music psychology essay

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• Review Article
• Published: 29 March 2022

Music in the brain

• Peter Vuust   ORCID: orcid.org/0000-0002-4908-735X 1 ,
• Ole A. Heggli   ORCID: orcid.org/0000-0002-7461-0309 1 ,
• Karl J. Friston   ORCID: orcid.org/0000-0001-7984-8909 2 &
• Morten L. Kringelbach   ORCID: orcid.org/0000-0002-3908-6898 1 , 3 , 4  

Nature Reviews Neuroscience volume  23 ,  pages 287–305 ( 2022 ) Cite this article

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Music is ubiquitous across human cultures — as a source of affective and pleasurable experience, moving us both physically and emotionally — and learning to play music shapes both brain structure and brain function. Music processing in the brain — namely, the perception of melody, harmony and rhythm — has traditionally been studied as an auditory phenomenon using passive listening paradigms. However, when listening to music, we actively generate predictions about what is likely to happen next. This enactive aspect has led to a more comprehensive understanding of music processing involving brain structures implicated in action, emotion and learning. Here we review the cognitive neuroscience literature of music perception. We show that music perception, action, emotion and learning all rest on the human brain’s fundamental capacity for prediction — as formulated by the predictive coding of music model. This Review elucidates how this formulation of music perception and expertise in individuals can be extended to account for the dynamics and underlying brain mechanisms of collective music making. This in turn has important implications for human creativity as evinced by music improvisation. These recent advances shed new light on what makes music meaningful from a neuroscientific perspective.

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Funding was provided by The Danish National Research Foundation (DNRF117). The authors thank E. Altenmüller and D. Huron for comments on early versions of the manuscript.

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Peter Vuust, Ole A. Heggli & Morten L. Kringelbach

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Patterns of pitched sounds unfolding over time, in accordance with cultural conventions and constraints.

The combination of multiple, simultaneously pitched sounds to form a chord, and subsequent chord progressions, a fundamental building block of Western music. The rules of harmony are the hierarchically organized expectations for chord progressions.

The structured arrangement of successive sound events over time, a primary parameter of musical structure. Rhythm perception is based on the perception of duration and grouping of these events and can be achieved even if sounds are not discrete, such as amplitude-modulated sounds.

Mathematically, the expected values or means of random variables.

The ability to extract statistical regularities from the world to learn about the environment.

In Western music, the organization of melody and harmony in a hierarchy of relations, often pointing towards a referential pitch (the tonal centre or the tonic).

A predictive framework governing the interpretation of regularly recurring patterns and accents in rhythm.

The output of a model generating outcomes from their causes. In predictive coding, the prediction is generated from expected states of the world and compared with observed outcomes to form a prediction error.

The subjective experience accompanying a strong expectation that a particular event will occur.

An enactive generalization of predictive coding that casts both action and perception as minimizing surprise or prediction error (active inference is considered a corollary of the free-energy principle).

A quantity used in predictive coding to denote the difference between an observation or point estimate and its predicted value. Predictive coding uses precision-weighted prediction errors to update expectations that generate predictions.

Expectations of musical events based on prior knowledge of regularities and patterns in musical sequences, such as melodies and chords.

Expectations of specific events or patterns in a familiar musical sequence.

Short-lived expectations that dynamically shift owing to the ongoing musical context, such as when a repeated musical phrase causes the listener to expect similar phrases as the work continues.

The inverse variance or negative entropy of a random variable. It corresponds to a second-order statistic (for example, a second-order moment) of the variable’s probability distribution or density. This can be contrasted with the mean or expectation, which constitutes a first-order statistic (for example, a first-order moment).

(MMN). A component of the auditory event-related potential recorded with electroencephalography or magnetoencephalography related to a change in different sound features such as pitch, timbre, location of the sound source, intensity and rhythm. It peaks approximately 110–250 ms after change onset and is typically recorded while participants’ attention is distracted from the stimulus, usually by watching a silent film or reading a book. The amplitude and latency of the MMN depends on the deviation magnitude, such that larger deviations in the same context yield larger and faster MMN responses.

(fMRI). A neuroimaging technique that images rapid changes in blood oxygenation levels in the brain.

In the realm of contemporary music, a persistently repeated pattern played by the rhythm section (usually drums, percussion, bass, guitar and/or piano). In music psychology, the pleasurable sensation of wanting to move.

The perceptual correlate of periodicity in sounds that allows their ordering on a frequency-related musical scale.

Also known as tone colour or tone quality, the perceived sound quality of a sound, including its spectral composition and its additional noise characteristics.

The pitch class containing all pitches separated by an integer number of octaves. Humans perceive a similarity between notes having the same chroma.

The contextual unexpectedness or surprise associated with an event.

In the Shannon sense, the expected surprise or information content (self-information). In other words, it is the uncertainty or unpredictability of a random variable (for example, an event in the future).

(MEG). A neuroimaging technique that measures the magnetic fields produced by naturally occurring electrical activity in the brain.

A very small electrical voltage generated in the brain structures in response to specific events or stimuli.

Psychologically, consonance is when two or more notes sound together with an absence of perceived roughness. Dissonance is the antonym of consonance. Western listeners consider intervals produced by frequency ratios such as 1:2 (octave), 3:2 (fifth) or 4:3 (fourth) as consonant. Dissonances are intervals produced by frequency ratios formed from numbers greater than 4.

Stereotypical patterns consisting of two or more chords that conclude a phrase, section or piece of music. They are often used to establish a sense of tonality.

(EEG). An electrophysiological method that measures electrical activity of the brain.

A method of analysing steady-state evoked potentials arising from stimulation or aspects of stimulation repeated at a fixed rate. An example of frequency tagging analysis is shown in Fig.  1c .

A shift of rhythmic emphasis from metrically strong accents to weak accents, a characteristic of multiple musical genres, such as funk, jazz and hip hop.

In Aristotelian ethics, refers to a life well lived or human flourishing, and in affective neuroscience, it is often used to describe meaningful pleasure.

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Vuust, P., Heggli, O.A., Friston, K.J. et al. Music in the brain. Nat Rev Neurosci 23 , 287–305 (2022). https://doi.org/10.1038/s41583-022-00578-5

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HYPOTHESIS AND THEORY article

The human nature of music.

• 1 Westmead Psychotherapy Program, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
• 2 The MARCS Institute for Brain, Behaviour, and Development, Western Sydney University, Sydney, NSW, Australia
• 3 Department of Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, United Kingdom

Music is at the centre of what it means to be human – it is the sounds of human bodies and minds moving in creative, story-making ways. We argue that music comes from the way in which knowing bodies (Merleau-Ponty) prospectively explore the environment using habitual ‘patterns of action,’ which we have identified as our innate ‘communicative musicality.’ To support our argument, we present short case studies of infant interactions using micro analyses of video and audio recordings to show the timings and shapes of intersubjective vocalizations and body movements of adult and child while they improvise shared narratives of meaning. Following a survey of the history of discoveries of infant abilities, we propose that the gestural narrative structures of voice and body seen as infants communicate with loving caregivers are the building blocks of what become particular cultural instances of the art of music, and of dance, theatre and other temporal arts. Children enter into a musical culture where their innate communicative musicality can be encouraged and strengthened through sensitive, respectful, playful, culturally informed teaching in companionship. The central importance of our abilities for music as part of what sustains our well-being is supported by evidence that communicative musicality strengthens emotions of social resilience to aid recovery from mental stress and illness. Drawing on the experience of the first author as a counsellor, we argue that the strength of one person’s communicative musicality can support the vitality of another’s through the application of skilful techniques that encourage an intimate, supportive, therapeutic, spirited companionship. Turning to brain science, we focus on hemispheric differences and the affective neuroscience of Jaak Panksepp. We emphasize that the psychobiological purpose of our innate musicality grows from the integrated rhythms of energy in the brain for prospective, sensation-seeking affective guidance of vitality of movement. We conclude with a Coda that recalls the philosophy of the Scottish Enlightenment, which built on the work of Heraclitus and Spinoza. This view places the shared experience of sensations of living – our communicative musicality – as inspiration for rules of logic formulated in symbols of language.

“There are certain aspects of the so-called ‘inner life’—physical or mental —which have formal properties similar to those of music—patterns of motion and rest, of tension and release, of agreement and disagreement, preparation, fulfilment, excitation, sudden change, etc. Langer (1942 , p. 228).

“The function of music is to enhance in some way the quality of individual experience and human relationships; its structures are reflections of patterns of human relations, and the value of a piece of music as music is inseparable from its value as an expression of human experience” Blacking (1995 , p.31).

“The act of musicking establishes in the place where it is happening a set of relationships, and it is in those relationships that the meaning of the act lies. They are to be found not only between those organized sounds which are conventionally thought of as being the stuff of musical meaning but also between the people who are taking part, in whatever capacity, in the performance” Small (1998 , p.9).

We present a view that places our ability to create and appreciate music at the center of what it means to be human. We argue that music is the sounds of human bodies, voices and minds – our personalities – moving in creative, story-making ways. These stories, which we want to share and listen to, are born from awareness of a complex body evolved for moving with an imaginative, future seeking mind in collaboration with other human bodies and minds. Musical stories do not need words for the creation of rich and inspiring narratives of meaning.

We adopt the word ‘musicking’ (as used above by Christopher Small) to draw attention to the embodied energy that creates music, and which moves us, emotionally and bodily. Further, we argue that music comes from the way in which knowing bodies ( Merleau-Ponty , 2012 [1945] , p. 431) prospectively explore the environment using habitual ‘patterns of action,’ which we have identified as our innate ‘communicative musicality,’ observed while infants are in intimate communication with loving caregivers ( Malloch and Trevarthen, 2009a ). In short case studies of infant interactions with micro analyses of video and audio recordings, we show communicative musicality in the timings and shapes of intersubjective vocalizations and body movements of adult and child that improvise with delight shared narratives of meaning.

Following a survey of the history of discoveries of infant abilities, we propose that the gestural narrative structures of voice and body seen as infants communicate with loving caregivers, ‘protonarrative envelopes’ of expression for ideas of activity ( Panksepp and Bernatzky, 2002 ; Panksepp and Trevarthen, 2009 ), are the building blocks of what become particular cultural instances of the art of music, and of dance, theater and other temporal arts ( Blacking, 1995 ).

As the child grows and becomes a toddler, she or he eagerly takes part in a children’s musical culture of the playground ( Bjørkvold, 1992 ). Soon more formal education with a teacher leads the way to the learning of traditional musical techniques. It is at this point that the child’s innate body vitality of communicative musicality can be encouraged and strengthened through sensitive, respectful, playful, culturally informed teaching ( Ingold, 2018 ). On the other hand, it may wither under the weight of enforced discipline for the sake of conforming to pre-existing cultural rules without attention to the initiative and pleasure of the learner’s own music-making.

The central importance of our abilities for music as part of what sustains our well-being is supported by evidence that communicative musicality strengthens emotions of social resilience to recover from mental stress and illness ( Pavlicevic, 1997 , 1999 , 2000 ). Drawing on the experience of the first author as a counselor, we argue that the strength of one person’s communicative musicality can support the vitality of another’s through the application of skilful techniques that encourage an intimate, supportive, therapeutic, spirited companionship.

Turning to brain science, focussing on hemispheric differences in performance and in response to music, and the affective neuroscience of Jaak Panksepp (1998) , we emphasize that the psychobiological purpose of our ‘muse within’ ( Bjørkvold, 1992 ) grows from the integrated rhythms of neural energy for prospective, sensation-seeking affective guidance of vitality of movement in the brain ( Goodrich, 2010 ; Stern, 2010 ).

We conclude with a Coda – an enquiry into the philosophy of the Scottish Enlightenment, which built on the work of philosophers Heraclitus and Spinoza. This view of living in community gives innate sympathy or ‘feeling with’ other humans a fundamental role within a duplex mind seeking harmony in relationships by attunement of motives ( Hutcheson, 1729 , 1755 ). It places the shared experience of sensations of living – our communicative musicality – ahead of logic formulated in symbols of language.

Music Moves US – Embodied Narratives of Movement

Small (1998) calls attention to music as intention in activity by using the verb musicking – participating as performer or listener with attention to the sounds created and the appreciation and participation by others. The compelling quality of music comes from the relationships of sounds, bodies and psyches. ‘Musicking’ points to our musical life in active ‘I-Thou’ relationships. Only in this intimacy of consciousness and its interests can we share ‘I-It’ identification and use of objects, giving things we use, including musical compositions, meaning ( Buber, 1923/1970 ).

‘I-Thou’ relationships are entered into through the body. The philosopher Merleau-Ponty (2012 [1945]) writes that “The subject only achieves his ipseity [individual personality, selfhood] by actually being a body, and by entering into the world through his body… The ontological world and body that we uncover at the core of the subject are not the world and the body as ideas ; rather, they are the world itself condensed into a comprehensive whole and the body itself as a knowing-body ” (p. 431; italics added). Musicking is knowing bodies coming alive in the sounds they make. Scores and other tools that record the product of musicking, performed or imagined, aid the retention of ideas, as semantics of language does, and they serve discussion and analysis – but they are not the same as the breathing, moving, embodied experience of human musicking ( Mithen, 2005 ).

Musicking is the expression of the sensations of what we call our communicative musicality , for the purpose of creating music that is enlivening and ‘beautiful’ ( Malloch, 1999 ; Malloch and Trevarthen, 2009a ; Trevarthen, 2015 ; Trevarthen and Malloch, 2017b ). We define communicative musicality as our innate skill for moving, remembering and planning projects in sympathy with others through time, creating an endless variety of dramatic temporal narratives in song or instrumental music. We describe this life-sharing in movement as having three components:

Pulse – a regular succession through time of discrete movements (which may, for example, be used to create sound for music, or to create movement with music – dance) using our felt sense of acting which enables the ‘future-creating’ predictive process by which a person may anticipate or create what happens next and when.

Quality – consisting of the contours of expressive vocal and body gesture, shaping our felt sense of time in movement. These contours can consist of psychoacoustic attributes of vocalizations – timbre, pitch, volume – or attributes of direction and intensity of the moving body perceived in any modality.

Narratives of individual experience and of companionship, built from sequences of co-created gestures which have particular attributes of pulse and quality that bring aesthetic pleasure ( Malloch and Trevarthen, 2009b ; Trevarthen and Malloch, 2017b ).

With music we create memorable poetic events in signs that express in sound our experience of living together in the creating vitality of ‘the present moment’ ( Stern, 2004 , 2010 ). The anthropologist and ethnologist Claude Lévi-Strauss draws attention of linguists to the structured ‘raw’ emotive power of music (beyond what words may be ‘cooked’ to say).

“In the first volume of the Mythologiques, Le Cru et le Cuit. Lévi-Strauss refers to music as a unique system of signs possessing ‘its own peculiar vehicle which does not admit of any general, extramusical use’. Yet he also allows that music has levels of structure analogous to the phonemes and sentences of language. The absence of words as the connecting level is an obvious and pertinent fact in the structuring of meaning within music as a sign system.” ( Champagne, 1990 , p. 76).

Goodrich (2010) , in her appreciation of the contribution of neuroscientists Llinás (2001) and Buzsáki (2006) to the science of the mind for skilled movement, cites Llinás’ evidence on the role of intuitive structural ‘rules,’ seen also in a musical performance.

“Llinás describes another method of keeping movement as efficient as possible: motor ‘Fixed Action Patterns’ (FAPs), distinct and complicated ‘habits’ of movement built from reflexes, habits that we develop to streamline both neural action and muscle movement. These are not entirely fixed, despite their name; they are constantly undergoing modification, adaptation, refinement, and they overlap each other… Llinás even argues that the extraordinarily precise motor control of Jascha Heifetz playing Tchaikovsky’s violin concerto is composed of highly elaborated and refined FAPs, a description most instrumentalists would find absolutely plausible” ( Goodrich, 2010 , p. 339).

As Llinás himself writes,

“Can playing a violin concerto be a FAP? Well, not all of it, but a large portion. Indeed, the unique and at once recognisable style of play Mr. Heifetz brings to the instrument is a FAP, enriched and modulated by the specifics of the concert, generated by the voluntary motor system” (Llinás, p. 136).

We add that skilled FAPs are not “composed of reflexes” as separate automatic responses. Rather they are purposeful projects that are animated to be developed imaginatively, and affectively, with exploration of their biomechanical “degrees of freedom,” as in Nikolai Bernstein’s detailed description of how a toddler learns to become a virtuoso in bipedal locomotion, which he calls The Genesis of the Biodynamical Structure of the Locomotor Act ( Bernstein, 1967 , p. 78). The testing of these locomotor acts is with an immediate and essential estimation by gut feelings ( Porges, 2011 ) of any risks or benefits, any fears or joy, they may entail within the body.

Music Reflects the Felt-Sense of our Future-Exploring Motor Intelligence

Consciousness is created as the ongoing sense of self-in-movement with which we experience and manipulate the world around us. Its origin is in our evolutionary animal past, evolved for new collaborative, creative projects, regulated between us by affective expressions of feelings of vitality from within our bodies ( Sherrington, 1955 ; Panksepp, 1998 ; Damasio, 2003 ; Mithen, 2005 ; Stern, 2010 ; Eisenberg and Sulik, 2012 ).

Using the philosopher and psychologist James (1892/1985) as a starting point for exploring the intimacy of feeling that supports and guides psychotherapy, Russell Meares (2005 , p.18), following the ‘conversational model’ of therapy developed with his collaborator psychiatrist/psychotherapist Hobson (1985) , identifies five dimensions of the self:

1. awareness which is necessary for the experience;

2. there is a shape to this inner life;

3. there is a sense of its ongoingness ;

4. our inner life has a connectedness or unity ;

5. our experience of our inner life goes on inside a virtual container which is our background emotional state and the background experience of our body .

These sensuous qualities of the experienced self are expressed in music, and in other temporal arts, as ‘the human seriousness of play’ ( Turner, 1982 ). Music, as Susan Langer says so clearly in the quote at the start of this paper, has qualities of this inner life described by Meares as shape, ongoingness and flow, connectedness and unity. The notion of music as expressive of the movements of our inner life has also been explored by music theorists, most notably Ernst Kurth (1991) . Likewise, in his book Self comes to Mind , Antonio Damasio likens all our emotion and feeling to a ‘musical score’ that accompanies other ongoing mental process ( Damasio, 2010 , p.254).

The ultimate motivation for creating music can even be traced to the cellular level. In Man On His Nature ( Sherrington, 1955 ), in a chapter entitled The Wisdom of the Body , the creator of modern neurophysiology Charles Sherrington called the coming together of communities of cells into the integrated body, nervous system and brain of a person “an act of imagination” (p. 103). Neuroscientist Rudolfo Llinás also grants subjectivity, a sense of self, to all forms of life. “Irritability [i.e., responding to external stimuli with organized, goal-directed behavior] and subjectivity, in a very primitive sense, are properties originally belonging to single cells” ( Llinás, 2001 , p.113). “Thinking”, writes Llinás (2001 , p.62), “ultimately represents movement, not just of body parts or objects in the external world, but of perceptions and complex ideas as well.”

Intrinsic to the sociability of this intelligence of movement is sensitivity for the exploration of the future, which is woven into our creation and experience of music. Karl Lashley (1951) reflecting on the evolution of animal movement, proposed that the ability to predict what might come next, and to plan the ‘serial ordering’ of separate actions, may be understood as the foundation for our logical reasoning as an individual, as it is for the grammar or syntax and prosody of our communication in language. It is essential for musicking. A restless future-seeking intelligence, with our urge to share it, inspires us to express our personalities as ‘story-telling creatures,’ who want to share, and evaluate, others’ stories ( Bruner, 1996 , 2003 ).

All animal life depends on motivated movement – the urge to explore with curiosity – to move towards food with anticipation, to move away from a predator with fear, to interact playfully with a trusted friend ( Eibl-Eibesfeldt, 1989 ; Panksepp and Biven, 2012 ; Bateson and Martin, 2013 ). A great achievement of modern science of the mind was the discovery by a young Russian psychologist Nikolai Bernstein of how all consciously made body movements depend upon an ‘image of the future’ ( Bernstein, 1966 , 1967 ).

Bernstein applied the new technology of movie photography to make refined ‘cyclographic’ diagrams of displacements of body parts, from which he analyzed the forces involved to fractions of a second. His findings reported in Coordination and Regulation of Movements became widely known in English translation in 1967, at the same time as video records of infant behaviors were described more accurately (see next Section The Genesis of Music in Infancy – A Short History of Discoveries), revealing their anticipatory motor control adapted for intelligent understanding of how objects may be manipulated, as well as for communication and cooperation ( Trevarthen, 1984b , 1990b ).

Our musical creativity and pleasure come from the way our body hopes to move, with rhythms and feelings of grace and biological ‘knowing’ (see Merleau-Ponty). The predicting, embodied self of a human being experiences time, force, space, movement, and intention/directionality in being. Together, these form the Gestalt of ‘vitality’ ( Stern, 2010 ), the ‘forms of feeling’ ( Hobson, 1985 ) by which we sense in ourselves and in others that movement, be that movement of the body or of a piece of music, is ‘well-done’ ( Trevarthen and Malloch, 2017b ).

The Genesis of Music in Infancy – A Short History of Discoveries

The ability to create meaning with others through wordless structured gestural narratives, that is, our communicative musicality, emerges from before birth and in infancy. From this innate musicality come the various cultural forms of music.

Any attempt to understand how human life has evolved its unique cultural habits needs to start with observing what infants know and can do. Organisms regulate the development of their lives by growing structures and processes from within their vitality, by autopoiesis that requires anticipation of adaptive functions. And they must develop and protect their abilities in response to environmental affordances and dangers, with consensuality ( Maturana and Varela, 1980 ; Maturana et al., 1995 ). Infants are ready for human cultural invention and collaboration as newly hatched birds are ready for flying – within ‘the biology of love’ ( Maturana and Varela, 1980 ; Maturana and Verden-Zoller, 2008 ). All organisms reach out in time and space to make use of the ‘affordances’ for thought and action ( Gibson, 1979 ).

Infants have no language to learn what other humans know, or what ancestors knew. But the vitality of their spontaneous communicative musicality, highly coordinated and adapted to be shared through narratives with sympathetic and playful companions, enables meaningful communication in the ‘present moment’ ( Stern, 2004 ; Figure 1 , Upper Right), which may build serviceable memories extended in space and time ( Donaldson, 1992 ).

FIGURE 1. Inborn musicality shared in movement. Upper Left: Infant less than one hour after birth watches her mother’s tongue protrusion and imitates. Upper Right: On the day of birth, a baby in a hospital in India shares a game with a woman who moves a red ball. The baby tracks it with coordinated movements of her eyes and head, both hands and one foot. Lower: A two-month premature girl, Nasira, with her father, who holds her against his body in ‘kangaroo’ care. They exchange short ‘coo’ sounds with precisely shared rhythm. Upper Left and Upper Right: Photos for own use of second author from colleagues Vasudevi Reddy and Kevan Bundell. Part reproduced from Trevarthen (2015) , Figure 1, p. 131. Lower: Photo from Trevarthen (2008) , Figure 2, p. 22. Original spectrograph in Malloch (1999) , Figure 3, p. 37.

In this section we review changes in understanding of infant abilities over the past century which can help explain the peculiar way music has in the past been seen by some leading psychologists and linguists as a relatively insignificant epiphenomenon, learned for play, not, as we argue in this paper, a source of all talents for communication, rooted in our innate human communicative musicality of knowing bodies ( Merleau-Ponty , 2012 [1945] ) moving with prospective intuition to engage the world in company, ‘intersubjectively,’ from the start ( Zeedyk, 2006 ).

Two leading scholars in medical science and the science of child development in the past century, Freud (1923) and Piaget (1958 , 1966 ), declared that infants must be born without conscious selves conceiving an external world, and unable to adapt their movements to the expressive behavior of other people. The playful and emotionally charged behaviors of mothers and other affectionate carers were considered inessential to the young infant, who needed only responses to reflex demands for food, comfort and sleep.

Then René Spitz (1945) and Bowlby (1958) revealed the devastating effects on a child’s emotional well-being of separation from maternal care in routine hospital care with nursing directed only to respond to those reflex demands. Spitz observed that babies develop smiling between 2 and 5 months to regulate social contacts ( Spitz and Wolf, 1946 ), and he went on to study the independent will of the baby to regulate engagements of care or communication, by nodding the head for ‘yes’ or shaking for ‘no’ ( Spitz, 1957 ).

In the 1960s a major shift in understanding of the creative mental abilities of infants was inspired by a project of the educational psychologist Bruner (1966 , 1968 ), and the pediatrician Brazelton (1961 , 1979 ), who perceived that infants are gifted with sensibilities for imaginative play and ready to start cultural learning from the first weeks after birth. Supported by insights of Charles Darwin and by new findings of anthropology and animal ethology they studied infant initiatives to perceive and use objects, and they were impressed by the intimate reciprocal imitation that develops between infants and affectionate parents and caregivers who offer playful collaboration with the child’s rhythms and qualities of movement. Film studies showed that young infants make complex shifts of posture and hand gestures that are regulated rhythmically, similar to the same movements of adults ( Bruner, 1968 ; Trevarthen, 1974 ).

While this new appreciation of infant abilities was developed at the Center for Cognitive Studies at Harvard, radically transforming the ‘cognitive revolution’ that was announced there by George Miller, Noam Chomsky and Jerome Bruner in 1960, nearby at the Massachusetts Institute of Technology, a project initiated by Bullowa (1979) sought evidence on the behaviors that regulate dialog before language. Bullowa used information from anthropology to draw attention to the measured dynamics of communication.

“For an infant to enter into the sharing of meaning he has to be in communication, which may be another way of saying sharing rhythm …. The problem is how two or more organisms can share innate biological rhythms in such a way as to achieve communication which can permit transmission of information they do not already share.” ( Bullowa, 1979 , p. 15, italics added).

Wanting to understand how the rhythmic flow of dialog can be shared with a child too young for speech, she pointed a way to the appreciation of the role of human communicative musicality as inspiration for the development of behaviors for carrying meaning in language – thinking and communicating in words that will be acquired to specify facts, and to describe and think about how these facts are related or may be used.

The importance of rhythm and the graceful narratives of movement displayed by infants as they communicate purposes and feelings was revealed sixty years ago by a psychobiological approach using photography and movie film, then video. Discoveries were made that challenged the theory that infants had no minds, no sense of self, and therefore no sense of others ( Zeedyk, 2006 ; Reddy, 2008 ). Most astonishing, and dismissed with derision by convinced rational mind-separate-from-body constructivists, was the finding that infants activate the many parts of their body with an exquisite sense of time, and that they can use the rhythms of expression skilfully to imitate in inter-synchrony with attentive responses from an adult (Figure 1 ).

In his work as a pediatrician, Brazelton (1961) , developing his now famous Neonatal Assessment Scale ( Brazelton, 1973 ; Brazelton and Nugent, 1995 ), accepted and encouraged the natural love mother and father felt for their new baby, and showed how appreciative the baby could be of their actions to each other and to the baby. This welcoming of the newborn as a person with intelligence and sociable impulses confirmed the parents’ belief that they could communicate feelings and interests by responding to their baby’s exquisitely timed looks, smiles, hand gestures and cooing with their own exquisitely timed gestures of voice and body. It transformed medical concern for the baby. As Brazelton declared in Margaret Bullowa’s book, “The old model of thinking of the newborn infant as helpless and ready to be shaped by his environment prevented us from seeing his power as a communicant in the early mother-father-infant interaction. To see the neonate as chaotic or insensitive provided us with the capacity to see ourselves as acting ‘on’ rather than ‘with’ him” ( Brazelton, 1979 , p.79).

New attention to newborns within hours of their delivery, with the aid of films, led to confirmation that the baby could imitate adult expressions with careful timing of movements of eyes, face, mouth and hands ( Maratos, 1973 , 1982 ; Meltzoff and Moore, 1977 ; Kugiumutzakis, 1993 ; Nagy and Molnár, 1994 , 2004 ; Nagy, 2011 ; Kugiumutzakis and Trevarthen, 2015 ; Figure 1 , Upper Left). The findings proved that the baby is born with an altero-ceptive awareness of another person’s body parts as having feelings in movement like their own proprio-ceptive ones. It also became clear that this consciousness appreciates the balance and drama of a collaborative narrative flow with shared rhythms – essential to our ability for musicking ( Trevarthen, 1974 , 1977 , 2005a ).

The pediatrician Sander, (1964 , 1975 ; republished in Sander, 2008 ) recognized that an infant and caregiver create a coherent system of actions regulated with feelings of vitality in shared time. This dynamic collaboration was also discovered by Daniel Stern when he examined recordings of a mother playing with her three-month-old twins ( Stern, 1971 ).

A stimulating contribution to this new approach came from the work of anthropologist and linguist Mary Catherine Bateson, daughter of anthropologists Gregory Bateson and Margaret Meade. In 1969 Bateson had her first child after beginning postgraduate studies at MIT with Margaret Bullowa, researching language development using statistical analysis of vocal expressions. Observing a film in Bullowa’s collection as well as the experience of rich exchanges with her own infant opened her awareness of the form and timing of communication that developed in the first 3 months, which she called ‘proto-conversation’ ( Bateson, 1971 ). She benefitted from attention to the field studies of Albert Scheflen on the stream of conversation ( Scheflen, 1972 ) and Ray Birdwhistell on body movements in natural conversation ( Birdwhistell, 1970 ).

Reviewing her work in Bullowa’s book, she said:

“… the mother and infant were collaborating in a pattern of more or less alternating, non-overlapping vocalization, the mother speaking brief sentences and the infant responding with coos and murmurs, together producing a brief joint performance similar to conversation, which I called ‘proto conversation’. The study of timing and sequencing showed that certainly the mother and probably the infant, in addition to conforming in general to a regular pattern, were acting to sustain it or to restore it when it faltered, waiting for the expected vocalization from the other and then after a pause resuming vocalization, as if to elicit a response that had not been forthcoming. These interactions were characterized by a sort of delighted, ritualized courtesy and more or less sustained attention and mutual gaze. Many of the vocalizations were of types not described in the acoustic literature on infancy, since they were very brief and faint, and yet were crucial parts of the jointly sustained performances.” ( Bateson, 1979 , p. 65).

Bateson’s work confirmed Bruner’s realization that Noam Chomsky’s hypothesis of a specific Language Acquisition Device (LAD) or innate ability of the child to construct syntax, the grammatical order of words, to formulate ideas ( Chomsky, 1965 ), paid no heed to the vital importance of a complementary ability of a parent to encourage enrichment of reference in communication with a young child, a Language Acquisition Support System (LASS). As Bruner, expressing his psychology of education, put it “the LADD needs a LASS” ( Bruner, 1983 ). Child and adult share rules of imagination for all kinds of movement, including spoken propositions.

A follower of Chomsky’s theory of the evolution of language as reasoning, Stephen Pinker, in his perhaps overly ambitiously titled How the Mind Works ( Pinker, 1997 ) claimed, “As far as biological cause and effect are concerned, music is useless.” He gave no attention to movement and time, the communication of infants, playful children, affectionate parents, the poetry of music, or Einstein’s theory of his mathematical invention as “sensations of bodily movement” ( Hadamard, 1945 ), thus misunderstanding the origins and purpose of rational discourse (see Sections Communicative Musicality and Resilience of the Human Spirit and Musical Affections of the Embodied Human Brain).

We now have evidence from many studies analyzing behaviors that demonstrate that infants show a rich spectrum of expressive movements of the upper parts of their bodies ( Trevarthen, 1984a ), not just the ‘categorical emotions’ identified by Paul Ekman ( Ekman and Friesen, 1975 ), but the ‘complex social emotions’ that Damasio (1999 , 2010 ) describes as regulators of well-being in intimate interpersonal relations, and expression of a moral personality in society – expressions of such feelings as embarrassment, shame, guilt, contempt, compassion, and admiration.

Most importantly, study of recordings reveal that modulations of timing, of rhythms, and of the flow of vitality forms shared with infants have the characteristics recognized as musical ( Trevarthen, 1990a ). These have been precisely defined by acoustic analysis of vocalizations of adult and infant in dialogs and games ( Malloch et al., 1997 ; Malloch, 1999 ; Trevarthen, 1999 ; Trehub, 2003 ).

Case Studies of Infant Musicality

We summarize here key findings related to the growth of musical abilities from studies of infant individuals that we have reported previously.

First there is evidence from a recording made by Saskia van Rees in an intensive care unit in Amsterdam ( van Rees and de Leeuw, 1993 ) that rhythms corresponding to those of human locomotion are present in vocalizations of a premature infant which are precisely coordinated with simple vocal exchanges with a caring father (Figure 1 , Lower).

The recording of a two-month premature girl with her father, who was holding her under his clothes against his body in ‘kangaroo’ care, shows that they exchange short ‘coo’ sounds, the father imitating her sounds, with precise timing based on a comfortable walking rhythm of andante – one step every 0.7 s. Father (F) and the baby Naseera (N) are equally precise in their timing, which also shows what a phonetician would recognize as a ‘final lengthening’ characteristic of a spoken phrase - when they are ready to stop the dialog the interval lengthens to 0.85 s. Following the shared phrase with its syllable-length durations, they exchange single sounds separated at 4 s intervals, the normal duration of a short spoken phrase. The recording supports our contention that even a prematurely born baby is skilled in sharing a musical pulse ( Trevarthen, 2009 ).

A recording with a blind 5-month-old girl illustrates intermodal attunement between the heard melody of a mother’s song and the proprioceptive feelings in the body of the baby of a gesturing left arm and hand (Figure 2 , Upper). The human ability to sense the shape of a melody within the body is intrinsic to our enjoyment of music as human communication ( Stern, 2010 ). Maria is totally blind and has never seen her hand. Maria and her mother were assisting in a project of Professor Gunilla Preisler in Stockholm to aid communication with blind and deaf infants.

FIGURE 2. Communicating in the rhythm of narratives with baby songs. Upper: A five-month-old girl, who is totally blind, ‘conducts’ her mother’s singing with her left hand. The graph of her hand movements with her mother’s voice marks, with black bars, three moments in the narrative, at 4, 16, and 28 s, where the infant anticipates the mother’s voice by 0.3 s. These are times, 12 s apart, when lines of the slow lullaby commence. The arrows identify moments when there is perfect synchrony between the mother’s voice and the baby’s index finger. The circled index finger movement is 300 msec ahead of a lift in the pitch of the mother’s voice. Lower: Two infants share the poetry of action songs with their mothers. A four-month-old enjoys her mother’s singing of a song and accompanies the narrative with movements of her baby’s hand. And a six-month-old imitates clapping movements in synchrony with the song. Both songs show an iambic rhythm of short and long syllables, and rhyming vowels, ‘bear’ with ‘there’ and ‘well’ with ‘bell,’ which the babies imitate with their voices. (Upper: Analyses of video from Professor Gunilla Preisler, University of Stockholm. Previously published in Trevarthen (1999) and Schögler and Trevarthen (2007) . Lower: From Trevarthen (2015) , modified from Figure 4, p.137.)

While her baby is lying down during bottle feeding, the mother sings two baby songs including “Mors Lille Olle,” well-known throughout Scandinavia. It was not realized until later when the video was viewed that Maria was ‘conducting’ the melodies with delicate expressive movements of her left hand, while the right hand was making unrelated movements, stroking her body. When Professor of Music at Edinburgh University, Nigel Osborne, saw the film he said, “Yes she is conducting using the conventional movements of a professional conductor, describing a phrase with a sweeping movement, pointing up for a higher pitch, and dropping her wrist at the close of a verse – and she is making the movements with some anticipation.” Microanalysis supported what he observed. At certain points in the course of the melody Maria’s finger moves 300 milliseconds before the mother’s voice. She knows the song well, and leads the ‘performance’ ( Trevarthen, 1999 ; Schögler and Trevarthen, 2007 ).

Although blind, Maria knows the feelings of anticipated movement of her hand, and uses them to sense and share the human vitality dynamics in her mother’s voice. This kinematic sensibility was identified by Olga Maratos in her pioneering research in imitation as foundational for the ability of a young infant to reproduce another person’s expression seen or heard ( Maratos, 1973 , 1982 ). Indeed, vocal perception, detecting the modulation of pitch and timing in an adult’s voice sounds, develops much faster than vocal production. The infant may be tracking sound with reference to the kinesics of the fastest and most complex gestural movements of her hands.

When taking part in a nursery song, infants demonstrate sensitivity for melodic phrase structure, attending to the rhyming vowels at the ends of lines, and by 5 months the infant can vocalize a matching vowel in synchrony with the mother ( Trevarthen, 2008 ). For our final example, the application of acoustic analysis with observations on gestural behaviors of infants in the middle of the first year, suggests that melodic patterns, common to different cultures, define four-line verses ( Imberty, 2000 ), with a pattern of Introduction, Development, Climax and Resolution, identified in proto-conversations with two-month-olds (Figure 2 , Lower, and Figure 3 ), and we note similarities with the sections recognized in classical Roman rhetoric or speech-making – exordium, narratio, confutatio , and confirmatio . In spite of very different conventions in musical performances in different communities, a parent, or a child, wanting to share the pleasure of songs and action games with a baby, naturally adopts the intuitive formula of a poetic verse to share a story of body movement.

FIGURE 3. Stories of changing pitch in the singing voice. These examples illustrate the narrative phases that infants respond to, which are found in infant directed speech or baby songs in different languages. (A) A proto-conversation of a mother with a 6-week-old. The baby shares the development, climax and resolution of the narrative, with vocalizations close to middle C. (B) A slow lullaby, of 26 s, has four-line stanzas, with rhyming vowels. (C) A more animated song of 18 s shows the same poetic organization with undulations of pitch and vowels rhyming between first and second lines and between final words of each verse. (A) Original in Malloch (1999) , Figure 5, p. 41. (B) From Trevarthen (2015) , a portion of Figure 4, p. 137, and Trevarthen (2016) , Figure 3, p. 10. Original in Malloch (1999) , Figure 10, p. 49. (C) Original in Trevarthen (1999) , Figure 2, p. 183.

Lastly, we present the work of Katerina Mazokopaki, a developmental psychologist who is a pianist and teacher of piano playing. She made a study of babies in Crete with her professor, Giannis Kugiumutzakis, an expert in analysis of imitative games with newborns ( Mazokopaki and Kugiumutzakis, 2009 ). The babies were left alone in a familiar place at home amusing themselves. Then a recording of a Greek baby song came on. Between 3 and 10 months old they all reacted in the same way. First they looked surprised; then they looked about as if someone had come into the room; and finally they smiled with delight and started performing with the music, inspired by the pulse and melody, joining the music with their different abilities to dance and sing (Figure 4 ).

FIGURE 4. Katerina Mazokopaki’s baby dancers: Upper Left: Georgos, 3.5 months lying on a comfortable bed, responds with a big smile and gestures of hands and feet to accompany the music. Upper Right: Katerina, 9 months, smiles, bounces and extends her arms to ‘fly’ into action. Lower Left: Panos, 9 months, smiles his greeting, then beats the floor rhythmically with his right hand. Lower Right: Anna, 10 months, standing in her cot, smiles and starts dancing vigorously, swinging her bottom. All four sing with the music (Photos supplied to the CT).

Communicative Musicality and Education into the Culture of Music

Mastery of a musical culture, and of language, starts with the intuitive vocal interactions between caregiver and infant ( Vygotsky, 1966 ). Our innate communicative musicality is the ‘raw material’ for cultural forms of music and the rules of grammar and syntax. A child makes stories in sound as an active participant whose pride to belong to the rich musical traditions of society propels them into learning and creating. This is the cultivation of communicative musicality to music, from innate self-expression to cultural practice and a musical identity ( MacDonald et al., 2002 ; MacDonald and Miell, 2004 ). It is brought to life, as language is, with the enthusiastic support of more experienced companions ( Bruner, 1983 ).

The desire for cultural participation is evident in informal learning in which children’s own musical culture grows from the vitality of The Muse Within ( Bjørkvold, 1992 ). It is nurtured from the music, live and recorded, that the child hears all around and contributes to spontaneously, along with the invention of talking and verse-making with playmates, often accompanied by rhythmic stamping, hopping and jumping ( Chukovsky, 1963 ). Our earliest shared signing of communicative musicality in infancy becomes dialogic ‘musical babbling’ from around 2 months old ( Trevarthen, 1990a ). Already at 2 months the infant is learning the cultural gestures and preferences that become the tools through which cultural meaning will be created and exchanged ( Moog, 1976 ; Tafuri and Hawkins, 2008 ). Lullabies are sung more often in cultures that value quiet infants, playsongs in cultures that value lively enthusiasm in infants ( Trehub and Trainor, 1998 ). A musical ‘proto-habitus’ is created ( Gratier and Trevarthen, 2008 ).

The infant is born ready to interact and discover her musical culture. Hearing responds to musical sounds from the third trimester of pregnancy ( Busnel et al., 1992 ), and infants can recognize music they heard before birth ( Hepper, 1991 ). They recognize musical contours and rhythmic patterns ( Trehub and Hannon, 2006 ), and ‘dance’ to music before they are one year old ( Zentner et al., 2010 ). Infant-inclusive singing is preferred, like infant-inclusive speaking 1 .

From about 3 months of age in many (probably all) cultures, mothers start to sing baby songs ( Trevarthen, 1986 ) to their infants. In a previous publication the second author summarized their characteristics:

(1) “The beat is clear and precisely modulated; usually in the andante range near moderato (90-100 beats per minute).

(2) Often the beat is marked by clapping, or by regular movements of the baby’s body.

(3) The mother sings with a clear melodic tone varying her pitch in a treble range and making rises and falls to make a simple development of the ‘emotional narrative’.

(4) Songs commonly have a clear stanza form — usually 4 lines, each of 3 or 4 beats, making a verse (which therefore lasts 8-15 seconds).

(5) Especially in the last line, well controlled musical tricks varying the beat ( rubato , sforzando, ritardando, accelerando ) are used to mark a climax and resolution.” ( Trevarthen, 1989 , p. 96).

More recognizable musical forms grow with the spontaneous singing of young children as they play alone or with others ( Barrett, 2011 ), practicing their musical craft. The Norwegian musicologist Jon-Roar Bjørkvold (1992) collected and studied the songs of 4–7-year-olds in three kindergartens in Oslo. He observed how they gave voice to emotion, conveyed information, and established relationships through learning and creating their own children’s musical culture. He identified two types of children’s singing – ‘egocentric’ for private pleasure, which, as the child matures, gives way to more social or ‘communicative’ music making.

As young children mature so they use their voice with a singing kind of expression in progressively more ‘symbolic’ ways. Fluid/Amorphous Songs “evolve in a completely natural way from the infant’s babbling as part of its first playful experiments with voice and sound. This type of spontaneous song, with its fanciful glissandi, micro-intervals, and free rhythms, is quite different from what we adults traditionally identify as song.” ( Bjørkvold, 1992 , p.65). Song Formulas , such as teasing songs, are symbolic forms for communicating and they flourish after the child begins to play with peers, typically at two or three. Elements of musically more complex Standard Songs are picked up from play with adults and hearing them sing, and are adapted to fit what the child is doing. This progressive ‘ritualisation’ of vocal creativity clarifies the adaptive motives for learning to sing, and how they express increasing narrative imagination for sharing ideas in culturally specific ways ( Gratier and Trevarthen, 2008 ; Eckerdal and Merker, 2009 ), paralleling the way language is mastered ( Chukovsky, 1963 ).

All through the development of children’s singing, repetition and variation, basic tools of any piece of music (for example, see Ockelford, 2017 ), are primary features as children explore the possibilities of musical form. Repetition and variation between the vocalizations of infant and caregiver feature from the very first shared vocalizations, regulating feelings in social interactions ( Malloch, 1999 ). Later, the growing child will continue to play with how music can convey affect and change their own and others’ mood, the four-part structure of Introduction, Development, Climax and Resolution, identified above in the structure of a proto-conversation, becoming the basis of large scale musical works, as well as verbal argument (for example, see the sections of classical rhetoric).

How the child’s spontaneous musicality, as it grows in group practice without formal training ( MacDonald and Miell, 2004 ), is received by the surrounding educational culture, is a vital ingredient in the child’s emerging ‘musical identity.’ Musical identity and self-efficacy or mastery of skill in music making inform each other, in reciprocal relationship. A child who sees themselves as a competent musician may attempt to learn a difficult piece of music, and their success at performing this piece will further bolster their sense of competence. And the way a child is welcomed into their musical culture is of vital importance as to whether this child thrives playfully with the musical tools at her disposal, developing her skill in the use of these tools, or shrinks away in disinterest because her own intrinsic musicality is not being heard or valued. If education does its job well, with the child as collaborative artist and thinker ( Trevarthen et al., 2018 ), our rich inner narrative of affective life, generated with our prospective awareness of body movement, is expressed in our social group to create a life-affirming, inclusive culture of shared artful rituals that celebrate the aesthetic grace and moral graciousness of joy in performance ( Frank and Trevarthen, 2012 ; Trevarthen and Bjørkvold, 2016 ). For example, the InCanto project ( Tafuri and Hawkins, 2008 ) is a wonderful example of infants’ and parents’ being encouraged to have their expression of music cultivated in such a way that the infant grows into a child who shows greater ability to sing in tune, a greater range of musical expression, and overall more enthusiasm for music participation.

Problems from introducing an emphasis on enforced cultural learning too early are demonstrated by Bjørkvold (1992) who studied the musical games of children in Oslo, Moscow, St Petersburg, and Los Angeles where educational, cultural, social and political practices are very different. In all three countries children showed spontaneous musicality, but in the nations of Russia and the US, where formal training in music was given greater value than it was in Norway, he found reduced spontaneous music making. He insists, “It is critically important for children to master spontaneous singing, for it is part of the common code of child culture that gives them a special key to expression and human growth” ( Bjørkvold, 1992 , p. 63). A comparable inhibitory effect of conventions of schooling has been recorded on the spontaneous expression of religious feelings and spirituality in the early years ( Hay and Nye, 1998 ). These innate sources of human imagining in collaborative, moral ways give value and meaning to the later cultivation of advanced cultural ideas and skills ( Valiente et al., 2012 ).

The importance of valuing both the child’s innate musical creativity and introducing a child into his musical culture so that he may thrive within it and contribute to it can be conceptualized as a balance between two educational necessities – providing a social environment where a child’s own skills and abilities are nurtured, and a place where training is provided into the ways of a particular culture ( Rogoff, 2003 ). Both build enthusiasm for cultural participation. This balance has been presented by Bowman (2012) and others as a consideration of two Latin roots for the English word ‘education.’ One, educare , means to train or to mold. Its motivation is the initiation of a person into cultural conventions, without which a person is left unable to live effectively within a particular culture, using its tools to communicate. The other, educere , means to lead out, or draw out. Without this more responsive nurturing, the person is left unable to engage with situations and solve problems not yet imagined. Their ability for creativity is compromised. These very different concepts of what education means are often experienced in schooling as being in tension, with educare often winning out, leaving the child with dry knowledge rather than living abilities supported by their own innate skills.

We propose that teachers and students of music at all levels learn how best to do their work by deliberately invoking the rhythms of the student’s innate creative vitality while demonstrating cultural conventions that make rich use of this talent ( Flohr and Trevarthen, 2008 ). Infants and toddlers make imaginative musical play in affectionate friendships with parents or peers ( Custodero, 2009 ); primary school children build relationships with the invention of stories in groups with free instrumental play and dance ( Fröhlich, 2009 ); and an advanced music student is assisted to master their instrument through their teacher encouraging their playing to be like a dance representing a narrative, rich in expressive feelings ( Rodrigues et al., 2009 ). In all instances the motives of the learner, and how they may change with development of the body and experiences gained, are of crucial importance ( Bannan and Woodward, 2009 ; Ingold, 2018 ). As with all education, the success of teaching depends on recognition of how children’s ‘zest for learning’ ( Whitehead, 1929 ; Dewey, 1938 ) changes with age and the development of body and mind.

We end this section with a quote from Bowman on the broader role of music in education. In times where the arts are often considered of marginal importance in education, it talks to the richness of our engagement with music in nurturing all learning experiences:

“The distinctive educational and developmental potential of music lies, I submit, in dynamic, bodily, and social natures, and distinctly ethical, responsive, and responsible kinds of know-how these afford. Practical knowledge is action embedded knowledge, quite distinct from theoretical knowledge and technical know-how. It is a kind of character-based sense of how best to proceed in situations where best courses of action cannot be determined by previous ones. This ability to discern the right course of action in novel, dynamic situations is precisely the kind of human asset required in today’s rapidly changing world. And musical engagements may, under the right circumstances, nurture this capacity in ways unmatched by any other human endeavour.” ( Bowman, 2012 , p. 31).

Communicative Musicality and Resilience of the Human Spirit

As Daniel Stern has written ( Stern, 2010 ), the human body has a rich range of gestural ‘forms of vitality’ – we move in musical ways. And within each actor there is both ‘self-sensing’ and ‘other-sensing’ of the degree of grace, or biological efficiency ( Bernstein, 1967 ) and hopefulness ( Trevarthen and Malloch, 2017a ) in the gestural narratives of our projects. These qualities of vitality, or well-being, transmitted to others, become the qualities of relationships and social activities – their moral values ( Kirschner and Tomasello, 2010 ; Narvaez, 2014 ; Trainor and Cirelli, 2015 ). They convey relational feelings for the degree of consensuality or sharing of expression in moving. Effort to manage the grace and morality of movements can be cultivated to assist well-being of those whose actions are confused or fearful - that is, the making or ‘poetry’ (from the Greek poiein , to make) of their movements may be enhanced to provide responsive and relational care or therapy ( Hobson, 1985 , ch3; Stern, 2000 , p. xiv; Osborne, 2009b ; Meares, 2016 ).

At times our healthy ability for graceful gesturing is met with circumstances that do not allow it to be expressed with its natural healthy vitality. For example, failure to gain a sympathetic appreciation of their musicality can cause an infant to express withdrawal and distress ( Murray and Trevarthen, 1985 ). Instead of joyful pride in sharing play they show sadness and shame ( Trevarthen, 2005b ). However, an infant’s communicative musicality can also be expressive of resilience and determination.

In the example presented in Figure 5A we see a consistent rigidity of expression and a lack of self-confident invention on the part of a mother suffering from BPD (borderline personality disorder). She repeats the same up-and-down vocal gesture again and again, with almost no vocal participation on the part of the infant. Where the infant does participate (shown by vocalizations with either a square or circle around them), the infant appears to be setting up the possibility for a dialog – vocalizing exactly on the ‘bar-line’ (bar 5, shown by a square) and then around the mother’s pitch (shown by a circle). Indeed, the infant’s vocalizations persuade the mother out of her repetitiveness – the mother momentarily takes notice of her infant and responds to her infant’s conversational offering by ceasing her unresponsive repetition and vocalizing once more at the infant’s pitch. But the dialog almost immediately breaks down, and the mother returns to her stereotypical, repetitive vocal gesturing.

FIGURE 5. Voice modulations that express emotions of relating in a psychological disorder, and in relational therapy. (A) A pitch plot of a mother suffering from BPD (borderline personality disorder) speaking to her infant. She repeats the same phrase with monotonous intonation, making a slight reaction to critically timed sounds made by the infant, but cannot establish shared affective engagement. (B,C) Changes in the prosody of a client’s speaking in communication with a therapist, before and after a therapeutic change, with improvement in self-confidence. (A) Original in Gratier and Apter-Danon (2009) , Figure 14.5, page 319. Reproduced with permission. (B,C) Originals in Malloch (2017) , Figures 4.1 and 4.2, p.72. Reproduced with permission.

As well as showing inflexible, ‘non-graceful’ behavior of a mother who is suffering from BPD, this example also shows the resilience and hope of the infant in the face of her mother’s rigid communicative style. This will of our communicative musicality, evident from the earliest of interactions with infants ( Papoušek, 1996 ), is utilized in therapies that employ in-the-moment intersubjective interactions as means for healing ( Stern et al., 1998 ; Stern, 2000 , p. xiv). This immediately responsive interaction may be through talking, through music-making, through dance, or touch. The common element is an individual who is highly skilled in attuning to nuances of interpersonal timing and gesture, and who aims to lead back to health another whose personal mindedness of time-in-the-body has become compromised through hardship, suffering, or biological disruption, perhaps leading to a sense of isolation and misunderstanding ( Trevarthen and Malloch, 2000 ). The therapist joins with the person who needs help, leading them back to health and wellbeing through their own therapeutic sense of the ‘minute particulars’ in that moment of meeting ( Hobson, 1985 , part 2).

Olga Maratos, a developmental psychologist who pioneered recognition of the ability of young infants to imitate expressions of an attentive and supportive adult ( Maratos, 1982 ) took part in the establishment in Athens of a residential school for children with autism, called Perivolaki , meaning ‘a little garden.’ It is a day-care center with facilities in beautiful surroundings that invite playful out-door activities, games with toys and creative shared occupations such as listening to and making music. They use the psychoanalytic concept of ‘transference’ of feelings or ‘unconscious desires’ to encourage sensitive intimate and consistent relations, each child having a trusting relationship with a particular member of the staff. Stability of activities is maintained, with close engagement with the parents, who are seen weekly during the first two years of the child’s stay at Perivolaki and every fortnight thereafter. The average length of stay is 4–5 years ( Maratos, 1998 ).

Olga explains that staff are trained to observe the children, think about them and discuss their behavior at staff meetings “with a view to understanding whether their autistic behaviour is defensive, refusing interaction and relations because they don’t make sense for them or because they are painful, or whether there is a pervasive lack of motivation for relating and communicating. We find both conditions present, at different times, in all our children” ( Maratos, 1998 , p. 206). This approach, adapting a psychoanalytic treatment which avoids diagnosis of the cause of the disorder, leads to a form of active and intimate ‘relational therapy,’ which does not rely on verbal formulation of anxieties and lack of trust.

Affect attunement has been defined as qualities of vocal and body gesture that carry meaning in parent–infant communication – it is, “the performance of behaviours that express the quality of feeling of a shared affect state, but without imitating the exact behavioural expression of the inner state” ( Stern, 1985 , p. 142). This largely unconscious ‘recasting’ of events is necessary to “shift the focus of attention to what is behind the behaviour, to the quality of feeling that is being shared” ( Stern, 1985 , p. 142). We say the relationship is now one of ‘companionship,’ a word from Latin meaning ‘to break bread with’ and defined here as the wish to be with an other for a mutually beneficial ‘inner’ purpose, apart from reasons of immediate survival, procreation or material gain. Companionship involves exchanging affect through sharing the quality or virtue of impulses of motivation, which is the original rich meaning of ‘sympatheia’ in Greek ( Trevarthen, 2001 ).

The therapeutic relationship, even in talking therapies focussed on what the language says about feelings, is underpinned by the manner or graciousness of our gestural exchanges – whether those qualities are carried in vocal prosody or bodily movements ( Stern, 2000 , p. xiv; Malloch, 2017 ). It is about the direct and desired sharing of feelings in human vitality. Stern (2010) writes eloquently on the importance of listening for the forms of vitality (the forms of feeling as Hobson, 1985 , called them) that are being expressed through prosody – “without the dynamic vitality features of the intention-unfolding process we would not experience a vital human being behind the words that are being said” ( Stern, 2010 , p.124). He also writes of the use of metaphors as carriers of images of our in-the-moment vitality (also see Hobson, 1985 , ch.4). For example, in the work of Stephen, the first author, as a therapist, here is the text of an exchange between him and a client discussing the client’s sense that his life has never measured up to his notion of what a successful life should look like:

Client: My father thought I was stupid. He’d call me ‘stupid boy.’ Therapist: The way you said that – perhaps a sort of exhaustion and emptiness – reminds me of the tide going out in a bay. Client: Empty… like something’s slowly leaving.

Here the focus on the vitality that the client associates with his father’s dismissing statement leads to a new experience to explore therapeutically – something is slowly leaving. Further discussion focussed on the experience of what ‘slowly leaving’ feels like. When the therapist works like this, “we move from an enquiry about intentions, means, and goal states to an enquiry about processes of creation, emerging, and becoming” ( Stern, 2010 , p.126). We move from distanced recollection or speculation to life in the present moment ( Stern, 2004 ).

The prosody of the client’s voice sometimes sums-up the therapeutic change itself. In the example below of Stephen’s work a client is talking of an emerging ‘new me’ in contrast to an ‘old me.’ 2 The ‘old me’ was marked with ‘a lack of self-respect.’ ‘I blame myself when things go wrong, I believe I’m not working hard enough.’ The voice is drone-like, body hardly moving. Figure 5B shows a four-second section of a pitch plot of ‘old me’ voice.

After describing ‘old me’ the client’s body relaxed, they looked up from the floor, hands lifted from their lap, the volume of their voice increased, its pitch lifted, and they began talking of ‘new me.’ ‘New me is more rational about life. This part says, “Well, I was uncommunicative this morning – that’s all right, that’s OK. That’s just the way I was. Doesn’t make me a bad person. Other times I communicate really well!” Figure 5C is a four-second pitch plot of ‘new me.’ The shift in the vitality of the musicality is clear. Stephen felt the distinct difference in the vitality of the two “me’s” of the client, and continued the session exploring how the new “me” might express itself in the world (see Malloch, 2017 , for further discussion of communicative musicality in therapy).

The role of our communicative musicality in supporting our wellbeing lies at the very heart of the practice of using music therapeutically. Music therapy covers a wide range of ways of using musical experiences – stories in sound – to heal and improve people’s lives. The Australian Music Therapy Association defines Music Therapy as: “a research-based practice and profession in which music is used to actively support people as they strive to improve their health, functioning and wellbeing.” It is the compassionate use of music to engage another emotionally, interpersonally, cognitively, and culturally. “Music is therapeutic because it attunes to the essential efforts that the mind makes to regulate the body, both in its inner neurochemical, hormonal and metabolic processes, and in its purposeful engagements with the objects of the world, and with other people” ( Trevarthen and Malloch, 2000 ). This is particularly so during improvisational music therapy, where the therapist supports the client towards change – greater integration of experience and freedom in communication ( Pavlicevic, 2000 , ch.6; also see Malloch et al., 2012 , on the effectiveness of improvisational music therapy with neonates).

However, the practice of music therapy is more than the therapeutic use of preverbal protomusic, however, important this is. Reflecting our discussion above on music and education, music therapy is also making use of the cultural forms of our musicality, and the power these cultural forms have within our psyche (for example, Donald, 1991 ; MacDonald et al., 2002 ; Stern, 2010 ).

A relationship between our communicative musicality and our culturally made music for the practice of music therapy is proposed by Pavlicevic and Ansdell (2009) . They emphasize the peculiarly musical relationship established within music therapy practice – that is, that the cultural elaboration of communicative musicality relates to our communal, social lives. Music therapy engages our shared communicative musicality, and welcomes us into the shared cultural, communal experience of musicking, using the tools of a particular cultural type of music – one of many musics in the world ( Stige, 2002 ).

Thus, part of the reason music therapy ‘works’ is its invitation for cultural collaboration – we exercise what has been called our ‘deep social mind’ ( Whiten, 2000 ) following particular cultural forms. This wish to learn the forms of culture, our ‘conformal motive’ ( Merker, 2009 ), comes to life within an environment where we sense our communicative gestures are being valued by another or others through the creation of shared narratives of vitality forms ( Stern, 2010 ). We feel ourselves to be both a companion in our shared narrative of communicative embodied gestures and a companion in a particular shared cultural collaboration. It is within this dual companionship that our deep yearning to belong is met and satisfied, and where healing can occur.

Musical Affections of the Embodied Human Brain

In our opinion brain science has been most insightful into the nature of the self and what makes us human, and how we share the joy and pains of life, when it investigates ‘Primary Process’ emotional guidance of brain growth for regulation of vitality in body movement and its ‘seeking’ awareness ( Hess, 1954 ; Solms and Panksepp, 2012 ). It offers us insight when it investigates how experiences develop by generating expectations of well-being in companionship and by enriching it with cultural meaning ( Trevarthen, 1990b ). It shows that differences in the rate of development of cognitive processes in left and right hemisphere at different ages are caused by different affections ( Thatcher et al., 1987 ; Chiron et al., 1997 ), from which arise correlations with musical behaviors and other creative forms of play, as well as Piagetian stages of rational mastery of the body and objects it uses, and development of language.

The neuroscientist Jaak Panksepp, who studied the emotions of mammals who do not cultivate music, but who use patterns of movement including signs with sound to regulate their social lives in ways that anticipate our richer experience of the sounds of our movement using the tools of culture, offers insight into why we are musical beings ( Panksepp and Bernatzky, 2002 ). And in a recent synopsis he agrees that mastery of language in early years depends on the sense of purpose we share in musical ways:

“Human languages are coaxed into the brain, initially by the melodic intonations of motherese by which emotional communication becomes the vehicle for propositional thought.” ( Panksepp et al., 2012 , p. 11).

Like the brain of any animal, the human brain grows to represent and regulate a body form in movement ( Trevarthen, 1980 , 2001 , 2004 ). And from even before birth, the self-formation of a personal self in the brain of the fetus is led by manifestations of movement.

“The first generalized movements occur in week 8 ( de Vries et al., 1984 ), but already in week 5 monoamine transmission pathways grow from the brainstem to animate the primordial cerebral hemispheres. Key components of the Emotional Motor System (hypothalamus, basal ganglia and amygdala) are in place when the neocortex is unformed.” ( Trevarthen, 2001 , p. 26).

After the baby is born and seeks intimate communication of all motives with a parent, the affective system remains as the director of learning and appreciation of what is gained by new awareness.

Psychiatrist and literary scholar Iain McGilchrist in The Master and His Emissary ( McGilchrist, 2009 ) has presented a brilliant review of behavioral and brain research, and a clear conception of complementary consciousness in the two cerebral hemispheres. “Music”, he writes, “being grounded in the body, communicative of emotion, implicit, is a natural expression of the nature of the right hemisphere” (p. 72).

McGilchrist’s research leads him to the political view that we are living in a society that grants too much power to the special refined perceptuo-motor and scientific skills of the left brain, while failing to appreciate how the right brain gives purpose and value to all that we do, thus pointing to the importance of closer cooperation between science and the fundamental values of the humanities. He draws on anthropological information about the universal principles of social understanding at very different levels of technical ability and manufacture, and on the importance in all social groups and cultures of musical performances, which he concludes, from a wide range of evidence, that music evolved before language and contributed to the formulation of its syntax and prosody (see Sachs, 1943 ).

Music, he says, was not,

“an irrelevant spin-off from something with more of a competitive cutting edge – namely, language…. rather the reverse. If language evolved later, it looks like it evolved from music…. Rousseau in the eighteenth century, von Humboldt in the nineteenth century and Jespersen in the twentieth, have thought it likely that language developed from music…. That we could use non-verbal means, such as music, to communicate is, in any case, hardly surprising. The shock comes partly from the way we in the West view music: we have lost the sense of the central position that music once occupied in communal life, and still does in most parts of the world today…. We might think of music as an individualistic, even solitary experience, but that is rare in the history of the world.” (p. 104).

And he quotes neurologist Oliver Sacks, who said:

“This primal role of music is to some extent lost today, when we have a special class of composers and performers, and the rest of us are often reduced to passive listening. One has to go to a concert, or a church or a musical festival, to recapture the collective excitement and bonding of music. In such a situation, there seems to be an actual binding of nervous systems, the unification of an audience by a veritable ‘neurogamy’ (to use a word favoured by early Mesmerists) ( Sacks, 2006 , p. 2528).

Twenty-six years before McGilchrist published his book, the anthropologist Victor Turner, famous for his book From Ritual to Theatre , drew on knowledge of the different functions of the hemispheres to identify play with a collaboration between them, in an article entitled “Play and drama: The horns of a dilemma”:

“Current ideas about differences between the left and right hemispheres of the brain provide a basis for speculating about the nature of play. Play encompasses both the rationality and order of the left hemispheric orientation, and the improvisation and creativity of the right. But play also transcends these oppositions, running rings about them as it encircles the brain’s consciousness” ( Turner, 1983 , p. 217).

Good, beautiful and enjoyable, music is created out of poetic play. Indeed, we play music ( Trevarthen and Malloch, 2017b ).

A sense of time in the mind is the fabric from which movements of all kinds are woven into ambitious projects that value elegance with efficiency. It is a manifestation of the ‘biochronology’ that is essential to the vitality of all forms of life ( Osborne, 2017 ). In Rhythms of the Brain , György Buzsáki (2006) presents a wealth of evidence that the brain functions as a coherent rhythmic system, always in synch., and with a rich array of rhythms that are organized to collaborate.

“At the physiological level, oscillators do a great service for the brain: they coordinate or ‘synchronize’ various operations within and across neuronal networks. Syn (meaning same) and chronos (meaning time) together make sure that everyone is up to the job and no one is left behind, the way the conductor creates temporal order among the large number of instruments in an orchestra” ( Buzsáki, 2006 , p. viii).

From Panksepp and Trevarthen (2009) , p. 114:

“Music is performed with the measure of expressive movements in time, and with tensions created by combining rhythms ( Osborne, 2009a ). The ‘architecture’ and ‘narration’ of moving in psychological time is also displayed with emotional qualities related to vital functions of the body ( Trevarthen, 2009 ). These psychobiological elements of vitality are charted in three bands or ranges of physical or scientific time: (1) for the felt and imagined ‘extended present’ (from 10 seconds to years); (2) for the conscious ‘psychological present’ ( Stern, 2004 ), with its serially ordered steps of motor control coupled to the physiological rhythms of breathing and variations in heart rate (0.3 to 7 seconds); and (3) for ‘reflex experiences’ and ‘just noticeable differences’ too fast to be regulated by movements that are prospectively controlled in awareness (5 to 200 milliseconds). (For detail and the sources of this description see Trevarthen, 1999 ).

The time of musical narrative, which Imberty (2000) calls the macrostructure or ‘story-without-words’ of music, is related to the times of expressive behavior that form ‘protonarrative envelopes’ of intuitive vocal and gestural play between infants and their mothers ( Stern, 1985 , 1995 ; Malloch, 1999 ). The period corresponding to a stanza or verse of 20 to 40 seconds may be manifested in the brain, as gamma waves or parasympathetic cycles, which control autonomic functions of the heart and breathing. It continues to be active through sleep to produce fluctuating rates of breathing and heartbeat, as well as electrical activity of the cerebral cortex that might be related to the rehearsal and consolidation of memories in dreaming ( Delamont et al., 1999 ). In wakefulness the narrative cycle is charged and modulated for intersubjective meaning with the ‘microtonal’ and ‘microtemporal’ variations of emotion that express urgency and facility in skilled control of moving within the voice of a singer or the playing fingers of an instrumental performer, and in the hearing of a listener ( Imberty, 1981 , 2000 ; Gabrielsson and Juslin, 1996 ; Juslin, 1997 , 2001 ; Kühl, 2007 ; Osborne, 2009a ). Music can assist the synchronization of physiological functions of respiration and heart activity and bring improvement in locomotor activity, and it can improve cognitive and memory processes by brain synchronization.”

Rhythmic co-ordination by the Intrinsic Motive Pulse (IMP) of the brain holds body movements together in composition of intentions and experiences ( Trevarthen, 1999 , 2016 ). It is the medium for all shared experiences and purposes, and for the convivial vitality of music making.

CODA: The Philosophy of Human Vitality

In her review of the role of movement and sense of time in the creation of intelligence, Barbara Goodrich, as a philosopher, traces a history of ideas supporting the view that consciousness is founded on emotions for agency, which we argue are the sine qua non for music. In opposition to the “implicit philosophical presuppositions inherited from the canon of Plato, Aristotle, Descartes, and Kant, e.g., that consciousness is self-reflective, passive, and timeless,” she proposes a natural science view.

“Western philosophy, however, also includes what might be described as a counter-tradition—and one that is more compatible with empirical biological science than the usual canon. Heraclitus, Spinoza, Schopenhauer, Nietzsche, and especially the 20th century French philosopher and psychologist, Merleau-Ponty, all anticipated aspects of Llinás’s and Buszáki’s approaches… sketching out a notion of consciousness emerging from motility, and generating new hypotheses for neurophysiological research.” ( Goodrich, 2010 , p. 331).

We have argued that music comes from this very foundation of consciousness in motivated motility, and we underline the importance of a philosophy that acknowledges the motives and feelings of our life, as well as the intelligence we show in relating to persons, other life forms, and objects in our environment, by recalling the achievements of the philosophers of the Scottish Enlightenment – Hutcheson, Hume, Smith and Reid. In line with Goodrich’s “counter tradition,” their work anticipates the new understanding of the human BrainMind pioneered by Panksepp and Damasio, which gives primary importance to feelings of vitality in movement, and to emotions that express positive and negative affections in sympathetic communication. This is the science of communicative musicality which underpins the music we create and enjoy.

The Scottish philosophers of the 18th Century, led by Francis Hutcheson, held that relationships and social life depend upon a universal human capacity for “innate sympathy,” which generates a conscience, a sense of beauty, a public ‘common sense’ that values happiness and is disturbed by misery, and a moral sense that perceives virtue or vice in ourselves or others ( Hutcheson, 1729 , 1755 ; Hume, 1739–1740 ).

Smith (1759) in his Theory of Moral Sentiments took ‘sympathy’ to designate any kind of ‘moving and feeling with,’ whether motivated positively or negatively, and including posturing and acting in the same expressive way as another’s body (cf. the work of Stern on ‘affect attunement’ quoted earlier), and he also imagined experiences of relating and being sensed, as, for example, interrogating one’s conscience.

“How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.”

“Sympathy… may…, without much impropriety, be made use of to denote our fellow-feeling with any passion whatever.” Part I – Of the Propriety of Action; Section I – Of the Sense of Propriety, Chapter I – Of Sympathy.

He examined his conscience to understand being a person in relations.

“When I endeavour to examine my own conduct, when I endeavour to pass sentence upon it, and either to approve or condemn it, it is evident that, in all such cases, I divide myself, as it were, into two persons; and that I, the examiner and judge, represent a different character from that other I, the person whose conduct is examined into and judged of. The first is the spectator, whose sentiments with regard to my own conduct I endeavour to enter into, by placing myself in his situation, and by considering how it could appear to me, when seen from that particular point of view’. The second is the agent, the person whom I properly call myself, and of whose conduct, under the character of a spectator, I was endeavouring to form some opinion.”

This picture of a duplex mind regulated by motives of sympathy anticipates the distinction made by William James in 1892 and by Martin Buber in 1923 between a fundamental “I-Thou” state of awareness and the objective “I-It” relations with the physical word we acquire in communication.

Otteson, joint professor of philosophy and economics, and chair of the Philosophy Department, at Yeshiva University, and adjunct Professor of Economics at New York University, has proposed that Adam Smith’s Theory of Moral Sentiments (1759) has a more profound message for commerce and industry than The Wealth of Nations .

“Smith’s picture thus has a clear anti-Freudian thrust: it denies the hydraulic picture of human emotions according to which emotions build up “pressure” that must be “released.” Instead, and more plausibly, it conceives of emotions as things that can be controlled and trained by exercising what Smith calls “self-command.” The activity of reciprocal adjustment is then repeated numberless times in every person’s lifetime, as it is between and among the people in one’s community, resulting in the creation of an unintended and largely unconscious system of standards. These standards then become the rules by which we determine in any given case what kind of behavior is, as Smith calls it, “proper” in a situation and what “improper”—meaning what others can reasonably be expected to enter into.” Otteson (2000 , November 01).

Smith was a great admirer of the messages of music and wrote about the communication of its poetic massages in his essay Of the Nature of that Imitation which takes place in what are called the Imitative Arts , published in 1777 ( Smith, 1777/1982 ).

Beginning with his A Treatise of Human Nature (1739), David Hume strove to create a natural science of human psychology in opposition to René Descartes’ rationalism. He concluded that desire rather than reason motivates our behavior. Anticipating Merleau-Ponty’s phenomenology he also argued against the existence of innate ideas, concluding that we know only what we directly experience. He held that inductive reasoning and causality cannot be justified rationally, rather we follow custom and constant relations between ideas rather than logic. He concluded that we do not have a ‘conception of the self,’ only sensations of being alive. Following his teacher Hutcheson (1729) , he believed that ethics are based on feelings rather than abstract moral principles.

Finally, there is a bold clarity in the work of Thomas Reid, the third great follower of the teachings of Hutcheson, and a vigorous debating companion to David Hume. He wrote An Inquiry into the Human Mind on the Principles of Common Sense ( Reid, 1764 ).

Reid founded the Scottish School of Common Sense. For him ‘common sense’ is based on a direct experience of external reality, experience that becomes internal in language, which is based on an innate capacity pre-dating human consciousness, and acting as an instrument for that consciousness. He distinguished the acoustic element from the meanings which seem to have nothing to do with the sounds as such, a state of language, which he calls ‘artificial,’ that cannot be the primeval one, which he terms ‘natural.’ He described the way a child learns language by imitating sounds, becoming aware of them long before he or she understands the meaning in the artificial state of contemporary adult speech. If, says Reid, children were to understand immediately the conceptual content of the words they hear, they would never learn to speak at all. Here Reid distinguishes between natural and artificial signs.

‘It is by natural signs chiefly that we give force and energy to language; and the less language has of them, it is the less expressive and persuasive…. Artificial signs signify, but they do not express; they speak to the intellect, as algebraic characters may do, but the passions and the affections and the will hear them not: these continue dormant and inactive, till we speak to them in the language of nature , to which they are all attention and obedience.’ ( Reid, 1764 , p. 52).

‘Language of nature’ we equate with our embodied moving consciousness – our communicative musicality. An excess of ‘artificial signs,’ perhaps aimed at increasing productivity, leads to loneliness and ruthless rationality. However, the cultivation of our communicative musicality, in ourselves and others, through playful music, dance, ritual and sympathetic companionship, makes our communal life of shared work of the body and mind creative in more hopeful ways. It restores our common humanity and our connection with all living things.

Ethics Statement

Informed consent was gained for all data presented in this paper.

Author Contributions

SM contributed to all sections of the paper, particularly sections Communicative Musicality and Education into the Culture of Music and Communicative Musicality and Resilience of the Human Spirit. CT contributed to all sections of the paper, particularly sections The Genesis of Music in Infancy – A Short History of Discoveries, Case Studies of Infant Musicality, and Musical Affections of the Embodied Human Brain.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

• ^ We regard the term ‘infant directed,’ usually used in this context, to be a misnomer that does not acknowledge the co-operative and shared nature of the interaction. We use ‘infant-inclusive’ to refer to the style of speech and singing that spontaneously occur between caregiver and infant.
• ^ Written consent was obtained from the client by the first author.

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Keywords : musicking, motor intelligence, gestural narrative, infant musicality, cultural learning

Citation: Malloch S and Trevarthen C (2018) The Human Nature of Music. Front. Psychol. 9:1680. doi: 10.3389/fpsyg.2018.01680

Received: 18 February 2018; Accepted: 21 August 2018; Published: 04 October 2018.

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Copyright © 2018 Malloch and Trevarthen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Stephen Malloch, [email protected] Colwyn Trevarthen, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Special issue of the APA journal Psychomusicology: Music, Mind, & Brain, Vol. 29, No. 2–3, June–September 2019. Articles discuss visual imagery as a potential mechanism of emotion induction during listening.

Special issue of the APA journal Psychomusicology, Vol. 27, No. 3, September 2017. Includes articles about music perception, music psychology, music and movement, music education, and music therapy.

Special issue of the APA journal Psychomusicology: Music, Mind, & Brain, Vol. 26, No. 2, June 2016. The issue aims to bring to the foreground recent developments in our understanding of music as a multimodal, as opposed to a strictly auditory, experience.

Special issue of the APA journal Psychomusicology, Vol. 25, No. 4, December 2015. The articles span perceptual, cognitive, affective, neurological, and therapeutic aspects of music, using an array of neuroimaging approaches, statistical approaches, and paradigms.

Special issue of the APA journal Psychomusicology: Music, Mind, & Brain, Vol. 25, No. 3, September 2015. The articles reflect the wide spectrum of Leo Beranek's contributions to the field of architectural acoustics and show how bridges can be built to connect different disciplines associated with performance spaces.

Special issue of the APA journal Psychomusicology, Vol. 25, No. 1, March 2015. The issue provides the first compilation of research articles on musical imagery that includes the topic of involuntary musical imagery, sometimes referred to as earworms.

Special issue of the APA journal Psychomusicology, Vol. 24, No. 1, March 2014. The articles further understanding of the ways in which emotions influence music cognition, as well as the ways in which cognitive appraisal of events, persons and/or objects influence music related emotions.

Special issue of the APA journal Psychomusicology: Music, Mind, and Brain, Vol. 23, No. 4, December 2013. The articles focus on the music, cognitive, and motor behaviors and processes associated with jazz improvisation.

Special issue of the APA journal Psychomusicology, Vol. 22, No. 2, December 2012. Includes articles about polyphony, rhythmic ability, metricality, musical encoding and recall in Alzheimer's disease, pitch identification in children with visual impairment, and music perception in those with cochlear implants.

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The Transformative Power of Music in Mental Well-Being

• August 01, 2023
• Healthy living for mental well-being, Patients and Families, Treatment

Music has always held a special place in our lives, forming an integral part of human culture for centuries. Whether we passively listen to our favorite songs or actively engage in music-making by singing or playing instruments, music can have a profound influence on our socio-emotional development and overall well-being.

Recent research suggests that music engagement not only shapes our personal and cultural identities but also plays a role in mood regulation. 1 A 2022 review and meta-analysis of music therapy found an overall beneficial effect on stress-related outcomes. Moreover, music can be used to help in addressing serious mental health and substance use disorders. 2 In addition to its healing potential, music can magnify the message of diversity and inclusion by introducing people to new cultures and amplifying the voice of marginalized communities, thereby enhancing our understanding and appreciation for diverse communities.

Healing Trauma and Building Resilience

Many historically excluded groups, such as racial/ethnic and sexual minorities and people with disabilities, face systemic injustices and traumatic experiences that can deeply impact their mental health. Research supports the idea that discrimination, a type of trauma, increases risk for mental health issues such as anxiety and depression. 3

Music therapy has shown promise in providing a safe and supportive environment for healing trauma and building resilience while decreasing anxiety levels and improving the functioning of depressed individuals. 4 Music therapy is an evidence-based therapeutic intervention using music to accomplish health and education goals, such as improving mental wellness, reducing stress and alleviating pain. Music therapy is offered in settings such as schools and hospitals. 1 Research supports that engaging in music-making activities, such as drumming circles, songwriting, or group singing, can facilitate emotional release, promote self-reflection, and create a sense of community. 5

Empowerment, Advocacy and Social Change

Music has a rich history of being used as a tool for social advocacy and change. Artists from marginalized communities often use music to shed light on social issues (.pdf) , challenge injustices, and inspire collective action. By addressing topics such as racial inequality, gender discrimination, and LGBTQ+ rights, music becomes a powerful medium for advocating for social justice and promoting inclusivity. Through music, individuals can express their unique experiences, struggles, and triumphs, forging connections with others who share similar backgrounds. Research has shown that exposure to diverse musical genres and artists can broaden perspectives, challenge stereotypes, and foster empathy among listeners especially when dancing together. 7

Genres such as hip-hop, reggae, jazz, blues, rhythm & blues and folk have historically served as platforms for marginalized voices, enabling them to reclaim their narratives and challenge societal norms. The impact of socially conscious music has been observed in movements such as civil rights, feminism, and LGBTQ+ rights, where songs have played a pivotal role in mobilizing communities and effecting change. Music artists who engage in activism can reach new supporters and help their fans feel more connected to issues and motivated to participate. 6

Fostering Social Connection and Support

Music can also serve as a catalyst for social connection and support, breaking down barriers and bridging divides. Emerging evidence indicates that music has the potential to enhance prosocial behavior, promote social connectedness, and develop emotional competence. 2 Communities can leverage music’s innate ability to connect people and foster a sense of belonging through music programs, choirs, and music education initiatives. These activities can create inclusive spaces where people from diverse backgrounds can come together, collaborate, and build relationships based on shared musical interests. These experiences promote social cohesion, combat loneliness, and provide a support network that can positively impact overall well-being.

Musicians and Normalizing Mental Health

Considering the healing effects of music, it may seem paradoxical that musicians may be at a higher risk of mental health disorders. 8 A recent survey of 1,500 independent musicians found that 73% have symptoms of mental illness. This could be due in part to the physical and psychological challenges of the profession. Researchers at the Max Planck Institute for Empirical Aesthetics in Germany found that musically active people have, on average, a higher genetic risk for depression and bipolar disorder.

Commendably, many artists such as Adele, Alanis Morrisette, Ariana Grande, Billie Eilish, Kendrick Lamar, Kid Cudi and Demi Lovato have spoken out about their mental health battles, from postpartum depression to suicidal ideation. Having high-profile artists and celebrities share their lived experiences has opened the conversation about the importance of mental wellness. This can help battle the stigma associated with seeking treatment and support.

Dr. Regina James (APA’s Chief of the Division of Diversity and Health Equity and Deputy Medical Director) notes “Share your story…share your song and let's help each other normalize the conversation around mental wellness through the influence of music. My go-to artist for relaxation is jazz saxophonist, “Grover Washington Jr” …what’s yours?” Submit to [email protected] to get featured!

More on Music Therapy

• Music Therapy Fact Sheets from the American Music Therapy Association
• Music Therapy Resources for Parents and Caregivers from Music Therapy Works

By Fátima Reynolds DJ and Music Producer Senior Program Manager, Division of Diversity and Health Equity American Psychiatric Association

• Gustavson, D.E., et al. Mental health and music engagement: review, framework, and guidelines for future studies. Transl Psychiatry 11, 370 (2021). https://doi.org/10.1038/s41398-021-01483-8
• Golden, T. L., et al. (2021). The use of music in the treatment and management of serious mental illness: A global scoping review of the literature. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.649840
• Schouler-Ocak, M., et al. (2021). Racism and mental health and the role of Mental Health Professionals. European Psychiatry, 64(1). https://doi.org/10.1192/j.eurpsy.2021.2216
•  Aalbers, S., et al. (2017). Music therapy for Depression. Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.cd004517.pub3
• Dingle, G. A., et al. (2021). How do music activities affect health and well-being? A scoping review of studies examining Psychosocial Mechanisms. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.713818
• Americans for the Arts. (n.d.). A Working Guide to the Landscape of Arts for Change. Animating Democracy. http://animatingdemocracy.org/sites/default/files/Potts%20Trend%20Paper.pdf
• Stupacher, J., Mikkelsen, J., Vuust, P. (2021). Higher empathy is associated with stronger social bonding when moving together with music. Psychology of Music, 50(5), 1511–1526. https://doi.org/10.1177/03057356211050681
• Wesseldijk, L.W., Ullén, F. & Mosing, M.A. The effects of playing music on mental health outcomes. Sci Rep 9, 12606 (2019). https://doi.org/10.1038/s41598-019-49099-9

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How Listening to Music Can Have Psychological Benefits

Research-backed reasons why listening to music can feel so good

Listening to music can be entertaining, and some research suggests that it might even make you healthier. Music can be a source of pleasure and contentment, but there are many other psychological benefits as well. Music can relax the mind, energize the body, and help people manage pain better.

The notion that music can influence your thoughts, feelings, and behaviors probably does not come as much of a surprise. If you've ever felt pumped up while listening to your favorite fast-paced rock anthem or been moved to tears by a tender acoustic performance, then you easily understand the power of music to impact moods and even inspire action.

The psychological effects of music can be powerful and wide-ranging. Music therapy is an intervention sometimes used to promote emotional health, help patients cope with stress, and boost psychological well-being. Some research even suggests that your taste in music can provide insight into different aspects of your personality .

At a Glance

Listening to music isn't just enjoyable—it's good for you, too! Research has found that it can help your brain process information more efficiently, increase your ability to cope with stress, and even help jog your memory. Keep reading to learn more about the many different benefits of listening to music, including a few that may surprise you.

Music Can Improve Cognitive Performance

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Research suggests that background music, or music that is played while the listener is primarily focused on another activity, can improve performance on cognitive tasks in older adults. One study found that playing more upbeat music led to improvements in processing speed, while both upbeat and downbeat music led to benefits in memory.

So the next time you are working on a task, consider turning on a little music in the background if you are looking for a boost in your mental performance. Consider choosing instrumental tracks rather than those with complex lyrics, which might end up being more distracting.

Music Can Reduce Stress

It has long been suggested that music can help reduce or manage stress. Consider the trend centered on meditative music created to soothe the mind and inducing relaxation.

Fortunately, this is one trend supported by research. Listening to music can be an effective way to cope with stress.

Research has found that listening to music has an impact on the human stress response , particularly the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system .

People who listen to music tend to recover more quickly following a stressor. Evidence also shows that high-frequency music leads to the greatest stress relief, lowering cortisol and increasing oxytocin levels.

Music Can Help You Eat Less

One of the most surprising psychological benefits of music is that it might be a helpful weight-loss tool. If you are trying to lose weight, listening to mellow music and dimming the lights might help you achieve your goals .

One study found that listening to music at its original tempo was associated with normal eating pace. Speeding up or slowing down the tempo resulted in higher food intake.

Other research suggests that when people are distracted by music or if the music contributes to increased arousal, they may disregard feelings of fullness and overeat.

The emotions people feel when listening to music can also affect eating behaviors. In one study, people were more likely to report that beer was sweeter, better tasting, and more enjoyable when they were listening to music associated with positive feelings.

However, it's important to remember that the findings on the relationship between food and music are mixed. More research is needed, but you might put this into practice by choosing background music that is at a middle-range tempo and avoiding tunes that are fast-paced and upbeat in order to minimize overeating.

Music Can Improve Your Memory

Many students enjoy listening to music while studying, but is that a great idea? Some feel like listening to their favorite music as they study improves memory , while others contend that it simply serves as a pleasant distraction.

It may help, but it also depends upon various factors, including the type of music, the listener's enjoyment of that music, and even how musically well-trained the listener may be.

In one study, musically naive students learned better when listening to positive music, possibly because these songs elicited more positive emotions without interfering with memory formation.

However, musically trained students tended to perform better on learning tests when they listened to neutral music, possibly because this type of music was less distracting and easier to ignore.

If you find yourself distracted by music, you may be better off learning in silence or with neutral tracks playing in the background.

Research on the effects of music on learning is mixed. While students often report that they find it helpful, study results often suggest that it can be distracting, particularly music with lyrics. However, listening to instrumental background music may have some benefits.

One study found that participants learning a new language showed improvement in their knowledge and abilities when they practiced singing new words and phrases versus just regular speaking or rhythmic speaking.

Music Can Help Manage Pain

Research has shown that music can be very helpful in the management of pain. One study of fibromyalgia patients found that those who listened to music for just one hour a day experienced a significant reduction in pain compared to a control condition.

In the study, patients were passively exposed to pleasant, relaxing music of their own choice as well as a control auditory condition. They then performed a timed motor task to measure their functional mobility and rated their pain levels. 

The results found that listening to music before the task helped reduce pain and increased mobility.

A 2015 review of research on the effects of music on pain management found that patients who listened to music before, during, or even after surgery experienced less pain and anxiety than those who did not listen to music.  

While listening to music at any point in time was effective, the researchers noted that listening to music pre-surgery resulted in better outcomes. The review looked at data from more than 7,000 patients and found that music listeners also required less medication to manage their pain.

There was also a slightly greater, though not statistically significant, improvement in pain management results when patients were allowed to select their own music.

Music May Help You Sleep Better

Insomnia is a serious problem that affects people of all age groups. While there are many approaches to treating this problem, research has demonstrated that listening to relaxing music can be a safe, effective, and affordable remedy.​

One review of the research found that music had a beneficial impact on sleep quality. Some evidence suggests that music could also improve how quickly people fall asleep and increase sleep duration, but more research is needed.

Another study found that listening to relaxing music before a nap improves subjective and objective sleep quality measures. People reported feeling that they slept better, and listening to music was associated with increased slow-wave sleep (aka deep sleep ).

Music Can Improve Motivation

There is a good reason why you find it easier to exercise while you listen to music. Researchers have found that listening to fast-paced music motivates people to work out harder.

One study found that people exercise significantly longer when listening to music than without. Another study found that listening to high tempo music during high-intensity exercise can improve performance without causing people to feel like they are exerting themselves harder. In other words, while you might be exercising harder, it doesn't feel harder when you are listening to music.

So if you are trying to stick to a workout routine, consider loading up a playlist filled with fast-paced tunes that will help boost your motivation and enjoyment of your exercise regimen.

Music Can Improve Mood

Another of the science-backed benefits of listening to music is that it just might make you happier. Research suggests that listening to music can help boost your happiness, mood, and subjective well-being in several ways:

• It helps enhance social connections, particularly during shared musical experiences like concerts
• It helps support better cognitive health in older adults
• Playing an instrument can improve cognition and well-being
• Combining music with dance and movement can help improve mood and well-being
• Music can help marginalized people feel more connected and empowered and increase overall well-being and self-esteem

Researchers suggest that listening to music can be a highly pleasurable experience that increases positive emotions and promotes the release of dopamine , a neurotransmitter tied to pleasurable feelings.

Music May Reduce Symptoms of Depression

Researchers have also found that music therapy can be a safe and effective treatment for a variety of disorders, including depression .

One study found that music therapy was a safe, low-risk way to reduce depression and anxiety in patients suffering from neurological conditions such as dementia, stroke, and Parkinson's disease.

While music can certainly have an impact on mood, the type of music is also important. Classical and meditation music offer the greatest mood-boosting benefits, while heavy metal and techno music are ineffective and even detrimental.

Music Can Improve Endurance and Performance

Another important psychological benefit of music lies in its ability to boost performance. While people have a preferred step frequency when walking and running, scientists have discovered that the addition of a strong, rhythmic beat, such as fast-paced musical track, could inspire people to pick up the pace.  

Runners are not only able to run faster while listening to music; they also feel more motivated to stick with it and display greater endurance. The ideal tempo for workout music is somewhere between 125 and 140 beats per minute.

While research has found that synchronizing body movements to music can lead to better performance and increased stamina, the effect tends to be the most pronounced in cases of low to moderate intensity exercise. In other words, the average person is more likely to reap the rewards of listening to music more than a professional athlete might.

So why does music boost workout performance? Listening to music while working out lowers a person's perception of exertion. You're working harder, but it doesn't seem like you're putting forth more effort.

Because your attention is diverted by the music, you are less likely to notice the obvious signs of exertion such as increased respiration, sweating, and muscle soreness.

Listening to music can inspire and entertain, but it also has powerful psychological effects that can improve your health and well-being. Instead of thinking of music as pure entertainment, consider some of the major mental benefits of incorporating music into your everyday life. You might find that you feel more motivated , happier, and relaxed as a result.

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Cui T, Xi J, Tang C, Song J, He J, Brytek-Matera A. The relationship between music and food intake: A systematic review and meta-analysis .  Nutrients . 2021;13(8):2571. doi:10.3390/nu13082571

Gold BP, Frank MJ, Bogert B, Brattico E. Pleasurable music affects reinforcement learning according to the listener .  Front Psychol . 2013;4:541. doi:10.3389/fpsyg.2013.00541

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Ludke KM, Ferreira F, Overy K. Singing can facilitate foreign language learning . Mem Cognit. 2014;42(1):41-52. doi:10.3758/s13421-013-0342-5

Garza-Villarreal EA, Wilson AD, Vase L, et al. Music reduces pain and increases functional mobility in fibromyalgia .  Front Psychol . 2014;5:90. doi:10.3389/fpsyg.2014.00090

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Jespersen KV, Pando-Naude V, Koenig J, Jennum P, Vuust P. Listening to music for insomnia in adults .  Cochrane Database Syst Rev . 2022;8(8):CD010459. doi:10.1002/14651858.CD010459.pub3

Cordi MJ, Ackermann S, Rasch B. Effects of relaxing music on healthy sleep .  Sci Rep . 2019;9(1):9079. doi:10.1038/s41598-019-45608-y

Thakare AE, Mehrotra R, Singh A. Effect of music tempo on exercise performance and heart rate among young adults .  Int J Physiol Pathophysiol Pharmacol . 2017;9(2):35-39.

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms

Genevieve a. dingle.

1 UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia

2 School of Psychology, The University of Queensland, St Lucia, QLD, Australia

Leah S. Sharman

3 School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia

Emma Beckman

Mary broughton.

4 School of Music, The University of Queensland, Brisbane, QLD, Australia

Emma Bunzli

Robert davidson, grace draper, sheranne fairley.

5 University of Queensland Business School, Brisbane, QLD, Australia

Callyn Farrell

Libby maree flynn, sjaan gomersall.

6 School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia

Mengxun Hong

Joel larwood, chiying lee, jennifer lee, lewis nitschinsk, natalie peluso, sarah elizabeth reedman.

7 Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia

Dianna Vidas

Zoe c. walter, olivia renee louise wright, associated data.

Background: This scoping review analyzed research about how music activities may affect participants' health and well-being. Primary outcomes were measures of health (including symptoms and health behaviors) and well-being. Secondary measures included a range of psychosocial processes such as arousal, mood, social connection, physical activation or relaxation, cognitive functions, and identity. Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation.

Methods: Nine databases were searched with terms related to the eight music activities and the psychosocial variables of interest. Sixty-three papers met selection criteria, representing 6,975 participants of all ages, nationalities, and contexts.

Results: Receptive and intentional music listening were found to reduce pain through changes in physiological arousal in some studies but not others. Shared music listening (e.g., concerts or radio programs) enhanced social connections and mood in older adults and in hospital patients. Music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. Group singing supported cognitive health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, and social connections. Playing a musical instrument was associated with improved cognitive health and well-being in school students, older adults, and people with mild brain injuries via effects on motor, cognitive and social processes. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Rapping, songwriting, and composition helped the well-being of marginalized people through effects on social and cultural inclusion and connection, self-esteem and empowerment.

Discussion: Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings. The review provides preliminary evidence that particular music activities may be recommended for specific psychosocial purposes and for specific health conditions.

“ Music tells us things – social things, psychological things, physical things about how we feel and perceive our bodies – in a way that other art forms can't” – David Byrne (2012), How Music Works, p. 101.

The body of research on music, health and well-being has developed rapidly in the past decade, yielding dozens of empirical studies, reviews (Daykin et al., 2018 ; Sheppard and Broughton, 2020 ), books (MacDonald et al., 2012 ; Bonde and Theorell, 2018 ), and journals such as the Journal of Music, Health and Well-being, The Arts in Psychotherapy , and Arts and Health . This work has been summarized in ground-breaking reports such as the UK All Party Parliamentary report on creative health (Gordon-Nesbitt and Howarth, 2020 ) and the scoping review of the role of the arts in improving health and well-being published by the World Health Organization (Fancourt and Finn, 2019 ). Despite rapid advances in the field, however, there remain some limitations in the literature which this review seeks to address. First, the term “music” has been used to refer to a range of activities, which are at times poorly defined (Kreutz, 2015 ). Consider the following examples: personalized music listening for pain management in people with fibromyalgia (Linnemann et al., 2015 ); group singing for adults with chronic mental health conditions (Williams et al., 2019 ); a hip-hop project for sexual health promotion in Indigenous school students (McEwan et al., 2013 ); and dance for Parkinson's (Shanahan et al., 2015 ). All four are examples of music and health projects yet these activities clearly engage distinct physical, social, and psychological processes to achieve improvements in participants' health and well-being. We need to better articulate what type of music activity we are referring to in studies of “music,” and to examine the evidence in relation to the health and well-being effects of specific music activities.

Secondly, research in the music, health and well-being field is often prone to risks of bias arising from methodological issues such as convenience sampling, small sample sizes, lack of control or comparison conditions, and lack of independent assessment (Dingle et al., 2019 ; Clift, 2020 ). For these reasons, we will adopt a simple measure of research quality based on guidelines from the British Psychological Society QMiP Guidance for qualitative psychologists (Qualitative Methods in Psychology REF Working Group, 2018 ) and the Cochrane Risk of Bias 2.0 guidelines (Sterne et al., 2019 ) for quantitative methods (see Methods section) to ensure that research with a level of quality informs the conclusions of this review.

Third, it is largely unclear how such music activities affect health and well-being. That is, what are the processes through which these effects are achieved? It may be the case that different music activities exert their effects through distinct processes. For example, dance for Parkinson's may improve participants' well-being through its effects on gait and synchronized movement whereas music listening for pain management might exert its effect through dampening physiological arousal or providing a distraction. The answers to this important question will help health professionals to make recommendations to individuals and their loved ones about whether a music activity or intervention is likely to help them to manage their health symptoms. Research into the biological mechanisms linking music activities with health and well-being outcomes has been summarized recently. Finn and Fancourt ( 2018 ) reviewed 44 studies that involved adults listening to music in clinical and non-clinical settings reported that 13 of 33 biomarkers tested (such as cortisol, blood glucose and immune system measures) were reported to change in response to listening to music, indicating a stress-reducing effect (Finn and Fancourt, 2018 ). Group singing in low stress conditions such as rehearsals is associated with decreased cortisol while singing in high-stress conditions such as performances has been related to increased cortisol levels (Beck et al., 2000 ; Schladt et al., 2017 ). Similarly, group drumming has been associated with a modulation of immune response (Fancourt et al., 2016 ). Given this existing evidence regarding the biological mechanisms, in this scoping review we will focus instead on the psychological (e.g., emotional, cognitive, behavioral, motor) and social (e.g., bonding, inclusion, identity, cultural) processes that might explain the health and well-being effects of music activities.

In planning the scoping review, we searched for a comprehensive theoretical model that would account for a spectrum of musical activities and health and well-being outcomes, through a range of psychosocial processes. Unfortunately, the field of music, health and well-being lacks a widely established and comprehensive framework (Dingle et al., 2019 ). Our conceptualization is aligned with the contextual model by Kreutz ( 2015 ) showing the beneficial effects of musical activities on well-being and quality of life. According to this model, engagement in a musical activity provides individuals with a new context in which to interact and the combination of individual and contextual variables evoke self-regulatory processes at conscious and/or subconscious levels. Examples of such processes shown in the model include modifying cognitions, emotions, and actions by strengthened self-regulation. The consequences are often an improvement of psychological well-being and other positive outcomes (Kreutz, 2015 ). The boundaries of how this works (to what degree, for how long, and for whom) remain unclear and subject to ongoing hypothesis-driven research.

We also drew variables from three other models in developing search terms for the review. The first was the Therapeutic Music Capacities Model (Brancatisano et al., 2020 ) which links individual properties of music to “therapeutic mechanisms,” leading to cognitive, psychosocial, behavioral, and motor benefits. Some of the therapeutic mechanisms specified in the TMCM are conceptually relevant to populations with neurological disorders for whom the model was developed but are rarely assessed as part of music intervention research (e.g., neuroplasticity, mirror neuron systems, auditory motor coupling, and neural entrainment). We adopted other mechanisms that are more commonly assessed in music research as some of our search terms, such as arousal, mood, and memory. Another model that informed the review is the BRECVEMA model (Juslin et al., 2010 ) which describes eight mechanisms by which music listening influences emotional responses, in addition to cognitive appraisal. BRECVEMA is an acronym for Brain stem reflex, Rhythmic entrainment, Evaluative conditioning, Contagion, Visual imagery, Episodic memory, Musical expectancy, and Aesthetic judgement. This model is most suitable for experimental music listening research, however, it can be argued that some of these mechanisms apply to other music activities (e.g., rhythmic entrainment may occur as part of instrumental music playing, dance, and rapping). A third model that has been applied to health interventions in groups is the social identity approach (Tajfel and Turner, 1986 ; Turner et al., 1987 ; Jetten et al., 2014 ). According to this model, to the extent that participants identify with their group, they may access psychological resources from the group such as support, meaning, control and self-esteem. This model has been shown to explain the health and well-being effects of group singing (Williams et al., 2019 ; Dingle et al., 2020 ; Tarrant et al., 2021 ) and other music activities such as dance and instrumental music groups (Kyprianides and Easterbrook, 2020 ; Draper and Dingle, 2021 ). From this model, we drew social connection, self-esteem, and identity as processes.

The scoping review was conducted by an interdisciplinary group of academics and students from the Schools of Psychology, Music, Human Movements and Nutrition, Physiotherapy, Business, and hospital based Clinical Research Centers at the University of Queensland during February to December 2020. We formed into small working parties of two to four people, each focusing on one of the eight music activity categories. Reliability was established by two or more members of each working group screening the same 50 abstracts in their category and meeting to ensure that the selection criteria were applied consistently. Following this, the remainder of abstracts were divided up among group members for screening. This process resulted in too many papers for inclusion in the full review, so the authors agreed to re-screen the “included” abstracts by applying our quality criteria to exclude all but the best quality research in each category. Importantly, studies in which the intervention was clearly music therapy or a form of psychotherapy were not included, as these bodies of research have been reviewed elsewhere. The literature search was conducted using nine search engines: CINAHL, Embase, Music Periodicals, PsycInfo, PsycNET, PubMed, Scopus, SPORTDiscus, and Web of Science. Search terms are available from the corresponding author on request. Inclusion criteria were that the papers report on empirical research (not reviews or theoretical papers), published in the English language, involving adult participants, and reporting on a health or well-being measure as well as one or more psychological or social process measures that we refer to as “mechanisms” (note that the authors of the studies did not necessarily regard their study design in this way). For quantitative studies, the following criteria were applied:

• a. The study used psychometrically validated measures of a health or well-being outcome and at least one process variable.
• b. The study had at least 20 participants per condition 1 .
• c. If a control or comparison condition was included, allocation of participants to conditions was randomized or a check was done to ensure that the two subgroups were comparable at the start of the study.
• d. Assessors were independent of the people delivering the music activity (to avoid demand characteristics on participants' responses).

For studies using qualitative methods, the following quality checks were applied:

• e. A description and explanation for the type of analysis was given.
• f. There was independence between the facilitators of the music program and those collecting and analyzing the data (or involvement of an independent coder in the analysis).

Overview of the Studies

The number of papers at each stage of the scoping review are shown in Table 1 . Detailed descriptions of the participants, design and intervention, process measures, health or well-being outcomes, and a summary of the results of each study are presented in Supplementary Table 1 . As would be expected, the health and well-being outcomes varied across the musical activity categories. In the receptive music listening studies, pain and indicators of post-operative recovery were common outcomes. In the studies of intentional music listening, pain was again a common outcome, as well as health behaviors such as exercise, symptom checklists and measures of well-being, health related quality of life, and patient satisfaction. In the music sharing studies, outcomes included pain, fatigue, agitated and aggressive behavior, quality of life, and well-being. The instrument playing studies reported health outcomes including cognitive health in older adults, health behaviors, social determinants of health (housing stability and criminal behavior), and well-being. In studies of group singing, the outcomes included mental and physical health, cognitive health, well-being, and quality of life. Studies of movement and dance reported outcomes for cognitive health, healthy weight, mental health, and quality of life. Studies of lyrics and rapping reported outcomes such as mental health and cognitive health. Finally, the studies of music composition, songwriting and improvisation included outcomes such as well-being and cultural determinants of health.

Flow of decisions about papers through the abstract screening, quality screening, and full text review process.

Process measures included arousal, emotion or mood, cognitive measures (e.g., memory, attention), self-esteem/achievement, physical activation, social connection, and identity. Most of the studies in the receptive music listening category and some of the intentional music listening studies reported on psychophysiological measures of arousal, such as blood pressure, heart rate, respiratory rate, and skin conductance. Although these could be viewed as biological measures (which was not the focus of the review or search terms), they are also commonly used in experimental psychological research as indicators of emotional arousal. For this reason, we kept these studies in the review. A summary of the process variables supported by the literature in each musical activity category is presented in Table 2 and explored in further detail in the following sections.

Summary of available evidence about the psychosocial mechanisms by which music activities affect health and well-being.

Key: +, studies reviewed showed positive evidence; +/–, some studies reviewed showed positive evidence some studies found no evidence; –, studies reviewed found no evidence; blank means the studies reviewed did not measure this .

Receptive Music Listening

There is some conceptual overlap between receptive music listening and intentional music listening (next section). We divided studies into the two categories based on the idea that receptive music listening involved participants being in places where music is playing but they were not involved in the music selection process whereas intentional music listening involved some degree of participant engagement in the choice of music they listened to. Among the receptive listening studies, there were 1,922 abstracts screened, 78 selected for full-text review, of which 11 met the criteria for inclusion (see Table 1 ). Nine studies were conducted in a medical setting and investigated the effects of music listening before, during, or after a medical procedure. These included dental procedures, elective surgery, and breast biopsy. Two studies examined the impact of background music on patients with severe dementia (Götell et al., 2002 ; Gotell et al., 2009 ). Methods of receptive listening generally utilized assorted ‘background music’ that was played for participants. These were described as instrumental or classical (Calcaterra et al., 2014 ; Franzoi et al., 2016 ; Kipnis et al., 2016 ; Seinfeld et al., 2016 ; Çetinkaya et al., 2018 ), new age (Kipnis et al., 2016 ; Téllez et al., 2016 ), relaxing (Twiss et al., 2006 ; Nilsson, 2009 ), or participant selected music (Twiss et al., 2006 ).

Across the studies in medical settings, health outcomes primarily focused on pain, recovery from operations, and patient satisfaction. The mechanism of these effects appeared to be the reduced levels of anxiety, distress, and increased relaxation among patients listening to background music compared to the control groups, who were generally in silence. Reductions to pain were less clear among children in one study where there were some age-based differences in pain reports, where older children showed more pain amelioration (Calcaterra et al., 2014 ). This may also have been due to older children being better able to understand the pain scale. In the two studies of older adults with dementia, both publications reported from the same study observing nine patients and carers undertaking a morning routine over three conditions: usual morning care, morning care with familiar background music, and caregiver singing. Results found that background music was related to patient functioning, well-being and decreased aggressive behaviors through its effects on physical activation, increased bodily and on sensory awareness, and a strengthened ability to carry out daily living tasks. Patients showed more agency and playfulness in their interactions with their carers, demonstrating improved social connection and interactions.

Intentional Music Listening

Following screening of 1,226 abstracts, 12 studies met the inclusion criteria for the review of intentional music listening research (described in Table 1 ). Methods of intentional listening across all studies utilized either researcher provided music and/or participant preferred music during the music listening interventions. Intervention lengths varied for each study and ranged from a single session of music listening (e.g., Särkämö et al., 2008 ) to 6 months (e.g., Clark et al., 2016 ). The way in which music listening was applied as an intervention was also mixed with some research emphasizing music listening during periods where participants were undergoing treatment or experiencing symptoms (O'Callaghan et al., 2012 ; Mercadíe et al., 2015 ), during recovery from health procedures (Särkämö et al., 2008 ; Drzymalski et al., 2017 ), or during specific daily activities, such as walking or relaxing (Clark et al., 2016 ; Helsing et al., 2016 ).

Health outcomes included pain, fatigue, health behaviors such as exercise, symptom checklists and measures of well-being, health related quality of life, and patient satisfaction. Music listening appeared to produce such outcomes through its effect on emotions regulation where several studies reported a reduction in feelings of distress, including specific measures of depression, anxiety, stress (Särkämö et al., 2008 ; Helsing et al., 2016 ; Sorensen et al., 2019 ); greater feelings of relaxation and nostalgia (Clark et al., 2016 ; Helsing et al., 2016 ; Kulibert et al., 2019 ; Sorensen et al., 2019 ); improved mood and reduced agitation (Clark et al., 2016 ; Ihara et al., 2019 ) (see Supplementary Table 1 ). The duration of these effects is difficult to ascertain due to the varying lengths of follow up across measures and studies. However, one study found that reduced levels of anxiety and pain were sustained for at least 12 h after music listening (Fernando et al., 2019 ). Several of these studies reported positive emotional effects of music listening compared to a control (no music listening group). However, two studies compared music listening with other active sound or meditation conditions and neither found differences between active conditions (Mercadíe et al., 2015 ; Sorensen et al., 2019 ). These studies lacked a no-music control condition, making it difficult to form robust conclusions about the efficacy of intentional music listening in these studies. Similarly, a study of 169 young people with at least mild psychological distress using a music and emotion regulation mobile phone app showed no differences on emotion regulation, distress, or well-being between the music listening and the waitlist group at 1 month follow up (Hides et al., 2019 ).

Cognitive mechanisms measured in the intentional music listening studies included measures of attention and verbal memory among stroke patients, which were better amongst music listeners compared to those who listened to audiobooks or controls (Särkämö et al., 2008 ) (see Supplementary Table 1 ). Another study took behavioral observations of music recognition and ability to follow rhythm among people with dementia (Ihara et al., 2019 ). Evidence for physical activation was limited to two studies. One used behavioral observations of people with dementia (Ihara et al., 2019 ) and revealed that intentional music listening increased expressions of joy, eye contact, eye movement, engagement, talkativeness, and moving/dancing. Similarly, a study of participants with cardiac disease (Clark et al., 2016 ) reported that listening to music while walking made them feel more energized and the music tempo influenced them to walk faster or maintain an enhanced pace, motivated them to move and some found it helped them to walk for longer periods.

Sharing Music

1,478 abstracts were reviewed with only five studies about music sharing meeting the inclusion criteria for full review. Only one study did not use live music, instead utilizing scheduled Radio programs to initiate music sharing across people's homes (Travers and Bartlett, 2011 ). These studies tended to report outcomes on well-being, quality of life, pain and agitated behavior. The processes by which shared music listening appears to achieve these outcomes was through emotion, cognition (memory), physical activation (synchrony), social connection, and a sense of identity (see Table 2 ). The strongest results were for improved mood and/or emotions, which were found to improve for shared music listening across all studies. Improved social interaction and communication also appeared to show consistent effects, which were particularly marked among participants with dementia, though less so for those with more severe dementia (van der Vleuten et al., 2012 ; Clements-Cortés, 2017 ; Shibazaki and Marshall, 2017 ; Toccafondi et al., 2018 ). As part of this, sharing music stimulated participants' memories and facilitated reminiscing and storytelling that were shared with musicians, staff, and family members. In contrast, music sharing through community radio programming found no changes to loneliness among this shared listening group, likely indicating that less social interaction was facilitated (Travers and Bartlett, 2011 ). These results imply that there is something unique about sharing music when in the physical presence of others.

Synchronized movement and physical activation increased during live music sharing alongside the ability to remember, cognitively perceive, and anticipate auditory musical elements (Clements-Cortés, 2017 ; Shibazaki and Marshall, 2017 ). Participants were reported to be clapping, singing, and generally moving to the music. Shibazaki and Marshall ( 2017 ) noted that these physical responses were even evident for people with mobility issues and among those who had suffered strokes. Finally, for people with dementia, even when dementia was advanced, carers and researchers observed clear cognitive effects while sharing music, such as participants being able to predict, anticipate, and expect different musical patterns and changes (Shibazaki and Marshall, 2017 ).

Instrumental Music

From 1,701 abstracts screened, nine studies of instrumental learning and playing met selection criteria for full review. These focused on health and well-being outcomes from musical instrument playing, such as cognitive health in older adults, health behaviors, social determinants of health (housing stability and criminal behavior), and well-being. Instrument playing was associated with these outcomes via its effects on cognitive, mood, and/or social processes (see Supplementary Table 1 and Table 2 ). Collectively, the research found that playing an instrument resulted in several positive outcomes, including improved mental health and quality of life and well-being (Perkins and Williamon, 2014 ; Seinfeld et al., 2016 ). Music instrument learning also resulted in improved enthusiasm, happiness, relaxation, and tolerance of uncertainty among people with learning disabilities (Wilson and MacDonald, 2019 ). Being part of a band or music group improved perceptions of social support and actual participation in social activities, interpersonal communication, self-esteem, and self-confidence among long-term musicians (Knapp and Silva, 2019 ), new musicians (Perkins and Williamon, 2014 ) and people with learning difficulties (Wilson and MacDonald, 2019 ). This latter study found that people who were socially isolated were more difficult to engage in music groups, with participants reporting lower levels of confidence and self-esteem (Wilson and MacDonald, 2019 ). Self-efficacy scores among children learning a musical instrument were also higher among those learning compared to those not learning an instrument, with this effect higher for girls, compared to boys (Ritchie and Williamon, 2011 ). This self-efficacy was related to greater levels of well-being and higher pro-sociality, with self-efficacy heightened particularly for girls.

Physical activation was found to be related to self-efficacy among children, where self-efficacy for music learning was associated with less hyperactivity, emotional symptoms, and behavioral problems (Ritchie and Williamon, 2011 ). Among older adults with higher SES, those learning to play a musical instrument reported a greater increase in the frequency of behaviors promoting physical activity and spiritual growth than older adults in the comparison condition (a U3A shared learning project) (Perkins and Williamon, 2014 ). Cognitive mechanisms were measured across several studies and found that for older adults, playing instruments was related to improvements in cognitive processing speed and attention, verbal fluency, executive function, visual scanning, and motor ability (Bugos et al., 2007 ; Bugos and Kochar, 2017 ), as well as letter fluency, learning, and short-term memory (Mansens et al., 2018 ). One study used fMRI in people with mild traumatic brain injuries following 8 weeks of piano lessons and found that there was a change to activation of the medial orbitofrontal cortex (OFC) (Vik et al., 2018 ). The OFC network regulates higher order cognitive processing, such as executive functions, including attention, decision-making, impulse control, and social behavior.

Group Singing

A total of 1,455 abstracts were identified in the initial search from which 14 studies met selection criteria for the full review, including six qualitative and eight quantitative studies (see Table 1 ). Prominent outcomes included mental health and well-being, cognitive health, and lung health. Group singing appeared to produce these health and well-being effects through the social, emotional and physical processes. Choral rehearsals have been found to increase feelings of social inclusion and connection over the duration of a singing rehearsal (see Supplementary Table 1 ). Studies involving both small and large group choirs of up to 232 members found that singing fosters social closeness, even in large contexts where individuals are not known to each other (Weinstein et al., 2016 ). Even after a single session of singing, a large group of unfamiliar individuals can become bonded to the same level as those who are familiar to each other within that group. These social inclusion effects are particularly important for various marginalized groups. For instance, 50 minority African Canadian women living in Nova Scotia identified choir singing and listening to spiritual music as spiritual activities that helped protect against the psychological effects of racism (Beagan and Etowa, 2011 ). The women described how singing supported their physical and mental health through a spiritual connection with the Lord and through their cultural connection with the African Christian community. In another study, women from nine different nationalities living in the UK who experienced postnatal depression participated in a 10-week singing group and reported that the sessions provided an authentic, social and multicultural creative experience (Perkins et al., 2018 ). Two Australian studies involving adults who were marginalized due to chronic mental and physical health problems described how choir singing helped them to develop social connections within the choir (Williams et al., 2019 ) and later with audiences (Dingle et al., 2013 ). Furthermore, a reduction in loneliness and an increased interest in life was reported by an ethnically and racially diverse group of seniors participating in a Community of Voices choir in San Francisco (Johnson et al., 2020 ).

Cognitive, social, and mood effects of group singing are prominent in older adult studies (Lamont et al., 2018 ). For example, in retirement village residents in Australia, those who attended an 8-session group music program called Live Wires showed significantly improved cognitive performance and identification with the retirement village compared with the control group (Dingle et al., 2020 ). Similarly, in the Singing for the Brain project in the UK, interviews with 20 people with dementia and their care givers indicated that important mechanisms were cognitive (accepting the diagnosis, positive impact on memory), social (a shared experience, feeling included and supported), and improved mood (Osman et al., 2016 ). Similarly a study in Finland assessed people with dementia and their caregivers before and after a 10-week program of either singing or music listening together, designed to coach the caregivers to incorporate music and singing into their dementia care (Särkämö et al., 2014 ). Music listening temporarily improved overall cognition, attention and executive function, and a longer-term improvement in orientation, while singing enhanced short-term and working memory. Music listening had a long-term positive effect on Quality of Life for both the patients and caregivers.

In terms of physical mechanisms, participants of the Sing for Lung Health choir described improvements in breathing, sputum clearance and exercise tolerance, as well as a general sense of improved well-being. Again, social connections and a shared purpose were key mechanisms, as well as physical activation (McNaughton et al., 2017 ). This 12-week program featured deep breathing, vocalization exercises and singing rounds of familiar songs.

A sense of achievement and a new identity as a member of a choir were mechanisms revealed in several studies (Dingle et al., 2013 ; Perkins et al., 2018 ; Williams et al., 2020 ), particularly during performances (McNaughton et al., 2017 ). Singing, however, is not necessarily better than other arts-based group activities in terms of health and well-being effects. A study 135 adults involved in seven different adult education classes in singing, creative writing and crafts found that mental and physical health, and satisfaction with life, improved in all groups (Pearce et al., 2016 ). In the study with marginalized adults, mental well-being improved for members of both a choir and a creative writing group as long as participants formed a sense of identity with their group (Williams et al., 2019 ).

Music, Movement, and Dance

This search retrieved 743 articles of which four studies met criteria for full review. The health outcomes measured differed widely across the four studies. These included improved measures of cognitive health in the participants with mild cognitive impairment (Doi et al., 2017 ); healthy weight measures (BMI and % body fat) of African American women (Murrock and Gary, 2010 ); improved cognitive health among stroke survivors (Jeong and Kim, 2007 ); and mental health of new mothers (Vlismas et al., 2013 ).

While social connection was acknowledged as an important process across most of these studies, only two measured types of social connection. Interventions were found to improve the quality of interpersonal relationships for stroke survivors compared to people who did not participate in movement interventions (Jeong and Kim, 2007 ), and to improve interactions between mothers and their infants (Vlismas et al., 2013 ). Specifically, mothers felt that they enjoyed interactions with their infants more and reported increases in dyadic reciprocity between them. Similarly, physical activation, while acknowledged as a driving mechanism, was only measured in two studies. For African American women, participating in a dance group meant that they were more physically active than those not participating in dance (Murrock and Gary, 2010 ). However, for adults with mild cognitive impairment, there was no difference in physical activity levels whether they were part of the dance group, playing instruments, or in a health education group. For one study, cultural identity was made salient for the participants, where African American women reported that the dance intervention and choreography incorporated the importance of their church, spirituality, values, and beliefs and provided a positive space for them to talk about their health concerns (Murrock and Gary, 2010 ).

Lyrics and Rapping

From 1978 abstracts reviewed, four articles focusing on rapping or other lyric-focused music activities met our inclusion criteria. The outcomes from these included mental health, well-being, and cognitive health. The effects of lyrics and rapping appeared to act on emotional and social processes, self-esteem and identity (see Supplementary Table 1 and Table 2 ). For instance, for children and adolescents, sung or spoken lyrics (including rap), resulted in improvements to measures of emotional well-being on the Strength and Difficulties Questionnaire (Uhlig et al., 2019 ) and teacher-rated emotional symptoms, empowerment, and fewer depressive symptoms (Travis and Bowman, 2012 ). Further, those least likely to report depressive symptoms were those who felt rap music inspired them to better connect with others, consider the experiences of others, and want to make a difference in their communities. Young people listening to rap and hip-hop showed that their sense of cultural identity was associated with music-based empowerment (Travis and Bowman, 2012 ), and physically engaging in rap and song among children influenced their levels of physical activation (Uhlig et al., 2019 ). This included reductions in hyperactivity and inattention, and improved goal-directed behavior (Uhlig et al., 2016 ). Sleep time also showed changes among this group those in the rap and sing group slept significantly more than children who did not participate in this program.

A study in university students found that exposure to lyrics related to suicide were associated with remembering more nihilistic lyrics than were present in the song (Peterson et al., 2008 ). However, after exposure to this music, many participants responded with stories that exhibited altruistic themes. Higher endorsement of lyrical messages around risk (e.g., violence, substance use, and derogatory treatment of women) was related to high self-esteem among young males (Travis and Bowman, 2012 ). For people with Alzheimer's disease and healthy older adults, memory was positively affected when they were exposed to lyrics that were spoken or sung (Simmons-Stern et al., 2012 ). For these older adults, both types of exposure to lyrics resulted in equal memory of a songs content.

Song Writing, Composition, and Improvisation

This search retrieved 1,280 articles, of which only three studies met the inclusion criteria for the review. Music composition was found to be an important tool for supporting healthy aging and well-being of older adults learning to compose music collaboratively with a string quartet and a professional composer. For these participants, composition also created more opportunities for creativity and feelings of control and self-efficacy (Habron et al., 2013 ) (see Supplementary Table 1 ). In the study by Bartleet et al. ( 2016 ), jamming and music making between Aboriginal and non-Indigenous musicians provided opportunities to develop deep, transformative, intercultural engagement and connection. For these groups, music making was a way to cross boundaries using music as a shared language and to understand and share in diverse experiences. Music students found that the simple act of jamming helped to build a strong rapport, sense of mutual respect, and life-long friendships. Identity making and relationships were very clear among the group-based song writing and composition studies. For example, older adults felt composition led to self and social identity making, and meaningful social engagement with other participants and musicians with some relationships enduring after the program ended (Habron et al., 2013 ).

In Fallon and colleagues' experimental study (2020), 105 university students were asked to complete a stressful task and were then randomly assigned to one of three recovery conditions: control, music listening, or music improvisation using a xylophone. The physiological measure (electrodermal activity) showed greater stress reduction during recovery for those in the music listening condition compared to the improvisation and control groups (Fallon et al., 2020 ). The improvisation group showed a significant improvement in self-reported levels of calmness, irritation (decrease), and satisfaction during the recovery phase.

This scoping review of 63 studies revealed that all eight categories of music activities demonstrated some benefits to health or well-being, although it is difficult to make generalized statements due to the diversity of study designs and measures across studies. An abundance of studies of music listening, group singing, and instrument playing met criteria for inclusion, but relatively few focused on music sharing, dance or movement to music, lyrics or rapping, or songwriting, improvisation and composition. As the descriptions in Table 1 indicate, some music activities featured in more than one category (e.g., music listening was involved to some extent in all eight types of activity, apart from some kinds of lyrics/rapping), while other activities were found in only one or two categories (e.g., movements to music were a key part of the movement and dance category, while movements to create music were characteristic of the instrument playing, group singing, and songwriting, composition, and improvisation category). The eight activities also represent a spectrum of engagement with the selection and creation of music, from very low levels in the case of receptive music listening through to very high levels in the case of songwriting, composition, and improvisation. The purpose of the music activity and the measures assessed in each study reflected this spectrum of engagement. By considering this full spectrum of music activities, the current review extends on previous reviews that had a narrower focus such as music listening (Finn and Fancourt, 2018 ), group singing (Williams et al., 2018 ), or instrument playing and dance (Sheppard and Broughton, 2020 ). It also highlights the need for future research in the field of music, health and well-being to clearly articulate the type of music activity under investigation (Kreutz, 2015 ).

In regard to the mechanisms by which these music activities produce effects on health or well-being, Table 2 summarizes the evidence drawn from the 63 papers reviewed. Receptive music listening tended to be used in health or medical spaces for the purpose of decreasing perceptions of pain and anxiety and for acute post-operative recovery, or in aged care settings for increased activation and improved mood among older adults with dementia. Many of these studies showed that decreased physiological arousal was a key mechanism by which music listening was related to effects on pain and anxiety. The most consistent results were lowered blood pressure, increase in oxytocin, and decrease in cortisol during music listening. Interestingly, music listening was associated with increased arousal, activation , and social interaction in the studies of people with dementia and their carers (Götell et al., 2002 ; Gotell et al., 2009 ). Of the 13 studies in this category, four measured pain outcomes, and three of these reported lower pain in the music condition (Calcaterra et al., 2014 ; Téllez et al., 2016 ; Çetinkaya et al., 2018 ) while one study did not find any effect of music listening on pain (Chantawong and Charoenkwan, 2017 ). It is possible that in this study, the researchers' selection of Western or New Age instrumental music did not align with the Thai women's personal preferences during the cervical excision procedure. These findings align with an earlier review showing how music listening can enhance medical treatments and can be used as an adjunct to other pain-management programs (Bernatzky et al., 2011 ). This review concluded that musical pieces chosen by the patient are typically more effective for pain management than music chosen by a staff member. Interestingly, a recent study found that the music people chose to manage pain was commonly high energy, danceable music with lyrics (Howlin and Rooney, 2020 ) so it should not be assumed that people select soft, slow tempo, instrumental music when in pain.

Positive effects on mood or emotion regulation were reported in studies across all music activity categories ( Supplementary Table 1 ). In the music listening categories, reductions in anxiety were commonly reported. These positive effects on anxiety and pain were not confined to music listening since comparison conditions also produced benefits. For example, a comparison hypnosis condition was associated with decreased anxiety and increased optimism in women undergoing breast tissue biopsy in a hospital clinic (Téllez et al., 2016 ) while silent relaxation was as effective as music listening for lowering cortisol and pain in knee replacement surgery patients (Finlay et al., 2016 ). Similarly, the 14 studies on intentional music listening commonly focused on the role of music in reducing distress, particularly in preparation for, during, or recovery from, significant health events. These studies revealed that actively listening to music showed effects on cognition, emotion, physical activation, and physiological arousal . These findings are consistent with an established body of research on music listening and affective responses on the two dimensions of arousal and valence (e.g., Juslin et al., 2010 ; Eerola and Vuoskoski, 2013 ). The mood enhancing effects of group music activities such as singing, dancing and instrument playing is consistent with the findings of a systematic review of the effects of social group programs (music groups and others) on depression (Dingle et al., 2021 ) and an earlier longitudinal study of 5,055 UK older adults showing that more group memberships measured in the first wave was associated with a decreased likelihood of depression up to 4 years later (Cruwys et al., 2013 ).

Enhanced social bonding and connection was found in studies across many of the music activity categories. For example, shared music listening in the form of live music concerts enhanced social connections and mood in older adults and in hospital patients, yet was featured in few studies, which suggests this is an underutilized approach within aged care and hospital services. Group singing was associated with health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, social connections, and identity. Both music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. These findings indicate that singing is not only beneficial for the identified patients but also for their caregivers and loved ones (Forbes, 2020 ). Social and cultural identity was another mechanism highlighted in relation to some music activities. The finding that identification with a music group is associated with the satisfaction of various psychological needs has been noted in several recent studies (Williams et al., 2019 ; Kyprianides and Easterbrook, 2020 ; Draper and Dingle, 2021 ). Singing, dancing, and hip-hop can help ethnic minority group members to connect with their culture (Murrock and Gary, 2010 ; Beagan and Etowa, 2011 ; Travis and Bowman, 2012 ).

Cognitive mechanisms such as improved memory or attention were noted in several music activity categories. For instance, group singing was associated with improved cognitive health in older adults and those with dementia. Learning to play a musical instrument was associated with cognitive performance, self-esteem, and well-being in diverse populations including school students, older adults, and people with mild brain injuries. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Clinicians and care workers planning to introduce a musical activity to enhance the cognitive health of their participants should consider the level of musical training and capability of new learners. It may be necessary to develop innovative ways for participants to engage with music that do not require an ability to read sheet music or to have a high level of fine motor skill. Group singing can be conducted using lyric sheets and a call-and-response style for learning the various vocal parts, as has been used successfully with marginalized adults (Dingle et al., 2013 ; Williams et al., 2019 ). Furthermore, innovative work is in progress adapting musical instruments so that they are simpler for older adults to create music with (MacRitchie and Milne, 2017 ).

Finally, self-esteem, empowerment, and sense of achievement were mechanisms by which rapping, choir singing, musical instrument playing, and composition, songwriting and improvisation produced positive effects on the health and well-being of participants. Rapping, songwriting and composition helped marginalized people to find their voice and increased social inclusion, intercultural connections, and empowerment.

Although the field of music, health and well-being requires further development, there is emerging evidence that specific music activities may be recommended for specific psychosocial purposes and for specific health conditions. Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings.

Author Contributions

GD designed the scoping review and led the write up. LS generated the search terms, conducted the library searches, assisted with the tabulation of results, and the write up. All authors contributed to the screening, reviewing, and summarizing of papers in their sections and contributed to the final manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1 This was based on power calculations showing that a sample of 24 is required for a within subjects (pre-post design) ANOVA to find a small effect size with a power of 0.8; while a total sample of 34 (17–18 in each condition) is required for a two-group comparison ANOVA with two assessment points to find a small effect size with a power of 0.8. Our guideline of 20 per condition was chosen to balance the pragmatics of fitting groups of people into halls and spaces where music activities typically take place with the need to design studies with sufficient power to detect an effect if one existed.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.713818/full#supplementary-material

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The Psychology of Music

Introduction, music and psychological mechanisms, impact on learning and productivity.

Music is probably the most abstract and difficult to understand the sort of art. For centuries scholars have been trying to explain the purpose of listening to music, creating it, and the way it can impact a human mind. Schäfer, Sedlmeier, Städtler, and Huron state that the common aim of listening to music is to “regulate arousal and mood, to achieve self-awareness, and as an expression of social relatedness” (2013, p. 1). Despite the numerous and often contradictory findings regarding the phenomenon of music, there are no doubts about the powerful connection it has with a human mind, emotions, feelings, and actions.

The music is not just a collection of random notes, but a story told in universally understood language. According to scientific research, music is believed to connect people to their personal past experiences and, thus, to manipulate peoples’ emotions and feelings. Listeners are not only able to percept the aesthetics of the musical composition but understand its deeper meaning.

The compositions people add to their tracklists, and the musicians they prefer may tell a lot about how their minds function. Taste in music often depends on such factors as age, gender, temperament, and views on life. The genres people favor usually reflect appropriate psychological behavior and predispositions. In her article for Medical Daily , Lizette Borreli (2015) describes the study, according to which the preferences of blues, jazz, and folk are more typical for open-minded and adventurous individuals. At the same time, people admiring pop, electronic, and dance music is usually friendly and extroverted (Borreli, 2015, para. 3).

Numerous studies have discovered the effect the music might have on learning abilities and work performance. One of the most famous theories on that matter regarded as a so-called ‘Mozart effect” (Lesiuk, 2005, p. 177). The scientists noticed the positive impact of this particular composer on thinking and creativity. Teachers often practiced playing classical music in a classroom during the exams and recommended implementing such an approach nationwide.

Lesiuk (2005) investigated the influence of listening to music at the workplace among computer system developers. She states that computer designers have to be creative and produce the work that is innovative and applicable at the same time. They work under pressure and often depend on a particular mood and inspiration. The individuals that felt optimistic and calm after listening to certain tunes processed the information faster and showed better productivity (Lesiuk, 2005). Music often helps people to cope with stressful situations at work, reduce the anxiety and think more clearly. The others, on the other hand, listen to the energetic music to create a positive environment in the office and increase the speed of task performance. Professional athletes claim that music makes them feel stronger and more confident, and achieve higher results during training and competitions.

However, individual aspects and certain criteria should be considered before implementing the idea of music at a workplace. Thompson, Schellenberg, and Letnic (2012) argue that sometimes unsuitable music can do more harm to the productivity and concentration of the team. The scholars discovered that loud and fast music tends to “disrupt reading comprehension” (Thompson et al., 2012, p. 1). In general, however, the scientists agree that an appropriately selected musical compositions stimulate the positive team spirit and increase the creativity.

People listen and write music due to the number of reasons, most of which are still unclear to the scientists. However, the deep connection between music and human psychological mechanisms was noticed many centuries ago. Musical preferences reveal a lot about peoples’ personalities and life experiences. There is a lot to be discovered about the way music communicates to the human brain, but it is apparent that it has a powerful impact on learning capabilities, creativity, and productivity of an individual.

Borreli, L. (2015). The psychology of music choice: cognitive thinking influences preference for music genre via empathy . Medical Daily . Web.

Lesiuk, T. (2005). The effect of music listening on work performance. Psychology of Music , 33 (2), 173-191.

Schäfer, T., Sedlmeier, P., Städtler, C., & Huron, D. (2013). The psychological functions of music listening. Frontiers in psychology, 4 , 511, 1-33.

Thompson, W. F., Schellenberg, E. G., & Letnic, A. K. (2012). Fast and loud background music disrupts reading comprehension. Psychology of Music , 40 (6), 700-708.

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