Question: How can music be therapeutic?

Susan Cartwright answered on 21 Jun 2015:

Many different parts of the brain respond to music. Studies of brain function while listening to music show that different people’s brains respond in very similar ways when listening to music; when the music was digitally modified to make it less musical, either by removing the time structure or changing the tonal qualities, the responses were not only different from the response to music, but much more disparate between individuals. The brain responses to music were not just in the brain areas that process sound, but also in other brain areas, in particular the area associated with planning and organising movement.

This widespread response makes it quite reasonable that music might be a good way to stimulate certain areas of the brain. The similarity of response in different people may help explain why listening to music is a common social activity across many different cultures.

The key feature in many cases of therapeutic use of music seems to be the rhythmic quality of music. The brain responds very strongly to rhythm – I am sure you have found yourself tapping your feet or nodding your head to music, without having deliberately decided to do so, and this response can often have therapeutic uses. For example, people with Parkinson’s disease, who often have trouble maintaining the rhythm of normal walking, can be helped by music therapy. The improvement does not just happen while they are participating in the therapy (in other words, having a music therapy session in the morning improves performance throughout that day), although on longer timescales it is not permanent (if the therapy is stopped, the improvement is lost on a timescale of a couple of months). Most people who stutter can sing without stuttering, and the use of music therapy can help such people develop more fluency in normal speech. There is some evidence that music therapy can help with mood disorders such as depression, although the Cochrane Collaboration (which combines results from independently published studies to assess the effectiveness of medical treatments) was not at all impressed with the quality of the studies reported.

The mechanism or mechanisms by which music therapy works are not clear, and probably differ when treating different things. In using music therapy to treat problems with walking, not only Parkinson’s disease but also stroke patients and people with cerebral palsy, it is certainly the rhythm that is important – some improvements are obtained just using a rhythmic sound like a metronome, though music is better. In treatment of speech disorders, rhythm and structure seem to be important, and it is probably relevant that music and speech both stimulate some of the same parts of the brain. In treatment of mood disorders, it is thought that the ability of music to induce different emotional states is important. In most of these results, actively making music or singing, especially with a lot of improvisation, is better than simply listening to music.

So, probably the reason that music is therapeutic is that it stimulates activity in relevant regions of the brain – though which regions of the brain are “relevant” probably depends on what you are trying to treat.