Literature Review of Music Therapy

Running head: LITERATURE REVIEW 1

Literature Review

Jessica Thompson

Walden University

LITERATURE REVIEW 2

Abstract

Objective: The objective of the literature review was to provide

a comprehensive summary of the current research on the health

benefits of music. The focus was on music on mental health and

the use of music therapy (MT) in the mental health field.

Methods: A review of the current literature was undertaken. Key

quantitative, qualitative, and mixed methods research, alongside

a program evaluation of art programs, were selected to summarize,

the state of current research in the use of music and music

therapy.

Data Sources: The following databases were searched for articles

to include in this review: Academic Search Complete, PsycINFO,

and ProQuest.

Conclusion: There is a very limited amount of research conducted

on MT. The increasing use of MT globally suggests that more

research, quantitative and qualitative, is needed.

LITERATURE REVIEW 3

Literature Review

The use of music therapy (MT) shows promising benefits in

many areas but is just one subset of creative art therapy,

sometimes known as expressive therapy or creative therapy. Dance,

movement, drama, writing, sand, art, music, play, and

horticulture all fall under the purview of creative art therapy.

Music research has existed since the early 20th century with over

100 years of practice and research (MacDonald, 2013). Music can

reduce stress and tension, improving coping with physical and

emotional stress, improve empathy and compassion, and reduce pain

and anxiety (Jurcău & Jurcău, 2012).

We have access to music as often as we want with phones,

iPods, radios in our cars, homes, workplaces, public places, and

institutions. Music affects emotion and may be able to manage and

regulate it, as well as stress, in day-to-day life (MacDonald,

2013). Recently there has been an increase in the use of MT in

China, Japan, Australia, Canada, Europe, and the United States as

will be evidenced in the review of the literature (McClean, Bunt,

& Daykin, 2012).The objective of this review highlights the scope

LITERATURE REVIEW 4

and breadth of current MT research of the last decade focusing on

the impact of music on mental health.

Review of Literature

An exhaustive search for articles was conducted using the

ProQuest, PsycINFO, and Academic Search Complete Databases for

inclusion in this review. Patterns were made manifest in the

selection process focusing in several areas: grief, terminal

illness and palliative care, dementia, and well-being. Additional

special topics deemed important to the review are included.

Participants

The selected research spans globally from Australia (Baker,

Grocke, & Pachana, 2012; Horne-Thompson, Grocke, 2008; McFerran,

2010; McFerran, Roberts, & O’Grady, 2010), Canada (Busch & Gick,

2012; Jessop, 2014), United Kingdom (Carr, d’Ardenne, Sloboda,

Scott, Wang, & Priebe, 2012; McClean, Bunt, & Daykin, 2012),

United States (Hilliard, 2003), and Romania (Jurcău & Jurcău,

2012). Participants of the studies ranged from bereaved children

and adolescents (McFerran, 2010; McFerran, Roberts, & O’Grady,

2010; Rosner, Kruse, & Hagl, 2010) to adults with PTSD (Carr et

al., 2012) or a terminal illness (Hilliard, 2003; Horne-Thompson

LITERATURE REVIEW 5

& Grocke, 2008; McClean, Bunt, & Daykin, 2012), and the elderly

facing dementia (Jessop, 2014). Albornoz’s (2013) study focused

on a convenience sample of interested parties, five music

therapists and two music therapy students who ranged in age from

23 to 50. Baker, Grocke, and Pachana (2012) researched not only

the effect music had on the individuals with dementia in their

homes, but the impact MT had on their spousal caregivers.

Music Therapy

One working definition of MT is “the use of sounds and music

within an evolving relationship between client/patient and

therapist to support and develop physical, mental, social, and

spiritual well-being” (MacDonald, 2013; McClean, Bunt, & Daykin,

2012, p. 402). Types of MT include: free improvisation of tuned

and untuned percussion instruments (Jessop, 2014; McClean, Bunt,

& Daykin, 2012; McFerran, 2010; McFerran, Roberts, & O’Grady,

2010), precomposed material (McClean, Bunt, & Daykin, 2012),

songwriting (McClean, Bunt, & Daykin, 2012; McFerran, 2010;

McFerran, Roberts, & O’Grady, 2010), listening to music (McClean,

Bunt, & Daykin, 2012; McFerran, Roberts, & O’Grady, 2010), group

and solo singing (Jessop, 2014), choir singing (Busch & Gick,

LITERATURE REVIEW 6

2012), and song sharing (McFerran, 2010). Bach, Mozart, and

Italian composers, meditation music, and other classical music

offers the highest benefit in reducing pain, anxiety, and stress

in patients (Jurcău & Jurcău, 2012). In the research selection

process, several themes of research emerged for deeper

consideration.

Terminal Illness and Palliative Care.

Hilliard (2003) and Horne-Thompson & Grocke (2008) put forth

two current quantitative studies that use MT as an intervention

for terminal illness and cancer. Doing so is believed to foster

physical, mental, social, and spiritual well-being, and serves as

an effective intervention to use with late stage terminal clients

for anxiety. Hilliard (2003) sampled 80 adult participants

receiving hospice care in their homes for a terminal cancer

diagnosis. The participants were randomly assigned to the

experimental or control group. The experimental group received

the routine hospice services that the control group received, but

in addition to MT that the control group did not receive. The

Hospice Quality of Life Index-Revised (HQOLI-R), Palliative

LITERATURE REVIEW 7

Performance Scale, and physical status assessments were

administered to all.

The quality of life for the experimental group was not only

higher than the control group, but it increased over time as the

experimental group got more MT. The control group had the

opposite result; their quality or life was lower and decreased

over time. Additionally there was a consistency to higher quality

of life in the experimental group even when physical functioning

began to decline (Hilliard, 2003).

The study conducted by Horne-Thompson & Grocke (2008) was

confined to individuals with end stage terminal illnesses in an

inpatient hospice setting. There were 25 participants that ranged

in age from 18 to 90 years old selected from individuals referred

to MT for anxiety. The participants were randomly assigned to an

experimental group that received a single MT session or a control

group that received a volunteer visit. The ESAS and a pulse

oximeter were used in a pretest-posttest design. The results of

the measures indicate that 8 of the 13 participants in the

experimental group had a significant decrease in anxiety compared

LITERATURE REVIEW 8

to only 1 of the 12 individuals in the control group (Horne-

Thompson & Grocke, 2008).

A third study, The Healing and Spiritual Properties of Music Therapy at a

Cancer Care Center, conducted 23 taped phone interviews of a 5-day

residential retreat program that offered MT. The qualitative

study used a modified grounded theory approach using a two-stage

method of coding. The identified themes within the interviews

were applied to Magill’s four overarching themes: transcendence,

connectedness, mean-making, and faith and hope. The result of the

study emphasized meaningfulness, group connectedness and harmony,

and a transformative experience that lends itself to musical

creativity and identity discovery (McClean, Bunt, & Daykin,

2012).

Grief.

McFerran, Roberts, and O’Grady (2010) compare music to a

metaphorical mirror and window for a teenager in that mirrors

reflect the self and the window “encompasses the social,

interpersonal, and cultural functions that music naturally serves

for young people” (p. 544). Using MT in a study of teenage

bereavement, McFerran participated in two research studies,

LITERATURE REVIEW 9

qualitative and mixed methods. Over the course of two school

terms, sixteen adolescents volunteered to be a part of the mixed

methods study divided into two groups. Group one was

predominantly male, and group two predominantly female, but both

groups had an average age of 14. Each week the groups met for 90

minutes of MT. Group one completed Self-Perception Profile for

Adolescents (SPPA) while group two completed the Adolescent

Coping Scale (ACS-Short Form), and both completed questionnaires

for the first and last session. The low participant numbers

returned no significant result from the SPPA. The groups reported

feeling as though they had permissions to grieve, being able to

move on, letting out, connected, and able to share (McFerran,

Roberts, & O’Grady, 2010).

In the qualitative study, adolescents were split into a

twelve-person group of mostly males with an average age of 14 and

a second group of eleven adolescents made up of mostly girls with

an average age of 13. Both groups participated in MT that

consisted of improvisation, song sharing, and song writing. Small

group interviews followed, no more than three adolescents at a

time, to collect data. Data analysis included the interviews,

LITERATURE REVIEW 10

session notes, session summaries, and CDs of two original songs

created by the adolescents, seven improvisations, and sixty-four

preferred songs. Axil coding resulted in four categories: letting

it out, being with other people who understand, music, and

outcomes (McFerran, 2010).

Dementia.

The two dementia studies approach the subject from different

points; the first looks at spousal caregivers and relationships

while the second takes a creative approach not only to an

intervention method but in reporting the results as well. An

Australian study of spousal caregiver-directed, home-based music

interventions explored the impact it had on the quality of

spousal relationships, caregiving satisfaction, and caregiver

wellbeing. Five couples were recruited using the following

methods: holding informative meetings for Alzheimer’s Australia

caregiver support groups, placing advertisements, publishing

articles in relevant newspapers and magazines, and contact with

community workers. Each couple met the criteria, living in their

own home with one partner having a dementia diagnosis, for an


active music intervention (AMI) 20 to 30 minutes long 3 times a

week for 6 weeks (Baker, Grocke, & Pachana, 2012).

A music therapist visited each couple to strategize music

use with the caregiver in order to give the caregiver confidence

in implementing the music on his or her own. Familiar songs were

sung, moving to music was encouraged, and listening quietly with

eyes closed was also employed. The caregivers were provided with

a diary of guided questions for the duration of the study,

completed pre and post measures, and a semi-structured interview.

The test measures used were the Geriatric Depression Scale short-

form (GDS-SF), Geriatric Anxiety Inventory (GAI), Mutual Communal

Behaviours Scale (MCBS), Positive Aspects of Caregiving

Questionnaire (PACQ), and the Neuropsychiatric Inventory

Questionnaire (NPI). The quantitative results were used to

identify changes in individual scores only because of the low

number of participants. The couples reported that MT facilitated

being able to spend quality time together, feelings of intimacy,

and being able to engage as they did before the dementia

diagnosis (Baker, Grocke, & Pachana, 2012).


Jessop (2014) employed a humanistic and client-centered

model with individuals aged 79 to 92 with mild to moderate

dementia. Seven individuals, two men and five women, took part in

the dementia care music therapy group that studied musical self-

actualization through the use of poetry, metaphors, and

representative imagery of the participants. The MT interventions

entailed using instruments and singing. The participants, who had

already established trust and relationships by being in the group

together, met for 13 videotaped MT sessions. Five identifiable

themes of musical self-actualization were discovered: physical,

cognitive, musical, communication, and affective (Jessop, 2014).

The results of the qualitative research were presented as an

image, vocative writing, and poetry to “better represent the

human quality of life experience and to more fully engage readers

holistically, emotionally, intellectually, and viscerally”

(Jessop, 2014, p. 51). Each participant of the study had a poem

created about them and received a title that represented his or

her role and identity amid the “Grand Orchestra”, the name given

to the group due to the researcher’s comparison to a grand

orchestra performance. The table below outlines the participants,


the roles they held, and the reasoning for those roles (Jessop,

2014).

The “Grand

Orchestra”

PARTICIPANT NAME ROLE REASONLeo “The Percussionist” Had an affinity for

percussion instruments

Arthur “The Violinist” An experienced violinist

Patricia “The Virtuoso” Played with intensity, keen presence, and commitment

Florence “The Opera Diva” Sang high, operatic notes with ease

Kathleen “The Conductor” Directed and guided the group in informal ways

Gertie “The Dancer” Losing her ability to communicate, she used creative physical movements

Daisy “The Listener” An active listener due to her declininghealth

Melissa* “The Concert Hall” The container that holds the participants and supports the music

*Melissa is the music researcher and therapist, but also had a

role.

PTSD.


Posttraumatic Stress Disorder, or PTSD, treatment was the

focus of a mixed methods study that explored the use of group

music therapy in a randomized controlled trial. MT is presented

as an alternative for an individual diagnosed with PTSD, who is

not benefitted by cognitive-behavioral therapy (CBT) and has

persistent PTSD symptomology. Seventeen participants between the

ages of 18 and 65 were recruited from the National Health Service

in London, United Kingdom. The criteria for the study was that

each participant received trauma-focused CBT treatment but

retained significant symptoms at the time of discharge, spoke at

least basic English, had a PTSD diagnosis, and were not currently

undergoing any other psychotherapy. The participants were divided

into a treatment group of nine and a wait-list control group of

eight for a ten week duration. They took part in a mixed methods

study that utilized the Impact of Events Scale-Revised, Beck

Depression Inventory II, and exit interviews. The results were

triangulated with the video recordings of the weekly group MT and

process notes to form the analysis. Participants showed a

significant improvement in avoidance, re-experiencing, and

hyperarousal. Further, the participants reported meeting people,


relaxing, and playing instruments were helpful. A few felt the

noise was too much, and some felt there should be more talking

about trauma. After the MT several reported that they felt more

at ease and less angry and agitated (Carr et al., 2012).

At-Risk Youth.

At-risk youth arts programs have a positive impact on

incarcerated juveniles, and art schools, religious-based

organizations, and government agencies have implemented arts

programs for seven to seventeen-year-old. However, there is

sparse research on why or how the positive impact occurs and the

outcome from different types of art. Art programs include

performing arts (dance, music, theater, poetry, and essays) and

visual arts (painting, sculpting, and writing). Collaboration is

an important component of art programs because students can have

needs that are not met by a single agency, and collaboration is

helpful to students and parents. The content of the curriculum,

the personality of the instructors, and logistical and practical

considerations can all play a part in the impact of arts program

on students. For instance, providing transportation and lunch or


snacks could enable more students to attend more regularly

(Miller & Rowe, 2009).

Special Topics

There were several topics related to music and the mental

health field that bared mentioning as part of the literature

review. Included in this section is a study of anxiety and

salivary cortisol in relation to MT for short term exercise

stress in sedentary individuals. Secondly, effect and

implications of crying in MT are explored, and lastly, the

correlation between music and well-being are presented.

Jurcău and Jurcău (2012) conducted a study with 44

individuals, 22 men and 22 women, evenly split and placed into an

experimental and control group. The mean age of each group was

26.2 ± 2 for the experimental group and 21.6 ± 4 for the control

group with each made up of 11 women and 11 men. Mozart’s Concert

no. 21 was played by headphones to the experimental group while

both groups went through short term exercise on cycle ergometers.

The purpose of the study was to the effect of MT on anxiety and

cortisol levels while exercising. Results showed that anxiety and

salivary cortisol were reduced after MT (Jurcău & Jurcău, 2012).


There is little research on the subject of crying in MT.

Albornoz (2013) conducted email interviews with five music

therapists and two music therapy students who showed interest in

being part of the study. All seven individuals had experience

crying in session either as the therapist or the client. Each

crying description was read, the significant elements of crying

were extracted, the general meaning of the crying were

formulated, the meanings were grouped by theme and described, a

structure was created of the descriptions and the study

participants were allowed to review and correct the results

before approving them (Albornoz, 2013). From the qualitative

research the results suggested that crying was a common,

spontaneous occurrence that co-occurred and increased:

the intensity of truth revelation

countertransference messages

acceptance of repressed feelings and cathartic emotional

release

“a feeling of reassurance upon acceptance of feelings that

had previously been ignored”

hard to define, nonverbal manifestations of emotion


confirmation of an overcome painful event

transitional life change messages (Albornoz, 2013)

Well-Being.

Research focused on the effect music has on personal well-

being was too prominent not to mention in the review. Community

music, like choral singing, allow for creative expression and

offer benefits on an individual and community level. There is

overlap in music, health, and well-being interventions: music

education, music medicine, music therapy, community music, and

everyday listening of music. This overlap suggests a need for

cross-collaboration to research the connection between the three.

Music is a part of every facet of our lives, and it can engage

our emotions, provide solace, and becomes part of our identities

(MacDonald, 2013).

Busch and Gick (2012) conducted a quantitative study of two

adult choirs in Ottawa consisting of 44 women and 15 men in all

measuring hedonic and eudaimonic well-being. The first choir was

entirely women while the second was made up of men and women. The

participants of the study were between the ages of 28 and 80 with

a mean age of 55.92. The participants were administered the Ten-


item Personality Inventory (TIPI), the Multidimensional Scale of

Perceived Social Support (MSPSS), the Positive and Negative

Affect Scale (PANAS), the Satisfaction With Life Scale (SWLS),

the Flourishing Scale (FS), the Vitality Scale (VS), and the Ryff

Scales of Psychological Well-Being (RPWB). The study consisted of

a single, two-hour rehearsal for a Christmas Concert (choir 1)

and a March concert (choir 2). The measurement schedule for both

groups was as follows:

Before Rehearsal After Rehearsal

General Information MSPSS

TIPI PANAS

PANAS SWLS

SWLS VS

VS FS

FS RPWB

RPWB

Research data suggests that an individual’s socioeconomic

status (SES) and whether he or she is an amateur or a

professional can also influence the benefits. Homeless


individuals are more inclined to place emphasis on the social

opportunity aspects of choral singing while individuals of the

middle class emphasize the challenge of learning and singing.

Additionally, amateurs are more likely to have an increase in

well-being after a rehearsal or singing lesson than a

professional would. Community music based choral singing offers

an opportunity for growth, learning, and self-expression in

addition to psychological, physical, and social benefits (Busch &

Gick, 2012).

Psychological

BenefitsPhysical Benefits Social Benefits

Improved mood Improved breathing Improved Social

Interaction

Self-actualization Making Friends

Improved self-esteem

Limitations and Future Research

While the small sample used in Albornoz’s (2013) qualitative

research were all music therapists and music therapy students,

the benefits of crying in MT have several implications for


further research and in the practice setting. It can facilitate

meaningful personal discovery, personal issue resolution, and

well-being. In addition, crying in MT can:

add depth to the therapy

provide a meaningful experience

creatively connect individuals with their backgrounds

facilitate resolution, and

allow the individual to connect with him- or her- self and

the innermost feelings (Albornoz, 2013).

There is a scant amount of quantitative research for music and

music therapy in the mental health field; however the last decade

has seen a burgeoning of mixed methods research. While there were

a highly varied participant sample and a wide variety of mixed

methods research, there were many limitations. The overwhelming

limitation of MT is the lack of research and in many cases, the

small sample sizes and scarcity of effect size reporting. Baker,

Grocke, and Pachana (2012) acknowledged that the sample size of

their study could not generate significant quantitative results,

even though, the GDS-SF, GAI, MCBS, PACQ, and NPI were used.


Further study is needed to test the effect of MT on distressing

symptoms like anxiety and pain (Horne-Thompson & Grocke, 2008).

Anxiety also factors into the research needed for dementia

spouse caregivers as Baker, Grocke, and Pachana’s (2012) research

showed initial high anxiety for one of the participants. Further

research could determine if this leads to changes in the level of

anxiety (Baker, Grocke, & Pachana, 2012). Dementia also requires

a comparison of the stages of the disease to determine what

stages are best for the intervention. Baker, Grocke, and Pachana

(2012) recommend mixed methods research as the focus of MT

interventions for dementia because of the options for reporting.

In future, choral singing and well-being research should explore

psychosocial factors in order to determine what role psychosocial

factors, like personality, might play. Additionally, samples need

to be larger, more varied and offer a comparison between group

and solo singing and singer and nonsingers (Busch & Gick, 2012).

In regards to MT interventions used with children, there

needs to be a clearer definition of childhood complicated grief

and reliable and valid measures for different ages, specifically

an adolescent-specific grief and loss outcome measurement tool


(McFerran, Roberts, & O’Grady, 2010; Rosner, Kruse, & Hagl,

2010). There also needs to be an accounting of drop-out rates in

research studies (Rosner, Kruse, & Hagl, 2010).

MT interventions with terminal cancer patients have unique

difficulties in studying length of life. In Hilliard’s (2003)

research, it is suggested that in the future research should

focus on establishing whether there are patterns regarding length

of life. There also needs to be a comparison the MT techniques

and research pertaining to multicultural issues (Hilliard, 2003).

Another facet of research in MT, crying, has had very little

research focus. In future studies there needs to be more

qualitative and quantitative research, an exploration of the

similarities and differences between different populations,

larger sample sizes, more in-depth interviews, and a comparison

of frequency and context of crying in relation to the types of MT

interventions (Albornoz, 2013).


References

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Study. Qualitative Inquiries in Music Therapy, 831-50.

Baker, F. A., Grocke, D., & Pachana, N. A. (2012). Connecting

through music: A study of a spousal caregiver-directed music

intervention designed to prolong fulfilling relationships in

couples where one person has dementia. Australian Journal of Music

Therapy, 234-19.

Busch, S. L., & Gick, M. (2012). A Quantitative Study of Choral

Singing and Psychological Well-Being. Canadian Journal of Music

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Carr, C., d'Ardenne, P., Sloboda, A., Scott, C., Wang, D., &

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Literature Review of Music Therapy

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