activity via tonality tions. Further analyses also revealed an association between
tracking, a method to detect neuroanatomical regions whose patients who reported using music to regulate their moods and
activity corresponds temporally to changes in the harmonic patients who indicated that more music therapy would help
structure of music. Both autobiographically associated PFC them do something enjoyable without the use of substances
sites exhibited tonality tracking, in addition to the left lingual (Baker etal., 2007). Future music therapy research might con-
gyrus. These results suggest that listening to autobiographi- sider replicating this study along with collection of serum
cally relevant music activates a memory network consisting of neurotransmitter levels. In particular, dopamine is associated
three left-hemispheric sites: the left mPFC (linked to self-ref- with pleasurable chills during music listening (Salimpoor
erential cognition), the ventrolateral PFC (linked to cognitive etal., 2011) and has also been established as a critical neu-
control of semantic memories such as facts), and the lingual rotransmitter for learning and neuroplasticity. Stegemller
gyrus (linked to visual memories). Furthermore, activation of (2014) suggests that music-induced changes in dopamine
this memory network mirrors tonal changes in the music. This activity may help strengthen synaptic connections related
explains musics ability to induce emotions via autobiographi- to newly learned behaviors that are paired with the music.
cal memories. Janatas findings also imply that specific har- Dopaminergic responses to preferred music may therefore be
monic changes in autobiographically relevant music might be able to enhance the neural processes involved in establishing
uniquely linked to memory formation. new behavioral patterns, such as abstaining from drugs and
It is possible that the memory network is less functional in alcohol.
populations with hypoactive prefrontal areas. Participants with
schizophrenia exhibit reduced PFC activation during working Re-Creative Music Experiences
memory tasks (Weinberger etal., 1996). And several reports Little research to date has looked at real-time neural pro-
have demonstrated differences in PFC activation between cesses involved in active music-makingparticularly in
PTSD patients and healthy controls (Lanius etal., 2006). This instances of playing or singing precomposed music. One
poses an interesting question for future research in PTSD and possible reason for this is that active music-making requires
schizophrenia treatment: can autobiographical music promote motor movement that could compromise neuroimaging data.
formation of new neural connections in damaged brain areas? Furthermore, active music-making inside a scanner is often
Either way, music therapists using autobiographical music to unfeasible.
facilitate reminiscence in these populations should be aware Singing represents a logical starting point for research
that the memory network might be compromised. because it is universal and requires less limb movement.
The left-sided nature of the music-induced memory network Jeffries, Fritz, and Braun (2003) conducted a PET study compar-
may also be important. Perhaps this is related to left frontal ing non-musicians neural activity during speech versus sing-
activation in response to emotionally positive stimuli. If so, ing. The participants sang well-known songs such as Happy
it would be consistent with both FAA and the asymmetrical Birthday. Additionally, participants spoke these same songs
functional features of the amygdala. Although highly specu- in a naturalistic speaking manner. Consistent with left-hemi-
lative, this could mean that music-induced autobiographical spheric localization of speech and language, results showed
memories have a greater tendency to be emotionally positive. that left-sided structures were activated more in the speaking
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134 Music Therapy Perspectives (2015), Vol. 33

condition and right-sided structures were activated more in the implicate training-related differences in neural strategies dur-
singing condition. In particular, their results revealed a cluster ing a complex music task, similar to the auditory-feedback
of activity in the right mPFC and dlPFC following the singing singing experiment by Zarate and Zatorre (2008). Regardless
condition. These results could be interpreted as a tendency of the cause of difference between groups, these results cer-
of singing to employ emotional cognition and self-referential tainly suggest that different people use different neural strate-
processes. Therefore, singing could be particularly helpful if a gies during musical improvisation. Additionally, only one of
client is cognizant of something during verbal processing but these strategies (in the HCG) involved activity in neural cent-
wants to internalize it on a deeper emotionallevel. ers linked to emotions. Perhaps some individuals simply have
In another singing investigation (Zarate & Zatorre, 2008), more connectivity between emotional circuitry and struc-
musicians and non-musicians participated in two singing tasks tures needed for musical improvisation. If so, this would have
in an fMRI scanner. In one task, participants simply reproduced significant implications for music therapists hoping to use
single tones (simple task); however, in another task, they improvisation as a medium for emotional processing.
were asked to match tones and maintain the same pitch while Several neuroscience researchers have recently investi-
ignoring another auditory stimulus one whole note above the gated instrumental improvisation using keyboards specifically
target pitch (ignore task). Comparison of neural activations designed for use in fMRI scanners. For example, de Manzano
between the musicians and non-musicians revealed an intrigu- and Ulln (2012) compared neural responses of professional
ing pattern: for the simple pitch-matching task, both groups pianists during three different performance tasks: sight-read-
exhibited activity in the same areas. However, in the ignore ing, improvising a melody, and random note generation. The
pitch-matching tasks, the two groups exhibited activations in results revealed activity in the left inferior frontal gyrus (also
different sites. Non-musicians exhibited more activity in the home to Brocas area for expressive speech) during both the
primary motor cortex, while musicians exhibited more activ- improvisation and random note generation, but not during the
ity in temporal lobe auditory processing centers. The authors sight-reading. Also, somewhat surprisingly, there were many
suggest a difference in neural strategy when faced with a more more areas activated during the random note generation than
challenging singing task: non-musicians appeared to adopt a the melody improvisationsand no structure was uniquely
motor-control strategy, while musicians appeared to utilize an active during the improvisation. Although this may seem to
auditory feedback strategy. This implies that neural process- suggest that random note generation is simply more stimulat-
ing differences between musicians and non-musicians are ing, the authors are careful to point out that the subject sample
most pronounced during complex musical tasks. This find- may be related. In other words, improvisation in professional
ing would be valuable to a therapist trying to find appropriate pianists might be automatic and strictly based on motor
instrumentation for a group of clients with varying musical memory, whereas random note generation involves a neuro-
backgrounds or facilitate similar neural activity between client logically foreign process. This might suggest more stimulation
and therapist. for anyone introduced to an instrument for the first time, as is
so often the case during music therapy sessions.
Improvisational Music Experiences Two other fMRI studies of keyboard improvisation yielded
Investigations into the neural architecture of instrumental seemingly contradictory results. Bengtsson, Cskszentmihlyi,
improvisation have proved challenging for the same reason and Ulln (2007) examined concert pianists improvising
cited above: such research is often unfeasible in a scanner. The modifications of written melodies. Their brains showed activ-
spatial constraints of a scanner pose problems, and metallic ity in the dlPFC and premotor area, among other sites. On the
objects cannot be used near an fMRI scanner, limiting pos- other hand, Limb and Braun (2008) investigated jazz pianists
sibilities for instrumental play. However, some studies have improvising over chords of a known song. They found deac-
used alternative experimental methods to examine musical tivation in the dlPFC in addition to activation in the mPFC.
improvisation with fMRI technology. Assuming that the results are not simply related to sample size,
Villarreal etal. (2013) studied neural correlates of musical how does one make sense of the inconsistency? One inter-
creativity in college music therapy students. In an fMRI scan- pretation might be the differences in experimental protocol.
ner, each subject heard a series of brief rhythms and used a As mentioned above, the dlPFC is known to be involved in
response box to tap a new, improvised rhythm or repeat the cognitive-emotional tasks related to perception of external
rhythm they had just heard. The researchers then divided the stimuli, whereas the mPFC is involved in more self-referential
students into a high creativity group (HCG) and low crea- and introspective emotional processes. Perhaps the written
tivity group (LCG) based on rhythmic originality compared notation used during the Bengtsson etal. (2007) experiment
to the stimulus. Interestingly, the researchers found that the demanded a different neural strategyone that was more
two groups exhibited neural differences during the impro- externally oriented. In contrast, the jazz pianists in the Limb
vised rhythm task. The HCG exhibited more activity in left and Braun (2008) study might have been familiar enough with
dlPFC and right insular cortex, another limbic-related struc- the chord progressions that their brains adopted a more self-
ture implicated in pleasurable music listening. The LCG, in reflective improvisational strategy. This, if accurate, would be
contrast, exhibited more activity in their supplementary and highly relevant to music therapists, suggesting that familiar-
primary motor areas (Villarreal et al., 2013). Although all ity and external stimuli during improvisation can impact how
these music therapy students came from the same degree pro- much self-concept processing is possible. The premotor activ-
gram, the researchers did not control any further for level of ity evident in results of Bengtsson et al. (2007) could also
music training. It is therefore difficult to gauge what the dif- be consistent with the motor-based strategy more prominent
ference between HCG and LCG means. Perhaps these results during novel tasks (similar to previously mentioned studies).
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On The Neural Mechanisms of Music Therapy in Mental Health Care 135

Alternatively, the contradictory results between these improvi- cognitive demand of any compositional intervention in music
sation studies might simply be explained by other slight dif- therapy.
ferences in research method (e.g., control conditions, jazz
pianists vs. concert pianists, etc.) or even just sampling error. Summary
Either way, further research is necessary. Investigations of music listening have revealed several neu-
The neural correlates of vocal improvisation are largely ral mechanisms of music-mediated emotion. The limbic sys-
un-researched. However, a 2012 publication by Liu et al. is tem (especially the amygdala) plays a key role in determin-
an exception. The aim of their experiment was to examine ing emotional salience of music (Koelsch et al., 2006). This
neural structures involved in freestyle rapping. Participants process is sensitive to harmonic dissonance, although other
were experienced freestyle rappers, and each performed two factors also contribute, such as the listeners musical back-
raps in the fMRI scanner: a freestyle rap and a preplanned/ ground and the presence of multimodal stimuli (Baumgartner
rehearsed rap. Researchers subtracted the rehearsed rap data etal., 2006; Eldar etal., 2007; Green etal., 2008). The neuro-
from the freestyle rap data to (presumably) reveal neural struc- transmitter dopamine is involved in music-mediated pleasure
tures of the spontaneous creative process. Similar to results (Salimpooor etal., 2011) and is also critical for neuroplastic
of Limb and Braun (2008), freestyling uniquely activated the changes during behavioral learning, suggesting that it may be
left mPFC and deactivated the right dlPFC. This is consistent crucial for music therapists helping their clients establish new
with the idea of musical improvisation as a reflective, self- behavioral patterns (Stegemller, 2014). Listening to autobio-
referential behavior. Furthermore, there was actually more graphically important music activates a left hemisphere music
activity in left hemispheric language centers during freestyl- memory network, which includes the PFC and is responsive to
ing, despite language use in both conditions. This might rep- specific harmonic changes (Janata, 2009).
resent a heightened degree of linguistic cognition necessary Although neurobiological mechanisms during active musi-
for freestylingand perhaps any lyrical improvisationwhich cal experiences have not been studied in depth until recently,
could support the use of improvisational singing interventions some trends are beginning to emerge. Singing is capable of
for clients having trouble verbalizing their feelings during ver- activating portions of the PFC associated with self-referential
bal processing. Future investigations are necessary to establish processing and emotional cognition (Jeffries et al., 2003).
population-specific benefits of lyrical improvisation. Similarly, musical improvisation can activate PFC areas
involved in self-reflection, particularly when the improvisa-
Compositional Music Experiences tion occurs within a familiar musical structure (Limb & Braun,
Neural mechanisms involved during musical composition 2008; Liu etal., 2012). Neural responses during active music-
have not been researched. Arecent study by Shah etal. (2013), making may also depend on musical complexity, level of
however, provides some interesting insight into the neural cor- music training, and creativity of the music-maker (Villarreal
relates of creative writing. In this study, participants with crea- etal., 2013; Zarate & Zatorre, 2008). The neural correlates of
tive writing experience took part in four tasks inside an fMRI music composition have not been investigated but are likely to
scanner. First, they read a creative writing passage. Then, they include a wide range of neural networks involved in emotion
copied the passage. Third, they were instructed to brainstorm and cognition.
a new creative writing passage. And finally, they wrote a pas- The above sections have provided a conceptual framework
sage using pen and paper (they were able to angle their arms for neural mechanisms involved during distinct types of music
outside the scanner and write on a notepad). Unsurprisingly, therapy interventions. Other features of the therapeutic rela-
the reading and copying tasks, respectively, activated language tionship will be discussed below. Specifically, the neurochem-
and motor brain structures. The other two tasks, however, istry of trust and social affiliation will be explored, as well as
yielded more intriguing data. Several sites exhibited activity musics influence on this neurochemistry. Finally, this article
during brainstorming, including the left dlPFC (cognitive-emo- will review neuroimaging research of psychotherapeutic tech-
tional perception), the right anterior insular cortex (implicated niques in mental health treatment.
in physiological self-awareness [Critchley, Wiens, Rotshtein,
Ohman, & Dolan, 2004]), and bilateral portions of the visual Music, Neuroendocrinology, Social Functioning, and the
cortex. Clearly, the thought process involved in composition Client-Therapist Relationship
involves a complex integration of multisensory cognition and Neuroendocrinology research has demonstrated the impor-
introspection. To analyze the writing tasks, researchers sub- tance of two peptide hormonesoxytocin and vasopressin
tracted neural activations that were also involved in the copy- in social affiliation and trust (both hormones also serve other
ing tasks to detect circuits unique to the creative process. Their functions). Although their social functions are still largely
analysis revealed activations in bilateral temporal lobe struc- unknown, preliminary findings have suggested that music can
tures associated with episodic memory and memory retrieval. influence both hormones. If so, this may be a key to under-
Taken as a whole, these results suggest a wide-ranging array of standing musics biological role in the clinical relationship
cognitive, emotional, and sensory processes that contribute to between client and music therapist. It could also demon-
composition. Although additional literature regarding the neu- strate a unique ability of music to promote healthy develop-
robiology of composition is sparse, one might imaginegiven ment of the client-therapist relationship. Furthermore, pro-
Shah etal.s (2013) resultsthat several neural strategies are motion of positive relationships and trust is often crucial in
possible throughout the process. The results also demonstrate mental health treatment. Social isolation is a common symp-
how complicated the creative process can be, highlighting the tom of schizophrenia, and improved social functioning is a

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136 Music Therapy Perspectives (2015), Vol. 33

common predictor of remission (Schennach et al., 2012). In and vasopressin were also evident in the control group after
clients with PTSD, connecting with others is often a primary music stimuli, suggesting that music may have triggered the
treatmentfocus. release of these trust-related hormones.
Several animal studies suggest that vocalizations are a key In another study (Ukkola-Vuoti et al., 2011), researchers
component of neuroendocrine-mediated social behaviors. found a positive correlation between music listening habits
For instance, female hamsters have demonstrated increased and a gene for a vasopressin receptor. However, the same
vocalizations following administration of oxytocin. Unusually gene was not correlated with musical aptitude. As the authors
abundant oxytocin receptors have been found in two spe- point out, their results imply a genetic connection between
cies of singing mice known for their complex vocalizations social affiliation and interest in music listening, irrespective
(Chanda & Levitin, 2013). In prairie voles, whose oxytocin and of musical aptitude. This could also help explain why some
vasopressin receptors are concentrated in reward pathways, people are more drawn to music than others.
social isolation triggers ultrasonic calls. By contrast, meadow Outside mental health settings, oxytocin and cortisol have
voles, whose oxytocin and vasopressin receptors predominate been examined following music interventions. For instance,
elsewhere, show no response to social isolation (Insel, 2010). Nilsson (2009) measured oxytocin levels in patients who lis-
This indicates that oxytocin and vasopressin are capable of tened to relaxing music during their bedrest. These patients
modulating reward-seeking emotional communicationspe- exhibited significant oxytocin increases, even an hour after
cifically, auditory emotional communication. music listening. Decreases in cortisol have been found in
In human research, a study by Seltzer, Ziegler, and Pollak medical patients following drum circles (Bittman etal., 2001),
(2010) examined the effect of vocalization on oxytocin using group music therapy (Burns, Harbuz, Hucklebridge, & Bunt,
a mother-daughter dyad paradigm. First, elementary-age girls 2001), and the Bonny Method of Guided Imagery and Music
completed a stressor task (public speaking and math perfor- (GIM) (Burns, 1999). Healthy adults have also exhibited
mance in front of an audience). Depending on group allo- cortisol reductions following Bonny Method GIM sessions
cation, they were then consoled by their mothers in person, (McKinney etal., 1997).
over the phone, or not at all. Researchers measured levels of Overall, the above literature suggests that music can medi-
oxytocin and cortisol, a hormone released during stress. The ate hormones related to stress and social affiliation. These bio-
girls cortisol and oxytocin levels were measured before the logical mechanisms help music foster a trusting client-therapist
stressor, immediately after the stressor, and at 15-minute post- bond and minimize client stress. Furthermore, the literature
stressor intervals up to one hour. Results showed distinct post- implicates auditory stimuli (including speech) as a key hormo-
stressor differences in cortisol levels between all three groups, nal trigger. This is particularly meaningful for music therapists
with the highest levels in the control group and the lowest planning interventions early in the therapeutic process, because
for girls who had in-person consolation. This makes intui- it places an emphasis on music and speech in the therapeutic
tive sense, suggesting that in-person consolation from a par- relationship. This interpretation might be extended to suggest
ent is more effective at reducing stress than consolation over that therapists should pay special attention to vocal tone, musi-
the phone, which is more effective than having no parental cal timbres, acoustics, word choice, and background sounds
consolation at all. However, oxytocin measurements revealed during the first few sessions with a new client. In other words,
different results. After the stressor, the control group exhib- the auditory components of the client-therapist communica-
ited no change in oxytocin, but oxytocin levels increased sub- tion may be the cornerstones of trust development.
stantially in both experimental groups. In fact, one hour post- If music can promote a trusting client-therapist relation-
stressor, the phone-consolation group exhibited significantly ship via hormonal mechanisms, it is possible that the same
higher oxytocin levels than the in-person-consolation group. mechanisms are capable of achieving other therapeutic goals
These results imply that vocal contact (even in the absence in mental health treatment. This could be especially true in
of live contact) affects release of both cortisol and oxytocin. populations with below-average oxytocin levels at base-
In other words, cortisol and oxytocinrespectively related to line. For instance, individuals with schizophrenia exhibit
stress and trustare subject to changes from auditory commu- less trust-related oxytocin release than healthy controls (Keri
nication. Thus, decreased cortisol and increased oxytocin may etal., 2009). Oxytocin administration has also been shown to
represent biological mechanisms involved in the development reduce amygdala hyperactivity in PTSD patients (Olff et al.,
and efficacy of the client-therapist relationship. 2014). Although more research is needed, music therapy may
Although the results of Seltzer etal. (2010) can be applied be capable of improving overall social functioning in these
to talk therapies as well as music therapy, other research has populations by boosting baseline hormone levels.
demonstrated a unique relationship between music and neu-
roendocrine hormones. Dai etal. (2012) used a music-based Neurobiology, Psychotherapy, and Mental Health
experimental protocol to investigate oxytocin and vasopres- While most of the neural mechanisms of psychotherapy
sin levels in participants with Williams syndrome. People with have not been fully established, there is ample evidence to
Williams syndrome often exhibit much more trust in strangers, support its influence on neural functioning in mental health
likely related to dysregulation of trust hormones. Dai et al. treatment. In most cases, specific techniques have been exam-
measured baseline hormone levels and hormonal responses to ined, such as the use of cognitive behavioral therapy (CBT)
different stimuliincluding music. These measurements were to treat phobias or behavioral therapy for people with obses-
compared with healthy controls. As expected, the participants sive compulsive disorder (Roffman, Marci, Glick, Dougherty,
with Williams syndrome exhibited higher levels of both hor- & Rauch, 2005). As another example, free association seems
mones throughout the entire study. But increases in oxytocin to result in more widespread cortical activation than focused
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On The Neural Mechanisms of Music Therapy in Mental Health Care 137

memory recall (Roffman et al., 2005). Even though referen- delivered by a music therapist in the context of a therapeutic
tial music appears to be most effective at inducing emotions relationship.
(Baumgartner et al., 2006; Eldar et al., 2007), the abstract Literature regarding the neural correlates of psychotherapy is
emotional qualities unique to music may allow it to stimulate rare, and neurobiological research on music therapy in mental
widespread neural regions similar to free association. health is even rarer. Until this is addressed, a complete under-
It is also worth mentioning that individuals with the same standing of music therapys role in mental health from a neu-
mental health diagnoses do not necessarily exhibit the same robiological perspective is out of reach. Still, a combination of
neural changes upon successful treatment. For instance, in qualitative accounts, quantitative behavioral evidence, and neu-
McGrath etal.s (2013) study of adults with major depression, roimaging evidence from other fields all suggest that music ther-
participants underwent pretest neuroimaging and were ran- apy is equally capable of affecting neural network changes when
domly assigned to treatment with either escitalopram (an anti- compared with other psychotherapeutic approaches. Moreover,
depressant medication) or CBT. Strangely, the results showed music therapy in mental health treatment may affect neural net-
that hypoactivity in the right anterior insula was associated works in ways that are distinct from other forms of therapy.
with responsiveness to CBT and poor response to escitalo-
pram, while hyperactivity in the right anterior insula was asso- Limitations and the Necessity for Future Research
ciated with responsiveness to escitalopram and poor response Although neurobiological research is becoming common in
to CBT. This implies that different individuals may be best health care, more research is needed to understand the neural
suited to different kinds of treatments, even if they have the mechanisms of music therapy, particularly in mental health
same mental health diagnosis. Most music therapists in mental treatment. The vast majority of aforementioned experiments
health settings have probably worked with some clients who including those focusing on receptive listeninghave exam-
simply responded less to music therapy; this is fully expected ined either professional musicians or healthy adult partici-
based on individual differences. pants. If musicians and non-musicians have different neural
Other researchers have investigated the effects of psy- responses to music, one might expect other neural differences
chotherapy on EEG correlates, especially FAA (more fron- among various subpopulations in mental health. Aclearer pic-
tal alpha activity in the right side, a predictor of depression ture of the neural mechanisms behind these differences will
and response to negative emotional stimuli). In a rare neuro- provide further insight for future music therapists.
physiological investigation of music therapy in mental health, Neuroimaging studies also have limitations. Most modern
Fachner, Gold, and Erkkil (2013) examined FAA of depressed neuroimaging technology is capable of localizing mental pro-
clients in a three-month psychoanalytical music therapy pro- cesses only on a macroscopic level. In contrast, the micro-
gram, which consisted of instrumental improvisation and scopic mechanisms behind emotion and cognition are extraor-
verbal processing. Surprisingly, FAA from pretest to posttest dinarily complex and poorly understood. Thus, any attempt to
became even more asymmetrically right sided (normally asso- study larger neural circuits assumes that such processes can be
ciated with increased negative affect) despite lower scores on understood macroscopically. Beyond that, each neuroimaging
a depression inventory. According to these results, it is pos- technique has several unique limitations in spatial/temporal
sible that music therapy could actually restructure emotional resolution, possible research methods, safety, and generaliz-
networksleading to an alternative neural pattern of emo- ability (refer to Hunt and Legge (this volume) for a lengthy
tional health. discussion of each method).
However, in another FAA study incorporating a music-
based intervention (listening to uplifting songs), depressed Concluding Remarks
adolescents exhibited less posttest FAA, consistent with simi- The body of literature referenced here sheds light on several
lar FAA changes after other forms of therapy (Jones & Field, relationships between music therapy methods, the neurobiol-
1999). While these results seem to conflict with the 2013 ogy of emotions, and the therapeutic relationship. This evi-
investigation by Fachner et al., some differences may be dence suggests several potential neural mechanisms contrib-
attributable to subject age, intervention style, and length of uting to the efficacy of music therapy. Many of these possible
treatment. Clearly, however, more research is needed to clar- mechanisms, along with relevant implications for music ther-
ify the role of music therapy in FAA. This could help establish apy in mental health treatment, are summarized in Table1.
music therapys neurobiological mechanisms in treatment of Musics capacity to stimulate emotional centers in the brain is
depression. well established and involves several factors, including harmonic
In another EEG study, participants undergoing an acute psy- changes, simultaneous referential stimuli, familiarity, autobio-
chotic episode listened to self-selected music. Their diagno- graphical memories, and musical training. Although less stud-
ses consisted of schizophrenia, schizoaffective disorder, and ied, active music-making and musical creativity processes are
bipolar disorder. Results revealed diffuse decreases in delta also capable of activating emotional centers, and likely involve
and beta waves during the music, which likely correspond different types of neural strategies depending on the individual
to favorable outcomeshigh delta waves often signal schiz- and/or nature of the music listening process. Overall, music-
ophrenia, and high beta waves are often present in bipolar induced emotions are associated with neural activity in many of
disorder (Galderisi, Mucci, Volpe, & Boutros, 2009; Boutros, the same networks involved in non-musical regulation of mood
Galderisi, Pogarell, & Segmiller, 2011). Further research and emotion. Many of these networks are also dysregulated or
is needed to explore effects of music on brain wave activ- dysfunctional in mental health disorders. By incorporating a
ity for persons with psychosesin particular, the use of live neurobiological perspective, music therapists working in mental
music that is based on the clients personal preference and health settings may be able to target and rewire dysfunctional
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138 Music Therapy Perspectives (2015), Vol. 33

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140 Music Therapy Perspectives (2015), Vol. 33

Brain waves: Oscillations of neural activity, often classified side). Part of the limbic system, the hippocampi are critical
according to frequency. for memory and spatial navigation.
Brocas area: A region on one side of the frontal lobe (typically Hormones: Signaling molecules that are transported in the
the left side) that plays a key role in production of language bloodstream and interact with many organs, including the
and speech. Damage to Brocas area causes expressive brain. Hormones are typically classified as either peptide or
aphasia. steroid, depending on their composition.
Cerebral cortex: The outermost layer of the brain, involved Hyperscanning: A combined recording technique to examine
in many important mental processes. The cortex is divided EEG changes in multiple subjects at the same time.
into four major lobes: frontal, temporal, parietal, and occip- Insular cortex (a.k.a. insula): A region of cerebral cortex that
ital. The word cortex can also be used to describe each is located within a deep fold separating the temporal, fron-
lobe (e.g., frontal cortex). tal, and parietal lobes. It is sometimes considered to be a
Cortisol: A steroid hormone produced by the adrenal gland separate lobe.
and released in response to stress. Cortisol promotes higher Limbic system: A collection of neuroanatomical structures
levels of blood sugar (glucose). involved in many functions, including emotions and memory.
Default mode network: A network of neuroanatomical struc- Lingual gyrus: A portion of the occipital lobe associated with
tures associated with introspective emotional process. complex visual processing and visual memories (named
Deoxyhemoglobin: One of two states of hemoglobin, the pro- lingual due to its tongue-like shape).
tein that carries oxygen in red blood cells. Deoxyhemoglobin Medial prefrontal cortex (mPFC): The medial (middle) portion
is the state of hemoglobin without oxygen attached. of the prefrontal cortex. The mPFC is involved with inter-
Dopamine: A neurotransmitter involved in many important nally oriented emotional processing.
processes, including the reward system. Motor cortex: A portion of the frontal lobe with neural pro-
Dorsolateral prefrontal cortex (dlPFC): The dorsolateral jections directly to the spinal cord. The motor cortex is the
(upper and outermost) portion of the prefrontal cortex. The primary brain area in control of movement.
dlPFC is involved largely in executive functions. It is also Neuroanatomical structures: Anatomical structures of the
associated with cognitive tasks related to emotional percep- nervous system, which can be classified based on location,
tion of external stimuli. function, and/or appearance.
Early right anterior negativity (ERAN): An event-related Neurotransmitters: Chemicals that are transmitted from one
potential (detectable via EEG) exhibited when subjects hear neuron to another across the synapse. They are involved in
harmonically inappropriate chords. almost all neuron activity.
Endogenous opioids: Refers to any opioids produced in the Neurophysiological: Pertaining to neurophysiology, a branch
body; they play a key role in the reward system, mediating of physiology concerning the nervous systemespecially
the perception of pleasure. the electrical activity of neurons and the types of electrical
Event-related fields (ERFs): Characteristic magnetic field or chemical connections between neurons.
changes, detectable in MEG recording, which are associ- Nucleus acumens (NAc): A part of the ventral striatum in
ated with responses to specific stimuli. the basal ganglia. The NAc plays a key role in the reward
Event-related potentials (ERPs): Characteristic voltage system a mediator of dopamine-mediated opioid release,
changes, detectable in EEG recording, which are associated which results in the sensation of pleasure.
with responses to specific stimuli. Oribitofrontal cortex: The ventromedial (lower and middle)
Fissure: A deep groove that separates portions of the brain, portion of the prefrontal cortex. The orbitofrontal cortex is
such as the longitudinal fissure, which separates the two associated with decision-making cognitive processes.
hemispheres. Oxyhemoglobin: One of two states of hemoglobin, the protein
Frontal alpha asymmetry (FAA): An EEG pattern characterized that carries oxygen in red blood cells. Deoxyhemoglobin is
by more right-sided frontal activity in the alpha frequency the state of hemoglobin with oxygen attached.
band. FAA is typically seen upon exposure to negative stim- Oxytocin: A hormone involved in trust and intimacy, as well
uli. It can also be an indicator of depression if detected at as other functions.
baseline. Parahippocampal gyrus: A region of cerebral cortex surround-
Frontal midline theta (FMT): An EEG pattern characterized by ing the hippocampus, involved in memory.
more activity in the theta frequency band along the brains Prefrontal cortex (PFC): A portion of the cerebral cortex, the
midline. Increased FMT is associated with fewer anxiety PFC is the frontmost part of the frontal lobe.
symptoms. Pregenual anterior cingulate cortex (pregenual ACC): The
Glial cells (a.k.a. glia): Cells that are part of nervous system portion of the ACC directly in front of the genu (another
tissue and mainly serve to support neurons. Glia are crucial structure). The pregenual ACC may be involved in mediat-
for healthy neural functioning, but do not actually partici- ing emotional processing in the amygdala, which is situated
pate in the electrochemical communication characteristic nearby.
of neurons. Premotor area: A portion of the frontal lobe adjacent to the
Gyrus (plural gyri): The top and outermost portion (ridge) of a motor cortex and involved in many processes, including
fold in the cerebral cortex. Folds (a.k.a. convolutions) allow planning movement.
a larger cortical surface area within the skull. Reward system: A collection of neuroanatomical structures
Hippocampus (plural hippocampi): Two neuroanatomical and neurotransmitters involved in reward-seeking behaviors
structures located within the temporal lobes (one on each and reward-based pleasure.
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On The Neural Mechanisms of Music Therapy in Mental Health Care 141

Serotonin: A neurotransmitter involved in many neural net- neuroimaging to describe the maximum frequency at
works, including the reward system. Serotonin is associated which an imaging machine can produce quality images
with feelings of happiness and pleasure. of a target.
Spatial resolution: The sharpness of images, often used in neu- Thalamus: A single neuroanatomical structure that serves as
roimaging to describe the smallest space distinguishable via a relay station between the cerebral cortex and other sites.
a given imaging technique. The thalamus is crucial in sensory and motor signaling.
Subcortical: Pertaining to brain structures deeper than (below) Vasopressin (a.k.a. antidiuretic hormone): A hormone largely
the cerebral cortex. involved in regulation of blood pressure and diuresis, but
Subgenual anterior cingulate cortex (subgenual ACC): The por- also with other functions, including trust.
tion of the ACC directly below the genu (another structure). Ventral pallidum: A part of the basal ganglia implicated in
The subgenual ACC may be involved in mediating emotional craving and substance abuse.
processing in the amygdala, which is situated nearby. Ventral stratium: A part of the basal ganglia and key compo-
Substantia nigra: A subcortical brain structure that is largely nent of the reward system. The ventral striatum includes the
involved with dopamine neurotransmission. It plays impor- nucleus accumbens, in addition to other structures.
tant roles in reward pathways and movement. Ventrolateral prefrontal cortex: The ventrolateral (lower and
Sulcus (plural sulci): The bottom and inner portion (groove) outer) portion of the prefrontal cortex.
of a fold in the cerebral cortex. Folds (a.k.a. convolu- Visual cortex: A portion of the occipital lobe involved in pro-
tions) allow a larger cortical surface area within the cessing visual information. The visual cortex is one of the
skull. most well-understood parts of the cerebral cortex; specific
Temporal resolution: The precision with which a device functions have been determined for several specific compo-
detects events on the basis of time, often used in nents of the visual cortex.

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