Music Therapy: Clinical Evidence

Overview

Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship. Unlike casual listening to music for pleasure, music therapy is conducted by credentialed professionals who assess clients’ needs, design music-based interventions, and evaluate outcomes using established clinical frameworks. The American Music Therapy Association defines it as a practice that addresses physical, emotional, cognitive, and social needs through musical experiences including singing, playing instruments, composing, improvising, and listening.

What makes music therapy uniquely powerful among therapeutic modalities is music’s privileged access to the brain. Music engages more areas of the brain simultaneously than any other human activity — auditory cortex, motor cortex, prefrontal cortex, limbic system, cerebellum, hippocampus, and corpus callosum all activate during musical engagement. This distributed neural activation explains why music can reach people when other interventions cannot: the Parkinson’s patient who cannot walk but can dance, the person with severe dementia who cannot recognize family members but can sing every verse of a beloved hymn, the nonverbal child with autism who begins to vocalize during improvisational music interaction.

The clinical evidence for music therapy has grown substantially over the past three decades, with randomized controlled trials and meta-analyses supporting its effectiveness for conditions ranging from Parkinson’s disease to neonatal intensive care, from chronic pain to depression. This article reviews the major clinical approaches and their evidence bases, with particular attention to the neurologic underpinnings that explain why music heals.

Major Clinical Approaches

Nordoff-Robbins Music Therapy

Developed by Paul Nordoff (a composer) and Clive Robbins (a special educator) beginning in the 1950s, Nordoff-Robbins (NR) music therapy is an improvisational approach in which the therapist and client create music together in the moment. The therapist uses piano, voice, and other instruments to meet the client musically — matching their tempo, energy, and emotional quality — and then gradually invites the client into increasingly complex musical interactions.

NR music therapy is grounded in the concept of the “music child” — the innate musicality that exists in every person regardless of disability or diagnosis. The therapist’s task is to reach this music child through creative improvisation, building a musical relationship that becomes a vehicle for emotional expression, social interaction, and developmental growth. NR therapy is particularly well-developed for work with children with developmental disabilities, autism spectrum disorders, and intellectual disabilities.

The Nordoff Robbins Center for Music Therapy at New York University and similar centers in the UK, Germany, Australia, and other countries provide training, clinical services, and research. Studies have demonstrated the effectiveness of NR approaches for improving communication in children with autism, emotional expression in adults with mental health conditions, and quality of life in palliative care settings.

Neurologic Music Therapy (NMT)

Neurologic Music Therapy, developed by Michael Thaut and colleagues at Colorado State University, represents the most systematically evidence-based approach in the field. NMT applies the neuroscience of music perception and production to the treatment of neurological conditions, using standardized techniques that target specific cognitive, sensory, and motor dysfunctions.

Thaut’s research program has demonstrated that the brain’s response to musical rhythm is fundamentally different from its response to other auditory stimuli. Rhythmic auditory stimulation (RAS) — the use of rhythmic cues to facilitate movement — directly entrains the motor system through auditory-motor neural pathways (the reticulospinal tract), producing measurable improvements in gait parameters (velocity, stride length, cadence, symmetry) in patients with Parkinson’s disease, stroke, traumatic brain injury, and other neurological conditions.

NMT encompasses 20 standardized techniques organized into three domains: sensorimotor (e.g., Rhythmic Auditory Stimulation, Patterned Sensory Enhancement, Therapeutic Instrumental Music Performance), speech and language (e.g., Melodic Intonation Therapy, Rhythmic Speech Cuing, Musical Speech Stimulation), and cognition (e.g., Musical Sensory Orientation Training, Musical Executive Function Training, Musical Attention Control Training). Each technique has a defined neuroscience rationale, clinical protocol, and evidence base.

Guided Imagery and Music (GIM)

The Bonny Method of Guided Imagery and Music, developed by Helen Bonny in the 1970s, uses carefully programmed sequences of classical music to facilitate deep exploration of consciousness. In a GIM session, the client enters a relaxed state, listens to a 30-45 minute music program, and reports the imagery, feelings, memories, and sensations that arise. The therapist serves as guide, supporting the client’s experience through verbal interaction during the music listening.

GIM draws from humanistic and transpersonal psychology, and the music programs are designed to support specific therapeutic goals — from emotional processing to spiritual exploration. Research on GIM has documented its effectiveness for mood disturbances, PTSD, chronic pain, and quality of life in medical populations (McKinney et al., 1997). A meta-analysis by Grocke and Moe (2015) found moderate to large effect sizes for GIM in improving mood and well-being.

Music and Parkinson’s Disease

Rhythmic Auditory Stimulation (RAS)

The most extensively documented application of music therapy in neurology is the use of rhythmic auditory stimulation for gait rehabilitation in Parkinson’s disease. Parkinson’s disease impairs the basal ganglia, disrupting the internal timing mechanisms that regulate movement. External rhythmic cues — provided through music, metronome, or rhythmically structured sound — bypass the damaged basal ganglia and entrain motor output through alternative neural pathways.

Thaut’s landmark studies demonstrated that RAS training produces immediate and sustained improvements in gait velocity (increases of 25-30%), stride length, and cadence in Parkinson’s patients. These improvements exceed those produced by conventional physical therapy alone and persist when the rhythmic stimulus is removed, suggesting that RAS training induces neuroplastic changes in motor control networks. A Cochrane review confirmed the effectiveness of rhythmic cueing for gait rehabilitation in Parkinson’s disease (Defined et al., 2015).

Beyond Gait: Music for Parkinson’s

Music therapy for Parkinson’s extends beyond gait rehabilitation to address speech (Lee Silverman Voice Treatment augmented with singing exercises), swallowing (rhythmic facilitation of swallowing mechanics), emotional well-being (group singing and instrumental music for depression and social isolation), and cognitive function (music-based cognitive training for executive function deficits). The ParkinSong program and similar group singing interventions have documented improvements in vocal intensity, breath control, and quality of life.

Music in Dementia Care

The “Alive Inside” Effect

The 2014 documentary Alive Inside brought worldwide attention to the power of personalized music for people with dementia. The film documented Henry, a man with advanced dementia who was largely unresponsive until headphones playing his favorite music from the 1930s and 40s were placed on him — at which point he became animated, singing along, dancing, and engaging in coherent conversation for the first time in years.

This phenomenon is explained by the neuroscience of musical memory. Regions of the brain that process familiar music — particularly the medial prefrontal cortex and supplementary motor area — are among the last to deteriorate in Alzheimer’s disease. Musical memories encoded in adolescence and early adulthood, when the brain is maximally receptive to musical learning, can persist even when other memories are lost. When these musical memories are activated by familiar music, they can temporarily restore cognitive and emotional functioning that appears to have been permanently lost.

Evidence-Based Music Interventions for Dementia

A comprehensive Cochrane review of music-based interventions for dementia (van der Steen et al., 2018) found that music therapy probably reduces depressive symptoms and may reduce overall behavioral symptoms and improve quality of life, emotional well-being, and anxiety in people with dementia. Active music-making (singing, playing instruments) appears more effective than passive listening, and personalized music (chosen based on the individual’s musical preferences and history) is more effective than generic music.

The MUSIC-IN-DEMENTIA protocol, the MMT (Multicultural Music Therapy) approach, and individualized music listening programs (such as Music & Memory, the organization featured in Alive Inside) have all demonstrated effectiveness in reducing agitation, sundowning, and the need for psychotropic medications in dementia care settings.

NICU Music Therapy

Music for Premature Infants

Music therapy in neonatal intensive care units (NICUs) addresses the sensory, physiological, and developmental needs of premature and medically fragile newborns, as well as the emotional needs of their parents. The NICU environment — with its bright lights, constant noise, frequent painful procedures, and separation from parents — is a profoundly stressful environment for developing brains that evolved to be surrounded by the rhythmic, muffled sounds of the womb.

Jayne Standley’s meta-analysis of music interventions in the NICU found significant effects on oxygen saturation, heart rate, behavioral state, feeding rate, and length of stay. The PAL (Pacifier Activated Lullaby) system, developed by Standley, uses operant conditioning — delivering lullaby music through a speaker when the infant sucks on a specially designed pacifier — to reinforce non-nutritive sucking, which facilitates the transition to oral feeding and may reduce NICU length of stay.

First Sounds: Rhythm, Breath, and Lullaby

The NICU music therapy program developed by Joanne Loewy and colleagues at Beth Israel Medical Center uses three specific interventions: the gato box (a wooden instrument that simulates the rhythmic sounds of the womb), song of kin (a lullaby that incorporates the family’s cultural musical preferences), and the ocean disc (a round instrument filled with small beads that creates sounds mimicking amniotic fluid). A multisite randomized controlled trial found that these interventions improved feeding behavior, caloric intake, and sucking patterns, while reducing heart rate and improving sleep (Loewy et al., 2013).

Music for Pain Management

Gate Control and Beyond

Music’s effectiveness for pain management has been documented across surgical, procedural, chronic, and cancer pain. Meta-analyses consistently show that music interventions reduce self-reported pain intensity, opioid consumption, and anxiety in perioperative settings (Hole et al., 2015). The mechanisms are multiple: distraction (music competes with pain signals for attentional resources), relaxation (music reduces sympathetic nervous system activation), emotional regulation (music modulates mood, reducing the affective component of pain), and neurochemical effects (music stimulates endogenous opioid and dopamine release).

Live music therapy appears to be more effective than recorded music for pain management, likely because the interactive, personalized nature of live music therapy engages additional therapeutic mechanisms (therapeutic relationship, agency, co-regulation). However, recorded music programs that are personalized to patient preferences and delivered at appropriate volume and timing can also produce significant pain reduction.

Songwriting as Therapy

Therapeutic songwriting — the process of creating original songs within a therapeutic relationship — has emerged as a powerful intervention for emotional expression, identity exploration, legacy-making, and meaning-making. In palliative care, songwriting allows patients to express feelings about their illness, create musical legacies for loved ones, and process existential concerns through the structured, creative process of crafting lyrics and melodies.

Baker and Wigram’s comprehensive framework for therapeutic songwriting identifies multiple methods: fill-in-the-blank (completing a partially written song), song parody (writing new lyrics to a familiar tune), strategic songwriting (therapist creates the music, client provides words), and original songwriting (collaborative creation of entirely new songs). Research has demonstrated the effectiveness of songwriting interventions for depression, grief, PTSD, and quality of life in medical populations.

Clinical/Practical Applications

Music therapy is practiced across the lifespan and across clinical settings: psychiatric hospitals (for emotional expression, social skill development, reality orientation), rehabilitation centers (for motor, speech, and cognitive rehabilitation), schools (for children with special needs), hospice and palliative care (for comfort, emotional support, legacy work), correctional facilities (for anger management, social skills, creative expression), and community settings (for wellness, prevention, and social connection).

Music therapy interventions can be adapted for any cultural context by incorporating the client’s preferred musical styles, instruments, and cultural practices. The universal human capacity for musical engagement — present in every known culture and evident from birth (neonates preferentially attend to musical sounds over non-musical sounds) — makes music therapy uniquely cross-cultural and accessible.

Four Directions Integration

• Serpent (Physical/Body): Music directly affects the body — entraining heart rate and respiration, modulating pain perception, facilitating motor output, and inducing physiological relaxation. Rhythmic auditory stimulation for Parkinson’s gait rehabilitation is perhaps the clearest example of music’s direct action on the body’s motor systems. Drumming, singing, and instrument playing engage the body actively, providing physical expression and sensory stimulation.

• Jaguar (Emotional/Heart): Music is the language of emotion. No other stimulus can so rapidly and reliably alter emotional state — a minor-key melody can evoke sadness in seconds, a driving rhythm can generate excitement, a familiar lullaby can soothe distress. Music therapy leverages this emotional power within a therapeutic relationship, providing a container for emotional expression that may be too intense or too complex for words.

• Hummingbird (Soul/Mind): Music engages the soul through its capacity for meaning-making and identity expression. The songs we love become part of who we are — markers of identity, relationship, and life experience. Songwriting, musical autobiography, and lyric analysis all engage the soul’s need for narrative, meaning, and creative expression. In dementia care, personalized music reconnects people with their deepest sense of self.

• Eagle (Spirit): Music has been a vehicle for spiritual experience across every human culture — from Gregorian chant to Sufi qawwali, from Aboriginal didgeridoo to Vietnamese ca trù. The capacity of music to induce altered states of consciousness, transcendent experiences, and feelings of connection to something greater than the individual self points to a spiritual dimension that clinical music therapy, at its best, honors and facilitates.

Cross-Disciplinary Connections

Music therapy connects to neuroscience (auditory neuroscience, motor control, neuroplasticity), psychology (behavioral, psychodynamic, humanistic, developmental), medicine (neurology, palliative care, neonatology, pain management), rehabilitation sciences (physical therapy, speech-language pathology, occupational therapy), education (special education, early childhood), anthropology and ethnomusicology (cross-cultural music and healing), and physics (acoustics, psychoacoustics). Emerging connections include music therapy and psychedelic-assisted therapy, music therapy and virtual reality, and computational music therapy.

Key Takeaways

• Music therapy is an evidence-based clinical profession that uses music interventions within a therapeutic relationship
• Nordoff-Robbins music therapy uses improvisation to reach the “music child” in every person; Neurologic Music Therapy applies neuroscience to neurological rehabilitation
• Rhythmic Auditory Stimulation improves Parkinson’s gait by 25-30%, exceeding conventional physical therapy
• Musical memory persists in dementia when other memories are lost, enabling personalized music to temporarily restore cognitive and emotional function
• NICU music therapy improves physiological stability, feeding behavior, and developmental outcomes in premature infants
• Music reduces pain through distraction, relaxation, emotional modulation, and endogenous opioid release
• Songwriting provides a structured creative process for emotional expression, legacy-making, and meaning-making

References and Further Reading

• Thaut, M. H. (2005). Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications. Routledge.
• Nordoff, P., & Robbins, C. (2007). Creative Music Therapy: A Guide to Fostering Clinical Musicianship (2nd ed.). Barcelona Publishers.
• Loewy, J., Stewart, K., Dassler, A., Telsey, A., & Homel, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131(5), 902-918.
• van der Steen, J. T., Smaling, H. J., van der Wouden, J. C., et al. (2018). Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, 7, CD003477.
• Hole, J., Hirsch, M., Ball, E., & Meads, C. (2015). Music as an aid for postoperative recovery in adults: A systematic review and meta-analysis. The Lancet, 386(10004), 1659-1671.
• Sacks, O. (2007). Musicophilia: Tales of Music and the Brain. Knopf.
• Baker, F., & Wigram, T. (2005). Songwriting: Methods, Techniques and Clinical Applications for Music Therapy Clinicians, Educators and Students. Jessica Kingsley Publishers.
• McKinney, C. H., Antoni, M. H., Kumar, M., Tims, F. C., & McCabe, P. M. (1997). Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychology, 16(4), 390-400.
• Kaimal, G., Ray, K., & Muniz, J. (2016). Reduction of cortisol levels and participants’ responses following art making. Art Therapy, 33(2), 74-80.