Abstract
 

For centuries, the therapeutic use of music has promoted healing and positivity for humans worldwide. Inspired by these qualities of music, this paper analyzes the effectiveness of music therapy from multiple lenses. First, it offers an overview that underscores the widespread use of music for beneficial purposes across time and cultures. This paper then draws upon contemporary scientific research to reinforce the positive role that music can play on mental health, surgical procedures, physical pain perception beyond surgical procedures, and child care. In order to provide a holistic understanding of music therapy, an examination of its limitations and recommendations for improvement are also integrated throughout this research. Lastly, this paper concludes by encouraging professionals to recommend music therapy for their clients in a variety of settings and advocates for continued research into this promising field.

Overview

In communities worldwide across the ages, the relationship between music and positivity was prominent. Dating back centuries, there was a common global belief that music can have an impact on the mind and body, and also align the soul with the harmony of the cosmos (Pieragostini). In fact, the healing power of music is a frequently occurring topic throughout history. It exists across “...a range of musico-theoretical, encyclopedic, and philosophical writings of the medieval and early modern periods” (Pieragostini). Multiple historical examples across time and cultures refer to musicians being sent to private homes to cure serious afflictions. The Chinese character that represents the concept of ‘medicine’ includes the character for ‘music.’ In ancient Greece, music was also used to ease stress, promote sleep, and soothe pain (Wong et al.). Furthermore, Native Americans and Africans used singing and chanting as part of their healing rituals. Even in medieval Italy, “...the Bolognese authorities’ belief that music can not only help maintain the health of mind and body but also cure a negative passion resonates with the notion of music’s healing power occurring in earlier and contemporary writings” (Pieragostini). This was partly because music was mentioned by physicians among possible remedies that could soothe melancholia, a disorder related to an excess of bile that might have resulted in a humoral imbalance in peoples’ brains. 

There are multiple ways through which music has been shown to impact human health for the better. All of these methods seem to stem from the fact that humans are rhythmic beings. “Our heartbeat, breathing, and brain waves are all rhythmic. The human brain and nervous system are hard-wired to distinguish music from noise and to respond to rhythm and repetition, tones, and tunes” (Komaroff). In light of this phenomenon, people are able to use music through a process of self-regulation and ground themselves in calmness. In fact, this assertion is supported through scientific research. “Neuroscientific studies have shown music to be an agent capable of influencing complex neurobiological processes in the brain and suggest that it can potentially play an important role…” (Shuai-Ting et al.).

Although music has multiple benefits for helping people amidst times of adversity, there are limitations to how it is defined and its usage. Defining music and its most beneficial genres can be difficult. This is because music can be highly personal and subjective. For instance, does the sound of rippling water qualify as music or is it just a control condition? Some researchers argue that rippling water cannot be defined as music because it lacks a structured rhythm or melody (Thoma et al.). Other researchers, however, define music in much broader terms. They state that sounds such as rippling water can be considered music because they are auditory stimuli that evoke certain emotional responses in people. 

No matter how music is defined, different tempos and melodies of music can have varying effects on people. “Soothing music, like Debussy’s ‘Clair de lune’ or George Winston’s ‘Moon,’ have different effects on the heart and body than something more rousing, like ‘Seventy-Six Trombones’ from The Music Man, Puccini’s ‘Nessun dorma,’ or almost anything from the Red Hot Chili Peppers” (Thoma et al.). Yet even this seemingly straightforward assessment can be problematic. Although a piece of music may appear to be calming because of its objective characteristics, people may associate emotional memories with it that can impact their recovery process. For example, a ‘soothing’ song like ‘Clair de lune’ may not be relaxing for people who associate that song with a traumatic period in their lives. In light of this, it is important for music therapists to provide patients with some agency in the selection process. This can be achieved by allowing patients to notify music therapists about any negative associations with certain pieces of music before it is used to try to help them across a variety of domains including mental health, surgical procedures, and pediatric care. 

Mental Health

Music has also been shown to exert a positive impact on listeners’ mental health. This is particularly true when they experience elevated stress levels. “The experience of stress arises when an individual perceives the demands from the environment as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus and Folkman). Recent research indicates that listening to music can have a profound beneficial impact on the psychobiological stress system. This is especially true during times of difficulty. “Listening to music prior to a standardized stressor predominantly affected the autonomic nervous system (in terms of a faster recovery), and to a lesser degree the endocrine and psychological stress response” (Thoma et al.). People who listened to soothing music before being subjected to a stress task seemed to show a more positive stress response. Researchers have found that this was especially true “...in terms of cortisol, salivary alpha-amylase, heart rate, respiratory sinus arrhythmia, subjective perception of stress, and anxiety when compared to non-music control groups, i.e. an acoustic control condition (sound of rippling water) and a control condition resting without acoustic stimulation” (Thoma et al.).

One example of such soothing music that resulted in these beneficial outcomes is the song “Miserere” by Allegri. This is a relaxing selection of music in the form of Latin choral singing. Researchers decided to use this piece of music as a single standardized music stimulus. Interestingly, “...this approach is thought to have a greater effect on stress reduction than music stimuli selected by the subjects themselves” (Thoma et al.). In addition, this restriction enabled researchers to avoid potential influences of memory or personal associations with music that the subjects might have chosen for themselves. 

Drawing upon the healing power of songs such as “Miserere” is particularly relevant during times of crisis, such as global pandemics. “‘Especially now, in times when people are feeling sad, stressed and isolated because of the COVID-19 pandemic, people should definitely turn to music to better their mental well-being,’ says GCBH Executive Director Sarah Lenz Lock, AARP's senior vice president for policy” (AARP). One of the main advantages of using music to enhance mental health is that it is easy to do and widely available. One such accessible technique in this regard is called ‘deep’ or active listening. Rather than use music as background noise, this process entails allocating time to concentrate on the sounds of each individual note and instrument. 

During active listening, people can also become aware of memories and physical sensations that transpire. For example, a relatively recent  anonymous graphic artist and immigrant to the United States  underwent cancer treatments in 2016 at the Mount Sinai Beth Israel Union Square Clinic. Although she faced extreme anxiety about this intense  healthcare regimen, she was able to use active listening to music as a therapeutic approach. As a result, this individual indicated that a significant reduction in anxiety was experienced and accompanied by a strong sense of relaxation (Schiffman). This individual also reported that actively listening to music resulted in an increased ability to counter insomnia that had accompanied such severe anxiety. 

Medical facility representatives who have implemented music-based interventions rooted in active listening have witnessed numerous mental health benefits among their patients. Ninety-two randomized controlled trials that included a total of 7,385 patients were part of a systematic review that showed that such music interventions significantly decreased anxiety (Kühlmann et al.). These trials revealed that participants who actively listened to relaxing music before a stressful situation showed different stress responses when compared to control groups that were not exposed to music. The non-music control conditions consisted of acoustic sounds such as rippling water and silence. Moreover, standardized music stimuli were selected by researchers and could influence study results – especially when compared to musical stimuli that might have been chosen by participants. “In our study, however, we used a music stimulus which had already been evaluated as relaxing in previous research, so we were confident that this stimulus had stress-attenuating capacity independent of individual preferences. Also, using researcher-selected music stimuli has been shown to have greater effects on stress reduction than music stimuli selected by the subjects themselves” (Thoma et al.).

Overall, study findings reveal that actively listening to relaxing, pre-selected music prior to a stress task can impact biological responses to such adversity. It is important to note that researchers had reported no significant effect of music with respect to autonomic responses among participants. Nevertheless, researchers had “...observed a trend towards a faster recovery in sAA activity and in RSA in the music group” (Thoma et al.). One of the most significant results occurred with respect to cortisol responses and their impacts on participant mental health. Cortisol is a hormone released in response to ‘fight or flight’ situations and is associated with increased levels of stress (Cleveland Clinic). Since cortisol levels declined significantly after the stress task for participants who actively listened to music, this suggests that they may have experienced decreased stress levels. 

Music-based therapeutic interventions have also shown promising results on mental health when they are used to help people cope with periods of loneliness. This was especially important during the COVID-19 pandemic. One experienced individual who helped illuminate this finding is Tom Sweitzer. As the co-founder and creative director of A Place to Be, a non-profit organization in Virginia, Sweitzer uses music therapy to help people who may suffer from social, emotional, and/or physical problems. “‘I always say that music keeps you company. We are all in a place right now where isolation and loneliness is pretty much a way of life for many people,’ Sweitzer said. ‘Music can fill in those gaps’” (Chapman). A Place to Be also uses a combination of mindfulness-based breathing techniques and music analysis to address issues of loneliness among his patients. “In sessions, the music therapist plays a song, and leads the patients in breathing in and out with phrases. Afterwards, the therapist leads a discussion where they break apart the lyrics of the song and talk about how it made the patient feel, using the music as a platform to discuss further issues or feelings” (Chapman).

Representatives of organizations with similar missions to that of A Place to Be also reinforce the importance of music as a remedy to isolation. This is a sentiment that was shared by clinicians from JB Music Therapy. According to its mission statement, JB Music Therapy “...is a company that empowers and connects every person to their best self regardless of circumstance. We champion music therapy through excellence in clinical practice and public education, transforming lives one note at a time” (JB Music Therapy Staff). During the COVID-19 pandemic, JB Music Therapy offered its patients virtual music therapy sessions. Many of these patients “...have been struggling with increased depression, social isolation and uncertainty for the future. Video call sessions work to address these issues, despite a slight decrease in the impact for patients when compared to in-person sessions” (Chapman). Moreover, Jesse Dollimont, a clinician who is employed by JB Music Therapy, offered insights into physiological changes that occur as a result of music therapy to address issues of isolation. Dollimont indicated that when a “...person listens to a song, the music simultaneously engages with regions of the brain involved in memory, emotion, physical movement and communication” (Chapman). 

Surgical Procedures
In addition to its positive impacts on mental health, music played in a variety of therapeutic settings can have measurable benefits in a number of medical circumstances. For instance, the Mayo Clinic offers The Healing Enhancement Program for people having heart surgery. In this program, patients are encouraged to actively listen to music before, during, and after surgery. With respect to methodology, “...the largest beneficial effect on both anxiety and pain was seen when patients selected music from a list provided. The smallest benefit was found when patients had freely chosen the music themselves” (Kühlmann et al.). Further analyses have also suggested that specific aspects of music interventions – including, but not limited to, instrument choice, harmony, and rhythm – are critical to surgery-related pain reduction.

The results from studies of music usage in the context of surgical settings are important for patient betterment. “Studies there indicate that music helps ease pain and anxiety and blocks out distracting or disturbing hospital sounds” (Wong et al.). Music interventions before, during, and after surgery all seemed to lead to a decrease in feelings of anxiety.  Interestingly, the largest beneficial effect was evident when music was offered before a given surgical procedure. In preoperative surgical settings, “...low-volume sounds benefit patients by increasing the pain treasure and reducing the mental stress level. Soft, silent classic or mediation music reduces the need for sedative drugs and pain killers. In general, music prevents stress-induced increase in heart rate and systolic blood pressure, more so than silence” (El Boghdady et al.). This suggests that using music therapeutically prior to surgery can decrease anxiety for patients and improve their overall experience significantly. 

Moreover, the calming effects of music are evident during surgical procedures. “Music interventions provided during general anesthesia significantly decreased pain compared with that in controls” (Kühlmann et al.). Active listening to music has also been linked to positive outcomes for patients after their surgical procedures have taken place. In these contexts, “...music reduced postoperative pain and anxiety and lessened the need for anti-anxiety drugs” (Schiffman). Indeed, postoperative music-based interventions have been shown to result in the largest effect on pain reduction. 

Another related issue that is important to examine is the impact of playing music in operating room settings on both patients and surgeons. “Playing music has significant effects on reducing patients’ anxiety during endoscopy and before surgery while acting as a distractor, and increasing patients’ threshold of pain. Music also has a positive effect on decreasing the operative time and on reducing stress of the surgical team” (El Boghdady et al.).  Despite these benefits, there is a risk that music in operating rooms can distract surgeons from their tasks. This, in turn, can jeopardize patient well-being and potentially lead to accidents caused by surgeons. Granted, “...performance can remain unchanged with music as the intense concentration required by a complex surgical task allows experienced surgeons to effectively block out noise as well as music” (El Boghdady et al.). Yet the costs of using music in this surgical setting may outweigh the risks. In order to gain more clarification about this concern, it is important to evaluate the extent to which music in operating rooms can impact a surgeon’s ability to successfully perform required job functions. 

Over the course of eighteen rigorous studies, surgeon performance was evaluated, with considerations made for different experience levels such as trainees, novices, and experts. Furthermore, a range of different surgical specialties were taken into account to help the analysis be as comprehensive as possible. “Participants consisted of surgeons working with general surgery, colorectal surgery, hepato-pancreato-biliary surgery, laparoscopy, micro-neurosurgery, ophthalmology, orthopaedic surgery, plastic surgery, robotic surgery, as well as urology and gynaecology” (El Boghdady et al.). An analysis of all of these studies showed a beneficial impact of music on surgeon task performances. “Strong scientific evidence for a positive or beneficial effect of music on surgeon's task performances was given in two high-quality studies” (El Boghdady et al.). 

For example, “...one study pertained to plastic surgery and demonstrated that music contributed to improved skin repair while trainees were exposed to music during their procedures. There was an overall reduction of the operative time of 8% in trainees. The reduced time improved to 10% in upper-level trainees. The quality of skin repair also improved slightly in the music-listening group” (Zhang et al.). An additional study revealed hand-eye coordination improvements in surgeons who were performing laparoscopic training tasks. On a quantitative level, average performance time was enhanced to varying degrees. From a qualitative perspective, listening to music “...enhanced spatial temporal reasoning…[and] qualities in music influence the performance of a complicated physical task” (Wiseman).

Additional scientific evidence that supports the positive therapeutic effect of music in operating rooms is based on a link between listening to relaxing music and enhanced surgical motor learning skills. “By correlating auditory stress with mental stress on surgical performance, positive implications for postgraduate surgical training were found. It was advised that music could be a low-cost yet efficient device to reverse some of the mental stressors’ negative effects on surgical motor learning” (Conrad et al.). It is important to note that these benefits were derived from classical music. This type of music boosted surgeons’ memory consolidation and improved their performance during periods of stress. 

There are certain reported instances, however, in which music has been shown to hinder surgeons’ task performances. Such studies have “...uncovered increased tensions due to frustration from unproductive communication. The impact of loud music on communication hindered the ability of nurses to hear the surgeon’s requests. Surgeons had to repeat themselves and therefore, it took a longer time for nurses to respond with assistance” (El Boghdady et al.). Moreover, a link was uncovered between the level of noise volume in operating rooms and rates of surgical-site infection (SSI) measured 30 days after surgery. This may be due to the fact that there was a lack of concentration among the surgical team caused by background noise. “Median sound-levels during surgery were higher for patients who developed SSI than for those with primary healing. Also, peak noise levels of at least 4 dB above the median were found for 22,5% of peaks for patients with SSI compared with 7% in those with primary healing” (El Boghdady et al.). 

Nevertheless, surgical teams that were able to distinguish music from mere loud background noise demonstrated different results. In a broad sense, researchers have stated that surgeons tend to enjoy music – as opposed to loud background noise – and do not generally consider this artform harmful to their surgical abilities. “The World Health Organization (WHO) recommends that the noise level in the operating theatre should not exceed 30 dB(A). High-volume noises produce detrimental effects not only for surgeons, but also for the patient and staff members” (Berglund et al.). At such high volumes, the largest negative impact was the surgical staff's decreased productivity as a result of worsening communication. This is because speech discrimination and comprehension were hampered by the disturbances brought on by high-volume noise. Additionally, the noise level increased further as a result of the workers raising their voices to be heard.  In light of this, miscommunication must be taken into account when playing music in operating rooms because it is one of the most often reported causes of medical errors and adverse occurrences (Berglund et al.).

 
Physical Pain Perception (Beyond Surgical Procedures)

Physical pain outside of a surgical context is widely regarded as one of the most common and expensive public health issues worldwide. For the purposes of this section, pain is defined as “A stimulus which causes or is on the verge of causing tissue damage often elicits a sensation of [physical discomfort] and a reflex escape or withdrawal response as well as a gamut of physiologic changes, e.g., faster heart rate, higher blood pressure, greater secretion of epinephrine into the blood stream, increased blood sugar, dilated pupils and sweating” (Brown et al.). Pain perception, like other perceptions, is extremely personal and can change depending on one’s condition. The extent to which someone experiences pain can also change according to the environment in which the stimulus is experienced. Despite the fact that there are numerous ways in which pain might be perceived, the original Gate Control Theory designed by Ronald Melzack and Patrick Wall in 1965 has arguably had the most significant impact on the biomedical world. In summary, this hypothesis postulates that the spinal cord, brainstem, and cerebral cortex are all capable of changing the pain signals that travel from the nerve receptors via the spinal cord to the brain. The possible inhibit­ing ability of certain cells along the transmission channel may result in little or no pain being felt, regardless of the stimulus’ relative strength levels (Katz and Rosenbloom). According to Melzack and Wall, neural activity in the spinal cord can function like a gate that may control how many nerve impulses are sent from receptors to a person’s central nervous system. To this end, researchers have found that it is possible to partially or completely reduce the perception of pain by increasing the activity of the larger, relatively fast-conducting nerve fibers in the spinal cord (Katz and Rosenbloom). 

Melzack and Wall noted that there are several components that can impact the aforementioned gate in the spinal cord. The pain experience “...consists of three major psychological dimensions: (a) sensory-discriminative, (b) motivational-affective, (c) cognitive-evaluative. In other words, cognitive, or higher central nerv­ous system processes, associated with thinking, influence the intensity and quality of pain experiences” (Brown et al.) This is where the impact of music on pain can come into play. Indeed, sensory input may be affected by brain functions that support attention, emotion, and memories of earlier experiences. This allows impulses from all areas of the body (including musical sounds) to affect spinal cord functioning and, ultimately, pain perception. 

The use of music in this context is related to the cognitive-behavioral approach to pain management. This approach places a significant emphasis on the function of cognitive elements and how they might relate to pain sensations that are experienced. The underlying premise is that people’s emotional and behavioral responses to certain events may be influenced by the cognitions (attitudes, beliefs, and expectations) they have (Turner and Chapman). It is noteworthy that changing one’s cognitions may be used to change how one experiences pain. This is because cognitive factors such as distraction and the importance of the pain to the individual can affect how one experiences pain.

Audioanalgesia, the use of auditory stimulation as a pain-reducing agent, is one of the most well-known uses of music in the medical sector. The reinforcing cues that music provides, such as moderate tempos and consistent rhythmic patterns, help to promote physical and mental relaxation techniques. These methods include, but are not limited to, slow, deep breathing that can help people reduce pain that they might experience. To reduce physical pain, music can cue rhythmic breathing, prompt positive emotions, as well as focus attention away from discomfort and extraneous sounds that could trigger painful associations. Multiple laboratory-based studies have revealed that while music does not increase the pain threshold, it does impact degrees of tolerance (Robson and Davenport). Clinicians have also found positive outcomes when utilizing music to lessen the impression of pain. One area in which this dimension was explored in detail is in the dental field. Dental patients were given a remote volume control box and instructed to turn it up if they felt any pain or wanted to disguise the sound of the drill. Studies indicate that music can result in dental-related pain suppression, sometimes to the extent of not requiring anesthesia (Brown et al.). 

The emotional state of people is another aspect of their physical pain experience. Anxiety, helplessness, and a lack of control are just a few of the emotions that can exacerbate a painful experience. When music is listened to as a coping mechanism, the patient will benefit from diversion or from the pleasant emotional states that the music’s rhythms and melodies provoke (Bonny). A learned association may form that links the performance of appropriate musical selections to the amelioration of the unpleasant experience. Moreover, people may sometimes choose to reframe a painful experience in order to cope with it. “For example, confronting and handling a potentially painful situation by altering one’s expectations redefines the painful situation” (Brown et al). In medical situations, people frequently feel uninformed about their physical pain and powerless to make much of a difference without help from a specialist. Patients may learn a cognitive strategy that allows a previously painful experience to be reconceptualized (Bonny). This can be achieved by actively listening to music for the purpose of gaining control over pain. In the process, such music therapy can help people overcome a sense of helplessness that typically comes with physical pain.

Music has two different properties that may be valuable for building positive pain-coping skills. These properties are known as attention-­distraction and affect. With respect to attention-­distraction, the temporal aspect of music is particularly relevant. Music “...exists only through time­ [and] requires the individual to commit himself to the experience moment by moment. Except for relatively minute deviations, music (whether an entire piece or merely a measure or phrase in repeated practice) cannot be interrupted without losing its intent…” (Gaston). Music must be continued in order for a finished thought or expression to develop, regardless of its length. Music therapy has the ability to modify one’s perspective of time. Engaging oneself cognitively in music may allow for distraction from the reality of the present, away from self-preoccupation. The clinical benefit of this is clear for the person who can ‘forget himself/herself’ in music: The sense of pain may or may not go away completely, but the amount of suffering involved would be decreased (Brown et al.). 

Another way in which music therapy can reduce physical pain is through an emotional dimension. Music evokes feelings, which may bring heightened significance to a situation and allow for self-catharsis. Since words may not be able to convey the thoughts and emotions associated with experiencing physical pain, it is important to address such affective components. Without doing so, there is a risk that such emotions might worsen the condition (Bonny). For many people who find it difficult to express their suffering, engaging on a deeply personal level with music might help ease their physical pain.

Child Care

The beneficial effects of music are not limited to adults. In fact, studies have shown that music also enhances the experience of children in both medical and non-medical settings. Researchers at Beth Israel Medical Center’s Louis Armstrong Center for Music and Medicine conducted a study across 11 mid-Atlantic newborn intensive care units. The study included 272 premature babies who had a gestation period of at least 32 weeks. Researchers “...examined the effects of three types of music: a lullaby selected and sung by the baby’s parents; an ‘ocean disc,’ a round instrument, invented by the Remo drum company, that mimics the sounds of the womb; and a gato box, a drum-like instrument that is typically used to simulate two-tone heartbeat rhythms” (Novotney). The music was played for the babies in a live format by certified music therapists, who tried to match their music to the babies’ heart beats and breathing rates. “The researchers found that the gato box, the Remo ocean disc and singing all slowed a baby’s heart rate, although singing was the most effective. Singing also increased the amount of time babies stayed quietly alert, and sucking behavior improved most with the gato box, while the ocean disc enhanced sleep” (Novotney).

The impact of music on children outside of medical settings is also significant. This is particularly true with respect to early childhood education and care (ECEC) among toddlers. For the purposes of this research paper, toddlers are defined as children ages one to three. Early childhood music education is one of the many ways that children may express themselves in the ECEC curriculum. This curriculum has been shown to combine their hobbies, subject areas, and cross-curricular competencies to promote their learning (Ruokonen et al.). Transversal competence is a notion that includes knowledge, skills, values, attitudes, and will. Thinking and learning, cultural competence, interaction and self-expression, self-care and daily life management, multiliteracy, information and communication technology proficiency, participation and engagement are all examples of transversal competencies (Ruokonen et al.). All of these are vital methods to learn for a future in which children’s language skills and talents are encouraged to flourish. 

Children can engage in a variety of artistic, musical, and cultural activities through ECEC. Children’s play, emotional expression, and creative thinking are stimulated by many types of expression – especially by music. Children’s musical enculturation begins at a relatively young age, according to ethnographic research (Llanes). Toddlers may even recall tunes before birth, according to recent brain studies (Young). This is because music fosters attentional, auditory, and spatial perceptive abilities. Babies and young children play in a variety of ways and make noises that might be characterized as music-based. Spontaneous vocalizations, rhythmic movements, imaginative play with sound-producing devices, and moving and vocalizing in response to live or recorded music are all examples of musical communication (Young). Even when toddlers struggled with speech, fun engagement with musical sounds have been consistently shown to improve their communication skills. 

In light of this, ECEC curricula offers music education that aims to increase children’s and connection to music as early in their development as possible. That is why they are taught to listen to sounds and build their awareness of fundamental musical ideas including loudness, duration, tone color, pitch, and form (Llanes). Children listen to music, dance to it, sing songs, enjoy nursery rhymes, and explore with body percussion and musical instruments. Through music and impromptu songs, ECEC curricula encourages children to express their feelings and use their imaginations. All creative endeavors, including visual arts, verbal or physical expression, dance, and theater, incorporate music. Additionally, children are grouped together to sing and produce small-scale musical concerts, which brings them delight and boosts their musical confidence (Llanes).

When teaching music to young children through ECEC curricula, both impromptu and planned activities are used. The primary goal of musical expression in early childhood education is to give children musical opportunities and experiences while fostering their interest in developing a special connection to music (Ruokonen et al.). Children’s capacity to detect music as well as the duration, loudness, and tone of sound and dynamics grow gradually through fun music education sessions. Listening, singing, rhyming, dancing, using body percussion, and playing other musical instruments are the fundamental components of learning music. Children are encouraged to engage their imaginations and to express themselves when listening to music, whether vocally by singing or narrating a narrative, or nonverbally through dancing or sketching (Ruokonen et al.). Children enjoy collaborating with others when practicing for small-scale musical concerts that they will give to their parents and their peers. 

According to early childhood music education research, music is not only fun for children but very important for their development. The process of interaction between melodic schemes is stimulated by early musical exchanges and children’s body motions during free play. These studies also emphasize the importance of singing with children as a means of communication before they talk (Young). Toddlers typically required encouragement to improvise and employ nonverbal interactions with adults. Studies involving preschoolers and primary school students have found beneficial links between music instruction and emotional growth. In these studies, children aged 7 and 8 who took music education classes scored noticeably higher on emotion comprehension tests than their non-music education counterparts (Ruokonen et al.). Additionally, some research suggests that music encourages toddlers to walk. When integrated with ECEC curricula, music and movement programs can increase the quality of some of the more sophisticated locomotive skills in children between the ages of four and six (Ruokonen et al.).

Research has also shown that toddlers are most creative and demonstrate a variety of expressions when they are highly engaged in an activity, such as when music is present and the activity is taking place in educational settings. By way of background, there are different settings of child engagement. These five levels are described by the Leuven Scale (Laevers). The child has a low amount of participation at the first level since their actions may be straightforward, stereotypical, repetitive, or passive. At the second level, toddlers are actually doing something, but for half of the observation period, there are times when they are not doing anything and are just staring off into space. During this second level, the child’s participation is insufficient to warrant continuing the activity (Laevers). The toddler can be easily distracted in the third level but mostly participates in continuous activity. At the fourth level, the child engages in continuous activity punctuated by intense periods of concentration. Even if their attention is momentarily broken, toddlers are able to eventually resume their activities from where they left off (Laevers). Yet the toddler displays the most prolonged, ongoing, and intense activity at level five. The degree of attention, inventiveness, energy, and perseverance at the greatest level of engagement must be present for virtually the whole observation period (Laevers). 

It is noteworthy to observe instances in which music-driven child behaviors are analyzed through the Leuven Scale. Studies show that between the ages of one and three, children are most receptive to music and scored high on the Leuven Scale (Ruokonen et al.). The age difference between three-year-olds and four-year-olds is evident. Receptivity to music and its accompanying effects on attention via the Leuven Scale fell below 30% among children aged four and older, and below 20% among kids aged five and six. One explanation for this is that music was used more frequently in daily educational practices with toddlers than with children aged four to six. Overall, however, music contributed to elevated Leuven Scale levels among children. As such, they experienced a significantly greater sense of attention during educational activities that supported learning. 

In contrast to groups where music was thought to be less significant, children were more frequently seen to be joyful and pleased. Furthermore, toddlers were also substantially less commonly angry or sad than without music interventions (Ruokonen et al.). In the groups with a stronger emphasis on music, there were more observations of the adults receiving, accepting, and taking part in children’s activities. An increase in receiving and accepting behaviors suggests that there are friendlier relationships between toddlers and adults. In addition, there was statistically less detrimental adult behavior (Ruokonen et al.). In general, the children received considerably more adult attention in the groups where music was emphasized.

Studies also demonstrate a favorable correlation between an emphasis on music and a high-quality learning environment in classrooms. In fact, this beneficial connection may not be limited to a classroom context. By extension, such studies seem to suggest that the music-child connection can strengthen parental engagement, the environment during lunch, and both indoor and outdoor activities (Young). Demand for educational leadership was also reduced in the groups where a major focus on music was placed. This suggests that the participants were more independent and less reliant on an authority figure. In fact, joy and well-being tended to be lacking in the groups where teaching efforts were seen to be more about surviving than long-term growing (Young). 

For toddler groups, music and singing were observed to be far more significant components of daily instruction than for children aged four to six. Several statistically significant relationships were discovered when the judged music relevance and the independently observed child activities were combined (Ruokonen et al.). For instance, there was more continuous intensive engagement and less casual and sporadic participation in the groups with a music emphasis. A significant degree of intermediate engagement with music may not have been the fault of the music itself. Indeed, it may have been caused by a failure on the part of ill-equipped or incompetent facilitators to self-regulate participation as required by the task and setting (Laevers). 

Furthermore, a greater variety and versatility of activity participation, including both routinely relaxing activities and intensely processed active activities, were associated with music emphasis. In terms of teaching, the outcome is a promising sign that music is connected to rich, imaginative, and colorful learning experiences (Young). Children seemed to be significantly happier and more frequently satisfied when exposed to music on a consistent basis. In addition, these children tended to be unhappy or depressed less frequently in the groups that placed a greater emphasis on music. When considered as a whole, these noteworthy outcomes demonstrate that music was linked to good sentiments that supported children’s learning and wellness (Ruokonen et al.). In groups with more occurrences of music, children’s social roles were less participatory and vastly more open. In addition, the social roles in groups with greater access to music appear to be far more accommodating and clearer among students and their respective educators as well as facilitators. 

Overall, it seems that the music-based outcomes are advantageous in terms of the high levels of socio-emotional learning that they provide. However, there are still several issues about how to further improve the groups that place a strong focus on music. For example, it may be important to explore whether the exercises should include more interactive components to encourage participation among children. In contrast to the other groups, adults were seen to have more positive and open interactions with the children and paid the children more attention (Young). It therefore appears that the adults’ improvements in their roles as facilitators and educators correlates with music exposure. Furthermore, it is clear from the most recent empirical study literature that the presence of adults affects the emotional listening behavior of one-year-old toddlers while they are listening to music (Ruokonen et al.). According to this viewpoint, the contact between adults and children while participating in musical activities in a typical context may be extremely beneficial and a subject for further research.

Despite these positive findings, the relationship between young children’s experiences in early childhood education and music in many cultures with various pedagogical theories and practices needs to be further studied. After all, it may not be possible to draw the conclusion that music contributes to children’s happy experiences and high-quality early childhood education in all situations (Young). Due to the fact that music focus was only assessed using one statement, the aforementioned study is also unable to distinguish between the numerous components of music and singing. These dimensions include, but are not limited to, music creation, music listening, and dancing, or otherwise moving to the music.

Due to its links to the growth of linguistic abilities, singing is one of the most significant activities in toddler music instruction. The links between music concentration and other assessed learning environment qualities, however, identify music as a component of high-quality education and happy experiences for toddlers (Levers). The statistically significant links indicate that these findings are valid. This is because neither the observers nor the evaluators had access to the learning environment assessments. Although there are individual variances regarding the adult participants’ capacity to support musical and/or other activities, they may be related to the training they received as opposed to the impact of music (Young). In any case, the study’s sample size was sufficient to make the assumption that regular musical activities significantly impacted children’s learning and wellbeing. Singing and music seem to be essential components of high-quality early childhood education. These factors fuel children’s pleasant experiences with learning, emotion, social contact, and adult interaction.

For the purpose of incorporating early childhood music education into routine procedures, teachers, other staff, and guardians need additional training and assistance. Improvised musical play and impromptu noises and songs between adults and children are necessary in early educational curricula. In-person music mentorship might raise instructors’ musical proficiency and sense of self-worth (Ruokonen et al.). Generalist instructors in early childhood education typically had favorable views about music. This can create a significant opportunity for this group to continue their professional development in music instruction. It is important to create appropriate pedagogical strategies and learning settings for the benefit of each child. To do so, continuous observation, documentation, and assessment of the learning and development of each student are required (Young). Indeed, it seems that one of the finest opportunities for early socialization, education, and well-being may be through music.

Of all the beneficial impacts that music can have on children, creating positive parent-child bonds is among the most important. This is especially true in light of the COVID-19 pandemic. The pandemic has impacted parent mental health and stress, which has an effect on parent-child interactions. The pandemic has disturbed family life in the United States and throughout the world. During this time of severe adversity, it seems that many parents have used music to help their children socialize with one another and to manage their emotions. Parent-child musical engagement was associated with parent-child attachment, controlling for relevant parent variables including parent distress, efficacy, education, and parent-child engagement in non-musical activities (Custodero et al.). 

These results indicate that music may be an extremely effective tool for building and maintaining parent-child relationships during a period of intense uncertainty and change. There are several reasons that account for this phenomenon. One reason is that maternal singing to newborns and infants can change the arousal levels of both parents and children simultaneously – especially during periods of distress. Mothers have also reported stronger pleasant emotional experiences after singing with their babies than after non-musical play. Furthermore, mothers tend to smile more while singing than when speaking to their children. Parents who sang or played music every day in a study of more than 2,000 parents with children under 3 reported less depressed symptoms than those who did not (Custodero et al.).

Additionally, music promotes social interaction and connection with others. Parents typically mention playing music for their infants to promote connection and involvement. For instance, when mothers were encouraged to sing to their newborns, as opposed to when they were not, the mother-baby attachment was noticeably stronger. Compared to parents who engage in non-musical play, parents who share musical experiences with their children may even feel closer to them. Joint musical experiences even in infancy are linked to prosocial conduct of children toward other peers or adults (Custodero et al.). 

There are also multiple specific aspects of music that may promote its connection to social bonding. Music has a rhythmic framework that is predictable and encourages synchronized movement with others. This can result in endorphin release and interpersonal synchrony processes that support the link between music and social bonding (Savage et al.). The pitch range and scale structure of such music may also enable vocal coordination, facilitating group experiences, and connection. Additionally, children’s attention is maintained and their social learning is supported by the repeated structure of music and the multimodal social signals (speech, facial expressions, movement, and touch) used in musical games (Custodero et al.). 

Musical experiences are also normal and frequent in parental interactions with young children. Numerous research studies aimed at describing newborns’ musical experiences noted a significant amount of musical exposure and activity (Savage et al.). Early childhood musical activities come in a variety of forms. While singing is a regular parent-child musical engagement, other typical pursuits include playing with musical toys, listening to and dancing to music with parents, and playing recorded music (Custodero et al.). Different musical endeavors can serve a variety of functions with respect to parent-child bonding. For instance, some parents may employ active musical activities like singing or dancing as a social experience, while other parents may utilize passive musical activities such as listening to music or viewing music videos to keep their child engaged. 

It is also crucial to comprehend the role of regular musical experiences for parents, their young children, and the parent-child relationship during the COVID-19 pandemic given the positive social and emotional effects of musical engagement that were previously mentioned. To this end, a recent study explored the musical activities in which parents and their children participated during the pandemic and assessed if changes to parent musical activity, child musical activity, or combined parent-child musical activity occurred in comparison to prior to the COVID-19 pandemic (Ilari et al.). The significance of music for regulating emotions and fostering social connections among family members during the COVID-19 pandemic was also explored. 

Specifically, an examination of whether parent-child music engagement was connected to parents’ affective attachment to their children during this time of hardship was explored in-depth. This was particularly important because many adult participants noted that, during the COVID-19 pandemic, they lost access to outside child care, reduced their time spent outside the home, and spent a lot more time with their children (Ilari et al.). The Postnatal Attachment Questionnaire (PAQ) was used to gauge parent-child attachment. The PAQ, which consists of 19 Likert scale items, uses statements to gauge how emotionally attached parents are to their children. Due to its emphasis on parents’ sentiments toward their children rather than children’s feelings or actions toward the parent, the PAQ, which was first designed for use with babies, has now been used to evaluate parent-child attachment in older children. 

To evaluate parenting self-efficacy, this recent COVID-19-related study used a Likert scale of one to represent that the parent did not feel competent being a parent. Moreover, a rating of five signified that the parent deemed himself or herself capable in this regard (Politimou et al.). Participants also answered the Family Activities Questionnaire (FAQ), which was developed from questions used in the Millennium Cohort Study, to gauge the total amount of time spent in parent-child activities (Politimou et al.). Parents were asked to rate how often they engaged in five different activities with their children on Likert scales that ranged from one (hardly ever) to five (many times a day). These activities included, but were not limited to, reading, drawing, dancing, writing, and playing outdoor games. 

During the COVID-19 pandemic, parent-child musical involvement, child musical activities, and parent musical engagement were all evaluated using descriptive statistics for pertinent music characteristics. A score of zero represented a response of “about the same” on all five-point Likert scales used to compare changes in musical activities between the COVID-19 pandemic and before this situation occurred (Ilari et al.). It was also important for researchers to determine if parents’ opinions of musical activities or justifications for utilizing music during the COVID-19 pandemic were substantially different from those before the pandemic. Correlations between parental involvement in music, parental attachment, parenting effectiveness, parent distress, non-musical family activities, parental education, child age, and change in time spent with child during COVID-19 were also examined (Ilari et al.).

Interestingly, it was demonstrated by researchers that parent-child musical involvement during the COVID-19 pandemic generally occurred at high levels. Overall, parents stated that their children engaged in a number of musical pursuits and spent most of their time viewing music videos, listening to music, and playing music with others (Ilari et al.). This seemed to be a significant difference from prior to the COVID-19 pandemic when engaging in such music-related activities was comparatively less. On average, parents agreed with seven to eight (out of ten) justifications for playing music for their children in these formats. The most frequently cited purpose of listening to music was to pass the time while waiting (88.7%), whereas the least frequently cited purpose was to ease the transition between tasks (55.9%) (Politimou et al.). 

When adjusting for the child’s age, there were a variety of different connections between multiple child-oriented musical activities and the causes for why parents played music for their children. Activities involving children’s active engagement included, but were not limited to, playing musical instruments, using musical toys, dancing to music, and socially participating in music. These activities were often most frequently and strongly connected with each particular musical activity’s intended purpose. Conversely, watching music videos was only ever done for the sake of developing academic abilities, honing communication abilities, and diverting children (Ilari et al.).

As mentioned previously, parents reported substantially higher levels of music creating and listening during the COVID-19 pandemic compared to beforehand. Parents agreed or strongly agreed that creating and listening to music helped them socialize with their children, manage their emotions, and even control their own emotions (Politimou et al.). Additionally, parents said that they were substantially more likely to use music for these objectives during the COVID-19 pandemic than they had been before the pandemic. This is especially true with respect to regulating children’s emotions and controlling personal emotions. In contrast, parents during the COVID-19 pandemic were less likely to utilize music to socially engage with other adults who were not in their household, compared to before the pandemic. They also continued to use music to communicate with the adults in their household.

Parent-child attachment and parent-child musical involvement showed a minor but substantial positive association. In fact, parental distress, parenting efficacy, and parent education were all substantially connected with parent-child attachment (Ilari et al.). Family activities other than music-making were substantially connected with parental and child musical participation. To this end, parent-child attachment ratings were strongly influenced by the model that took into account parent distress and self-efficacy, parent education level, child age, non-musical family activities, and change in time spent with child during the COVID-19 pandemic. While parent-related factors such as parent distress, self-efficacy, and parent education were the main predictors of parent-child attachment, parent-child music engagement was still significantly correlated with parent-child attachment even after adjusting for these factors (Politimou et al.). Family activities that were not musical, on the other hand, do not seem to be a reliable predictor of fostering strong, positive parent-child bonds.

Conclusion
 

This paper has examined the therapeutic use of music from a variety of angles. To demonstrate the broad usage of music for promoting positivity throughout time and civilizations, this paper provided a historical review of this phenomenon. This paper then used recent scientific findings to support the beneficial effects that music can exert in the domains of mental health, surgical procedures, physical pain perception beyond surgical procedures, and child care. Specifically, music can promote positive mental health to the extent that people can engage in deep listening skills. With respect to surgical procedures, music can assist patients in the healing process and, when used at low volumes, boost surgical team performance. Outside of strictly surgical-based settings, music therapy can decrease pain perception and reduce the quantity of pain medication that patients require. Lastly, music has been shown to boost the well-being of children in both medical and non-medical settings. Moreover, children who participated in activities where music was emphasized had higher levels of sustained engagement with their adult caregivers. In light of all the aforementioned findings, more research into this promising area is encouraged to continue promoting the therapeutic uses of music on a broad scale.

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