A neuroscience-based rationale for patient-preferred live music as a receptive music therapy intervention for adult medical patients: A literature review

Abstract

Although patient-preferred live music (PPLM) is a frequently utilised receptive music therapy intervention, a neurological rationale for this treatment does not yet exist. The current paper reviews existing literature and proposes several potential neurologic rationales for PPLM as a receptive music therapy intervention for neurotypical adult patient populations. Additionally, the authors discuss gaps in the current research and make suggestions for further inquiries. The term ‘patient-preferred live music’ is parsed into four separate components: music, familiarity/preference, choice/autonomy, and live performance. The authors searched relevant neuroscience and music therapy literature to find research concerning each of these components. Results indicated extensive neuroscience research regarding the brain’s neurologic response to music, mostly pertaining to the reward system and the process of dopamine release. Additionally, the authors found evidence to suggest that exposure to familiar stimuli and the act of making a choice may both be neurologically reinforcing. Research regarding the mirror neuron system may be a vital entry point from which to begin investigating the live and social aspects of PPLM. Further music-specific and neuroscience research is required to confirm these hypotheses. While various researchers have investigated individual components of PPLM, there is a lack of basic music therapy and neuroscience research regarding the paradigm as a whole. Further investigation is warranted.

Full text

Approaches: An Interdisciplinary Journal of Music Therapy
11 (2) 2019
ISSN: 2459-3338 | www.approaches.gr
236
ARTICLE
A neuroscience-based rationale for patient-preferred
live music as a receptive music therapy intervention
for adult medical patients: A literature review
Anusha Ramaswami
University of Minnesota, USA
Michael J. Silverman
University of Minnesota, USA
ABSTRACT
Although patient-preferred live music (PPLM) is a frequently utilised receptive
music therapy intervention, a neurological rationale for this treatment does not
yet exist. The current paper reviews existing literature and proposes several
potential neurologic rationales for PPLM as a receptive music therapy
intervention for neurotypical adult patient populations. Additionally, the authors
discuss gaps in the current research and make suggestions for further inquiries.
The term ‘patient-preferred live music’ is parsed into four separate components:
music, familiarity/preference, choice/autonomy, and live performance. The
authors searched relevant neuroscience and music therapy literature to find
research concerning each of these components. Results indicated extensive
neuroscience research regarding the brain’s neurologic response to music,
mostly pertaining to the reward system and the process of dopamine release.
Additionally, the authors found evidence to suggest that exposure to familiar
stimuli and the act of making a choice may both be neurologically reinforcing.
Research regarding the mirror neuron system may be a vital entry point from
which to begin investigating the live and social aspects of PPLM. Further music-
specific and neuroscience research is required to confirm these hypotheses.
While various researchers have investigated individual components of PPLM,
there is a lack of basic music therapy and neuroscience research regarding the
paradigm as a whole. Further investigation is warranted.
KEYWORDS
patient-preferred live
music,
neurologic,
neuroscience,
music therapy,
brain
Publication history:
Submitted 27 Apr 2017
Accepted 21 Dec 2017
First published 21 Jan 2018
AUTHOR BIOGRAPHIES
Anusha Ramaswami (MT-BC) graduated from the University of Minnesota in 2017. Currently employed by a private music therapy practice,
Anusha serves a variety of clients in the Minneapolis-St. Paul Metro Area with Autism Spectrum Disorder, developmental disabilities,
emotional and behaviour disorders, and psychiatric disorders. [ramas045@umn.edu] Michael J. Silverman (PhD, MT-BC) is director of Music
Therapy at the University of Minnesota. He currently serves on the Editorial Board for the Journal of Music Therapy. Specialising in acute care
adult mental health, Michael is actively engaged in clinical research at the University’s Medical Centre. [silvermj@umn.edu]
INTRODUCTION
In their systematic review of patient-preferred live music with adult medical inpatients, Silverman,
Letwin and Nuehring operationally defined patient-preferred live music (PPLM) as “a receptive music

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therapy experience involving music selected and preferred by the patient that is performed live by a
qualified music therapist” (Silverman, Letwin & Nuehring, 2016, p. 2). The researchers analysed eight
PPLM-based studies meeting inclusion criteria and noted results were consistently positive in support
of the use of PPLM. The researchers found evidence to support PPLM, when delivered by a qualified
music therapist, as an applicable intervention for affective states including pain and nausea as well
as physiological measures for adult cancer and transplant patients. However, with an understanding
that there is no existing neuroscience-based literature that supports the PPLM model as a whole, the
present paper aims to: 1) dissect the term ‘patient-preferred live music’ and provide potential
neurologic explanations for the effectiveness of each of its components; 2) highlight limitations of
current literature; and 3) suggest directions for future research. As music therapy becomes an
increasingly relevant field, researchers, clinicians, and consumers must pursue a neurologic rationale
for specific interventions, seeking to answer why certain practices are successful in an effort to use
them most effectively. Vital to this understanding is an awareness of how music therapy interventions
may function to affect neural change and alter behaviours, cognitions, and affective states.
MUSIC AS A NEUROLOGIC REWARD IN PPLM
At the basis of understanding the effectiveness of PPLM is a simple – yet incredibly complex – inquiry:
how does the human brain respond to music? Several researchers have investigated the activation of
the neurologic reward system in response to music listening, focusing much of their research on the
release of dopamine. Central to this process are the Nucleus Accumbens (NAc) and the Ventral
Tegmental Area (VTA) (Berridge & Robinson, 2003; Blood & Zatorre, 2001; Kelley & Berridge, 2002;
Koelsch, 2014; Menon & Levitin, 2005). Dopaminergic neurons, located in the VTA, are projected
through the mesolimbic pathway, eventually arriving in the medial forebrain bundle and supplying
structures of the limbic system and the NAc (Siegel & Sapru, 2015).
Blood and Zatorre (2001) conducted a positron emission tomography (PET) study and identified
a correlation between VTA activation and intensity of pleasurable responses to participant-selected
music. In PET scans, the researchers observed increases in cerebral blood flow in the ventral striatum,
left dorsomedial midbrain, right thalamus, and anterior cingulate cortex, all areas associated with
reward, emotion, and arousal. In this study, the researchers did not explicitly state whether the musical
selections presented were live or recorded, though contextual cues may be used to infer that the music
was pre-recorded. This highlights the importance of reporting guidelines to increase transparency in
music-based interventions (Robb, Burns & Carpenter, 2011). The authors of these guidelines advised
that when recorded music is utilised, the researcher should “specify placement of playback equipment
and the use of headphones vs. speakers,” in addition to describing “who determined/controlled
volume,” and the “decibel level of music delivered and/or use of volume controls to limit decibels”
(Robb, Burns & Carpenter, 2011, p. 4). Implementation of these reporting guidelines can provide
valuable information for clinicians and investigators when attempting to use and generalise research.
Menon and Levitin (2005) completed an investigation similar to that of Blood and Zatorre (2001),
citing the importance of studying this process with advanced and more accurate fMRI technology. In
this study, the researchers reported utilising digitised sound files in the “music” and “non-music”
conditions. The music condition contained short excerpts from songs in the classical music canon,

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while the control condition utilised “scrambled” version of the same songs which the researchers
manipulated to maintain pitch and loudness while removing any sense of musical continuity or
predictability. The researchers found evidence suggesting that passive music listening stimulates a
network of structures in the mesolimbic system involved in reward processing. Structures including
the NAc, VTA, hypothalamus and insula work in tandem to regulate the brain’s response to rewarding
stimuli. The researchers found a positive correlation between NAc reaction to music and release of
dopamine in the VTA. This study reaffirms the findings of Blood and Zatorre (2001), this time utilising
the high resolution of the fMRI to measure and observe the activation of the Nucleus Accumbens.
Menon and Levitin (2005) further suggested that passive music listening may provide an effective way
to explore the neural mechanisms of anhedonia in patients with mental health disorders, as well as
potential dysfunctional responses in the NAc, VTA, insula, hypothalamus, and orbitofrontal cortex, all
of which are implicated in processing affect.
Dopamine release, in addition to immediately affecting reinforcement pathways and reward
processes, has meaningful implications for cortical development. Researchers have demonstrated
that a combination of dopamine release in the VTA and sensory stimulation results in cortical
remapping, an influential component in reward processing and reinforcement learning (Bao et al.,
2001; Chanda & Levitin,2013). As noted by Stegemöller (2014), it is generally accepted that dopamine
plays an integral role in neuroplasticity. She suggests, “music therapists may be providing an
enhanced learning environment for non-music tasks/behaviours through music-stimulated
dopaminergic mediated neuroplasticity mechanisms” (p. 217). Additionally, Altenmüller and Schlaug
(2015) highlighted the importance of the neurotransmitter serotonin in brain plasticity. While dopamine
triggers feelings of pleasure resultant from unexpected or novel stimuli, serotonin triggers feelings of
satisfaction from expected stimuli, both vital processes in reinforcement learning.
Music listening is not the only activity that works to stimulate the mesolimbic reward pathway.
Researchers demonstrated that increases in dopamine levels in the VTA and NAc also occur in
response to primary rewards like food or water and even act as a reinforcing effect for some addictive
drugs (Berridge & Robinson, 2003; Kelley & Berridge, 2002). The same structures activated by music
are likely to be activated in response to other euphoria-inducing stimuli, including eating, drinking,
sexual behaviour, and using certain drugs of abuse. These selective circuits, including structures such
as the NAc, VTA, periaqueductal gray, brainstem, and parts of the hypothalamus, may provide positive
reinforcement associated with these rewarding activities (Blood & Zatorre, 2001; Siegel & Sapru, 2015).
As early as 1980, Goldstein found that the music-activated neurologic pleasure response could be
blocked by the opioid agonising drug naloxone. Goldstein’s finding suggests that the pathway
mediating musical reward response could be the same conduit that reinforces opioid use. Although
there is a dearth of contemporary research specific to the relationship between musical reward and
opioid-activated pathways, musical activation of reward circuitry may have meaningful implications in
the treatment of drug addictions.
In addition to the wide body of research regarding dopamine release in response to music
listening, some researchers have suggested a relationship between music listening and changes in
autonomic response. It has long been hypothesised that regulatory functions including heart rate and
respiration, which are largely mediated by the hypothalamus, may respond to pleasurable music
listening (Blood & Zatorre, 2001; Goldstein, 1980; Krumhansl, 1997). In their fMRI study, Menon and

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Levitin (2005) observed increased activation in the hypothalamus in response to pleasant music. The
authors cited high correlations not only between NAc and VTA responses, but also between NAc and
hypothalamic responses. They further suggested a “tight link” (p. 182) connecting the affective and
cognitive systems, proposing meaningful implications for understanding human emotional and
physical responses to music. Koelsch (2014) confirmed this notion in his meta-analysis of studies on
music-evoked emotions, citing numerous researchers who observed increased activity in the
hippocampal region in response to music listening. These findings aligned with another study by
Koelsch and colleagues (2006), wherein the researchers found that a network of limbic and paralimbic
structures (including the amygdala, hippocampus, parahipocampal gyrus, and temporal poles)
responded to musical stimuli containing emotional valence, both pleasant and unpleasant. Based on
their findings, the researchers suggested the effectiveness of music to regulate neuronal activity in
this network of structures, in both an inhibitory and excitatory capacity.
FAMILIARITY AND PREFERENCE IN PPLM
Patient preference is a vital component of PPLM. Although there is evidence to support the use of
familiar music in music therapy, neuroscience research about the relationship is scarce. Stegemöller
(2014) advocates the use of preferred music when attempting to increase dopamine release in the
listener’s reward centre. Mitchell, MacDonald and Brodie (2006) found that patient-preferred music
resulted in a “significantly greater feeling of control over a painful experience” (p. 348) and greater
negative effect on mood disturbances than other distraction conditions during an autologous stem
cell transplantation procedure. In an initial meta-analysis of music in medical and dental settings,
Standley (1986) suggested the use of music therapy interventions utilising patient-selected or
preferred music to act as an audioanalgesic. The author found evidence to suggest that music,
especially when used in conjunction with other medical anaesthetics or analgesics, may be effective
in reducing pain, anxiety and stress in a wide variety of patient populations. The researcher also noted
the potential of patient-preferred receptive music to enhance chemical effects, thus reducing the
amount, duration or side effects of medication administration, and possibly even shortening the length
of hospitalisation. A majority of the studies included in Standley’s meta-analysis utilised recorded
music listening, and patient diagnoses ranged from neonatal care to cancer and dental procedures.
Dependent variables included a variety of physiological measures including pulse rate, stress hormone
levels, muscle relaxation and blood pressure, as well as affective states such as pain and anxiety
perception. Several of the studies analysed by Standley noted the inverse effect of music on the
amount of analgesic medication requested or administered.
Additionally, O’Kelly et al. (2013) found that for healthy control participants, live performance of
preferred music resulted in the greatest positive effect on EEG amplitude when compared with
improvised live music entrained to respiration, digital recording of disliked music, and white noise. It
is important to note, however, that for healthy control data reported in this study, participants were
instructed to keep their eyes closed, potentially minimising any effect of the live/social components
of the musical stimulus and limiting the investigation to the patient preference aspect. Furthermore,
the researchers found significantly increased EEG amplitude associated with preferred music for the
experimental group of patients in vegetative and minimally conscious states, as well as increased

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blink rate in response to preferred music within the group of patients in a vegetative state. Although
this research adds to the growing rationale for further study of PPLM, it cannot necessarily be
generalised to the larger population, most of whom do not fall into the same clinical context.
It is possible that the familiarity of patient-selected music makes it especially stringent in the
therapeutic setting, even if the music therapy consumer is not conscious of this preference. In an early
study, Wilson and Zajonc (1980) found that participants reliably discriminated between familiar and
unfamiliar stimuli, even if the stimuli themselves were not consciously recognised. That is, if
participants heard stimuli that they had been exposed to in the past, even if not conscious of their
recognition, they still reported preference for familiar over new stimuli. Relatedly, Redish (2013)
described the brain’s memory storage system in terms of “pattern completion” (p. 259), wherein the
brain’s content-addressable memory system uses existing neural connections to retrieve large
amounts of information with just partial content. With minimal information about the stimulus itself
and with relatively little cognitive processing required, participants may feel and react more positively
toward stimuli they have heard before than that which is unfamiliar. This seemingly subconscious
preference for familiar stimuli over unfamiliar may contribute to the impact of PPLM in the therapeutic
setting.
Using Perlovsky’s (2007) “knowledge instinct” as a framework, Koelsch (2015) explained how
possessing an understanding of the structure of a musical piece may result in feelings of pleasure or
reward. A familiar song fulfils a person’s inherent desire to understand, and thus they experience it as
rewarding. Koelsch continues by hypothesising that this would potentially activate the dopaminergic
reward pathway, although he noted that this has not yet been empirically supported. The familiar
structure of a preferred song might lead to an increased dopaminergic response, thus making the song
more rewarding to the listener.
Although outside the scope of this paper, it should be noted that the process of auditory
stimulation itself and the expectedness of familiar music may have important implications for the
motor system. Thaut (2015) describes how the auditory system is extensively connected with motor
centres in the brain at cortical and subcortical levels. The author explains how firing of auditory
neurons, upon rhythmic and musical stimulation, entrains motor neuron firing. As a result, the motor
system is primed “toward a state of readiness to move” (p. 258). Although constituting older research,
other investigators utilising EEG demonstrated the priming and activation of muscle groups in
response to rhythmic and musical stimuli via reticulospinal pathways (Paltsev & Elner, 1967; Rossignol
& Jones, 1976). This relationship between familiar musical stimuli and neurologic response, though it
may be supported from a behavioural standpoint, has yet to be studied empirically in terms of
dopamine release in the mesolimbic pathway. Further study through a neuroscience lens may result
in a deeper understanding of this process.
CHOICE AND AUTONOMY IN PPLM
In their review of PPLM for adult medical patients, Silverman, Letwin and Nuehring (2016) noted the
sense of autonomy that is afforded a patient who receives PPLM. First, the patient has the opportunity
to initially accept or decline music therapy services. For a patient in a medical setting who likely has
few opportunities for choice, the act of making this initial decision may be empowering in itself.

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Moreover, the authors claimed that by choosing preferred music and having the opportunity to
manipulate certain features of the music therapy session, patients may perceive themselves as in
control of their environment. This, too, would likely induce feelings of empowerment and autonomy.
Similarly, psychological researchers have long suggested the positive influence of choice on
behavioural performances such as learning and memory tasks (Iyengar & Lepper, 1999; Perlmuter,
Monty & Kimble, 1971; Setogawa, Mizuhiki, Matsumoto, Akizawa & Shidara, 2014). In a recent study,
Setogawa et al. (2014) suggested self-choice was critical in that when a participant chooses a task
rather than being instructed to complete it, that task’s value might be enhanced. This enhanced value
could actually function to improve the participant’s performance on a memory or learning task.
In a classic study, Perlmuter, Monty and Kimble (1971, p. 49) reported that participants’
performance was less disrupted when being “forced” to learn two competing sets of materials (A-B,
followed by A-C) than when they were able to choose the first set of material and forced to learn the
second. That is, when an opportunity for choice was given, then taken away, their performance on the
task was more negatively affected. The researchers continued by suggesting that people who “have
the opportunity to choose their own responses…may learn faster than subjects who do not exercise
choice” (Perlmuter, Monty & Kimble, 1971, p. 52). Iyengar and Lepper (1999) found that Anglo-American
students performed better on anagram tasks when given the choice of which puzzle to complete than
when they were not given a choice. When told their mother or the experimenter chose the puzzle, the
students performed significantly worse on the task. In contrast, Asian-American participants actually
performed better when told the task was chosen for them by their mother. Motivation in response to
self-choice may in fact be a cultural phenomenon. It is possible that socio-cultural factors play a vital
role in the understanding of and reaction to perceived autonomy. Future research concerning this
factor is warranted.
Neuroscientific research regarding exactly why the action of making a choice may be
neurologically rewarding is scarce. Redish (2013) identified the importance of the nucleus accumbens
(NAc) in both the deliberative decision-making and reward systems. This particular brain structure is
vital in the processing of both evaluation of choices and reward. The NAc receives information from
the hippocampus about past experiences and potential future outcomes and uses this information to
evaluate the options presented. According to Redish, the NAc includes cells that “respond to reward
consumption, as well as other cells that respond to cues that predict rewards, and other cells that
seem to represent the expected value of an outcome” (Redish, 2013, p. 81). Only further neuroscience
research can determine if the NAc or other brain structures perceive decision-making as a reinforcing
experience, and if this is in fact dependent on cultural background, as suggested by Iyengar and Lepper
(1999).
LIVE AND SOCIAL ASPECTS OF PPLM
Several music therapy researchers found results indicating patient preference for live music over
recorded music in receptive music therapy interventions (Bailey, 1983; Cassileth, Vickers & Magill,
2003; Silverman, Letwin & Nuehring, 2016; Standley, 1986). In Bailey’s (1983) study of 50 hospitalised
patients with cancer, subjects who experienced live singing and guitar playing reported significantly
less anxiety and greater vigour than the control group that heard tape-recorded performances. In

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Standley’s (1986) meta-analysis, the researcher suggested the significance of using live music, rather
than pre-recorded music, to improve patient physiological and affective states, citing the importance
of music therapists’ ability to manipulate musical elements in response to patient state. Both the live
component of PPLM and the social reinforcement of receiving a face-to-face music therapy
intervention may be vital to its effectiveness. Koelsch (2015) explains the importance of social contact
as a basic human need and potential for music as a conduit for social cognition, including “figuring
out intentions, emotions, desires, and beliefs of other individuals” (p. 198). This aligns with Cassileth,
Vickers and Magill’s (2003) finding that live music therapy more effectively reduced pain and had a
greater impact on mood when compared to a non-structured recorded music listening condition. The
social aspects of a live musical interaction may play a major factor in the effectiveness of PPLM for
improving mood states, when compared with recorded music listening.
The growing base of neuroscience research involving the mirror neuron system may have a
profound influence on the developing neurologic rationale for PPLM. This system consists of a set of
visuomotor neurons in the ventral premotor cortex that are activated in response to both performed
and observed actions (Rizzolatti & Craighero, 2004). Mirror neurons were initially discovered in the
monkey ventral premotor cortex, but there is substantial evidence to suggest the presence of
analogous neuronal structures in the fronto-parietal regions of the human brain (di Pellegrino, Fadiga,
Fogassi, Gallese & Rizzolatti, 1992; Gallese et al., 1996; Molenberghs, Cunnington & Mattingley, 2012;
Rizzolatti et al., 2001; Rizzolatti, 2005). Mirror neurons appear to be implicated in both processing and
comprehending human motor actions. Furthermore, they may be related to higher-level processes
such as imitation, language and empathy (Molenberghs, Cunnington & Mattingley, 2012; Rizzolati,
2005; Wan, Demaine, Zipse, Norton & Schlaug, 2010). Koelsch, Fritz, Cramon, Müller and Friederici
(2006) found that music listening activated motor areas implicated in the creation of vocal sounds. In
their fMRI study, the researchers observed activation in the brain areas representing vocal production,
even when participants were simply listening to music they perceived as pleasant.
Although there is limited empirical research on the topic, the salience of PPLM may be attributed
to a process referred to as emotional resonance or emotional contagion (Juslin & Västfjäll, 2008;
Koelsch, 2015). Acknowledging the lack of research on this particular subject, Koelsch (2015)
theoretically discusses several different aspects of this process, wherein an individual perceives an
emotion, be it a sound, a gesture or a facial expression, and mirrors or mimics the same emotion either
internally, externally or both. The author explains the example of people listening to music that they
perceive to be joyful. The listeners then embody ‘joyful’ music by smiling, singing along or moving with
the music. In turn, this motor feedback actually evokes a feeling of joy. The author also discusses this
process at the neuronal level, describing the process of sounds modulating arousal via the limbic
pathway. Additionally, the author discusses the human mechanoreceptors, Pacinian corpuscles,
which may become stimulated by musical sounds and thus lead to affective change.
Similarly, Juslin and Västfjäll (2008) outlined potential implications of the mirror neuron system
in the process of emotional contagion, describing a situation in which a “voice-like” cello moves a
listener to “experience the same sad emotion” (p. 565) expressed by the musical selection. De Gelder,
Snyder, Greve, Gerard and Hadjikhani (2004) described a phenomenon where seeing body language
expressing “fear” led to increased activity in brain areas associated with both motor processing and
emotion. This connection between observed motor actions and emotional response may have

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meaningful implications for understanding the importance of live music in music therapy
interventions. Juslin and Laukka (2003) noted that music commonly imitates emotional speech, and
Juslin’s (2001) Super-Expressive Voice Theory suggests that humans are particularly attuned to the
voice-like characteristics of music due to the neural response to such stimuli. In the medical music
therapy setting, this theory of emotional contagion might translate to the music therapist using tools
such as words, facial expressions, gestures and vocal inflection to create an ideal atmosphere for the
patient’s emotional wellbeing.
Perhaps as a result of the mirror neuron system and the process of emotional contagion, the
listener may automatically and subconsciously mirror the emotion she or he perceives in a live musical
stimulus. Presumably, a live music therapy experience such as PPLM would provide an even stronger
basis of emotional stimuli for the listener to perceive and mirror. However, there is scant empirical
research regarding the relationship between the mirror neuron system and emotional contagion, even
without the added variable of music. Given further research specific to the music therapy domain,
these findings may add to the growing research base supporting the use of live music therapy
interventions, as opposed to recorded music listening such as music medicine.
CONCLUSIONS
Based on the existing music therapy literature, it appears that PPLM is a preferred and effective
receptive music therapy intervention for improvement of affective states in adult medical patients
(Silverman, Letwin & Nuehring, 2016). PPLM, however, like many other music therapy interventions,
has yet to be explored from a neuroscience-guided perspective. In order for the evidence base and the
music therapy field to grow, clinicians and consumers should continue pursuing neurologic
explanations for the active change mechanisms of specific music therapy interventions. This paper
calls attention to several potential neurologic explanations for the effectiveness of PPLM by breaking
the intervention up into its individual components and reviewing the existing literature related to each
of these components. However, the current research alone is not sufficient to empirically support the
use of PPLM. The basic music therapy research required to rationalise the entire PPLM paradigm does
not yet exist.
Though numerous researchers have explored individual aspects of PPLM, there is minimal
literature regarding PPLM as a whole intervention. For instance, there is substantial evidence to
support the neurologically rewarding nature of music via various dopaminergic and autonomic
responses, but that alone does not necessarily justify the use PPLM (Berridge & Robinson, 2003; Blood
& Zatorre, 2001; Kelley & Berridge, 2002; Koelsch, 2014; Menon & Levitin, 2005; Stegemöller, 2014).
Similarly, some researchers have studied the patient preference aspect of PPLM without approaching
the question of live versus recorded music (Blood & Zatorre, 2001; Menon & Levitin, 2005), while others
focused on live versus recorded music without including the variable of patient preference (Bailey,
1983; Standley, 1986; Cassileth, Vickers & Magill, 2003). Furthermore, there is extremely limited
neuroscience research available regarding the perceived reward value of choice/autonomy, and music
therapy researchers have yet to study this topic in relation to PPLM. The comprehensive research on
this topic that does exist, including the study by O’Kelly and colleagues (2013), delves into only three
of the four components of PPLM, and is so specific to a specialised clinical setting that it cannot be

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appropriately generalised to a neurotypical population. Lastly, these numerous facets of PPLM lack
the solid neuroscience backing to connect them all.
The existing research, although it lays an initial foundation, is insufficient to rationalise PPLM
from a neurologic standpoint. Future research might examine the relationship between mirror neurons,
music, and emotional contagion, as well as the specific differences in processing live versus recorded
preferred music in adult neurotypical populations, and the neurologic reward processes relating to
choice and autonomy. In the contemporary era of heightened accountability and evidence-based
practice, basic research is warranted and may help to justify the use of PPLM and differentiate it from
other non-music therapy approaches like music medicine.
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Ελληνική περίληψη | Greek abstract
Ένας βασισμένος στη νευροεπιστήμη συλλογισμός που αφορά
τη ζωντανή μουσική που προτιμάται από τους ασθενείς ως μια
δεκτική μουσικοθεραπευτική παρέμβαση για ενήλικες ασθενείς:
Μια βιβλιογραφική επισκόπηση
Anusha Ramaswami | Michael J. Silverman
ΠΕΡΙΛΗΨΗ
Παρόλο που η ζωντανή μουσική που προτιμάται από τους ασθενείς (patient-preferred live music, PPLM)
χρησιμοποιείται τακτικά ως παρέμβαση δεκτικής μουσικοθεραπείας, δεν υφίσταται ακόμη μια νευρολογικά
βασισμένη επιχειρηματολογία για αυτήν την παρέμβαση. Το παρόν άρθρο εξετάζει την υπάρχουσα
βιβλιογραφία και προτείνει διάφορες πιθανές νευρολογικά βασισμένες αιτιολογήσεις για την PPLM ως μια
παρέμβαση δεκτικής μουσικοθεραπείας για νευροτυπικούς ενήλικους πληθυσμούς ασθενών. Επιπλέον, οι
συγγραφείς συζητούν για τα κενά στην τρέχουσα έρευνα και κάνουν προτάσεις για περαιτέρω διερευνήσεις.
Ο όρος «ζωντανή μουσική που προτιμάται από τον ασθενή» αναλύεται σε τέσσερα ξεχωριστά στοιχεία:
μουσική, οικειότητα/προτίμηση, επιλογή/αυτονομία, και ζωντανή απόδοση/εκτέλεση. Οι συγγραφείς
αναζήτησαν τη σχετική νευρολογική και μουσικοθεραπευτική βιβλιογραφία για τον εντοπισμό έρευνας
σχετικά με καθένα από αυτά τα στοιχεία. Τα αποτελέσματα έδειξαν εκτεταμένα νευροεπιστημονικά
ερευνητικά δεδομένα σχετικά με τη νευρολογική απόκριση του εγκεφάλου στη μουσική, κυρίως σχετικά με
το σύστημα ανταμοιβής και τη διαδικασία της απελευθέρωσης της ντοπαμίνης. Επιπλέον, οι συγγραφείς
βρήκαν ερευνητικά τεκμήρια που υποδηλώνουν ότι τόσο η έκθεση σε γνώριμα ερεθίσματα όσο και η πράξη
της επιλογής μπορεί να ενισχύονται νευρολογικά. Η έρευνα σχετικά με το σύστημα των κυττάρων

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246
καθρεφτών [mirror neuron system] ίσως είναι ένα ζωτικό σημείο εισόδου από το οποίο μπορεί να αρχίσει η
διερεύνηση των ζωντανών και κοινωνικών πτυχών της PPLM. Απαιτείται περαιτέρω έρευνα σχετικά με τη
μουσική συγκεκριμένα και με τη νευροεπιστήμη για την επιβεβαίωση αυτών των υποθέσεων. Ενώ διάφοροι
ερευνητές έχουν μελετήσει μεμονωμένα συστατικά της PPLM, υπάρχει έλλειψη βασικής
μουσικοθεραπευτικής και νευροεπιστημονικής έρευνας σχετικά με την πρακτική αυτή στο σύνολό της.
Δικαιολογείται έτσι η ανάγκη για περαιτέρω έρευνα.
ΛΕΞΕΙΣ ΚΛΕΙΔΙΑ
patient-preferred live music, νευρολογική, νευροεπιστήμη, μουσικοθεραπεία, εγκέφαλος