Effects Of Group Music Therapy On Depressive Symptoms in Women

Music therapy is a clinical intervention that uses music-based experiences to address therapeutic goals.

It can involve listening to, creating, or performing music under the guidance of a trained therapist.

For mental health, music therapy can help reduce stress, improve mood, enhance emotional expression, and promote social connection.

It has shown promise in treating conditions like depression, anxiety, and PTSD by engaging cognitive, emotional, and sensorimotor processes through musical activities.

Gaebel, C., Stoffel, M., Aguilar-Raab, C., Jarczok, M. N., Rittner, S., Ditzen, B., & Warth, M. (2025). Effects of group music therapy on depressive symptoms in women – The MUSED-study: Results from a randomized-controlled trial. Journal of Affective Disorders, 374, 1-10. https://doi.org/10.1016/j.jad.2025.01.011

Key Points

• Group music therapy (GMT) combined with treatment as usual (TAU) showed greater reductions in momentary depression symptoms compared to TAU alone in women with major depressive disorder (MDD).
• GMT did not show significant effects on self-rated or observer-rated depression measures compared to TAU alone.
• GMT led to improvements in emotion regulation, mood regulation through music, and health-related quality of life immediately post-intervention.
• Effects were primarily observed immediately post-intervention and not sustained at 10-week follow-up.
• The study highlights the potential of GMT as an economical approach to treat MDD, yielding health-promoting effects on depression symptoms, emotion regulation, and quality of life.
• Limitations include high dropout rate, data loss due to COVID-19 pandemic, uncertain long-term effects, and homogeneous female sample.
• The research underscores the need for manualization and further evaluation of music therapy approaches for treating depression.

Rationale

Music therapy (MT) has shown promise as a complementary treatment for major depressive disorder (MDD), but existing research has yielded inconclusive results due to methodological limitations (Aalbers et al., 2017).

MDD, characterized by impaired emotion regulation and social functioning, affects approximately 300 million people worldwide, with women experiencing nearly twice the prevalence of men (National Institute of Mental Health, 2023).

Music can directly influence emotions and has demonstrated efficacy in treating mental disorders (Geretsegger et al., 2017; van der Steen et al., 2018; Ghetti et al., 2022).

However, the therapeutic mechanisms of MT in treating MDD remain insufficiently investigated (Maratos et al., 2008; Gassner & Mayer-Ferbas, 2020).

This study aims to address these gaps by investigating the effectiveness of outpatient group music therapy (GMT) in women with MDD, focusing on depressive symptoms, emotion regulation, and quality of life.

By employing a randomized controlled trial design and incorporating ecological momentary assessment, the research seeks to provide more robust evidence for MT’s efficacy and deepen understanding of its underlying modes of action in treating depression.

Method

The study employed a single-center, randomized-controlled trial design with two parallel arms: the intervention group (IG) receiving GMT + TAU and the waitlist control group (CG) receiving TAU only.

The study was conducted at Heidelberg University Hospital between August 2019 and May 2021.

Procedure

Participants were randomly assigned to either the IG or CG. The IG underwent a 60-minute individual session followed by 10 weekly 120-minute GMT sessions.

The GMT program combined fixed and adaptable elements, encompassing both active and receptive techniques.

Data collection occurred at pre-assessment (T0), post-intervention (T1), and 10-week follow-up (T2).

Sample

The study included 102 women aged 18 to 65 diagnosed with current MDD.

Participants were divided into six cohorts for GMT, with 16-18 patients per cohort randomized at a 1:1 ratio into IG or CG.

Measures

• Primary outcomes: Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory-II (BDI-II), and momentary depression in everyday life (assessed using ecological momentary assessment).
• Secondary outcomes: Heidelberg Form for Emotion Regulation Strategies (H-FERST), Brief Music in Mood Regulation Scale (B-MMR), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – 5 dimensions (EQ-5D).
• Control variables: Childhood Trauma Questionnaire (CTQ), type and process of TAU, presence of physical illnesses, age, and body mass index (BMI).

Statistical measures

The study used multilevel modeling (MLM) for hypothesis testing of primary outcomes. Two-level MLMs were used for questionnaire data, and three-level models for ecological momentary assessment data.

Effect sizes (Cohen’s d) were computed for secondary outcomes. Sensitivity analysis was performed using per-protocol analysis.

Results

Hypothesis 1: GMT + TAU would lead to stronger reductions in observer-rated retrospective depressive symptoms compared to TAU alone.

Result: No significant interaction effect between group and time was found (b = -1.29, p = .39).

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Hypothesis 2: GMT + TAU would lead to stronger reductions in self-rated retrospective depressive symptoms compared to TAU alone.

Result: No significant interaction effect between group and time was found (b = -4.4, p = .052).

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Hypothesis 3: GMT + TAU would lead to stronger reductions in self-rated momentary depressive symptoms in daily life compared to TAU alone.

Result: A significant interaction effect between group and time was found (b = -10.51, p = .004).

Secondary outcomes:

• Emotion regulation: Small but significant effects were found for maladaptive emotion regulation strategies (rumination and experience suppression) and adaptive strategies (social support).
• Mood regulation through music: Small to large effect sizes were found for various subscales of the B-MMR, favoring the IG.
• Quality of life: A medium effect size was found for general health status, favoring the IG.

Insight

The study reveals that group music therapy (GMT) can effectively reduce momentary depressive symptoms in women with major depressive disorder (MDD), although it did not show significant effects on retrospectively assessed depressive symptoms.

This discrepancy highlights the potential limitations of relying solely on retrospective measures and underscores the value of ecological momentary assessment in capturing real-time experiences of depression.

The improvements observed in emotion regulation, mood regulation through music, and quality of life suggest that GMT may offer broader benefits beyond symptom reduction.

These findings align with previous research indicating that music can influence emotion processing, enhance social skills, and engage the reward system (Koelsch, 2014; Zatorre, 2015).

However, the lack of sustained effects at follow-up raises questions about the long-term impact of GMT and the potential need for ongoing or booster sessions.

This aligns with previous studies that have found limited long-term effects of music therapy interventions (Aalbers et al., 2017).

Future research could explore the optimal duration and frequency of GMT sessions, investigate the specific mechanisms by which music therapy influences depressive symptoms, and examine the potential of combining GMT with other evidence-based treatments for depression.

Additionally, studies including male participants and diverse cultural contexts could help determine the generalizability of these findings.

Implications

The findings of this study have several important implications for clinical practice and future research in the field of music therapy for depression:

1. Integration of GMT in depression treatment: The significant reduction in momentary depressive symptoms suggests that GMT could be a valuable complementary treatment for MDD, particularly in addressing real-time experiences of depression. Mental health professionals should consider incorporating GMT into comprehensive treatment plans for patients with MDD.
2. Focus on emotion regulation: The improvements in emotion regulation strategies highlight the potential of GMT to address a core deficit in MDD. Clinicians could emphasize emotion regulation techniques within GMT sessions to maximize therapeutic benefits.
3. Personalized music interventions: The positive effects on mood regulation through music indicate that teaching patients how to use music effectively for emotional self-regulation could be a valuable therapeutic tool. Clinicians could work with patients to develop personalized music-based strategies for managing depressive symptoms in daily life.
4. Quality of life improvements: The observed enhancements in quality of life suggest that GMT may have broader positive impacts beyond symptom reduction. This underscores the importance of considering holistic outcomes in depression treatment.
5. Ecological momentary assessment in research: The discrepancy between momentary and retrospective measures of depression highlights the value of real-time assessment methods. Future studies should consider incorporating ecological momentary assessment to capture a more comprehensive picture of treatment effects.
6. Need for long-term interventions: The lack of sustained effects at follow-up suggests that longer interventions or booster sessions may be necessary. Researchers should investigate optimal treatment durations and explore ways to maintain therapeutic gains over time.
7. Manualization of GMT: The study underscores the need for standardized GMT protocols to facilitate replication and wider implementation. Developing and validating manualized GMT approaches should be a priority for future research.
8. Gender-specific interventions: The focus on women in this study raises questions about potential gender differences in response to GMT. Future research should explore whether similar effects are observed in male populations and consider developing gender-specific music therapy interventions if necessary.
9. Combination with other therapies: Given the positive effects on emotion regulation and mood, future studies could investigate the potential synergistic effects of combining GMT with other evidence-based treatments for depression, such as cognitive-behavioral therapy or mindfulness-based interventions.
10. Cost-effectiveness analysis: The study suggests that GMT could be an economical approach to treating MDD. Future research should include formal cost-effectiveness analyses to determine the economic viability of implementing GMT in various healthcare settings.

Strengths

The study had many methodological strengths including:

• Sufficient statistical power with a sample size of 102 participants.
• Comprehensive evaluation of depression using multiple perspectives (self-rating, observer-rating, and ecological momentary assessment).
• Randomized control-group design, enhancing the validity of the findings.
• Use of ecological momentary assessment to capture real-time depressive symptoms in participants’ natural environments.
• Focus on a homogeneous sample of women, reducing potential sex-specific biases in outcomes.
• Inclusion of both active and receptive music therapy techniques, providing a comprehensive intervention approach.
• Assessment of secondary outcomes related to emotion regulation and quality of life, offering insights into broader effects of the intervention.
• Rigorous monitoring and adherence to the study protocol, ensuring integrity of the trial.
• Blinding of assessors during pre-assessment and observer ratings at post-assessment, reducing potential bias.
• Use of multilevel modeling for data analysis, accounting for the nested structure of the data.
• Inclusion of a sensitivity analysis (per-protocol analysis) to check the robustness of the findings.

Limitations

This study also had several methodological limitations, including:

• High dropout rate and data loss due to the COVID-19 pandemic, potentially affecting the generalizability of results.
• Limited long-term follow-up, with only self-rated depression assessed at the 10-week follow-up point.
• Homogeneous female sample, limiting generalizability to male populations or other demographic groups.
• Lack of an active control group, which could have helped account for non-specific effects of group participation.
• Partially manualized intervention approach, which may limit the reproducibility of the treatment.
• Potential confounding effects of ongoing treatment as usual (TAU) that were not fully controlled for in the analysis.
• Absence of assessment for homework compliance, which could have provided insights into the impact of between-session practice.
• Limited ability to identify specific working factors within the music therapy intervention due to the process-driven approach.
• Potential impact of COVID-19 restrictions (e.g., mask-wearing) on the therapeutic process, particularly in terms of emotional recognition and social interaction.
• Lack of assessment of side effects in the control group, limiting comparisons of adverse events between conditions.
• Absence of subgroup analyses due to the relatively small sample size.

These limitations suggest caution in interpreting the results and highlight areas for improvement in future research.

Larger, more diverse samples, longer follow-up periods, and more standardized intervention protocols could address many of these limitations.

Additionally, future studies should consider including active control groups and more comprehensive assessment of potential confounding variables.

References

Primary reference

Gaebel, C., Stoffel, M., Aguilar-Raab, C., Jarczok, M. N., Rittner, S., Ditzen, B., & Warth, M. (2025). Effects of group music therapy on depressive symptoms in women – The MUSED-study: Results from a randomized-controlled trial. Journal of Affective Disorders, 374, 1-10. https://doi.org/10.1016/j.jad.2025.01.011

Other references

Aalbers, S., Fusar-Poli, L., Freeman, R. E., Spreen, M., Ket, J. C., Vink, A. C., Maratos, A., Crawford, M., Chen, X.-J., & Gold, C. (2017). Music therapy for depression. Cochrane Database of Systematic Reviews, 11, CD004517.

Geretsegger, M., Mössler, K. A., Bieleninik, Ł., Chen, X. J., Heldal, T. O., & Gold, C. (2017). Music therapy for people with schizophrenia and schizophrenia‐like disorders. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD004025.pub4

Ghetti, C., Chen, X. J., Brenner, A. K., Hakvoort, L. G., Lien, L., Fachner, J., & Gold, C. (2022). Music therapy for people with substance use disorders. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD012576.pub3

Koelsch, S. (2014). Brain correlates of music-evoked emotions. Nature Reviews Neuroscience, 15(3), 170-180. https://doi.org/10.1038/nrn3666

Maratos, A., Gold, C., Wang, X., & Crawford, M. (2008). Music therapy for depression. Cochrane database of systematic reviews, (1). https://doi.org/10.1002/14651858.CD004517.pub2

National Institute of Mental Health. (2023). Major Depression. Definitions. https://www.nimh.nih.gov/health/statistics/major-depression

Van der Steen, J. T., Smaling, H. J., Van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J., & Vink, A. C. (2018). Music‐based therapeutic interventions for people with dementia. Cochrane database of systematic reviews, (7). https://doi.org/10.1002/14651858.CD003477.pub4

Zatorre, R. J. (2015). Musical pleasure and reward: Mechanisms and dysfunction. Annals of the New York Academy of Sciences, 1337(1), 202-211. https://doi.org/10.1111/nyas.12677

Keep Learning

Socratic questions for a college class to discuss this paper:

1. How might the observed discrepancy between momentary and retrospective measures of depression impact our understanding and assessment of depressive symptoms in clinical practice?
2. What are the potential mechanisms by which group music therapy might improve emotion regulation in individuals with depression?
3. How could the gender-specific focus of this study (women only) influence the interpretation and application of its findings? What considerations should be made when generalizing these results to other populations?
4. Given the lack of sustained effects at follow-up, what strategies could be employed to potentially extend the benefits of music therapy over time?
5. How might the COVID-19 pandemic have influenced the study’s results, beyond the reported data loss and attrition? Consider both direct and indirect effects on the intervention and participants.
6. What ethical considerations should be taken into account when using waitlist control groups in studies of interventions for mental health conditions?
7. How might the process-driven approach to music therapy in this study compare to a more manualized approach in terms of benefits and limitations?
8. In what ways could the integration of neuroimaging or physiological measures enhance our understanding of the effects of music therapy on depression?
9. How might cultural factors influence the effectiveness of music therapy for depression? How could future research address this aspect?
10. Considering the economic implications mentioned in the study, how might the cost-effectiveness of group music therapy compare to other established treatments for depression?