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Dr. Howland is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
The author has disclosed no potential conflicts of interest, financial or otherwise.
Exploring psychotherapeutic issues and agents in clinical practice
The song "Mr. Tambourine Man" was written by Bob Dylan and recorded by him for commercial release in 1965. Because of its melody and the exotic emotional imagery the words evoke, the song has been interpreted by many individuals as alluding to the effect of drugs, and that Mr. Tambourine Man is a coded reference to a drug dealer ( Robertson & Fishkin, 1971 ). Although Dylan claims the song was not about drugs, I believe that music can be considered a drug therapy. In this month's column, I will review some of the neurobiological effects of music and studies investigating the therapeutic use of music.
Neurobiological Effects of Music
Although music might be considered noninvasive and nonpharmacological, this is not strictly true if one considers the neural processes involved in music perception and processing. Acoustic information is translated into neural activity in the cochlea and further transformed in the auditory brainstem, but then directly and indirectly engages many other brain structures ( Koelsch, 2011 ). Much as a drug is absorbed and circulates throughout the body and brain to reach its target(s), music is absorbed by the cochlea and then transmitted throughout the central nervous system.
Music has been used therapeutically since antiquity, but study of the psychological and physiological effects underlying the putative health benefits of music are more recent ( Conrad, 2010 ). Fancourt, Ockelford, and Belai ( 2014 ) comprehensively reviewed the literature on the chemical and biological effects of music. They identified 63 studies investigating the effect of music on various neurotransmitters, hormones, immune system components, autonomic nervous system function, and psychological responses.
The most common and consistent finding among 28 studies in their review was that music exposure reduced state and trait measures of anxiety, which was associated with decreased cortisol levels. Decreased cortisol levels were the most common endocrinological finding in 29 studies reviewed by Fancourt et al. ( 2014 ). The hypothalamic-pituitary-adrenal (HPA) axis is the body's primary stress-response system, and cortisol is the major adrenal gland...