A contribution from music therapy to the discipline of health psychology
Introduction
There is a notable lack of recognition in the field of health psychology regarding the beneficial effects of health musicking. Health psychology is "the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness" (Wikipedia). In this essay, I propose the concept of music as a "cultural immunogen" to advocate for musicking as a behavior that promotes health and protects against illness.
To communicate effectively with the field of health psychology and behavioral medicine, I suggest a rhetorical framework for advancing health musicking, rooted in metaphors from medical science. Terms such as "immunogens," "pathogens," and "antigens" are commonplace within medical discourse, as well as in health psychology and prevention. By metaphorically reframing musical engagement within this immunological paradigm, I aim to elucidate how various forms of musicking can function as antigens within a broader health promotion matrix. Through this lens, music emerges as a potent contributor to the repertoire of health-promoting behaviors. Specifically, I will highlight how recent arts and health initiatives, particularly research stemming from the discipline and practice of music therapy, can significantly contribute to health psychology and behavioral medicine.
I will elaborate on the notion of "cultural immunogen" as a parallel to the concept of a "behavioral immunogen," introduced by American psychologist Joseph Matarazzo in the 1980s. Matarazzo documented how health behaviors contribute significantly to combating major post-war health challenges like heart disease, cancer, and other life-threatening conditions. Redefining "behavioral immunogens" to "cultural immunogens" involves utilizing cultural artifacts or the arts, particularly music, to expand the repertoire of behaviors that promote health.
It is worth noting that some of the biomedical diseases that formed the backdrop of Matarazzo’s theories in the 1980s, such as heart disease and cancer, still exist. However, many contemporary health challenges are related to depression, anxiety, stress, pain and insomnia. Although these challenges are often seen as individual problems, they may result from life conditions and social arrangements stemming from disempowerment, social isolation, and dislocation, leading to stress, estrangement, and loss of meaning. These states lead to pathogenic behaviors, which in turn trigger immunogenic responses of a cultural kind. An illustrative example is how the Covid-19 pandemic resulted in social isolation, prompting the well-known singing from balconies in Italy. This act of singing became a cultural antigen in response to the pathogenic behavior stemming from social isolation. Thus, diseases with known biomedical causes, like those due to the Covid-19 virus, have behavioral consequences. Some of these consequences can be addressed through behavior associated with cultural performance.
Using medical terminology as a rhetorical device, I will refer to musical "antigens" to demonstrate how "health musicking" fosters health behaviors and a sense of well-being. I propose exploring four major "musically induced antigens": (1) agency, (2) emotional regulation, (3) music as a social resource, and (4) meaning-making. These antigens are interconnected or entangled with phenomena such as identity, self-efficacy and empowerment, emotions and meanings, networks and belonging, and spirituality and transcendence. By utilizing the "laboratory" of music therapy and referencing research from the fields of music therapy and music medicine, we can investigate how these connections operate.
In summary, a study of music therapy theory, practice, and professional performance can detail how health musicking serves preventative and promotive health functions, enhancing the quality of life for modern individuals.
Music Therapy within Health Psychology
The field of music therapy offers significant contributions to health promotion and prevention, aligning closely with the discipline of health psychology. This connection supports the advancement of research within music therapy and music and health, potentially incorporating health musicking into folk medicine practices and public health domains.
By introducing the concept of music as a “cultural immunogen,” I aim to highlight the role of musical engagement in safeguarding and enhancing subjective health and quality of life. While music has long been recognized as a form of folk medicine or a part of personalized public health, there remains a reluctance to fully integrate it into our broader health culture. Extensive research and clinical practice in music therapy provide ample evidence supporting the therapeutic benefits of music. Additionally, the ubiquitous presence of music in daily life—whether through listening, attending concerts, or engaging in amateur musical pursuits—underscores its pervasive influence.
In the 1980s, psychologist Joseph Matarazzo spearheaded efforts to illustrate the potential synergy between psychology and medicine in enhancing public health. This period saw a decline in the threat posed by traditional infectious diseases due to advancements in medical science, pharmacology, and improved social conditions in Western countries. However, despite these improvements, conditions such as heart disease and cancer continued to impose a considerable toll on society, often stemming from stress-related behaviors (Type A behavior) or unhealthy lifestyle choices like poor diet and obesity (Matarazzo, 1984).
Matarazzo introduced the concept of “behavior pathogens” to describe detrimental lifestyle habits that predispose individuals to heightened mortality risks. He developed a theory of “behavior immunogens,” representing behaviors conducive to health and longevity. Until that time, it was common to identify only pathogens or life-threatening diseases. With the introduction of salutogenic thinking by Antonovsky (1977), researchers began to look for behaviors that could enhance health. Within health psychology, a diverse array of behaviors was identified as part of the repertoire of immunogenic conduct. Notable examples include dietary guidelines, smoking cessation, moderate alcohol consumption, oral hygiene practices, proper sleep hygiene, and seat belt usage while driving.
When this essay seeks to expand or transform the concept of “behavior immunogens” into what I have named “cultural immunogens,” a different set of behavior immunogens is introduced, all related to what we may call “health musicking.”
A New Set of Pathogens and Antigens
While Matarazzo’s framework primarily addresses health-related concerns, its direct applicability to the intersection of music and health is limited due to its individualistic and biomedical focus on health and disease. However, there is a growing interest in public health research in exploring how cultural engagement, such as musicking, correlates with population health outcomes. Examining the role of musical practices in addressing health-related challenges highlights the potential for cultural immunogenic behaviors to enhance well-being.
We must consider how a new set of risk factors prevail in contemporary society, largely due to changing life conditions. Matarazzo observed that microbial pathogens no longer posed the same threat to health and mortality; instead, other risk factors, or behavior pathogens, emerged as new threats. Expanding on this argument, we can introduce a new set of risk factors prevalent in contemporary society, not stemming from individual behavior but from structural conditions within society. These include stress-related labor, economic inequality, social marginalization, and dislocation. Such risk factors have psychological as well as biological consequences, leading to pathogenic behaviors such as stress, disempowerment, lack of autonomy, and estrangement.
Considerations such as social isolation, loneliness, disempowerment due to psychological or social factors, emotional distress, and existential crises are pertinent to contemporary health services. These facets—encompassing my proposed antigens of vitality, agency, belongingness, and meaning—represent key dimensions of present-day health challenges, transcending the scope of lifestyle diseases prevalent during Matarazzo’s era. Today, society grapples with a range of psychological and social complexities that intersect with health and well-being.
However, it is prudent to temper assertions regarding the direct correlation between these health challenges and mortality rates. Instead, a more nuanced discussion can focus on how musical engagement may influence subjective health perceptions and quality of life, thereby potentially serving as a conduit for health promotion. Conducting comprehensive investigations into the links between cultural behaviors and mortality may pose empirical challenges within public health research. Therefore, leveraging empirical findings from the broader field of music and health can substantiate theoretical arguments regarding the role of music-making as a cultural immunogen. Moreover, we also know how the body reacts to negative stress and how the body-mind relationship should not be overlooked.
The Evolution of Music Therapy as a Cultural Movement
Many years ago, in the early days of the development of music therapy, I published an article suggesting that the field of music therapy should not only be seen as a therapeutic tool but also as an emerging cultural movement (Ruud, 1988). Later, I was inspired by readings in sociology (Hetherington, 1998) that highlighted how many critical, political, and alternative movements originated in small, communitas-like groups and eventually became part of mainstream culture. These were communities where ideas and engagement fueled the formation of new lifestyles, embodying an "expressive identity" that emphasized lifestyle, health, and cultural performance. For instance, movements like vegetarianism and ecological food production began on the societal fringe but gradually broght into mainstream culture.
I believed this idea could apply to music therapy as well. Starting in Norway in the 1970s within special education, music therapy expanded into mental health, somatic hospitals, and other health and cultural contexts (Ruud, 2022). Over time, it gained acceptance by health authorities and became a recognized profession in various fields. We developed a broader understanding of music therapy, differentiating it as a practice, profession, and scientific discipline. This led to exploring everyday health musicking and recognizing its role in emotional regulation and social participation. Concurrently, music therapy solidified as a discipline, supported by substantial research and professional reflection.
In recent decades, particularly with the advent of new digital technologies, music has taken on regulatory functions in daily life, and people increasingly take responsibility for their own health. Music therapist researcher David Aldridge introduced the concept of "health as performance" to music therapy. Around the turn of the century, Christopher Small's redefinition of music as "musicking" and Brynjulf Stige's concept of "health musicking" further influenced our understanding (Small,1998, Stige, 2002).
Developing the Concept
In the 1990s, I researched the connection between music and identity, resulting in the publication of “Musikk og identitet” (Music and Identity) (1997, revised in 2013). I also wrote an article on the subject (Ruud, 1987a) and connected music to life quality (1987b). Around the turn of the century, I interviewed people about their everyday use of music related to their health and well-being, first reporting this in the article “Music as a Cultural Immunogen: Three Narratives on the Use of Music as a Technology of Health” (Ruud, 2002). This title reflected Tia DeNora’s influence, particularly her book “Music in Everyday Life” (2000) and her interpretation of Foucault’s “self-technologies” related to emotional self-regulation.
During my later training as a psychologist, in a course on health psychology, I encountered the concept of “behavioral immunogens,” which are behaviors that protect health, such as brushing teeth, using seat belts, and quitting smoking (Matarazzo, 1984). However, none of the textbooks at that time mentioned cultural behaviors like listening to music for regulatory functions, participating in a choir to prevent social isolation, or attending concerts for aesthetic purposes and existential experiences. From my music therapy experience and growing research, I saw how music therapy proved effective in numerous situations. We had evidence and strong theoretical support for health musicking’s effectiveness in treatment, health prevention, promotion, care, and education.
Many contributed to this development. At CREMAH, the Research Center for Music and Health at the Norwegian Academy of Music, we published the anthology “Musical Life Stories: Narratives on Health Musicking” (Bonde, Skånland, Ruud, and Trondalen, eds., 2013) to bridge the gap between everyday health musicking and professional music therapy. Another 2013 publication edited by Marie Skånland summarized my empirical work (Ruud, 2013). The Community Music Therapy movement also significantly influenced this development (Stige and Aarø, 2012). CREMAH obtained funding from the Norfra, and from 2011 to 2013 we gathered around fifty researchers and Ph.D. students within the field of music and health from the Nordic countries for three yearly seminars outside Oslo. The funding made it possible to invite leading international researchers in the field of music and health to lecture and participate in the seminars, such as Stephen Clift, Brian Adams, Suzanne Hanser, Raymond McDonald, Patrik Juslin, Marcel Zentner, Gary Ansdell, Tia DeNora among others.
The growing “Arts and Health” movement also marked a change in the attitude towards how cultural behavior gains significance in health. Lars Ole Bonde, alongside Töres Theorell, published “Music and Public Health. A Nordic Perspective,” establishing music’s role in public health and folk medicine (Bonde and Theorell, 2018). Due to Bonde’s initiatives, Nordic researchers are invited to annual workshops on “Music and Public Health,” leading to ongoing research on music’s potential health effects within public health contexts.
Initiatives to measure public health involve handling vast amounts of data (Sund, 2009). The Danish Institute of Public Health, through another initiative from Lars Ole Bonde, and with some economic support from CREMAH, included questions pertaining to music and health in their annual investigation into the health of the Danish population.
As reported in the booklet by Bonde, Ruud, and Stensæth (2023), the study by Ekholm & Bonde (2018) showed that “people use music for many different purposes in everyday life, and that age is an important variable. It also documented how active amateur musicians reported significantly better health than both professional musicians and non-musicians, and that a majority of the population have a firm belief in music as a health resource. This belief was—unsurprisingly—related to how much respondents attended live music performances. The study also documented an association between parental support for providing music in childhood (privately and/or in institutions; formal and/or informal) and a later interest in music as a hobby or profession. Seen in the context of music education, it would be important to document a closer relationship between musical training and deliberate health musicking.” In conclusion, Bonde later wrote:
“These results somewhat contradicted cultural participation studies that found no extra benefit from active participation in cultural activities. The findings pointed toward a specific health potential of active musicking—especially for amateurs—and on this background, the researchers formulated a number of recommendations for public health initiatives (Ekholm & Bonde, 2018). Preventive and rehabilitative music activities and experiences (active as well as receptive, from small listening groups to community choirs) can fairly easily and at low cost be designed for special target groups, for example, men over 45 and, more generally, citizens over 65” (Bonde in Jacobsen, Pedersen, and Bonde, eds. 2019, 229).
While more research is needed to understand health musicking’s overall population impact, we have substantial evidence from music therapy for individual benefits. In 2020, I published the monograph “Towards a Sociology of Music Therapy: Music as a Cultural Immunogen” (Ruud, 2020), advancing the grounding of a theory of musical immunogens.
Further Implications
There are still many steps to take before music is included in health prescriptions alongside dietary and lifestyle advice from health authorities. However, awareness of the connection between cultural activity and health promotion is growing. This is evidenced by the many arts and health projects initiated in several countries around the turn of the century. The increasing acceptance of music therapy by health authorities and the public points toward expanding health musicking into the public sphere.
By considering the diverse practices of music therapy as a laboratory for health musicking, we can extract principles and contingencies that operate in health prevention, promotion, and therapeutic change. This knowledge shows how engaging in musicking can establish similar contexts and effects as music therapy, even without a therapist’s presence, as demonstrated in self-help books by Hanser and Mandel (2010) and Hanser (2024).
Some music therapists may view everyday health musicking as outside their domain, considering music therapy solely as a professional practice. However, within the discipline of music therapy, everyday health musicking is part of our domain and research interest. We can apply the knowledge and evidence from professional music therapy to public health and everyday musicking, thereby enhancing its role in health promotion.
Four Forms of Musical Antigens
A cultural immunogen is a metaphorical application of the term “immunogen” from medical science. During the COVID-19 pandemic, we became familiar with how scientists developed new vaccines containing various antigens to protect us from the virus. An antigen is a substance that protects us from being contaminated by a threatening virus. Metaphorically speaking, a cultural immunogen is a type of behavior within the cultural domain—specifically music—that might serve the same function as an antigen, not biologically but psychologically or metaphorically. Although there is interesting research in psychoimmunology on how listening to music might alter our immune system, this has not been my focus.
I have been looking for cultural immunogens related to musical behavior. This includes how listening to music, playing and learning an instrument, participating in choirs or co-singing, performing in rock bands and other musical groups, and attending concerts affect our subjective health and well-being. I have identified four categories of antigens to be elaborated on further below: agency, vitality, belongingness, and the experience of meaning.
Agency
There is a long tradition in music therapy of observing how musicking can enhance competency, foster identity, and promote empowerment. Participants in musical performances develop skills, build self-esteem, and gain a sense of accomplishment. Music acts as a powerful tool for self-expression and identity formation, allowing individuals to connect with their cultural roots, personal values, and shared experiences within a community. In many ways, how music strengthens our agency is fundamental to performing healthy behaviors. Agency is also connected to the other antigens, as there is an interactive relationship between agency, belongingness, and meaning.
Many theories show how our agency depends on how and what we think about ourselves and how we draw conclusions from our experiences. We know these theories explain how mastering different tasks influences our motivations and strengthens our self-esteem, self-confidence, perseverance, and willingness to overcome difficulties to obtain our goals, become empowered, and gain control of our lives.
Specific theories, such as Albert Bandura’s notion of “self-efficacy,” are important for understanding how our belief in our ability to perform specific actions influences the desired outcome (Bandura, 1977). Through self-observation of emotions, behavior, and thoughts, we evaluate our behavior and outcomes, which can strengthen or weaken our self-efficacy. Other people’s judgments and past experiences with success or failure also influence our self-efficacy. How we perceive earlier success impacts our self-efficacy, and positive feedback and encouragement play an important role.
Another important contribution to this bundle of theories comes from Self-Determination Theory (SDT), as proposed by Deci and Ryan (2000). The theory posits that the fulfillment of three basic needs promotes health and well-being: autonomy, competence, and relatedness. Autonomy involves feeling in control of our actions and choices and ensuring our actions align with our values and interests. Competence is important for experiencing efficiency in mastering our environment and achieving our goals. Relatedness involves feeling connected to others, being supported and cared for, and experiencing social belonging.
When these needs are satisfied, we develop intrinsic motivation, driven by internal factors such as self-development, fulfillment, and interest in the task itself. This internal motivation influences our locus of control.
The notion of “empowerment” is also crucial. Empowerment involves individuals or groups gaining power and autonomy in their lives, circumstances, and decisions. We strengthen empowerment by building self-esteem, self-confidence, and self-efficacy and supporting individuals in gaining autonomy, competence, and a sense of social belonging. Empowerment extends beyond personal or psychological processes; it includes social empowerment, enabling individuals or marginalized groups to access resources, opportunities, and rights, gain social recognition, and contribute to society. Community empowerment enhances capacities and power to address local issues, allocate resources, redistribute power, challenge oppressive structures, promote social justice, and foster collective action.
This theoretical background informs how we apply music-cultural antigens when addressing health challenges. We can learn from music therapy, its various practices, and professional experiences how different forms of health musicking or specific methods can provide agency or psychological or community empowerment. As we will see in the following sections on vitality, belongingness, and meaning, agency is always involved, either as a presupposition or an outcome of successful health musicking.
Vitality
The last decade has produced much research demonstrating how musicking is related to our emotional life. Musicking raises emotional awareness, helps conceptualize emotions, challenges our emotional tolerance, and provides a tool for emotional expressivity. Technological developments like the internet, streaming, and smartphones have made music accessible throughout the day, usable as a self-technology or aesthetic technology (DeNora, 2000) to regulate moods and energies. Music philosopher Joel Krueger (2019) writes about “music’s capacity to scaffold emotional consciousness, including the self-regulating processes constitutive of emotional consciousness.” In other words, we can use music to control, alter, and regulate our moods and emotions to adapt to our immediate goals.
Everyone has likely experienced varying levels of energy, vitality, or good spirits depending on the day. Some are fortunate to wake up every morning full of energy after a good night’s sleep, while others struggle to find the strength to get through the day. Vitality is perceived as an inexplicable force or energy source that enhances everyday life. If music can be a source of vitality, it will significantly impact our health and well-being.
In my previous discussions on music as a cultural immunogen and its connection to quality of life, vitality has been a central category alongside agency, belonging, and meaning. Reflecting on the many articles and book chapters I’ve written on this topic, I see that vitality has been used alongside terms like emotional attention, expressiveness, affective resonance, or joy and pleasure.
I haven’t used the term “vitality” in a reflective theoretical or systematic way, and I’m not alone in this. Many people take the term’s meaning for granted or attribute different meanings to it, leading to diverse understandings of the concept. Vitality is often used with terms like energy and vigor. The terminology for vitality in literature includes joy, sensation, experience, condition, situation, phenomenon, and positive affect. Researchers describe vitality as a dimension of health, mental health, and even as “health” itself. Studies show that vitality can indicate and predict well-being.
Philosophical and spiritual traditions, both in ancient history and Eastern religions, also describe vitality as a life force or energy that flows through living beings. In Greek philosophy, vitality was referred to as “enthusiasm.” Eastern traditions promoting vitality include yoga, Pilates, Reiki, Zen meditation, and Tai Chi, often conceptualizing vitality as a fundamental health-related force that can be enriched or depleted. The psychoanalytic tradition after Freud highlights that unresolved conflicts drain vitality. More recently, psychiatrist Daniel Stern has used the term “vitality affects” to describe affective experiences.
Finnish researcher Olga Lavrusheva (2020) has clarified the term’s use by conducting a scoping review of the literature, examining the extent of available research on vitality. Lavrusheva describes vitality as a fuel in everyday life, accessible to everyone, and links it to more than just physical energy. Vitality is described as an experience, a feeling, and a disposition. It is a fluid concept, a “boundary object” recognized but conceptualized differently by everyone. Research indicates that vitality is important for health, reinforcing physiological predispositions and enhancing rehabilitation effects. It has positive effects on psychological states, reducing anxiety, and increasing confidence and self-control.
Vitality is increasingly included in research issues, particularly in self-determination theory (SDT), which emphasizes the importance of autonomy, independence, and relationality for motivating personal growth and experiencing vitality. Conversely, control that weakens self-determined behavior depletes individual vitality.
Research links vitality with psychological states, social relationships, agency, and meaning in life. Psychological attitudes and dispositions leading to increased vitality include positive meaning, joy, inspiration, personal belief, positive mood, psychological security and purpose, self-actualization, self-esteem, autonomy, spiritual strength, and mindfulness. Autonomy, competence, and “relatedness”—being in relation and finding resonance in life investments like family, friends, music, cultural interests, or work—are crucial.
Self-determination theory highlights factors like motivation for mastery, following one’s interests, focusing on goals, experiencing autonomy, and self-regulating behavior, which can be linked to using music in emotional regulation. Competence, or believing in one’s abilities to achieve goals, is crucial here. The need for belonging—social support, interactions, and participation in joint activities, another cultural antigen—is also associated with vitality. When existential meaning, competence, agency, and belonging are linked to vitality, all aspects of music and quality of life that music therapists deal with can be connected to vitality. Physiological conditions also relate to vitality, though we’ll leave them aside here.
Emotional Regulation
Emotional regulation is a central theme in psychology and must be connected to vitality. It involves naming a feeling, tolerating it, and giving it expression. We regulate our emotions by changing them, making feelings disappear, or prolonging them. We can regulate away unpleasant emotions, calm ourselves down, and remove stress. We can transform a dark mood into a brighter one.
We use specific strategies to regulate emotions and mental states. One strategy involves confronting unpleasant emotions, thinking through situations, and helping ourselves transition to a better state. Another well-known strategy is reappraisal, where we try to think about the situation and mood rationally (“it probably wasn’t meant that way…”). Rationalization is another approach, where we relate to the situation realistically (“this isn’t the end of everything, it usually passes”). We can also vent our emotions and express them or engage in active adaptation by doing something about the situation, such as confronting a person or starting a long-overdue task. Introspection, where we try to understand our own feelings, is another strategy. Sometimes, we suppress emotions by avoiding the feeling, mood, or thought altogether.
We have a repertoire of tactics and strategies to deal with emotions, and music is one of many methods we use to change a mood, raise energy levels, or reduce tension. Numerous tactics contribute to emotional regulation: taking a bath, going for a run, breathing exercises, keeping a journal, sleeping, self-soothing, and so on. The question is whether music holds a special position among these tactics and whether it plays a unique role in emotional regulation. With a rich variety of music forms, artists, and individual pieces, music proves to be a potent source of emotional regulation.
Music, or musical engagement, can be part of the set of tactics we choose from to gain control over our emotions. Music is closely connected to emotions, and most people have experienced how music affects their feelings. Playlists are often named after the mood we want to set. In this way, music becomes an effective tactic for influencing our emotions. Music can involve everything from listening to music we like, playing alone or with others, attending a concert, singing in a choir, or dancing.
Swedish music psychologist Patrik Juslin has proposed a model for the mechanisms that may be involved when music triggers emotions, known as the BRECVEMA theory. Each letter points to different mechanisms activated when we engage with music. The “B” (Brain) refers to the brain’s role under the influence of music. Sometimes our brainstem reacts reflexively when we are startled by a loud, sudden sound, such as in a cinema. Here, it is not necessarily the music creating the feeling, but the sound itself. “R” (Rhythm) in music can influence our emotions. Rhythmic “entrainment” refers to how our body starts interacting with the music, even affecting our pulse.
Juslin’s concept of “Evaluative conditioning” (E) involves a specific piece of music repeatedly played in conjunction with a particular event that made us happy or sad. When we hear this music again, the same feeling arises, a process known in psychology as conditioning. Emotional contagion from the music also plays an important role. For example, an individual might feel that the music resembles their own emotions. Artists and musicians play a crucial role when they convey emotions through instruments and voice. The music resembles the emotion, having specific gestural character, dynamics, vitality form, contour, and emotional curve that remind us of a feeling. Many theories and concepts in music psychology support this central point in understanding why music triggers emotions.
Visual imagery (V), or images we form while listening to music, can also trigger emotions. The same applies when music evokes memories of specific episodes (E) in our lives, known as episodic memory in psychology. The well-known theory “Darling, they’re playing our tune” illustrates this, where music reminds us of significant life events and evokes feelings associated with a particular piece of music. Such emotional reactions can be quite incomprehensible to an outsider.
For many, the music itself is a crucial factor in emotional reactions—music we like, music that has accompanied us throughout life, or music with lyrics we respond to. This pertains to our aesthetic response to music. The context in which the music is experienced also plays a significant role in our perception. Music can accompany daily activities, dance, singing, or concerts. Thus, music can enhance other tactics and strategies. It can be challenging to isolate these mechanisms in BRECVEMA from one another. When music is used for relaxation, the most common tactic in emotional regulation, it may lead us to become more rational. As we relax, we can employ more strategies to handle an emotional challenge.
Research shows that most emotions induced by music are positive. The American psychologist Barbara Fredrickson has demonstrated how positive emotions are crucial for our mental health. She states that positive feelings expand our thought and action repertoire. They create a free space and make us feel good. Positive emotions combat negative thoughts, foster reorientation, and provide new opportunities for action.
Not all emotional regulation is beneficial. Some young people use music to escape from everyday life and to ruminate on negative experiences. Instead of confronting difficult feelings, they can be suppressed or ventilated in ways that exacerbate problems. Music is used to sustain unpleasant emotions, which can have adverse effects, sometimes harmful to health, leading to depression and antisocial behavior.
Sometimes the harmful use of music is linked to specific musical genres and styles, such as heavy metal, leading to erroneous conclusions. Instead of talking about potentially harmful music, we should discuss harmful forms of musical engagement and ways of using music. The same music that can amplify anger, sadness, and depression for some can be vital for others. However, listening to music and lyrics expressing darkness and sadness can lead to depression in people vulnerable to such moods if they listen to it for extended periods.
Researchers now warn against polarizing the effects of music listening as either harmful or beneficial. Katrina MacFerran points out that there can be gradual transitions between listening that leads to rumination and isolation, to experiences of withdrawal, escaping problems, and self-comfort. From feeling overwhelmed by stressful emotions and pessimistic thoughts, listening can also lead to optimism and vitality. In a more optimistic state, emotions can be regulated and diverted from the negative; one can calm down, reassess situations, and move towards experiences of relaxation and inspiration, enjoying the music and gaining new energy. MacFerran also emphasizes that the same piece of music can be part of this journey as the listener defines the experience in light of their situation. Here, intention plays a significant role, as the person is aware of what they want to get out of the music. This is where music therapists can help by making the person aware of their music use and assisting in creating playlists.
Belongingness and Social Participation
A fundamental characteristic of music is its ability to create a sense of togetherness and belonging. As we have noted, a major issue in contemporary society is the widespread sense of social isolation. Loneliness and social isolation are major threats to health. Amateur music provides numerous ensembles—choirs, bands, orchestras—that offer participation and the opportunity to experience belonging to a community. Keywords from the literature include network, “bonding and bridging,” and social capital, all of which point to how musical communities can provide a context for cultural antigens to counteract the adverse effects of social isolation.
Norwegian sociologist Tjora has identified seven categories for understanding how a community can be created: solidarity, integration, interaction, identification, communication, work, and presence (Tjora 2018). Health musicking practices often align with these categories, especially in the realm of community as interaction. Here, the essence of community is rooted in social interactions and negotiations among people. Using concepts from symbolic interactionism and ethnomethodology, we can examine processes and situations where communities are formed and evolve. Tjora’s concepts can be applied to musical events in health musicking, helping us understand the meanings, occasions, and values of musical communities.
From an ethnomethodological perspective, communities are created through members’ interactive production of the normal and expected, constituted through local practice. The essence of community lies in these negotiations and interactions. For instance, in a rock band rehearsal (which we may term a ‘composition community’), these dynamics are at play.
Tjora introduces the concept of “interaction ritual chains,” derived from American sociologist Randall Collins. Through micro-sociological analyses, Collins demonstrates how social membership arises from shared focus and emotional entrainment, creating self-reinforcing feedback processes that lead to “moments of emotional experiences,” which become “motivational magnets” of cultural significance. This concept is integral to musicking in ensembles, where situations become the starting point for community. These situations can form a chain of interaction rituals over time, contributing to the creation of emotional energy that is linked to individuals and unleashed in social contexts (see also Stige and Aarø, 2012; Tuastad, 2024).
This is reminiscent of sociologist Durkheim’s concept of collective effervescence—vital energies that are overstimulated, leading to stronger passions and more intense emotions. Such collective emotions, regulated rhythmically towards song and dance, enhance the feeling of community and bring individuals together.
Tjora introduces several other concepts for community formation, such as festivals as situational communities, emotional communities, and co-presence vigilance. These concepts can be used to study music community exercises at both macro and micro levels (Tuastad, 2024).
Research on Musical Togetherness
There is significant research on how musical communities, ensembles, bands, music groups, and especially choirs contribute to promoting subjective health. Notably, various types of choirs have emerged aimed at specific medical and psychological conditions. For instance, there are choirs for people with COPD and breathing difficulties, choirs for language rehabilitation after brain injuries, dementia choirs, and choirs for people with mental health issues. The literature also includes choirs for people in special situations, such as choirs for the homeless, choirs in prisons, and choirs for people in refugee camps.
Regarding instrumental ensembles, research has been conducted on orchestras in refugee camps, laptop orchestras, drum circles, ukulele groups, brass bands, MIDI keyboard ensembles, and rock bands for older women (English, 2022).
As noted by Wood and Torras (2022), we find ensembles in various forms—in closed formats, as well as in gatherings of people defined as clients together with music therapists, assistants, other musicians, and the audience. Ensembles are influenced by the social spaces where the music-making takes place, instruments, architecture, furniture, guidelines, musical, health-political, and cultural forces, etc. Thought of within such an “assemblage,” to adhere to poststructuralist theory, there are no clearly defined boundaries for what an ensemble is (Wood and Torras, 2022). Additionally, there are numerous theoretical frameworks from which ensembles or musical groups can be understood.
From a public health perspective, it is important to study how the adult population can benefit from participation in musical ensembles. Karen Burland (2022) has examined how participants in four British instrumental ensembles, all consisting of adult amateurs, perceive the impact of participation on their identity formation and personal development. She discusses the findings from this musical leisure activity in relation to how people typically experience their working lives. Burland identifies five dimensions of participation in such instrumental ensembles: group affiliation, opportunities for learning, joy and renewal, well-being and health, and a summarizing factor related to music and identity.
Participants highlight the experience of belonging to a group with similar interests and values (like-minded others). The joy is linked to the social aspects of music-making, as well as the reward of achieving something together with others. The ability to immerse oneself in the collectively created sound provides a sense of self-worth and meaningful contribution. Friendship and belonging, meeting new people, regular social interaction, and feeling part of a community with shared interests create a sense of responsibility towards the ensemble that goes beyond the individual desire to make music.
Another category pertains to the desire to learn and develop new skills, and to be challenged within a supportive learning environment. The degree of challenge, the atmosphere, and the support from fellow musicians are crucial here, as is the tolerance for mistakes and the feeling of encouragement without being overwhelmed. Regular practice can be important, along with a positive social atmosphere that enhances enjoyment and trust.
Joy and renewal are closely linked to group affiliation but also to the music-making itself. Music can be experienced as rewarding, with participants feeling they receive more than they contribute. Participants do not find the music too demanding, but rather that musical participation is intrinsically rewarding. Participation feels rejuvenating, overcoming fatigue and anxiety associated with the workday.
Health and well-being pertain to engaging in music and experiencing the “flow” state that allows participants to forget time, the workday, and personal worries, leading to relaxation and de-stressing. Older participants experience mental flexibility. For those with busy jobs, housework, and children, music-making creates a sanctuary, a time to do something for oneself.
Regarding identity, Burland also finds that participation in ensembles contributes to participants feeling special, as if they are part of something that provides a sense of self-realization, extending beyond the identity achieved through work. When ensemble participation is compared to working life, it clearly shows how the musical community compensates for many negative aspects experienced at the workplace, such as stress, repetitive tasks, exhausting work, negative experiences, lack of respect, workload, and poor management. In contrast to these experiences, music-making is filled with joy and personal benefit.
There are many ways to categorize the responses from such qualitative studies. Others might highlight the opportunities for achieving a sense of mastery through participation. This is particularly relevant for participants from underprivileged groups. Participation in ensembles fosters empowerment, which involves developing a sense of agency, control, greater autonomy, purpose, and meaning.
Other studies emphasize communicative dimensions, both within the ensemble and outward towards an audience. Research by Bailey and Davidson (2010) on choirs for the homeless highlights the importance of social communication between choir members and the audience. The same applies to research on choir participation for inmates in prisons, where individuals experience being seen and recognized in a different light than just as inmates and criminals. Other aspects highlighted include respect and recognition, the value of collaboration and supportive relationships, creating space for others, and developing listening attention, empathy, and sympathy.
Much of this research on collective music-making, health, and quality of life focuses on various types of choirs, but there are also examples of research on a range of ensembles. When evaluating this research, it is useful to ask whether different ensembles can provide the same benefits, whether they are instrumental groups or rock bands. We can also question whether the genre plays a role or if gender and age are variables worth considering. In discussions about effects, we should also ask whether the impact is due to the music itself or the social practice.
Social context can be important, and from a public health perspective, it is interesting to know if choirs and ensembles in workplaces can create a good work environment. Two Norwegian choir researchers, Anne Balsnes and Dag Jansson (2022), have pointed out how workplace choirs can change how colleagues perceive each other. The shared music-making creates challenges that can bring participants out of their comfort zones, facilitating learning processes and breaking down hierarchies within a work environment. Recently, in Norway, we have seen how absence from work due to illness has increased, especially in cases of long-term illness. One important step to bring people back to work will be to arrange the workspace in such a way that people thrive and gain energy from work instead of being drained. Choirs or co-singing during the week may be an opportunity for improving the work environment.
When we ask what it is about collective music-making that provides positive experiences, some point to the importance of socio-emotional synchronization and entrainment that occurs through shared music-making. It is plausible that cooperation, a sense of closeness, and social bonding are facilitated through the experience of being in sync with others (Rabinowitch and Gill, 2022).
Meaning and Transcendence
Health musicking not only facilitates empowerment, agency, belonging, social interaction, and personal growth, but also provides profound experiences of meaning and transcendence. Strong emotional experiences, described as “kama muto” in many cultures, are central to these transcendental moments (Swarbrick, 2023). As documented by Swedish music psychologist Alf Gabrielsson (2008), people often report strong emotional experiences in response to listening to and performing music. These experiences often lead to a sense of resonance, a concept explored by sociologist Hartmut Rosa (2022).
Resonance
Hartmut Rosa examines how rapid economic and technological advancements create a hectic pace and stress in modern life, often diminishing the quality of life. He introduces the concept of “dynamic stability,” the continuous need for resource expansion and growth to maintain economic stability, leading to a cycle of perpetual striving and hastened living.
Acceleration, a hallmark of modernity, is characterized by rapid transportation, communication, and production methods, creating a “time crunch” mentality and necessitating multitasking. This constant influx of technological innovations demands perpetual adaptation, fostering urgency and immediacy. Individuals often prioritize urgent tasks over meaningful pursuits, feeling perpetually time-strapped.
Rosa argues that while a fast-paced lifestyle isn’t inherently negative, its detrimental effects surface when it leads to alienation. This pervasive acceleration results in a sense of detachment from the world, creating a silent, cold, and rigid existence devoid of meaningful connections. Alienation causes profound disconnection from both people and surroundings.
The solution, according to Rosa, lies in “resonance.” Resonance signifies a profound relationship with the world, where individuals and their environment mutually influence and transform each other. This resonance stems from genuine encounters and engagements that deeply impact individuals. However, resonance cannot be contrived or controlled; it is inherently unpredictable and arises from authentic interactions.
Rosa’s framework of resonance includes three axes of connection to the world: relationships with others, engagement with the material world, and connections to transcendent realms such as art, nature, and spirituality. Music occupies a central role within this framework, facilitating profound engagement and resonance.
Entanglements
By examining musical antigens in isolation, we may miss how they are interconnected. Participation in music can be understood through concepts such as network, belonging, and its relation to agency, empowerment, and meaning-making. In music therapy literature, agency is about how musicking under the right conditions can be a source of mastery, self-confidence, increased competency, and self-efficacy. This agency is at play whenever we engage in musical performance, listening, and discussing music.
Within a resource-oriented practice, music therapists have learned how people come to musicking with resources and competencies to be recognized, acknowledged, and expanded. Engaging in musicking involves cognitive, emotional, socio-communicative, and motor behavior, offering opportunities for intellectual growth, self-determination, and empowerment.
Health Musicking in Everyday Life
As we have seen, there are various ways to influence one’s health behavior through musicking. In music therapy, four major approaches to health musicking are employed: listening to music, performing, composing/songwriting, and improvisation. In therapy, a music therapist is always present to help, direct, and support the individual in achieving health. In the context of everyday use of music to improve one’s subjective health or to regulate stress, anxiety, or mood, we need to specify some of the musical strategies and emphasize the personal effort required to initiate changes in behavior and lifestyle. Musicking is no easy solution to distress; it requires planning, lifestyle choices, motivation, and perseverance to achieve the desired goals.
1. Musical Performance
Learning to play an instrument can have lifelong consequences for activating cultural immunogens. It will increase your interest in music and have lasting effects on self-esteem, self-concept, and sense of competency. Musical skills provide access to playing with others, performing our identity, being part of musical communities, and creating a sense of belonging. Co-singing, choirs, rock bands, orchestras, drum circles, and online group improvisation offer opportunities for networking, bonding, and bridging. Long-term involvement is a major source of resonant and meaningful experiences.
2. Listening to Music
Listening to music offers opportunities for emotional regulation, increased energy, aesthetic experiences, and deepening musical connections that can lead to resonant experiences. Developing musical references and forming musical tastes provide a rich foundation for developing strategies for emotional regulation and creating playlists for use in everyday health musicking. By providing bodily experiences, listening to music can increase the sense of vitality and lead to a sense of well-being.
3. Musical Autobiography
Reflecting on your musical history, the situations and experiences where music has touched you or been a part of life-changing circumstances, can be recorded in a musical autobiography. Writing an autobiography or narrating your life through musical experiences can evoke memories of turning points in life. A musical autobiography helps create a sense of continuity, crafting a meaningful lifeline and assisting in sorting out resonant experiences.
Self-Help Books
Sometimes, being involved in music may not automatically lead to better health. Issues such as anxiety, depression, stress, and pain require thought and effort to overcome. Several serious self-help books specifically address how to incorporate music into a process of health promotion and prevention (Hanser and Mandel, 2010; Hanser, 2024). These books, authored by highly skilled music therapists, are supported by personal experiences and references to updated research.
What becomes evident from these books is that there is no easy “quick fix” to using musicking to influence one’s health. Hanser and Mandel (2010) detail how much of the work typically provided by music therapists is now left to the individual user. This means setting goals, assessing distress, providing a detailed account of musical tastes, and understanding how personally selected pieces of music affect your body, emotions, and thoughts. To support this assessment process, you will need to record your observations to make a plan for the health musicking process. It will take motivation, time, and endurance to reach these goals.
Creating Personal Playlists
When it comes to listening to music, you can create your own personal playlists. These should be selected from your preferred genre and thoughtfully evaluated through a process of reflexive listening. There might be playlists to help transition from a sad mood to a happier one, lists that provide energy, or playlists designed to calm and support. According to the iso principle, you should start listening to music that matches your current mood and then gradually shift to music that reflects your desired mood. This process, known as “entrainment,” means that physical movement, breath, and emotional responses synchronize with the music. Listening to music while doing relaxing exercises or becoming aware of your breath can help regulate both body and emotions.
Lyrics can play an important role. In stressful situations, we might need to stop the flow of negative thoughts and worries, possibly breaking dysfunctional thought patterns that lead to a depressive state. Hanser (2014) suggests developing self-affirmative thoughts and a repertoire of jingles to remind and support us in overcoming negative thoughts. “Power songs” illustrate how music can serve self-affirmative purposes. Beyoncé’s “Run the World,” Miley Cyrus’s “Flowers,” and Lady Gaga’s “Born This Way” are suggested as illustrative examples.
Singing, whether songs or mantras, can also reduce blood pressure, anxiety, and depression, increase breath control, and alter brain waves, according to research.
Self-Help Strategies for Stress, Pain, Depression, Anxiety, and Insomnia
The aforementioned “health musicking” antigens provide a general foundation for understanding music as a cultural immunogen. These antigens primarily address psychological issues such as agency, vitality, the effects of social isolation, and a sense of meaninglessness. While these antigens do influence our physiology and bodily states, more focused activities are often needed to address persistent health challenges related to stress, anxiety, insomnia, and pain. For such physical well-being challenges, we can learn strategies and techniques from music therapy to help in the self-administration of music. Self-help literature produced by music therapists offers advice and procedures for applying music to mitigate stress, pain, anxiety, and insomnia.
Stress
Negative stress is a major source of bodily distress leading to various health challenges. Research indicates that music can reduce both stress and pain. Listening to music has been shown to lower cortisol levels, the hormone associated with stress, and can decrease the perception of pain, which often causes stress. Music’s soothing effects on the mind and body help create a relaxing environment, reducing stress and providing a distraction from stressful moments.
For stress reduction, music therapy often involves creating a calming atmosphere with slow tempos and soft melodies. This can help slow heart rate and breathing, lower blood pressure, and induce a state of relaxation.
Pain
Music therapy for pain management can include both passive listening and active engagement, such as singing or playing instruments, to help divert attention from pain and promote positive emotions. According to the International Association for the Study of Pain (IASP), pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This definition emphasizes the importance of the subjective experience of pain, highlighting that negative thoughts, particularly when stressed, can intensify the pain.
There are several types of pain: nociceptive, neuropathic, idiopathic, and psychogenic. Additionally, procedural pain is often described in music therapy literature.
• Nociceptive pain occurs when nociceptors, nerve fibers that conduct pain signals to the brain, are activated due to actual or potential tissue damage.
• Neuropathic pain results from nerve or brain damage and does not necessarily stem from a pain-inducing stimulus, often considered “false” pain. Phantom pain is an example.
• Idiopathic pain has an unknown cause, such as pain in the back, muscles, neck, and shoulders.
• Psychogenic pain is caused by psychological factors, with psychological issues manifesting as physical symptoms.
Pain can also be categorized as acute, chronic, visceral, or referred:
• Acute pain is temporary and comes on quickly.
• Chronic pain lasts longer than three months.
• Visceral pain originates from internal organs.
· Referred pain is felt in a different part of the body than where the source of the pain is located.
Historically, pain was thought to be processed by a specific center in the brain. However, the Gate Control Theory introduced in the 1960s suggests that pain impulses can be blocked or amplified en route to the brain, indicating that the brain can alter the pain experience. The Neuromatrix Theory, a more recent development, connects pain with activities in a network involving multiple brain areas, suggesting that genetics, culture, and learning influence pain perception. This theory supports the use of music in medical procedures, as music therapy interventions can modulate neural patterns associated with pain.
Pain is associated with a lack of relaxation, and fear of pain increases bodily tension, which in turn increases pain. Music can interrupt this cycle by providing relaxation and distraction, thereby affecting our perception of time and making periods of pain more bearable.
Anxiety
A recent review article highlights that listening to music can reduce anxiety and worries. Anxiety is one of the most prevalent mental health issues; in the USA, 18 percent of the population has experienced an "anxiety disorder" in their lifetime, with only 20 percent receiving treatment. The diagnosis of "generalized anxiety disorder (GAD)" involves excessive worry and fear, often negatively impacting daily life.
Common treatments for anxiety disorders include medication and cognitive-behavioral therapy. If listening to music can yield positive results, it could reach many more people, providing advice and guidance regardless of distance, and helping individuals influence their own mental health. After Covid-19, the incidence of anxiety disorders has increased, along with the need for help. Greater awareness of how music can help could extend resources in the mental health field where they are often scarce.
Several possible explanations for why anxiety is reduced when listening to music are found in the literature. Physiological explanations include stress reduction, affecting heart rate and blood pressure. Emotional self-regulation is another factor, where music is used to change emotional states.
A review found that listening to music significantly reduces anxiety across all groups studied, whether in everyday settings, within the criminal justice system, or among people with memory challenges. This effect is linked to music's ability to regulate emotions, although the specific mechanisms were not tested. The length of listening, group listening, researcher-chosen music, or other conditions did not significantly affect the results. Everything seemed to work positively, highlighting the potential for individuals to manage their own anxiety through music.
This field is accessible to everyone—laypeople, healthcare workers, music therapists and in eventyrdagene health musicking. In carefully designing playlists individuals may come to understand the regulating effects of music. To bring an open-minded approach to music, recognizing how musical taste and identity are related, may help people to construct playlists to meet different challenges.
Depression
Depression is a condition characterized by a lowered mood (feeling sad and down), loss of interest and pleasure in activities that were previously enjoyable, and feeling that one has less energy than before. Depression is one of the most common mental disorders. In Norway, it is estimated that between 7 and 10 percent will experience a depressive disorder within a year. Women are affected twice as often as men.
A search on the internet with "music and depression" as keywords yields numerous references to individual studies and meta-studies that show the positive effects of music therapy (Albers et al., 2017). One of the most cited studies is the Finnish RCT study, which was published some time ago in the reputable journal The British Journal of Psychiatry (Erkkilä, Punkanen, Fachner, Ala-Ruona, Pöntiö, Tervaniemi, 2011). In a commentary on this study, three British researchers highlight how it is the musical activity itself that is decisive for the effect on depression (Maratos, Crawford, and Procter, 2011). They can assert this because the Finnish study involved several therapists who performed musical improvisation according to a carefully specified protocol. This suggests that it is not the therapist's personality or the therapeutic alliance or relationship that can explain the effect on the state of mind.
If the effect can be explained by the musical activity itself, this could indicate the potential for transfer to situations involving musical activity without the presence of a music therapist. Maratos, Crawford, and Procter propose three factors that may contribute to music having a beneficial effect on low mood and depression. Firstly, they say, the musical activity itself has an aesthetic value that is meaningful and brings joy. To the extent that depression involves a loss of meaning, the aesthetic qualities that emerge, whether through interaction or listening to music, function to establish or maintain the "resonance string" that Rosa refers to as significant. In music aesthetics and music psychology, we find several theories about how music creates and gives meaning to the listener.
The next factor the authors highlight is the physical aspect of performing music, which involves getting people active and providing a sense of themselves as physical beings. This also relates to the nature of music, its ability to engage us in musical processes. Even if we feel unmotivated, we can experience so-called entrainment, where we are drawn into interaction with others and experience cooperation and interplay. The third category they suggest may help explain the effects of music can be seen as an extension of physical involvement and relates to the relational aspect. This reference goes back to early experiences of musical interaction, known as communicative musicality.
Insomnia
Lack of sleep, sleep difficulties, and severe sleep disorders are significant health challenges today. Many people, especially youth, struggle to put away their smartphones before bedtime, often reported in the news alongside tips for improving bedtime routines. Surveys show that about 27% of the population reports issues with insomnia, which includes subjective complaints about sleep disturbances, such as the quality, duration, or continuity of sleep, as well as the time it takes to fall asleep. Insomnia involves problems with maintaining sleep, waking up too early, or not feeling rested after sleep (Jespersen, Koenig, Jennum, and Vuust, 2022). According to the Store Norske Leksikon, there are several classification systems for sleep disorders. The ICSD-3 contains more than 100 diagnoses in six subgroups (see more in Waage, 2024).
An internet search reveals a wealth of research on sleep problems, including studies specifically on the use of music. These include individual studies with selected music for small groups, systematic reviews, and meta-studies, as well as research on music choices and characteristics of “sleep music.” Self-help literature also recommends listening to music combined with breathing and relaxation techniques to fall asleep, as suggested in Suzanne Hanser’s new book (Hanser, 2024).
Research on sleep architecture involves understanding the time it takes to fall asleep, the different phases of sleep from light to deep sleep, and the various brain activities from fast to slow brain waves, as measured by EEG. Subjective measures, such as questionnaires often based on the Pittsburgh Sleep Quality Index, are used alongside more comprehensive and objective measurements like polysomnography, which captures a range of physiological reactions during sleep.
Both short-term and long-term sleep deprivation leads to various physical and mental problems. Sleep quality plays a crucial role in well-being and quality of life. Lack of sleep can lead to issues such as poor concentration, anxiety, weakened immune system, high blood pressure, chronic pain, breathing difficulties, fatigue, absenteeism, and increased risk of accidents. Medication is not recommended as its effects diminish over time, can lead to dependency, and cause long-term side effects (Jespersen, Koenig, Jennum, and Vuust, 2022).
Research Findings
A meta-study from Cochrane analyzed 13 studies with a total of 1007 participants who listened to pre-recorded music for 25-60 minutes over three months. The analysis showed moderate to strong evidence that sleep quality improved, primarily for those with moderate sleep problems rather than severe sleep disorders. Improvements included the time it took to fall asleep, the duration of sleep, and sleep efficiency (the proportion of time spent in bed that was actually spent sleeping). However, listening to music had no effect on interrupted sleep.
The improvement mainly concerned the subjective experience of music’s effects, with inconsistent results for objective measures (Jespersen, Koenig, Jennum, and Vuust, 2022). The authors of the meta-analysis note that more research is needed to understand the effects of music listening on different subgroups of sleep difficulties.
Research also indicates that listening to music before bed is one of the most common measures people take to improve sleep quality. A large online survey shows that 62% of respondents have used music to fall asleep at least once. Various other studies and review articles also suggest that people find music beneficial for improving sleep quality. One study found that listening to music an hour before sleep affected the duration of deep sleep, which produces slow brain waves (Delta waves) (Cordi, Ackermann, and Rasch, 2019).
Individual Differences
There are significant variations in how people use music, and researchers discuss possible reasons for individual reactions to music. This includes not only the type of music people prefer to fall asleep to but also the rituals associated with music listening, such as breathing techniques or cognitive strategies to distract from racing thoughts that can hinder sleep. Other explanations include music masking noise or being conditioned to associate music with a good sleep strategy. Music’s effect on the autonomic nervous system is also mentioned, as is how music listening can reduce stress and anxiety.
One reason for individual differences is the varying levels of motivation among listeners. Research shows that people listen to music before sleep for four main reasons: to change their mental state, to feel safer, as a distraction, or out of habit. Motivation is also linked to music preferences, which is worth investigating further. For example, the effects of music are suggested to be most effective for people more susceptible to suggestion. Research indicates differences in how people respond to hypnosis or placebo effects. A hypothesis that suggestibility could influence music’s effect on a short sleep period (a 90-minute nap) in a group of women showed positive effects even on those less susceptible to suggestion (Cordi, Ackermann, and Rasch, 2019).
Many attempts have been made to determine if a particular type or genre of music is best for promoting sleep. Previous research indicated that classical music is the most common genre people listen to before bed. However, with new technology, it’s possible to analyze large amounts of music people use as sleep aids. Spotify tracks playlists, genres, and music forms associated with “sleep.” This music can be analyzed with modern digital tracking to identify common characteristics across different playlists.
A research team found 225,626 audio tracks on Spotify linked to “sleep” (Scarratt, Heggli, Vuust, and Jespersen, 2022). Generally, this sleep music was softer, slower, more instrumental (less use of lyrics), and featured more acoustic instruments compared to the general music on Spotify. However, there was significant variation. The researchers identified six subgroups, with three containing music that was faster, louder, and more energetic than the average “sleep music.” This highlights the large individual differences in music choices for sleep quality.
Potential Effects of Music
We saw earlier that music’s effects could depend on individual factors, such as suggestibility. But we can also ask if there are characteristics of the music itself that explain its effects. We know from other studies that we prefer to listen to music with reduced tempo, energy, and volume at night and in the morning, and again in the evening. Research shows such music can lower arousal levels, possibly through entrainment with autonomic biological processes related to respiration and heart rate during music listening. This entrainment also applies to brain activity levels.
However, as noted, effects also occur with more energetic music. An example researchers mention is the use of the upbeat song “Dynamite” by the K-pop band BTS, which has syncopations, melodic grooves, and a busy rhythm section, and appeared in 245 instances as sleep-inducing. One reason this music might be used in sleep rituals is its familiarity, allowing listeners to predict its musical progression easily. The brain continually makes predictions about what will happen next. If something deviates from expectations, the brain becomes alert and makes new predictions. Familiar music requires less brain energy, which could be a hypothesis worth testing.
Music seems primarily effective for milder sleep problems, and it’s important for people to choose their own music. More research is needed on specific hypotheses, such as how genre preferences, motivation, and the use of music with other relaxation techniques and bedtime rituals, as well as factors like age, gender, and musical background, play a role.
It may be necessary to create effective playlists and teach relaxation exercises. It’s also important to remember that people with sleep problems typically do not seek medical help but try to find other solutions independently. The music chosen for playlists should be tested. To create a good playlist, one must pay attention to how their body and breathing respond to the music during listening, according to Hanser (2024).
Summing Up
Sociologist Tia DeNora writes about the importance of creating a space, an asylum, where we can feel free from stress. A place where we have control, feel comfortable, are creative, and can act according to our own interests. DeNora describes two different tactics or strategies to achieve this. We can withdraw from reality for a while by listening to music, watching a movie, reading a book, sleeping, traveling, eating, drinking, playing Yahtzee, or watching TV. We can also choose a more active way to recuperate, such as singing in a choir, writing a blog, playing in a band, participating in church activities, or learning a new language. The difference between these two forms of recuperation, what DeNora calls “removal” and “refurnishing,” is that through the latter, we develop skills that we can invest in new social experiences with other people.
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