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Psychomusicology: The Clinical Relevance of Music in Health Psychology
Eric K. Willmarth, Ph.D.
Clinical Psychomusicologist 
Saybrook University
Published online: December 2025
  © The Author(s) 


Abstract
Background: The use of music to assist in the treatment of medical and psychological conditions has evolved over centuries and remains a field in continuous development. 
Methods: This article provides a very brief review of the psychophysiology of music along with some of the issues, clinical applications, and definitions related to psychomusicology, music therapy, music medicine, and music-assisted treatment.  
Conclusions: Music appears to be an effective, cost-efficient, accessible, low-risk, and well-accepted adjunctive modality that can contribute to the treatment of many disorders, including chronic pain, anxiety, and depression, within a wide range of clinical settings and cultural contexts
Keywords: Psychomusicology, Music Therapy, Music Medicine, Adjunctive Therapy, Psychophysiology




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Introduction
For over 20 years, the author conducted weekly group therapy sessions in two different clinical settings for patients dealing with chronic pain and depression. Group size averaged from 6-10 patients whose participation ranged from months to years.  A key practice that evolved from these groups was the selection of one patient at the end of each session to bring a recording of their “favorite music” to the next meeting.  The following session would then begin with the patient explaining why they had chosen their music selection, after which the whole group would listen to the recording. A visiting presenter, observing this for the first time, commented: “Watching the group while the music was playing, I would never have guessed that this was a pain and depression group.  Looking at their faces, I saw only smiles and joy”.  This article will attempt to look at the evidence supporting the adjunctive use of music in the field of clinical health psychology.  
Music Medicine vs Music Therapy vs Music-Assisted Therapy vs Psychomusicology
While there are sometimes blurry distinctions in practice, the term “music therapy” is reserved for those who are board-certified as music therapists, generally requiring a degree in music. (Salamon, 2024).  Music medicine, on the other hand, refers to the use of music as an adjunctive therapeutic technique employed by professionals from various disciplines, including physicians, social workers, psychologists, occupational therapists, physical therapists, and others. The term psychomusicology refers specifically to psychotherapists using music as an adjunctive technique in practice or research. 
A distinction is also sometimes suggested that music medicine involves primarily the passive listening to music, as in the example given in the introduction, while music therapy is more likely to engage the clients in active participation or performance. (Gold, 2011). This is a more blurry distinction, dependent on the context and skills of the therapist and client. Therapeutic drumming circles are certainly active and may be used by certified music therapists and psychomusicologists alike. Another, more generic category has also emerged in the phrase “Music-Assisted Therapy,” which seems to cover all the bases for both music medicine and music therapy. (De Luca, 2020)
Brandt et al. (2014) completed a direct comparison of music therapy and music medicine when addressing the psychological outcomes and pain levels of cancer patients. They report: “The quantitative data suggest that both interventions were equally effective in enhancing target outcomes”. (p.1261) Research on the impact of music on health often combines both music therapy and music medicine, as in the Cochrane Library review on music interventions by Brandt et al. (2021). In this current review, an attempt will be made to differentiate between music therapy and the more encompassing terms of psychomusicology, music-assisted therapy, and music medicine, when possible.
The Psychophysiology of Music
Listening to music appears to produce measurable psychophysiological changes across the autonomic, endocrine, and central nervous systems. Music and musical features such as tempo, rhythm, tone, frequency, and timbre have been shown to impact heart-rate variability, stress hormones, and neural activity ( Zhang et al. 2025). Lata and Kourtesis (2021) suggest that both the hypothalamic pituitary-adrenal axis and the autonomic nervous system are impacted by listening to music.  They add that in studies conducted in healthy adults, listening to certain types of music results in a decrease in both cortisol levels and sympathetic activity (reduction in heart rate frequency and blood pressure). (Lata & Kourtesis, 2021). Looking specifically at the impact of music-assisted therapy on the psychophysiology of pain, Arnold et al. (2024) suggest that multiple areas are involved, including the periphery, spinal cord, brainstem, limbic system, and multiple areas of the cerebral cortex. Loomba et al. (2012) found that selected music could evoke a decrease in blood pressure and heart rate.  
Merrill et al. (2023) note that the psychophysiological changes elicited by music are not necessarily positive. Listening to “disliked” music resulted in heightened arousal, with increased heart rate, body temperature, and skin conductance response
Koelsch (2005, 2014, 2020) has published extensively on the neuroscience and neuroimaging studies related to music-evoked emotions. He notes music’s “power to evoke strong emotions and influence moods” (Koelsch, 2014, p. 170).  His work in reviewing MRI and other functional neuroimaging studies suggests that brain structures such as the amygdala, hypothalamus, hippocampus, cingulate cortex, and other areas are influenced directly by music and, in turn, can influence mood and emotion. He predicts that “The potential of music to modulate activity in these structures has important implications for the use of music in the treatment of psychiatric and neurological disorders.” (Koelsch, 2014, p. 170). This foundational work provides some insights into the successful application of music in health psychology in areas ranging from pain, depression, anxiety, and other clinical conditions.   
Music and Health
Music has been utilized extensively in both clinical and non-clinical populations, across various healthcare settings, and in other applications, such as sports performance. (Nidhal et al., 2025).  Within healthcare, another distinction can be made between work with pathological conditions and work with a more general population seeking wellness or enhanced health functioning. The use of music in preventative healthcare would be an example of the latter category. Daykin et al. (2018), for example, reviewed the literature on subjective well-being outcomes when music was used as an intervention.  They concluded that “There is reliable evidence for positive effects of music and singing on wellbeing in adults”. (p. 39). Similar support has been offered by Fancourt et al. (2017) for drumming circles and by Florian & Rosemond (2017). Music has also been employed in an effort to delay or prevent dementia, as well as to improve the quality of life for those individuals suffering from dementia.  Within the field of health psychology, however, the majority of work appears to have been focused on pathological conditions and the impact that music-assisted therapy can provide.  Pain management, along with the treatment of depression and anxiety, makes up the core of this work.  Stress management is also frequently addressed in the music therapy literature and is equally applied to both pathological and non-pathological populations. This review will focus on the application of music-assisted therapy with individuals suffering from medical and/or psychological disorders.   
Applications: Chronic Pain
Chronic Pain impacts millions of people around the world.  Nahin et al. (2023) estimate that over 20% of the US population suffered from chronic pain in 2020. The impact on individuals with chronic pain is comprehensive and can include both the sensory pain experience and the severe psychosocial impact and limitations associated with chronic pain. While the “opioid crisis” has resulted in a reduction in the pharmacological treatment of pain, the need for alternatives has increased.  (Dowell et al. 2016). 
Recently, Chen et al. (2025) published a review and meta-analysis on the use of music therapy with individuals experiencing chronic pain. Their review included nine randomized controlled trials. Although the term “music therapy” is used throughout the review, only three of the studies reported using music therapists, while most of the others used a “trained nurse.” Included in their original search strategy was the term “music intervention.”  Combining music therapy with music-assisted therapy, the study included 787 patients, most of whom received individual interventions, with only one study using group therapy.  The authors reported a significant reduction in both pain and depression with the use of a music intervention compared to a standard care control.  They did not find a significant improvement in either anxiety or quality of life. 
While chronic pain (pain lasting more than 3 months) can exist for countless reasons, cancer pain is one of the most common and most frequently identified causes, with 70-90% of individuals with advanced cancer reporting severe pain. (Valeberg et al., 2007.)  Jethva et al. (2025), in a study with 43 individuals with cancer in a palliative care setting, report a significant improvement in pain perception, along with improvement in other symptoms, when treated by certified music therapists. Earlier, Brandt et al. (2014) did not find a direct impact of music therapy or music medicine on pain perception, although they did report other positive impacts with the use of music. More recently, Brandt et al. (2024) again found that music therapy did not have a direct impact on pain intensity, but that pain-related self-efficacy was a primary moderator that should be incorporated into future music therapy interventions. In a 5-year retrospective study at a National Cancer Institute-designated comprehensive Cancer Treatment Center, Licht et al. (2022) reported both statistical and clinically meaningful reductions in pain among patients who received music therapy from certified music therapists.  
Another common, if less well-defined, source of pain impacts individuals suffering from fibromyalgia. Wang et al. (2020) reviewed 7 randomized controlled trials involving the use of music interventions with patients identified as suffering from fibromyalgia. While noting inconsistent methods, small sample sizes and the general low quality of the available literature, They conclude that “… music therapy is superior to non-music therapy in the treatment of pain, depression, and improvement of quality of life in fibromyalgia patients.” (p, 327) Alparslan et al. (2016) investigated the effect of listening to recorded music in this population and found a significant reduction in pain levels compared to a non-treatment control. Noting the widespread musculoskeletal pain present with fibromyalgia, Espi-Lopez et al. (2016) completed a study combining music with low-impact aerobic exercise, resulting in a decrease in general discomfort as well as improved treatment adherence. Although the term “music therapy” was used, it appears that physical therapists, rather than certified music therapists, were involved, which, for the purposes of this paper, would categorize the study as “music-assisted therapy.” 
Applications: Anxiety and Distress
Several of the studies cited above related to the use of music in the treatment of chronic pain also report on the impact of music on mood, including anxiety and depression.  Looking first at anxiety, the majority of studies seem to address anxiety in specific situations, such as undergoing medical treatment, rather than addressing generalized anxiety disorder.  For example, Rossetti et al. (2017) describe the use of music therapy with cancer patients beginning the first phase of radiation therapy. While noting that 10-20% of patients undergoing radiation therapy have clinically significant anxiety, they include “distress” as an additional measure.  Compared to a control group, which did not receive music therapy, the researchers concluded that; “Music therapy, provided by a board-certified music therapist, may offer a safe, cost-effective means of alleviating patient anxiety and distress” (p.108). Earlier, studies also support the use of music therapy or music-assisted therapy to reduce anxiety in radiation treatment (Clark et al., 2006., Chen et al., 2013), ventilation therapy (Chlan et al., 1998; Han et al., 2010), burn debridement (Fratianne  et al., 2001), chemotherapy (Ferrer, 2007), gynecologic surgery (Xu et al., 2021),  and end-of-life care (Horne-Thompson & Grocke (2008).
Lu et al. (2021) reviewed 32 randomized controlled trials evaluating the impact of music therapy on anxiety.  Music therapy was found to have a significant positive impact on anxiety at follow-up compared to control groups. More recently, de Witte et al. (2025) conducted a systematic review and meta-analysis of the literature on anxiety and music, encompassing both formal music therapy and other music-assisted treatments.  The review included 51 studies and concluded that patients undergoing music therapy showed marked decreases in anxiety levels across various settings. While a significant decrease was observed in patients’ self-reports of anxiety when using music-assisted treatment, the change in physiological measures related to anxiety was not found to be significant. In one of the relatively small number of studies looking specifically at Generalized Anxiety Disorder, Gutiérrez et al. (2015), using a pre-post design that did not include a control group, conclude that “It appears that music therapy was an effective psychotherapeutic treatment in the psychiatric care of patients with GAD.”(p. 24).
Applications: Depression
Depression is now the leading cause of disability worldwide, estimated to impact over 300 million people, and it accounts for approximately 800,000 deaths per year (WHO, 2025). Given the staggering impact of this disorder, it is not surprising that multiple medical and psychological interventions have been studied, including the use of music therapy and other music-assisted interventions.  Similar to the study by Brant et al. (2014) cited above, Tang et al. (2020) conducted a meta-analysis of randomized controlled trials (RCTs) and examined the independent impact of music therapy and other music-assisted treatments on depression. In studies identified as music therapy, treatment was provided by a credentialed professional who completed an approved music therapy program. Studies in which treatment was provided by those who had not completed a music therapy program were identified as music medicine studies. In reviewing 51 RCTs, the researchers found that both music therapy and music medicine interventions resulted in a significant reduction in the symptoms of depression, compared to control groups, with music medicine showing a stronger effect compared to music therapy. 
In a Cochrane review summary related to music therapy and depression, Roddis and Tanner, (2020) found that the addition of music therapy to treatment-as-usual resulted in a decrease in depressive symptoms compared to patients who received only treatment-as-usual. No significant difference was found when comparing active to passive music interventions.  
A number of studies looked at specific patient populations when investigating the impact of music on symptoms of depression.  Geipel et al. (2022) looked specifically at adolescent patients and found that not only was music effective in decreasing symptoms of depression, but the treatment was also well accepted.  Zhao et al. (2016) found similar results working at the other end of the age spectrum with elderly individuals with symptoms of depression. 
As noted previously in this article, depression is also a common element for patients suffering not only from mental health concerns, but also those coping with chronic pain, cancer, and other medical conditions and loss.  In most cases, music therapy and music medicine have been found to be beneficial, particularly when combined with other medical and/or psychological interventions. 

Summary
In this brief review, support has been offered for the clinical application of music therapy, psychomusicology, and the multiple other forms of music medicine or music-assisted treatment. There does not appear to be a strong clinical advantage to the often more active patient engagement associated with formal music therapy, and some reviews suggest that more passive approaches may have a slightly stronger effect, although this will vary depending on the context and multiple other variables. There certainly does not appear to be a standard protocol at this point for the application of music in clinical practice. While some argue that the modality of music should be left to the domain of certified music therapists, others argue that the tool of music is best placed in the hands of licensed psychotherapists and other licensed healthcare providers.  In almost all cases, it appears that music is best seen as an adjunctive technique that can complement existing treatment for medical and psychological disorders.  There is also consensus that much additional research is needed to expand support for music-related interventions and to explore areas where music could benefit those in need of additional and/or alternative options.  









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