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Music Therapy
Music therapy is the use of music to improve clients' quality of life. Music therapy is an evidence-based, clinical use of music interventions. The Music Therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients improve their health and quality of life. Music therapists primarily help clients improve their health in several domains, such as cognitive, motor, emotional, communication, social, and educational by using both active and receptive music experiences such as improvisation, re-creation, composition, and receptive methods and discussion of music to achieve treatment goals. There is a wide qualitative and quantitative research literature base for music therapy.

Some commonly found practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence/orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke victims. Music therapy is used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities. [1]

According to Dr. Daniel Levitin, "Singing and instrumental activities might have helped our species to refine motor skills, paving the way for the development of the exquisitely fine muscle control required for vocal or signed speech” [2]

Music has been found to be an effective tool for music therapists through extensive research. It is beneficial for any individual, both physically and mentally, through improved heart rate, reduced anxiety, stimulation of the brain, and improved learning. Music therapists use their techniques to help their patients in many areas, ranging from stress relief before and after surgeries, to neuropathologies such as Alzheimer's disease. Studies have been carried out on patients diagnosed different mental disorders such as anxiety, depression and schizophrenia and there has been a visible improvement in their mental health after the therapy.[4] One study found that children who listened to music while having an IV inserted into their arms showed less distress and felt less pain than the children who did not listen to music while having an IV inserted.[3]

!!!Approaches used in music therapy that have emerged from the field of music education include Orff-Schulwerk (Orff), Dalcroze eurhythmics, and Kodály method. Models that developed directly out of music therapy include neurologic music therapy (NMT), Nordoff-Robbins music therapy and the Bonny method of guided imagery and music.[5]:460–468 2

!!!Music therapists may work with individuals who have behavioral-emotional disorders.[2][6][unreliable medical source?] To meet the needs of this population, music therapists have taken current psychological theories and used them as a basis for different types of music therapy. Different models include behavioral therapy, cognitive behavioral therapy, and psychodynamic therapy.[5]:469–473 The therapist has an ongoing responsibility to evaluate the extent to which the client progresses through the therapy and whether the methods of therapy being used help or hinder the client.[7]

Receptive
Receptive music therapy involves listening to recorded or live music selected by a therapist.[10] It can improve mood, decrease stress, pain, anxiety level, and enhance relaxation. Although it doesn't affect disease, it can help with coping skills.[11]

Active
Recipients engage in some form of music-making, whether it's singing or playing instruments. For instance, Baylor, Scott, and White researchers are studying the effect of harmonica playing on patients with COPD in order to determine if they help improve lung function.[12] Another example of active music therapy takes place in a nursing home in Japan. The therapists teach the elderly to play easy-to-use instruments in order to help overcome physical difficulties.[13]

Nordoff-Robbins
Main article: Nordoff-Robbins music therapy

Paul Nordoff, a Juilliard School graduate and Professor of Music, was a pianist and composer who, upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. Clive Robbins, a special educator, partnered with Nordoff for over 17 years in the exploration and research of music's effects on disabled children—first in the United Kingdom, and then in the US in the 1950s and 60s. Their pilot projects included placements at care units for autistic children and child psychiatry departments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and other handicaps. Their success at establishing a means of communication and relationship with children with cognitive impairments at the University of Pennsylvania gave rise to the National Institutes of Health's first grant given of this nature, and the 5-year study "Music therapy project for psychotic children under seven at the day care unit" involved research, publication, training and treatment.[14][page needed] Several publications, including Therapy in Music for Handicapped Children, Creative Music Therapy, Music Therapy in Special Education, as well as instrumental and song books for children, were released during this time. Nordoff and Robbins' success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. Funds were granted to support the founding of the Nordoff Robbins Music Therapy Centre[15] in Great Britain in 1974, where a one-year graduate program for students was implemented. In the early eighties, a center was opened in Australia, and various programs and institutes for music therapy were founded in Germany and other countries. In the United States, the Nordoff-Robbins Center for Music Therapy was established at New York University in 1989.[citation needed]

The Nordoff-Robbins approach, based on the belief that everyone is capable of finding meaning in and benefiting from musical experience, is now practiced by hundreds of therapists internationally. This approach focuses on treatment through the creation of music by both therapist and client together. The therapist uses various techniques so that even the most low functioning individuals can actively participate.[16]

Orff
Further information: Orff Schulwerk

Gertrude Orff developed Orff Music Therapy at the Kindezentrum München. Both the clinical setting of social pediatrics and the Orff Schulwerk (schoolwork) approach in music education (developed by German composer Carl Orff) influence this method, which is used with children with developmental problems, delays, and disabilities.[17] The area of social pediatrics was developed after the Second World War in Germany by Theodor Hellbrügge, who understood that medicine alone could not meet the complex needs of developmentally disabled children. He consulted psychologists, occupational therapists and other mental healthcare professionals whose knowledge and skills could aid in the diagnostics and treatment of children. Gertrude Orff was asked to develop a form of therapy based on the Orff Schulwerk approach to support the emotional development of patients. Elements found in both the music therapy and education approaches include the understanding of holistic music presentation as involving word, sound and movement, the use of both music and play improvisation as providing a creative stimulus for the child to investigate and explore, Orff instrumentation, including keyboard instruments and percussion instruments as a means of participation and interaction in a therapeutic setting, and lastly, the multisensory aspects of music used by the therapist to meet the particular needs of the child, such as both feeling and hearing sound.[17]

Corresponding with the attitudes of humanistic psychology, the developmental potential of the child, as in the acknowledgement of their strengths as well as their handicaps, and the importance of the therapist, child relationships are central factors in Orff music therapy. Theoretical foundations are also influenced by the strong emphasis on social integration and the involvement of parents in the therapeutic process found in social pediatrics. Knowledge of developmental psychology puts into perspective how developmental disabilities influence the child, as do their social and familial environments. The basis for interaction in this method is known as responsive interaction, in which the therapist meets the child at their level and responds according to their initiatives, combining both humanistic and developmental psychology philosophies. Involving the parents in this type of interaction by having them participate directly or observe the therapist's techniques equips the parents with ideas of how to interact appropriately with their child, thus fostering a positive parent-child relationship.[17]

Bonny method of guided imagery in music
Further information: Guided imagery

Music educator and therapist Helen Lindquist Bonny (1921–2010) developed an approach influenced by humanistic and transpersonal psychological views, known as the Bonny method of guided imagery in music (GIM). Guided imagery refers to a technique used in natural and alternative medicine that involves using mental imagery to help with the physiological and psychological ailments of patients.[18] The practitioner often suggests a relaxing and focusing image and through the use of imagination and discussion, aims to find constructive solutions to manage their problems. Bonny applied this psychotherapeutic method to the field of music therapy by using music as the means of guiding the patient to a higher state of consciousness where healing and constructive self- awareness can take place. Music is considered a "co-therapist" because of its importance. GIM with children can be used in a one-on-one setting or group setting, and involves relaxation techniques, identification and sharing of personal feeling states, and improvisation to discover the self, and foster growth. The choice of music is carefully selected for the client based on their musical preferences and the goals of the session. The piece is usually classical, and it must reflect the age and attention abilities of the child in length and genre. A full explanation of the exercises must be offered at their level of understanding.[18]

The use of guided imagery with autistic children has been found to decrease stereotypical behaviors and hyperactivity, increase attention and the ability to follow instructions, and increase self-initiated communication, both verbal and non-verbal.[19][page needed]

Characteristics of Music for Receptive Music Therapy
Bonny (Bonny Method of Guided Imagery and Music) writes a lot about the different features of music types in the classical genre.[20] Classical music can have multiple layers, including a melodic line, harmony structure and base line. All of these aspects work together with other things to create different layers of musical sound. Classical music is written in different forms: ternary form, sonata form, theme and variations, prelude and tone poem.

Ternary form

 * associated with the Baroque era
 * for therapy work
 * forms a stable and safe musical container, where the repetition of the open section that is recognizable before the period of change

Sonata Form

 * associated with the Classical and Romantic era
 * composed of three parts: introduction, exposition, development and recapitulation

Theme and variations

 * uses different eras of music composition
 * the melody may be played by different instruments
 * the melody might become elongated by making each note twice is original length or shortened by making each note half the length

Prelude

 * a short piece for an orchestra that is already completed
 * the most receptive music therapy is Debussy's Prelude to the Afternoon of a Faun and Ravel's Pavane for a Dead Princess

Tone poem

 * from the Romantic Era and the 20th century
 * some examples include Ein Heldenleben (A Hero's Life) and Enchanted Lake

New Age Music

 * allows relaxation while drawing images like landscapes enhanced by computer generated sounds
 * Kobialka is a type of new age music that produces large volume music that has violins playing over the background of synthesizes sounds
 * Kobialka often very relaxing because the quality is seamless

Celtic Music

 * average in character
 * sometimes there are vocal selection involved in Celtic music, adding to the appeal of the song choice
 * 12 minutes maybe be able to cause deep relaxation
 * one example is the Watermark by Enya

Meditative Music

 * has a diverse range of styles and instrumentation
 * most of them have single-line melody of a wooden or pan-flute

Trance Music

 * musical therapists who work with adolescent-aged clients often use this type of music
 * a style of electronic dance music that was created in 1990s
 * has a tempo between 130 and 160 bpm
 * enhances a feeling of calmness despite the rapid pace

Jazz Music

 * emerged in the early part of the twentieth century
 * generally known as the music of black Americans
 * the blues is a slow kind of jazz music that is uses gentle relaxation
 * a sedative in receptive music therapy methods
 * examples include I Got Rhythm by Louie Armstrong or In a Mellotone by Duke Ellington

Approaches used with adolescents
Music therapy may be used with adolescent populations to treat disorders that are usually diagnosed in adolescence, such as mood/anxiety disorders, eating disorders, or inappropriate behaviors, including suicide attempts, withdrawal from family, social isolation from peers, aggression, running away, and substance abuse.[21][22] Goals in treating adolescents with music therapy, especially for those at high risk, often include increased recognition and awareness of emotions and moods, improved decision-making skills, opportunities for creative self expression, decreased anxiety, increased self-confidence, improved self-esteem, and better listening skills.[23]

Methods
Two main methods for music therapy in this age group include group meetings and individual sessions. Both methods may consist of listening to music, discussing moods and emotions in or toward music, analyzing the meanings of specific songs, writing lyrics, composing music, performing music, and musical improvisation.[22]

Private individual sessions can provide personal attention and are most effective when the music used is preferred by the patient. Using music that an adolescent can relate to or connect with can be successful in helping adolescent patients view the therapist as a safe and trustworthy adult, and to engage in the therapeutic process with less resistance.[22] Music therapy conducted in groups provides opportunities for an adolescent individual to feel a sense of belonging, to express their opinions, learn how to socialize and verbalize appropriately with peers, improve compromising skills, and develop tolerance and empathy.[21] Group sessions emphasize cooperation and cohesion, and can be quite effective in working with adolescents.[24]

In one way or another, music plays a big part in a human's life. From the time we are babies our mothers sing us lullabies to calm us; https://www.youtube.com/watch?v=4y8CdZqEjvY[25] sometimes while a baby is still in the womb a mother will expose a fetus to music. “Inside the womb, surrounded by amniotic fluid, the fetus hears sounds. It hears the heartbeat of its mother, at times speeding up, at other times slowing down. And the fetus hears music, as was recently discovered by Alexandra Lamont of Keele University in the UK. She found that, a year after they are born, children recognize and prefer music they were exposed to in the womb”[26].

Assessment
Assessment includes obtaining a full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and nonmusical functioning (social, physical/motor, emotional, etc.).[27][28]

In infants born prematurely
Premature infants are those born at 37 weeks or earlier. They are subject to numerous health risks, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. The coordination for sucking and breathing is often not fully developed, which makes feeding a challenge. The improved developmental activity and behavioral status of premature infants when they are discharged from the NICU, is directly related to the stimulation programs and interventions they benefited from during hospitalization, such as music therapy.

Music is typically conducted by a musical therapist in the neonatal intensive care unit (NICU), with five main techniques designed to benefit premature infants:[29][page needed]

1. ===== Live or Recorded Music ===== : Live or recorded music has been effective in promoting respiratory regularity and oxygen saturation levels, as well as decreasing signs of neonatal distress. Since premature infants have sensitive and immature sensory modalities, music is often performed in a gentle and controlled environment, either in the form of audio recordings or live vocalization, although live singing has been shown to have a greater effect. Live music also reduces the physiological responses in parents. Studies have shown that by combining live music, such as harp music, with Kangaroo Care, maternal anxiety is reduced. This allows for parents, especially mothers, to spend important time bonding with their premature infants. Female singing voices are also more effective at soothing premature infants. Despite being born premature, infants show a preference for the sound of a female singing voice, which makes it more beneficial than instrumental music.[30]

2. ===== Promotion of healthy sucking reflex ===== : By using a pacifier-activated lullaby device, music therapists can help promote stronger sucking reflexes, while also reducing pain perception for the infant. The Gato Box is a small rectangular instrument that stimulates a prenatal heartbeat sound in a soft and rhythmic manner that has also been effective in aiding sucking behaviors.[31][unreliable medical source?] The music therapist uses their fingers to tap on the drum, rather than using a mallet. The rhythm supports movement when feeding and promotes healthy sucking patterns. By improving sucking patterns, babies are able to coordinate the important dual mechanisms of breathing, sucking and swallowing needed to feed, thus promoting growth and weight gain. When this treatment proves effective, infants are able to leave the hospital earlier.

3. ===== Multimodal stimulation and music ===== : By combining music, such as lullabies and multimodal stimulation, premature infants were discharged from the NICU sooner, than those infants who did not receive therapy. Multimodal stimulation (MMS) includes the applications of auditory, tactile, vestibular, and visual stimulation that helps aid in premature infant development. The combination of music and MMS helps premature infants sleep and conserve vital energy required to gain weight more rapidly. Studies have shown that girls respond more positively than boys during multimodal stimulation.[32] While the voice is a popular choice for parents looking to bond with their premature infants, other effective instruments include the Remo Ocean Disk and the Gato Box. Both are used to stimulate the sounds of the womb. The Remo Ocean Disk, a round musical instrument that mimics the fluid sounds of the womb, has been shown to benefit decreased heart rate after therapeutic uses, as well as promoting healthy sleep patterns, lower respiratory rates and improve sucking behavior.[33][unreliable medical source?]

4. ===== Infant stimulation ===== : This type of intervention uses musical stimulation to compensate for the lack of normal environmental sensory stimulation found in the NICU. The sound environment the NICU provides can be disruptive; however, music therapy can mask unwanted auditory stimuli and promote a calm environment that reduces the complications for high-risk or failure-to-thrive infants. Parent-infant bonding can also be affected by the noise of the NICU, which in turn can delay the interactions between parents and their premature infants. Music therapy creates a relaxed and peaceful environment for parents to speak and spend time with their babies while incubated.[34]

5. ===== Parent-infant bonding ===== : Therapists work with parents so they may perform infant-directed singing techniques, as well as home care. Singing lullabies therapeutically can promote relaxation and decrease heart rate in premature infants. By calming premature babies, it allows for them to preserve their energy, which creates a stable environment for growth. Lullabies, such as "Twinkle Twinkle Little Star" or other culturally relevant lullabies, have been shown to greatly soothe babies. These techniques can also improve overall sleep quality, caloric intake and feeding behaviors, which aid in development of the baby while they are still in the NICU. Singing has also shown greater results in improving oxygen saturation levels for infants while incubated than has mothers' speech alone. This technique promoted high levels of oxygen for longer periods of time.[35]

In Infants in the Cardiac Intensive Care Unit
In studies on music therapy with infants in the cardiac intensive care unit, music therapy has been used on infants in hopes of improving their lives during their time in the CICU. Many infants show a decrease in both their average heart and respiratory rates. The infants' average blood pressure typically decreases after the music therapy sessions, as well. Although there are individual differences between each of the infants, most infants show improvements after music therapy interventions.

In Children
Music therapy has multiple benefits that contribute to the maintenance of health and the drive toward rehabilitation for children. Advanced technology that can monitor cortical activity offers a look at how music engages and produces changes in the brain during the perception and production of musical stimuli. Music therapy, when used with other rehabilitation methods, has increased the success rate of sensorimotor, cognitive, and communicative rehabilitation.[36] Music therapy intervention programs typically include about 18 sessions of treatment. The achievement of a physical rehabilitation goal relies on the child's existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. Regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. Both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as a dynamic force of change toward rehabilitation.[37]

Music has many calming and soothing properties that can be used as a sedative in rehabilitation. For example, a patient with chronic pain may decrease the physiological result of stress and draw attention away from the pain by focusing on music.[38][self-published source?]

Music therapy used in child rehabilitation has had a substantial emphasis on sensorimotor development including balance and position, locomotion, agility, mobility, range of motion, strength, laterality and directionality.[38][self-published source?] Music motivate and can be an element of distraction.[37] Rhythmic stimuli has been found to help balance training for those with a brain injury.[37]

Singing is a form of rehabilitation for neurological impairments. Neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria, muscle control disturbances (due to damage of the central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. Singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. For example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression.[37]

Music therapy is thought to be helpful with children with autism spectrum by providing repetitive stimuli which aim to "teach" the brain other possible ways to respond that might be more useful as they grow older.[39][self-published source?] Studies on the long term effects on music therapy in children with autism indicate many positive effects in children. Some of these effects include increased communication skills, decreased stress, increased social interaction, and the ability to be creative and to express themselves. Music therapy not only benefits the child with autism, but the family as a whole. Many of the mothers of children with autism claim that music therapy sessions have allowed their child to interact more with the family and the world. Music therapy is also beneficial in that it gives children an outlet to use outside of the sessions. Many children after participating in music therapy want to keep making music long after the sessions end.

Autism
Music has played an important role in the research of dealing with autism, mainly in diagnosis, therapy, and behavioral abilities according to a scientific article written by Thenille Braun Janzen and Michael H. Thaut. This article concluded that music can help autistic patients hone their motor and attention skills as well as healthy neurodevelopment of socio-communication and interaction skills. Music therapy also resulted in positive improvement in selective attention, speech production, and language processing and acquisition in autistic patients.

Heart Disease
According to a 2013 Cochrane review, listening to music may improve heart rate, respiratory rate, and blood pressure in those with coronary heart disease (CHD).[41]

Stroke
Music is useful in the recovery of motor skills.[42] In a study on stroke patients in the recovery phase, music therapy was used in addition to other types of therapy in one group of patients and was not used in the other group. While both groups showed an increase in their standard of living, the group that used the music therapy showed more of an increase than the group that didn't. The group that used music therapy also showed less anxiousness and depression after the therapy. While both groups showed an increase in the strength of their non-dominant hands, the group with music therapy showed a much larger increase. Also, patients that underwent music therapy were able to regulate their emotions better and showed increased communication as a whole.

Dementia
Music therapy is beneficial to older adults all over the world. Dr. Hanne Mette Ridder, a musical therapy expert from Denmark, studied the importance of the roles of musical therapists and caregivers on the mental well-being of patients suffering from dementia. The use of musical interaction has made a positive impact in many countries by improving older adults' overall health. According to Karen Stuart, South Africa has poor quality services provided by hospital care facilities to elders dealing with dementia, therefore she discovered singing to be an effective method for improving patients well-being. The playing of classical music or therapeutic singing resulted in: enjoyment, awareness, and engagement. Providing a source of music in hospitals or care centers are valuable methods for contributing to the care of the patients, while also relieving stress placed on the caregiver and forming a bond between the patient and the caretaker.[3]

Like many of the other disorders mentioned, some of the most common significant effects can be seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A meta-study of over 330 subjects showed that music therapy produces highly significant improvements in social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. The effectiveness of the treatment seems to be strongly dependent on the patient and the quality and length of treatment.

In another study, a group of adults suffering with dementia participated in group music therapy. In the group, these adults engaged in singing, drumming, improvisation, and movement. Each of these activities engaged the adults in different ways. The singing aided with memory, as these adults improved memorization skills in by taking out specific words in the chorus of a song and by repeating phrases back to the music therapist when the therapist sang a phrase of a song to them. Drumming led to increased socialization of the group, as it allowed the patients collaborate in order to create particular rhythms. Improvisation allowed the patients to get out of their comfort zone and taught them how to better deal with anxiety. Lastly, movement with either one arm or two increased social interaction between the patients.

Another meta-study examined the proposed neurological mechanisms behind music therapy's effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load.

Aphasia
Broca’s aphasia, or non-fluent aphasia, is a language disorder caused by damage to Broca’s area and surrounding regions in the left frontal lobe. Those with non-fluent aphasia can understand language fairly well, but they struggle with language production and syntax.

Neurologist, Oliver Sacks, author of Musicophilia: Tales of music and the Brain, has studied neurological oddities in people, trying to understand how the brain works. Sacks concluded that people with some type of frontal lobe damage often “produced not only severe difficulties with expressive language (aphasia) but a strange access of musicality, with incessant whistling and singing and a passionate interest in music. For him, this was an example of normally suppressed brain functions being released by damage to others” (315). Sacks had a genuine interest in trying to help people affected with neurological disorders and other phenomena associated with music and how it can provide access to otherwise unreachable emotional states, revivify neurological avenues that have been frozen, evoke memories of earlier, lost events or states of being and attempts to bring those with neurological disorders back to a time when the world was much richer for them. He was a firm believer that music has the power to heal.

Melodic intonation therapy, developed in 1973 by Neurological researchers Sparks, Helm, and Albert, is a method used by music therapists and speech-language pathologists to help people with communication disorders caused by damage to the left hemisphere of the brain by engaging the singing abilities and possibly engaging language-capable regions in the undamaged right hemisphere.

While unable to speak fluently, patients with non-fluent aphasia can often sing words, phrases, and even sentences they cannot express otherwise. MIT harnesses the singing ability of patients with non-fluent aphasia as a means to improve their communication. Although its exact nature depends on the therapist, in general, MIT relies on the use of intonation (the rising and falling of the voice) and rhythm (beat/speed) to train patients to produce phrases verbally. In MIT, common words and phrases are turned into melodic phrases, generally starting with two step sing-song patterns and eventually emulating typical speech intonation and rhythmic patterns. A therapist will usually begin by introducing an intonation to their patient through humming. They will accompany this humming with a rhythm produced by the tapping of the left hand. At the same time, the therapist will introduce a visual stimuli of the written phrase to be learned. The therapist then sings the phrase with the patient and ideally, the patient is eventually able to sing the phrase on their own. With much repetition and through a process of “inner-rehearsal” (practicing internally hearing one’s voice singing), a patient may eventually be able to produce the phrase verbally without singing. As the patient advances in therapy, the procedure can be adapted to give them more autonomy and to teach them more complex phrases. Through the use of MIT, a non-fluent aphasic patient can be taught numerous phrases which enable them to communicate and function during daily life.

The mechanisms of this success are yet to be fully understood. It is commonly agreed that while speech is lateralized mostly to the left hemisphere, some speech functionality is also distributed in the right hemisphere. MIT is thought to stimulate these right language areas through the activation of music processing areas also in the right hemisphere  Similarly, the rhythmic tapping of the left hand stimulates the right sensorimotor cortex in order to further engage the right hemisphere in language production. Overall, by stimulating the right hemisphere during language tasks, therapists hope to decrease dependence on the left hemisphere for language production.

While results are somewhat contradictory, studies have found increased right hemispheric activation in non-fluent aphasic patients after MIT. This change in activation has been interpreted as evidence of decreased dependence on the left hemisphere. There is debate, however, if changes in right hemispheric activation are part of the therapeutic process during/after MIT, or are simply a side effect of non-fluent aphasia. In hopes of making MIT more effective, researchers are continually studying the mechanisms of MIT and non-fluent aphasia. One specific study tested the effects of music therapy on a group of patients dealing with aphasia. The results showed that patients who underwent music therapy and patients who underwent speech/language therapy displayed the same positive effects. Despite the results during the therapy, patients who underwent music therapy and speech/language therapy showed a large increase in vitality, but patients who only underwent speech/language therapy did not show any improvements after the therapy sessions ended.

Psychiatric Disorders
A 2016 meta-analysis on the effects of music therapy in schizophrenic patients showed that the treatment in patients who underwent music therapy was more effective than patients who did not undergo music therapy with their treatments. Some of the positive effects that resulted from the music therapy sessions include decreased aggression, as well as less hallucinations and delusions.

A 2017 Cochrane review found that moderate- to low-quality evidence suggests that music therapy as an addition to standard care improves the global state, mental state (including negative and general symptoms), social functioning, and quality of life of people with schizophrenia or schizophrenia-like disorders. However, effects were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided.[59]

A 2017 review of studies of music therapy for children and adolescents with major depressive or anxiety disorders found that music-based interventions may be efficient in reducing the severity of internalizing symptoms in children and adolescents.[60] There is moderate-quality evidence that music therapy added to treatment as usual is more effective than treatment as usual alone in people with depression.[61]

Michael J. Silverton (Ph.D., MT-BC, and Full Professor) is the Director of the Music Therapy Program and a Professor at the University of Minnesota. Silverman is published extensively in peer-reviewed journals and is the author of scholarly texts as well. He works in musical therapy, special education rehabilitation and research. The purpose of this work is to discuss the need for additional research in the field of controlled psychiatric music therapy. This paper discusses cognitive behavioral therapy and the analytical dynamics of music and the psychotherapy field. It was written for those in the mental health field. It may be too scientific to be used for this topic but there could be some information pertinent to the layman. The article refers to data sheets and tables. The paper is written from research data and fact based scientific research data. [62]

A 2017 theoretical review on the use of music therapy in post-traumatic stress disorder suggests that music therapy may be a useful therapeutic tool to reduce symptoms and improve functioning among individuals with trauma exposure and PTSD, though more rigorous empirical study is required.[63]

Brain injuries
Susan Gaidos is a science news journalist and correspondent with degrees in journalism and biology. Gaidos has received awards in medicine and science writing from the Council for Advancement and Support of Education and writes scientific articles for several publications. She writes about topics ranging from nanotechnology to brain biology. Her article discusses stimulation of the brain by music and the possibility of using music as a therapeutic treatment for emotional disorders and brain injuries. She quotes musicians as well as physicians in this article. http://ez.trl.org/login?url=https://search-proquest-com.ez.trl.org/docview/744655386?accountid=1229[64]

Cultural aspects
Music has been looked upon for centuries as an accompaniment to rituals and cultural traditions. Michael B Bakan, author of the book World Music: Traditions and Transformations states that “Music is a mode of cultural production and can reveal much about how the culture works” [65] Music and cultures are evolving over time and people are becoming more accepting of each other and each other's cultures and customs. Just recently Mariah Carey was the first woman to perform on stage in Saudi Arabia and her hair was not covered. She performed despite activists (Saudi women) calling for the cancellation of the show. https://www.youtube.com/watch?v=lPAZ6oid16E [66]Carey showed respect by wearing a more sedate and demure costume than she usually wears when performing. The Saudi women have started driving and Mariah Carey was allowed to perform in front of a huge crowd, where at one time a woman would have been killed for doing what just comes naturally to her. This change of attitude on the part of the Saudis proves that music must in some way affect the brain and the emotions or Mariah Carey would never have been allowed to do what she did. In this case, hopefully, it is building a bridge between our nations that promotes peace.