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MUSIC, HEALTH AND WELL-BEING
Music, health, and well-being: A review
RAYMOND A. R. MACDONALD, BSc (Hons) PhD CPsychol AFBPS
School of Music, Edinburgh College of Art, University of Edinburgh, Edinburgh, UK
Abstract
The relationship between arts participation and health is currently very topical. Motivated by a desire to investigate
innovative, non-invasive, and economically viable interventions that embrace contemporary definitions of health,
practitioners and researchers across the world have been developing and researching arts inventions. One of the key
drivers in this vigorous research milieu is the growth of qualitative research within health care contexts and researchers
interested in exploring the potential benefits of musical participation have fully embraced the advances that have taken place
in health-related qualitative research. The following article presents a number of different types of qualitative research
projects focused on exploring the process and outcomes of music interventions. It also presents a new conceptual model for
music, health and well-being. This new model develops on a previous version of MacDonald, Kreutz, and Mitchell (2012b)
by incorporating new elements and contextualization and providing detailed experimental examples to support the various
components.
Key words: Music health and well-being, psychology, therapy community, music
(Accepted: 21 June 2013; Published: 7 August 2013)
The relationship between arts participation and
health has received significant and growing aca-
demic, media, and public attention over the past
10 years. Motivated by a desire to investigate inno-
vative, non-invasive, and economically viable inter-
ventions that embrace contemporary definitions of
health, practitioners and researchers across the world
have been developing and researching arts inven-
tions. The focus of this research has been on activities
that not only facilitate the exploration of creativity
but are also enjoyable, accessible and have significant
impact upon key health indicators (MacDonald,
Kreutz, & Mitchell, 2012a). In many ways, research
within the musical domain has been at the cutting
edge of this new generation of research investigating
the beneficial effects of arts participation. One of the
key drivers in this vigorous research milieu is the
growth of qualitative research within health care
contexts and researchers interested in exploring
the potential benefits of musical participation have
fully embraced the advances that have taken place
in health-related qualitative research. Much of the
qualitative research discussed within this article
utilized phenomenology as a key theoretical ap-
proach (Moran, 2000). In particular, interpretative
phenomenological analysis (IPA) (Smith, Flowers, &
Larkin, 2009) is utilized as an analytical framework.
IPA is particularly useful in the context of music and
health as it has a focus on personal lived experiences
and how participants make sense of their experience.
A number of different types of qualitative research
projects are presented and these focus on exploring
the process and outcomes of music interventions.
This article also presents a new conceptual model
for music, health, and well-being. This new model
develops on a previous version of MacDonald,
Kreutz, & Mitchell (2012b) by incorporating new
elements and contextualization and providing de-
tailed empirical examples to support the various
different components. The model is also developed
with the aim of increasing multidisciplinary dialogue
across the multitude of professions that are involved
in researching the relationship between musical par-
ticipation and wider health parameters. With music
therapists at the vanguard, this group of profes-
sions includes psychologists, neurologists, teachers,
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Correspondence: R. MacDonald, School of Music, Edinburgh College of Art, University of Edinburgh, 12 Nicolson Square, Edinburgh, EH8 9DF, UK.
E-mail: raymond.macdonald@ed.ac.uk
Int J Qualitative Stud Health Well-being
#2013 R. MacDonald. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0)
Licence (http://creativecommons.org/licenses/by/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.
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Citation: Int J Qualitative Stud Health Well-being 2013, 8: 20635 - http://dx.doi.org/10.3402/qhw.v8i0.20635
occupational therapists, medical doctors, and archi-
tects. This article also addresses an urgent need for
cross-pollination of ideas and collaborative research
projects incorporating multidisciplinary dialogue
across all disciplines involved in researching the
relationship between music, health, and well-being.
After an overview of the model, this article presents a
number of empirical examples to further highlight
both the distinctive features and the overlapping
elements of the various disciplines involved in prac-
tising within the overarching topic of music, health,
and well-being.
Music therapy
When conceptualizing the entirety of interventions
that are defined within the music, health, and well-
being framework, there are a number of discrete but
related areas that can be considered, and these are
outlined in Figure 1. The first is music therapy, and
it is important to acknowledge that while the field of
music, health, and well-being is currently experien-
cing significant interest, the discipline of music
therapy has a long history of research dating back
to the early part of the 20th century (Bunt, 1994).
Indeed, the profession of music therapy within a
modern context has been developing practice and
producing research for nearly 100 years (Wheeler,
2009). This work has had a significant impact
and there are a number of well-established journals
dedicated to research within the area of music
therapy (Bonde & Trondalen, 2012). Music therapy
has many different definitions but for the purposes
of this article, a key element of the music therapy
process is an emphasis upon the therapeutic relation-
ship between clinicians and clients or participants.
Thus, music interventions that fall under the music
therapy category will focus on positive psychological
and/or physiological benefits for the participants and
the interventions will be delivered by qualified music
therapists. Also, music therapy interventions neither
will have musical developments in terms of increas-
ing technical skills as a primary objective nor will
they be primarily concerned with a general increase
in artistic activities within the musical domain. For a
comprehensive review of music therapy approaches,
see Bonde & Trondalen (2012). Recent advances in
music therapy included new models of practices that
incorporate community-based activities (Ansdell,
2004; Stige & Aarø, 2011). In particular, commu-
nity music therapy is one example (Pavlicevic &
Ansdell, 2004; Stige & Aarø, 2011). The concept of
health musicing also broadens the music therapy
approach to include a multitude of activities outwith
the conventional clinical context (Ruud, 2012; Stige
& Aarø, 2011).
Community music
Community music in contrast will not have thera-
peutic effects as a primary concern but may have
increased access to artistic activities outside conven-
tional institutional setting as an objective (Hallam &
MacDonald, 2008; Higgins, 2012). Community
choirs and percussion classes are good examples of
community music interventions. Also, there may
not be an emphasis on the development of discrete
technical skills but the primary objective may be
providing an opportunity for creative expression in
informal settings (Veblen, Messenger, Silverman, &
Elliott, 2012). However, and this is an important
point, many community music interventions view
positive psychological benefits as an important
secondary benefit (Hallam & MacDonald, 2008).
For example, a community choir may be seeking to
give older adults the chance to enjoy singing together
but the enjoyment, freedom of expression, and social
support afforded by a choir may bring about devel-
opments in self-confidence and self-esteem. Thus,
there is an overlap between community music inter-
ventions and music therapy interventions. Also, the
recent developments in music therapy, discus-
sed above, have reached into community contexts
(Pavlicevic & Ansdell, 2004). In these situations,
music therapists may facilitate music groups in
informal settings and while the aims may still be
explicitly therapeutic, the social and musical context
may have more in common with community music
interventions that what might be considered as a
traditional music therapy context (hospital, health
centre, private practice, etc.).
The field of community music is an exponentially
growing area of interest for music researchers and
over the past 1520 years, the increasing output of
Figure 1. Conceptual framework for music, health and well-being.
R. MacDonald
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journal articles has supported its development into
a distinct and unique field of practice (Higgins,
2012). It is now an established area of research with
a dedicated journal, The International Journal of
Community Music and a commission of The Interna-
tional Society for Music Education. Although it
appears to have significant and distinct character-
istics, it is an area that is difficult to define as there
are many overlaps into ‘‘general’’ areas of musical
activity. There are many descriptions of the term
‘‘Community Music.’’ On the one hand, it is prac-
ticed throughout the world in formal and informal
settings and in some respects all music making can
be defined as ‘‘community-based’’ since all music
has a social context. However, community music has
emerged as a distinct field of practice and as an
influential approach to both music education and as
a means of increasing access to all types of musical
activities. Indeed, a key concern of community
music practitioners is to increase access to music
making for all members of the public (Veblen,
2008).
Definitions of community music focus upon the
practical, activity-based features of community
music. They also discuss fluid hierarchies that may
exist within community music activities and these
definitions also emphasize the process-based nature
of community music. The published literature dis-
cusses educational issues relating to the training of
community music practitioners and also the educa-
tional emphasis of community music programmes
(Higgins, 2012). Finally, many of the published
papers within community music discuss the wider
benefits of community music activities. These bene-
fits may be for the individual but they also extend
to the group and in some cases reach out further
to resolve conflicts and develop empathy between
different groups. For example, Bowman (2009)
discusses how musical engagements in community
music settings develop ‘‘character, habits, disposi-
tions.’’ Large-scale community music groups like El
Sistema have come to international attention over
the past 10 years. Founded in 1975 by economist
and musician Jose´ Antonio Abreu, El Sistema is a
publicly financed voluntary sector community music
education programme in Venezuela which provides
access to music education for thousands of children
from disadvantaged backgrounds. There are two
significant El Sistema projects running in Scotland,
UK. In a group setting, Langston and Barrett’s
(2008) case study of a community choir illustrates
the value of the ‘‘social capital’’ that is derived from
being a member of the group and for conflict
resolution beyond the group, Hayes’ (2007) report
notes how a community music group (in this case a
choir formed from gay/lesbian/bisexual/transgender
communities) can help bind communities by ‘‘build-
ing bridges through song.’’ While all these interven-
tions are undoubtedly community music in their
design and delivery, the therapeutic aims and
speculated outcomes create some overlaps with
music therapy and this is represented in the over-
lapping circles in Figure 1.
Music education
Music education is another key element of Figure 1
and recent advances now mean that music education
has much to contribute to the music, health, and
well-being agenda. In most contexts, music edu-
cation is defined by an explicit focus upon the
development of conventional music skills. For ex-
ample, many music classes in schools and univer-
sities focus on developing an instrumental technique
or specific technical knowledge. Private lessons may
involve pupils being taught by a teacher with the goal
of passing grade exams. Once again the primary
function is not therapeutic or social, however, many
music educationalists are interested in the wider
benefits of music teaching. Indeed, recent research
has begun to investigate the effects of conventional
music lessons upon other non-musical aspects of
psychological functioning and here there is an over-
lap with music therapy and community music
(Butzlaff, 2000). For example Costa-Giomi (2012)
examines the evidence to support the assertion that
attending music lessons can produce significant
increases in other cognitive areas. Raucher (2008)
also discusses the possible beneficial effects of music
education upon a range of psychological and
social variables. There has also been considerable
debate about the effects of music upon a range of
cognitive skills that may be enhanced via listening
(Johnson & Memmott, 2006). However, there is
significant discussion within the academic commu-
nity about the extent to which these effects are
reliable and to what extent they sustain over time
and there is currently no way to predict the precise
effects of music listening on cognitive functioning
(Schellenberg, 2012).
Also, the revolution that has taken place within
music education over the past 20 years means that
school and university music education is no longer
dominated by western classical music. It is now
possible to study popular music and engage in more
informal types of music activities within an institu-
tional music education framework. Thus, music
education now has overlaps with community music
as well as with music therapy. Indeed, the growth of
community music over the past 20 years in many
ways echoes the revolution that has taken place in
music education. While music is one of the most
Music, health, and well-being
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important recreational activities that young people
engage with (Zillmann and Gan, 1997), there is
evidence to suggest that adolescents lose interest in
formal music education at just around the same time
that music is becoming a crucial part of their iden-
tity (MacDonald, Miell, & Hargreaves, 2002). The
movement within music education to broaden its
scope and remit to include a wider range of music
experiences, incorporating popular music, has re-
sulted in a regeneration of formal music activities
within educational institutions. This move is partly
responsible for the increased interest in music,
health, and well-being within music education.
Ever yday uses of music
The 4th segment of Figure 1, everyday uses of
music, is not a distinct field of practice in the way the
other sections are; however, it has significant rele-
vance to the debate around the effects of music on
health and well-being (DeNora, 2000). Continuing
research within the psychology of music has high-
lighted the profound effects of music listening and
there is no doubt that music is a separate channel
of communication affecting emotions in significant
ways (Hargreaves, Miell, & MacDonald, 2012).
Music may be uniquely suited to managing or
regulating emotions and stress in everyday life since
it has the capacity to both distract and engage
listeners in a variety of cognitive and emotional
ways (DeNora, 2010; Mitchell & MacDonald,
2012; Saarikallio, 2011; Sloboda & O’Neill, 2001).
Every time we select a piece of music to listen to, we
make a number of very sophisticated and highly
nuanced psychological assessments about our cur-
rent state of mind and the environment in which we
are listening to music. For example, how do I feel right
now, how do I want to feel in five minutes, what music
will help me achieve these goals. Who else is listening?
What they will think of my musical choices? Impor-
tantly, these complex psychological assessments are
made quickly and in many ways without explicit
conscious effort. In this way, we recognize that our
musical listening has profound effects on how we
feel and also affects the other people who may be
listening to our musical selections. Music listening is
therefore crucially implicated in mood maintenance
and we can think of our music selection as a form of
psychological self-help. Beneficial effects of music
listening on subjective well-being and physical health
outside clinical contexts have been reported by a
number of researchers (DeNora, 2007; Pelletier,
2004; Standley, 1995). This issue has become even
more important as modern technological advances
mean that we can now listen to our own personal
music collection 24 hours a day. A key point is that
informal music listening may have significant posi-
tive effects upon our health and well-being and there
is a growing recognition that this is now an im-
portant field of study. Thus, work within the every-
day uses of music category has overlaps with music
therapy. Also, everyday music listening has connec-
tions with music education in the sense that our
music preferences influence how we may want
to learn to play a musical instrument and music
listening forms an important part of many formal
music education programmes. Everyday music lis-
tening also overlaps with community music in
many ways in that our musical taste and listening
habits inform decisions about how we may wish to
engage in music making. These types of disciplinary
overlaps are explicitly incorporated into the model
highlighted by the overlapping circles.
Music medicine
The final section of the graph, music medicine,
refers to a specialized area of work within music,
health, and well-being taking place within medical
contexts. It is perhaps a more focused and specia-
lized discipline with fewer people working in this
area than in the other broader categories of the
model. However, it can be considered a distinct field
of practice with textbooks, journals, and definitions
of the type of work that takes places with this area
(Spintge, 2012). The work of Ralph Spintge has
been particularly influential in developing the prac-
tice of music medicine. A typical type of music
medicine intervention may involve patients under-
going operations listening to music to help reduce
pain and anxiety perceptions. This is based on the
observation that patients undergoing medical treat-
ment in hospital operating theatres suffer from
complex sets of conditions including pain, anxiety,
and distress and that music listening may offer an
opportunity to ameliorate these symptoms. There is
a growing body of evidence highlighting the positive
effect of these types of music medicine interventions
upon both psychological and physiological para-
meters. On-going research in this area now spans
3 decades and 160,000 participants (Spintge, 2012).
Various different types of methodologies have been
used to develop this area of work including psycho-
logical and physiological measurements such as self
reports (open questionnaires, Thematic Appercep-
tion Test, e.g. Westen, 1991), observable behaviour
and facial action coding systems (Ekman, 2003),
plasma levels of stress-hormones, EEG, PET,
neurovegetative and cardiovascular responses, drug
consumption, length of hospital stay and other econo-
mic outcome variables (Hatano, Oyama, Tsukamoto,
Sakaki, & Spintge, 1983; Spintge, 1992). This
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approach is applied in surgery and anaesthesia,
dental care, pain medicine, palliative care, intensive
care, obstetrics, paediatrics, geriatrics, ophthalmol-
ogy, and neurology (Arnon et al., 2006; Brice &
Barclay, 2007; Leard, 2007; Leins, 2006).
In some ways, music medicine interventions are
very closely related to music therapy as they explicitly
have therapeutic outcomes as a primary objective.
They have no overlap with music education or
community music hence their position within the
model. Another important point is that most music
medicine interventions use ‘‘prescribed music’’ and
so clinicians make informed assumptions about
the effects of particular pieces of music upon the
patients’ psychological and physiological function-
ing. The relationship between structure and prefer-
ence is a key point discussed in more detail below.
A central aim of this article is to highlight the
parallels and contrasts between the different sec-
tions of the model and to further develop multi-
disciplinary dialogue between professional practises
that are quite distinct, but also have significant
points of overlap. For example, community music
therapy can take place outside institutions such as
hospitals and schools and therefore have elements
in common with community music (Stige & Aarø,
2011). Also, some of the aims of commu-
nity music therapy may overlap with commun-
ity music so both interventions may share the goal
of increasing access to music activities for dis-
advantaged groups. Thus, the intersection between
community music and community music therapy
within the model becomes an important area of
overlap. Similarly, community music and music edu-
cation may also share some goals and employ similar
practises (e.g. the development of instrumental skills
through teaching). Thus, the two circles represent-
ing music education and community music can also
overlap in important ways. Music education can
include wider psychological developments as a
secondary goal and this can overlap with therapeutic
approaches. Everyday music listening also has im-
portant intersections with the other components of
the model. Individual music preferences can be an
important part of music therapy interventions and
formal music education takes into consideration
students’ tastes and preferences when developing
curriculum guidelines. Similarly, community music
approaches have everyday music listening, tastes and
preferences at the heart of interventions that seek to
increase access to music activities by developing
enjoyable and rewarding music projects for partici-
pants. There are many ways in which all the major
components of the model can overlap so the sec-
tion at the centre is also important. For example,
community music interventions that have musical
developments and psychological developments as an
aim that also focuses on compositional activities, will
include elements of all the large four circles within
the model and so will occupy the intersections of the
circles at the centre of the model.
Empirical examples
The following section of this article gives some
empirical examples highlighting how related research
covers the various categories within the model. This
work further shows how the different categories have
discrete characteristics but also overlaps with the
other areas. These examples also signal the impor-
tance of qualitative methods in developing knowl-
edge regarding the process and outcomes of music,
health, and wellbeing-related interventions.
Music therapy
Pothoulaki, MacDonald, and Flowers (2012) report
the results of a music therapy intervention investi-
gating the relationship between the categories of
community music and music therapy. In this study,
nine patients at a cancer hospice received group
music therapy focused on improvization, once a
week for 12 weeks. Before and after the intervention,
all participants were interviewed. These interviews
were transcribed and analyzed using IPA music as
the analytical framework work (Smith, Flowers, &
Osborn, 1997). The analysis revealed a number of
key themes namely; playing the instruments, group
interaction/dynamics, self-confidence, relaxation: haven,
escape and being carried away, stress relief, the impor-
tance of the group, positive feelings and the musical
experience, illness-forming a strong bond, free expression-
communicating through music.
The extract below is an example from the free
expression and communication through music
category:
Yes. Well, we can all communicate (.) at the same
time (.) by playing an instrument whereas if you are
verbally communicating you cannot all talk at the
same time, whereas we can all play a tune and all be
heard at the same time. And then if you hear
someone, you can pick up their rhythm and you can
join in as well or maybe pick up someone else and
join in with them. So, everybody is playing a tune
and everybody is communicating and you can pick,
(.) you know, certain tunes or sounds (.) or rhythms
if you like and join in with the other person.
This participant is emphasizing how music functions
as a separate channel of communication. Importantly,
Music, health, and well-being
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for this participant, as was the case for many of the
participants, a belief that music was free from the
constraints of the rules of spoken language-facilitated
freedom of expression that was viewed as crucial to
the process and an important part of why the sessions
had therapeutic value. A key point here is that while
this intervention is explicitly a music therapy ap-
proach, the group improvization sessions were set up
and delivered using ideas that also resonate with a
community music approach. Participants all defined
themselves as non-musical and the sessions were
designed as an opportunity for participants to explore
their creativity and have fun in a friendly environment
while giving access to creative music activities.
Another type of music therapy example of rele-
vance is Therapeutic Songwriting. Therapeutic
Songwriting is a music therapy intervention where
participants compose new music as a means of tack-
ling health-related problems (Baker & Ballantyne,
2012). Central to this approach is a creative colla-
boration between the client and therapist within the
context supportive therapeutic relationship (Wigram
& Baker, 2005). There is growing evidence to suggest
that this type of work leads to positive therapeutic
outcomes across a range of diagnoses (Baker et al.,
2008). Therapeutic Songwriting creates opportu-
nities for people to develop, negotiate, and maintain
many different types of identities. Moreover, partici-
pants are able to construct life narratives through
song and this can facilitate personal reflections on key
aspects on life; relationships, beliefs, qualities and
attributes, and so on (Baker & Ballentyne, 2012;
McFerran, Baker, Patton, & Sawyer, 2006). Group
identities can also be explored through these types
of compositional activities (McFerran et al., 2006;
McFerran & Teggelove, 2011).
Baker and MacDonald (in press) report the song-
writing experiences of 26 participants involved in
a therapeutic songwriting project with a qualified
music therapist. Participants were interviewed about
their experiences after the creation of each song and
again at 6-week follow-up. The analysis highlighted
five main themes: artistic concerns; initial expectations;
responses to listening to one’s own song creations;
exploring the self; and relationship with the thera-
pist. Flow experiences of the type described by
Csikszentmihalyi (1998) were evident in the tran-
scripts. Importantly, these experiences have been
highlighted by many researchers as being key in-
dicators of positive and rewarding experiences
during artistic endeavours (MacDonald, Byrne, &
Carlton, 2006). Flow experiences of being fully
immersed in the songwriting process, altered per-
ception of time, and experiencing a balance between
ability and effort were especially evident in people’s
description of their creative processes. Song writing
was viewed as an enjoyable means to explore the
self, enhancing mood, and creating a satisfying
artistic product. Flow experiences were evident in
participants reporting of changes in perception
of time. Time was perceived to have moved fast;
participants sensed they ‘‘lost track of time’’ and
were disappointed when their sessions came to an
end.
I just find time passes so fast. I looked at my clock
as you went out, and it had been an hour. I was
like, ‘are you serious?’ It felt like it was only like
fifteen minutes.
As participants created songs, they experienced
becoming fully focused. They described being
‘‘fully absorbed and in tune’’, unaware of other
things going on around them in the environment,
‘‘everything else seemed to disappear’’.
I was just speechless. It was breathtaking. It was a
really intense euphoria I guess I was just so lost in
the music.
I just felt totally into it. It really absorbed my
full conscious, totally just focused you know on
writing a good lyric or verse ...
The above research projects are good examples of
music therapy interventions that overlap into com-
munity music. For example, Therapeutic Song
writing challenges the existing stereotypes regarding
the composition process. Traditional views of com-
position construct this activity as an elite musical
process and one that can only be seriously under-
taken after intense musical study. However, the
results from this work highlight that individuals
with little music experience can engage in composi-
tional activities that can be meaningful, rewarding,
and enjoyable. Similarly, the music therapy with
cancer patient example also shows how individuals
who self-define as non-musicians can engage in
group improvization sessions that are musically and
artistically rewarding. Both of these examples em-
phasize the universal potential of music communica-
tion within everybody and highlight the overlap
between community music and music therapy inter-
ventions. Importantly, one distinctive feature that
separates these music therapy approaches from the
others presented in this article is that the music
therapist forms a clinical relationship with the par-
ticipants and this clinical relationship is of para-
mount importance within the musical environments.
These projects also have links with music education
approaches since Therapeutic Songwriting may also
facilitate the development of compositional skills
and confidence in music making. Similar develop-
ments in confidence may also be evident for the
participants in the improvization study who may also
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develop instrumental skills. Finally, this work also
has connections with the music in everyday life
section of the model since musical preferences and
listening histories are crucial influences when com-
posing new songs.
Ever yday music listening
While everyday music listening is not a distinct field of
practice in the same manner that the other sections of
the diagram operate, it is still a crucial element of the
processes related to music, health, and well-being
interventions (Ska˚nland, 2011; Ska˚nland, 2012).
One of the principle reasons we listen to music is for
mood regulation and in this way music can be
considered an informal type of self-medicated ther-
apy. Two important and related issues must be taken
into consideration when investigating contemporary
music listening practices. The technological revolu-
tion in relation to digital listening devices has
facilitated access to entire personal music collections
via small digital devices 24 hours a day (MacDonald
et al. 2012b). Also, increased understanding of how
personal and emotional factors beyond the music
itself influences music perception and highlights the
importance of the associative context of listening in
terms of predicting the effects of music (Juslin &
Sloboda, 2010; MacDonald et al. 2002; Miell,
MacDonald, & Hargreaves, 2005). The importance
of familiarity and past associations makes under-
standing the role of personal preference when in-
vestigating the effects of music crucial. Two studies
demonstrated that preferred music could be an
effective aid to reducing anxiety for patients in
hospital contexts (MacDonald et al., 2003). A further
study in a Greek hospital with patients undergoing
going kidney dialyses reported a significant reduction
in pain perceptions for participants listening to self-
selected music during the procedure (Pothoulaki
et al., 2008).
Further examples of work in this area include a
series of studies investigating the effects of preferred
music upon a variety of psychological variables.
In these studies, participants listened to self-selected
music during a perceptual experiment. Results
showed positive effects upon pain and tolerance
levels in laboratory settings where participants lis-
tened to different types of experimental stimuli while
undergoing the cold presser technique (Mitchell,
MacDonald, & Knussen, 2008). This technique
invites participants to place their hands in cold water
until the water becomes too cold.
In the first of these studies (Mitchell, MacDonald,
& Brodie, 2006a), 54 participants selected recorded
music from personal collections. During a listening
experiment, participants tolerated a painful stimulus
significantly longer and reported feeling significantly
more control over this pain when listening to their
preferred choice in comparison with white noise or
conventional ‘‘relaxing music.’’ A further study com-
pared visual and auditory stimuli using a similar
design (Mitchell, MacDonald, & Brodie, 2006a).
This study compared the effects of self-chosen music
to a selection of 15 well-known paintings, and to
a silence control in 80 participants. Additionally,
a measure of state anxiety was taken following each
condition and a music listening behaviour question-
naire investigated everyday listening habits. Findings
of this study largely replicated the earlier results;
preferred music listening leading to significantly
longer tolerance and greater perceived control than
both silence control and chosen art. Anxiety, mea-
sured by a short-form state anxiety questionnaire
(Spielberger, 1983) was significantly lower during
music listening compared to the other two conditions.
The aim of the musical behaviour questionnaire was
to explore individual differences in music listening
and to help identify who may benefit most from self-
selected music listening. Those people who listened to
favourite music most frequently experienced sig-
nificantly lower levels of anxiety. This suggests that
familiarity may indeed be important in this therapeu-
tic context, potentially combining anticipation and
tension release from the musical flow and structure
itself with the emotionally engaging associations held
with it. A further significant correlation was found
between knowledge of lyrics of the chosen song
and pain tolerance during the music condition,
again supporting the importance of familiarity in
engagement.
In terms of the underlying psychological mechan-
isms, listening to self-selected music may induce
heightened emotional response and distract atten-
tion more effectively. Concurrently, selecting and
listening to one’s chosen music may facilitate a sense
of increased control in unfamiliar or threatening
situations. Music listening in these contexts acts as
a stimulus that is distracting. When we are listening
to our favourite music, we are not attending to the
noxious stimulus or at least attending to it with less
intensity. Listening to our favourite music is also
emotionally engaging so this emotional engagement
draws us away from the noxious stimulus. Also,
listening to self-selected music in a laboratory con-
text represents bringing a familiar stimulus into an
unfamiliar environment and may also enhance feel-
ings of control in unfamiliar situations.
A key question raised by these studies is to
what extent the structural features of the music
(e.g. tempo, mode, rhythm etc) were important in
facilitating the therapeutic effects. The music
selected by participants across the these studies
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cover a wide range of genres, including chart
pop, rock, punk, hip-hop, and dance. Examples of
opera (Pavarotti), metal (Metallica), pop music (The
Beautiful South) were evident. These varying styles
of music, with many different structural features,
yielded similar effects of increased pain tolerance
and perceived control. Therefore, music with very
different structural features can be rendered func-
tionally equivalent by the role of preference. That is,
the participants chose music with contrasting struc-
tural features to produce the same effect, namely,
reducing pain and anxiety perceptions. Specifically,
key aspects of the therapeutic potential of music
listening relate to an associative relationship that a
listener has with a piece of music, for example the
music may remind the listener of a happy occasion.
To further investigate this issue, Knox et al. (2011)
performed detailed structural and content analysis
of a selection of tracks found to be effective in these
experiments. From three of the previous studies
(Mitchell et al., 2006a; Mitchell, MacDonald, &
Brodie, 2006b; Mitchell & MacDonald, 2009), 76
tracks were selected as having the greatest overall
effect on pain perception. Following structural analy-
sis of the music, mood classification results showed
that preferred music chosen by participants fell
predominantly in the ‘‘content’’ mood cluster as
defined in the Circumplex Model of Affect by Russell
(1980). This indicates a tendency towards low
arousal and positive valence. The results suggest
that in addition to personal preference, emotion
expressed by music, as defined by its acoustical
content, is important in enhancing emotional en-
gagement with music and therefore some structural
features are important in predicting therapeutic
effects. This result indicates that pain tolerance was
greater for music that has less tonal (pitch) variation.
This result suggests that pain intensity levels are lower
for music in which there may be less prominent chord
changes, bass lines, or strong melodies. See Knox
et al. (2011) for a full discussion of key structural
features.
This discussion also has relevance to music
medicine interventions because, as stated above,
music medicine interventions place particular em-
phasis upon the structural features of music and
relationship between these structural features and
therapeutic outcomes.
In summary, preference is a key variable to take
into consideration when investigating the therapeu-
tic effects of music listening. Preference interacts
with structure in such a way that when participants
are free to select their favourite music, they choose
music with certain structural features that facilitate
this therapeutic effect. This approach combines
some of the key features of music listening in every-
day contexts with a music therapy approach and can
therefore be considered as operating in the area
between everyday music listening and music therapy.
Community music
There is a growing body of research investigating the
processes and outcomes of community music and
one particular set of studies highlights the overlap
between music education, music therapy, and com-
munity music (MacDonald, Davies, & O’Donnell,
1999). This project investigated a music intervention
focused on playing a Javanese Gamelan. The inter-
vention was delivered by a Glasgow-based music
production company called Limelight (previously
Sounds of Progress) who specialize in working with
disadvantaged groups and individuals with special
needs. A key feature of these studies is that the aim
of the workshops was not primarily to teach people
music or to deliver positive therapeutic effects for
the participants. The primary aims of the Gamelan
workshops were to increase access to enjoyable
creative music activities for individuals from disad-
vantaged groups; in this case a group of individuals
with mild or moderate learning difficulties. How-
ever, a secondary goal of the intervention was the
development of specific music skills for the partici-
pants. Furthermore, it was also hypothesized that
the participants would develop along a number
of psychological dimensions. Thus, this community
music intervention also had educational objectives
(the development of music skills) and therapeutic
objectives (psychological developments). In com-
parison to a number of control groups, the 20
individuals who attended 1 hour Gamelan work-
shops once a week for 3 months showed significant
improvement in musical ability and communication
skills. Moreover, the communication improvements
correlated with the musical improvement scores.
A subsequent qualitative study investigated the
subjective experiences of individuals who took part
in similar activities organized by the music company.
The qualitative interviews highlighted the impor-
tance of these types of community music activities
for developing positive music identities, once again
highlighting the interplay between community
music, music education and therapeutic outcomes.
The two extracts below emphasize the importance
of professional standard music activities for the
participants
T: it makes it easier, sometimes, to talk to people,
yeah (.) you know, having a, having a gift (.)
because (.) at one time (.) people would come up
and talk to my Dad instead of me, and (.) but now
when they hear you singing [ ...] you know they’ll
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come and talk to you. [...] It was great when SOP
did the school tours, remember the school tours?
I: aye [interviewer was involved with this project]
T: it was great the kids never treated (.) the kids
came up and asked for your autograph you know,
just the same as an ordinary (.) an ordinary, just
the same as they would (.) you know
T: I remember I used to go up in the ambulance
up to the hospital years ago (.) and there was this
old woman she was always complaining about her
illness (.) we used to call her 57 varieties! (both
laugh) She used to always say about me, ‘you
know, he’s in a wee world of his own there’ (.) and
you’re sitting
listening! (both laugh) and you’re
sitting listening ‘oh aye, I’m in a wee world of my
own here!’ (laughs) (.) but there again, (.) that
same old woman, I started a sing-song in the
ambulance one time and she started to talk (.) she
started to talk to me
normally! (laughs) you know
what I mean? (both laugh) so there you go [...]
she forgot about the ‘wee world of my own’ when
Istartedthesing-song![...] The attitude changed.
In both extracts, the participant points to an
important change in the difficulties he experienced
in interacting with others was brought about by his
music. When his identity as ‘‘musician’’ became
salient to them, rather than seeing him only as
‘‘disabled,’’ people began to relate to him directly
rather than ignoring and bypassing him. In the first
extract, this was in a professional context in which
the audience asked him for autographs as they would
of any performer, and although the other was not a
professional context, music again served the purpose
of facilitating interaction. The first extract highlights
a very common and well-reported issue for indivi-
duals with disabilities; that they are often ignored in
public situations.
The use of the terms ‘‘ordinary’’ and ‘‘normally’’
in the examples above is important since they under-
line the point made by many disability researchers
that to be seen and treated as ‘‘ordinary’’ and
‘‘normal’’ is so often to be seen as something
different from having a disability. An important
struggle for many people with impairments in deal-
ing with other people’s expectations is to extend the
use of the terms ‘‘normal’’ and ‘‘ordinary’’ beyond
the able-bodied community, which is so often what
those terms imply. For the participants, their per-
ceptions of the shift in people’s assumptions and
expectations following a music performance were
striking. The extracts identify some important and
pervasive themes for understanding the powerful
role which music can play in this process.
The qualitative study explores the social roots of
personal identity; examining the details of complex
interactions between individuals involved in musical
activities and the reflections on these interactions by
some of the individuals involved, in particular the
impact of such activities on their changing personal
identities. Musical activities can be particularly
effective as catalysts for identity development be-
cause of the high degree of mutual engagement
necessary between performers, and because of the
impact of being involved in valued activities on their
feelings of self-confidence and empowerment. Once
again, signalling the interaction between therapeutic
and educational outcomes within a community
music context.
The results from the quantitative studies high-
lighted the impact that music interventions can have
on discrete personal and social factors. The qualita-
tive examples suggest that involvement in musical
activities also has more general effects on the way in
which people think about both themselves and their
position within society. These two developments are
related in that music can be thought of as not only
facilitating specific changes in musical and psy-
chological factors, but also as contributing to the
identity projects in which the individuals are engaged.
Whilst the above examples focuses our debate upon
the activities of one particular music company, this
has been presented as an example of how any musical
participation, suitably structured, can be an excellent
vehicle for leading to musical and personal gains for
participants. These effects will not only be found with
participants in Limelight activities, but rather suggest
that when music is employed for therapeutic/educa-
tional objectives in a structured and goal-directed way
by individuals with musical expertise and training,
then outcomes of the type reported here can be
expected.
As one participant explains in the extract below,
he has made profound and fundamental develop-
ments in personal identity through his involvement
in musical activities, and it is important to explore
the sites of such changes as well as individuals’
reflections on these processes. For this participant
and others, working with others in the professional
theatre and music world was in some senses awe-
inspiring, and yet also made possible the identifica-
tion of common efforts and ambitions amongst all
in the show, transcending their other differences,
and giving them a common identity as professional
musicians and actors.
T: when I worked with (.) when I did that show
with Wildcat [well known Scottish professional
theatre company] you know, you really felt ‘oh
god, you’re working with all these you know (.)
(laughs) people’ you know
I: uh huh
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T: you know, it makes you feel (.) makes you feel
(.) you must, you must have been, (.) you must
have been worth something, you know (unclear)
it’s better not to get (.) you know too big headed
about it, Gordon
I: aye
T: but you just feel, you feel different,
you’re working with these people you know
(laughs) you’re probably part of these people
(laughs) when you’re in a show with them!,
you know! But they’re just the same, (.) they’re
no different from anybody, they’re just the same
as you and me
Discussion
The preceding paragraphs have presented a number
of overarching themes. First, a model outlining how
music, health, and well-being can be conceptualized
as a distinct field of practice was discussed. The
unique features of the different elements: music
therapy; music education; community music; music
in everyday life; and music medicine were empha-
sized but important points of overlap between the
areas were highlighted as crucial points of multi-
disciplinary exchange and collaboration. These inter-
sections of practice are particularly important
areas of interest in terms of developing future
research agendas. This article then presented a
number of experimental examples highlighting the
parallels, contrasts, and elements of overlap across
these areas.
Two projects utilizing an explicit music therapy
approach were discussed. The first, a group impro-
vization session with cancer patients, highlighted key
features of the musical and social environment that
can facilitate positive experiences for the partici-
pants. A key point here is that the improvisatory
context of the sessions was of paramount impor-
tance. Improvization in general and improvized
music specifically is currently the focus of consider-
able academic attention (MacDonald & Wilson, in
press). Musical improvization provides opportunities
for negotiating difference through creative colla-
boration and understanding the unique musical,
mental, individual and social processes through
which improvization takes place in music is, a key
area of interest for music psychology (Wilson &
MacDonald, 2012). The unique psychological and
musical features of improvization make it an im-
portant artistic, educational, and therapeutic process
and as such has considerable relevance for the model
presented within this article. Improvization is also
accessible in that it is a process that everybody can
engage in; we are all musical improvizers at some
level (MacDonald & Wilson, in press).
The second study within a music therapy context
utilized Therapeutic Song writing as an approach.
This project highlighted ways in which the song
writing process can be creative, collaborative, and
expressive and an important technique for facilitat-
ing positive developments for participants. These
elements link both the music therapy research pro-
jects and also relate to other projects presented in
this article. For example, research presented within
the community music section of the article focused
upon the work of Limelight and this example high-
lighted developments in discrete psychological and
musical variables and also developments in identity
processes for participants. Key elements of the
musical social environment within this project in-
cluded a professional approach to music making and
the opportunity for performance and recording
activities. Thus, the music therapy examples and
the community music examples share key musical
and social elements with each retaining distinctive
features. All of these examples focus on increasing
access for creative music activities for groups of
individuals who can be considered ‘‘disadvantaged.’’
All of the interventions take an inclusive egalitarian
approach to music making that allows participants
considerable freedom to develop musically accord-
ing to their needs and goals. These processes are
scaffolded within a safe and encouraging envi-
ronment by expert musician(s) or therapist(s) who
help facilitate the process using their expertise and
knowledge. The music therapy inventions will retain
a distinctive focus upon the therapeutic relationship
between client and participants and the community
music project will retain a focus upon the develop-
ment of basic music skills.
Another important focus of this article is to
highlight the utility of qualitative methods for devel-
oping knowledge of the process and outcomes of
music interventions focused upon health and well-
being. Qualitative methodology has a number of key
features that make it a particularly useful approach
to research within this area. Music is completely
woven into the fabric of our lives. It provides the
focus of, or the soundtrack to, countless social
situations, and can also provide refuge or solace in
private moments. Also, everyone has a sense of the
ways in which they participate in music, and of their
own level of ability and interest, and so it forms an
important part of identity development and main-
tenance for many people, especially given that
music plays a central role in contemporary society
(MacDonald et al., 2002). Thus, qualitative meth-
ods, which are particularly good for giving a voice
to the subjective and phenomenological aspects of
R. MacDonald
10
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experience, can help reveal the unique ways in which
music is important within the lives of individuals.
Also, qualitative methods provide ways in which
commonalities across individuals’ different musical
experiences can be developed and synthesized. For
example, in Pothoulaki et al. music therapy study
previously discussed, all of the participants self-
defined as non-musicians yet each had highly
nuanced and individualized musical identities that
were important during the improvization group
sessions. IPA, as an analytical framework, enabled
these individualized music identities to become
manifest in the analysis and for key themes to
emerge. One conclusion from the analysis was that
the musical communication was enjoyable and
meaningful for all of the participants. Also, this mu-
sical communication had important and tangible
connections to particular aspects of their lives.
This discussion raises a number of issues about
professional practises and identity for the practi-
tioners involved. All of the professionals whose work
has relevance to music, health, and well-being have
highly developed and specific skill sets that enables
effective working within each of the areas. Music
therapy in particular has a very diverse and highly
specialized range of different types of music clin-
icians working under the general heading ‘‘Music
Therapist’’ (Ansdell & Pavlicevic, 2008; Barrington,
2008). For example, a psychodynamic dynamic
music therapist will practise in very different ways
from a community-based music therapist. There are
now different models of health musicing and these
different models all have different types of interven-
tions associated with them (Bonde, 2011; Ruud,
2012).
Conclusions
This article has explored music, health, and well-
being across a range of contexts. Using the cate-
gories of music therapy, music education, music
medicine and music and everyday life, it highlights
how the current research into the beneficial effects of
music has universal relevance across all areas of
health and social care and incorporates topics from
across the academic spectrum. Moreover, the multi-
disciplinary relevance of this topic facilitates a
pluralistic approach to research and practice that
incorporates theoretical ideas from each of the
disciplines presented. It is important to note that
these disciplines contain highly distinct features
whilst simultaneously having areas of overlap and
points of intersection as demonstrated by the con-
ceptual model. While there is still much to learn
about the process and outcomes of well-being-
related music interventions, it is a field of practice
and research that has major contributions to make in
positively influencing key aspects of health. Qualita-
tive research methods have much to contribute to
this process since these approaches facilitate the
exploration of the subjective and phenomenological
aspects of musical experience and it is these very
individual aspects of musical life that lie at the heart
of why music has powerful beneficial effects upon
health.
Conflict of interest and funding
The author has not received any funding or benefits
from industry or elsewhere to conduct this study.
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