Gebhardt, Von Georgi - 2007 - Music, Mental Disorder and Emotional Reception Behavior

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Music, mental disorder and emotional

reception behavior
Article · December 2007
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Music Therapy Today
Vol. VIII (3) (Dec) 2007
Music, mental disorder and

emotional reception behavior
Gebhardt, Stefan & von Georgi, Richard
Abstract
Objective: Current research based on neurobiological findings provides
evidence for direct effects of music on the modulation of activation and
arousal. In the current study associations between the functional-recep-

tive use of music in everyday life on specific diagnostic groups of mental
disorders (according to the international classification of disorders, ICD-
10) were ascertained.
Methods: n=55 patients with addictive, schizophrenic, affective, neu-

rotic, and personality disorders (mean age 46 ± 14 years) of the Depart-
ment of Psychiatry and Psychotherapy of the University of Marburg/
Germany were included. The „Inventory for the assessment of Activa-
tion- and Arousalmodulation through Music“ (IAAM) was used to ascer-
tain the dimensions: Relaxation (RX), Cognitive Problem Solving (CP),
Reduction of negative Activation (RA), Fun Seeking (FS) and Arousal
Modulation (AM). Data were compared by ONEWAY analysis with
healthy control populations (n=187 students aged age 21 ± 3 years;
n=106 adults aged 43 ± 6 years).
419
Gebhardt, S. & von Georgi, R. (2007) Music, mental disorder and emotional reception behavior. Music Ther-
apy Today. Vol.VIII (3) December. available at http://musictherapyworld.net
Results: Significant differences were found with respect to diagnostic

groups and the control samples for the parameter RX (p<0.001), CP
(p<0.001), RA (p<0.001), FS (p<0.001), but not for AM. Further analy-
ses with respect to possible sex and age influences results in specific pat-
terns of the use music for emotion modulation in these fife scales
compared to the patient groups (p<0,001).
Discussion: The results suggest that patients with mental disorders

clearly tend to use more music for RA, RX and CP than control samples,
while healthy young persons tend to an increased positive stimulation.
However, positive stimulation is reduced especially in patients with per-
sonality disorders, where a strong RA by music is apparent. In particular
patients with addictive disorders, but also patients with schizophrenic
disorders show for all parameters high scores. In contrast, patients with
affective disorders demonstrate a lack of RA.
Conclusion: This first study provides preliminary hints, that the func-
tional-receptive use of music for the modulation of emotional activation
processes in patients with mental disorders is quantifiable. Further stud-
ies with respect to findings in different mental disorders on the basis of
this approach are warranted.
KEYWORDS: music, reception, psychiatric disorders, activation, emotion, arousal mod-

ulation, relaxation, cognitive
1. Introduction
The high impact of music on psyche and therefore on mental disorders is
unchallenged. Since ancient times music is an integral part of cure pro-
cesses in many cultures. Therefore, music reception should play a crucial
role within the dynamic of mental disorders, and hence for the course and
1. Introduction 420
therapy of mental disorders (Sheratt, Thornton & Hatton, 2004; Gebhardt

& von Georgi, 2007). Especially on the basis of a multitude of recent
neurophysiological studies demonstrating impacts of music – not only on
the cortex – but also directly on basic emotional systems (Panksepp &
Bernatzky, 2002), one should expect differences of modulation of emo-
tions by use of music between different patient groups with mental disor-
ders. This assumption goes in line with recent studies explaining the
conscious everyday life use of music by means of a neurobiological
approach (von Georgi, Grant, von Georgi & Gebhardt, 2006a).
Investigating the current state of research on the impact of music on psy-

chological dimensions three separate categories have to be differentiated:
studies on (a) active and (b) receptive/passive music therapy and (c) on
the functional-receptive, everyday life use of music, as an interactional
process. The latter being the concern of the current study refers to the fact
that listening to music is mostly preceded by an active action which is
associated with more or less conscious individual-specific aims of action
(Leontyev, 1978; Frese & Sabini, 1985; Hacker, 1994), which are based
on learned behavior and personality dispositions. In the following some
aspects of these three categories will be addressed with respect to healthy
subjects and patients suffering from non-psychiatric or mental disorders.
Studies on healthy individuals provide evidence for links between music

preferences and personality dimensions (Rentfrow & Gosling, 2003; von
Georgi, Grant, von Georgi & Gebhardt, 2006b) or between types of
music (e.g. excitative versus sedative) and aroused feelings or physiolog-
ical responses of heart rate, respiration and blood pressure (Iwanaga &
Moroki, 1999, Blood & Zatorre, 2001). A reduction of anxiety levels was
found in healthy subjects exposed to their preferred musical selections
(Salamon et al., 2003). In a meta-analysis a significant decrease of
arousal due to stress was found by use of music alone or music assisted
1. Introduction 421
relaxation techniques (Pelletier, 2004). It also could be shown that in the

presence of music, the cortisol level ceases to increase after a stressor
(Khalfa et al., 2003). Hereby the association of stress coping strategies
and the use of music seems to be influenced by socio-psychological
covariables (von Georgi, König & Gebhardt, in press).
Music in non-psychiatric diseases has been studied predominantly on a

therapeutic basis. For example, active music therapy is effective on
motor, affective and behavioral functions, e.g. in patients with Parkin-
son's disease (Pacchetti et al., 2000). In patients undergoing hemodialysis
active music therapy may be applied as a method of nursing intervention
contributing the improvement of quality life by reducing anxiety and
depression (Kim, Lee & Sok, 2006). But also merely the reception of
music induces relaxation before and after surgery or diagnostic proce-
dures, helping to save sedative drugs, what results in a positive effect for
the course of the illness (Mok & Wong, 2003; Good et al., 2005; Sied-
liecki & Good, 2006). Cancer patients are as well interested in receptive
music therapy and their interest and preference were associated with neg-
ative affect, anxiety, age, perceived intervention-specific benefits, barri-
ers and self-efficacy (Burns et al., 2005). Further, pleasant music
contributes to pain relief, where the personal preference seems to be an
influential factor (Lai, 2004; Mitchell & MacDonald, 2006; Roy, Peretz
& Rainville, 2007). One study found more power and less pain, depres-
sion and disability by use of music in patients with chronic non-malig-
nant pain than the control group (Siedliecki & Good 2006).
Studies on patients with mental disorders revealed significant effects of

active and receptive music therapy. Koger, Chapin & Bronts (1999)
found in a meta-analysis of 21 empirical studies on subjects suffering
from symptoms of dementia an overall significant effect of music ther-
apy, while another meta-analysis of 5 studies displayed inconclusive
1. Introduction 422
results, possibly due to poor methodological quality of the examined

studies (Vink, Birks, Bruinsma, Scholten, 2004). Meta-analyses of quan-
titative studies on music therapy in children and adolescents with autism
(9 studies; Whipple, 2004) or psychopathogical symptoms (11 studies;
Gold, Voracek & Wilgram, 2004), however with methodological deficits,
showed overall efficacy of both active and receptive music therapy with-
out significant differences (Whipple, 2004), in particular for patients with
behavioral and developmental disorders (Gold, Voracek & Wilgram,
2004). Further, results from a metananalysis of 19 studies with a total of
543 patients suffering from psychotic symptoms indicate a significant
reducing effect on symptoms of psychosis irrespective whether active or
passive music therapy was applied (Silverman, 2003), whereas according
to a more recent meta-analysis of 4 studies with merely moderate meth-
odological quality active music therapy may be more affective in patients
with psychosis (Gold, Heldal, Dahle & Wigram, 2005).
Apart from such studies evaluating active or passive music therapy,

almost no systematic scientific data on the functional-receptive use of
music in everyday life of individuals suffering from mental disorders
exist. For example, current psychobiological models of addictive disor-
ders are focused on the capability of drugs to cause a pathological exploi-
tation of the neural rewarding system often combined with the use of
music, e.g. by means of rave parties (Nencini, 2002), and with aggressive
behaviors (Chen, Miller, Grube & Waiters, 2006). According to a study
on tobacco smoking in a group of 152 high school and college students a
higher preference for music associated with anxiety and depressed mood
among smokers was found (Posluszna, Burtowy & Palusinski, 2004).
Altogether, music studies on patients concentrate predominantly on

active or in part passive (i.e. receptive) music therapy, but have ignored
largely examining the active everyday life use of music, which is for
1. Introduction 423
example mirrored by preference behavior. Studies on the functional-

receptive effect of music were restricted predominantly to “ad hoc” sur-
veys, the situation-dependent rating of presented music examples (see
Gembris, 2002) or to more general effects, e.g. stress reduction effects
(see Pelletier, 2004). No differentiation of music effects on different
diagnostic groups of patients with mental disorders within one represen-
tative general psychiatric patient population has been carried out so far.
However, especially this music reception behavior might have a crucial
impact on psychological dimensions highlighting the need for a compre-
hensive assessment of patient needs and preferences prior to intervention
(see also Burns et al., 2005). The investigation of variables influencing
the use of music in patients with mental disorders should not only lead to
a better insight in psychopathological processes, but also have an impor-
tant impact on the development of empirically based music therapy con-
cepts.
One reason might be found in the fact that no reliable and valid psycho-
metric instrument assessing the way of music reception and the use of
music in everyday life has existed so far. Therefore, the “Inventory for
the assessment of Activation- and Arousalmodulation through Music”
(IAAM), has been developed in order to ascertain quantitatively the basic
dimensions of the functional utilization of music for the modulation of
emotional activation processes (von Georgi, Abou Seif, Grant & Beck-
mann, 2004; von Georgi, Grand, Adjormand & Gebhardt, 2005; von
Georgi, Grant, von Georgi & Gebhardt, 2006a; von Georgi, 2007). Theo-
retically the basic dimensions of using music in everyday life are inte-
grated into the neurophysiological model of Gray & McNaughton
(2003), what enables the connection of different theoretical and empirical
approaches as well as the linkage to neurophysiological research results
(von Georgi, Grant, von Georgi & Gebhardt, 2006a). First empirical data
1. Introduction 424
clearly show the development of personality-dependant strategies to

modulate negative and positive emotions. These strategies can be mea-
sured and have direct positive influence on physical well-being (von
Georgi, Grant, von Georgi & Gebhardt, 2006a, 200b; von Georgi, Cimbal
& von Georgi, in press).
Thus, in the current study for the first time possible differences of func-
tional-receptive effects of music of patients suffering from mental disor-
ders categorized according to diagnostic groups to the International
Classification of Disorders (ICD-10; Dilling, Mombour & Schmidt 2004)
were assessed.
2. Method
STUDY SAMPLE: n=55 patients (32 female; mean age 46 ± 14 years) consecutively admit-
ted at the Department of Psychiatry and Psychotherapy of the Philipps-
University of Marburg/Germany were categorized according to the diag-
nostic groups of ICD-10 with mental and behavioural disorders due to
psychoactive substance use (F1; n=7), schizophrenia, schizotypal and
delusional disorders (F2; n=11), mood affective disorders (F3; n=21),
neurotic, stress-related and somatoform disorders (F4; n=8) and disorders
of adult personality and behavior (F6; n=8), while subjects of other ICD-
10 diagnostic groups (e.g. organic, including symptomatic, mental disor-
ders (F0); behavioral syndromes associated with physiological distur-
bances and physical factors (F5); mental retardation (F7); disorders of
psychological development (F8)) were missing in this sample. The mean
global functioning according to the Global Assessment of Functioning
Scale (GAF; scale range 0 – 100; American Psychiatric Association,
1987) of the study sample was 51 ± 11.
2. Method 425
CONTROL SAMPLES: (a) n=181 students (128 female; mean age 21 ± 3 years) of the first
semester medicine (von Georgi, Cimbal & von Georgi, in press). (b) 106
adult persons (53 male; mean age 43 ± 6 years), recruited by chance out
of selected middle-class companies, insurance institution as well as club
associations (Lahn-Dill-Kreis, Kreis Gießen). Inclusion criteria of this
control sample were a minimum age of 30 years and the patient's agree-
ment to participate in the study. The majority was employed, married and
had at least one child (von Georgi, König & Gebhardt, in press).
ASSESSMENT: „Inventory for the assessment of Activation- and Arousalmodulation

through Music“ (IAAM) showing high reliability and validity (von
Georgi, Grant, von Georgi & Gebhardt, 2006a; von Georgi, 2007) mea-
sured the situation-dependent everyday life use of music according to the
parameters Relaxation (RX), Cognitive Problem Solving (CP), Reduc-
tion of negative Activation (RA), Fun Seeking (FS) and Arousal Modula-
tion (AM). Further, the „Selbstkonzept-Inventar“ (SKI) (von Georgi &
Beckmann, 2004) was used, its results are not demonstrated in the current
composition.
STATISTICS: First, using univariate analysis of variance (ONEWAY analysis) the three
samples were studies for significant differences in mean values. To
exclude, that possible group differences do not display the result of influ-
ences of age or sex, all IAAM scales were corrected for the influence of
these variables and using the unstandardized residuals ONEWAY analy-
sis was carried out again. In a third step, in order to get differential find-
ings with respect to the strength of use of music within the patient
sample, possible differences of mean values considering diagnostic
groups of the ICD-10 were assessed.
2. Method 426
3. Results
Reliability assessment of the different scales (Cronbach’s Alpha) resulted
in sufficient reliability coefficients of the scales RX, CP, RA, FS and AM
for the student control sample (0.91; 0.91; 0.90; 0.86; 0.84), the adult
control sample (0.92; 0.91; 0.90; 0.87; 0.86) as well as the patient sample
(0.90; 0.89; 0.92; 0.88; 0.86). Thus, also in the current study there is good
evidence for the reliability of these scales.
TABLE 1. Results of the ONEWAY-analyses of the fife IAAM-Skales

Students Adult Patients ONEWAY
IAAM-Scale Model M SD M SD M SD F(DF=2) p

RX RD 20.48 8.78 15.84 9.35 23.24 9.39 13.99 <0.001
UR 0.14 8.72 -2.44 9.44 4.70 9.24 10.67 <0.001
CP RD 19.93 9.14 12.80 8.74 21.56 9.37 25.27 <0.001
UR 0.23 9.04 -2.90 8.83 5.57 9.20 14.77 <0.001
RA RD 19.42 9.23 12.77 8.63 20.71 10.69 20.50 <0.001
UR -0.13 9.30 -2.33 8.70 5.51 9.94 12.20 <0.001
FS RD 27.52 8.22 21.39 8.25 21.31 8.55 23.51 <0.001
UR 0.51 8.01 -0.48 8.22 -0.75 8.93 0.73 0.484
AM RD 10.36 6.66 9.62 6.79 12.74 7.94 3.32 0.037
UR -0.41 6.57 -0.46 6.77 2.66 7.85 4.06 0.018
Legend: RX: relaxation; CP: cognitive problem solving; RA: reduc-
tion of negative activation; FS: fun seeking; AM: arousal modula-
tion; Model: raw data (RD) vs. by age and sex adjusted
uncorrected residuals (UR); M: mean; SD: standard deviation;
ONEWAY: results of the one factorial variance analyses; F: F-
value; DF: degrees of freedom; p: significance level
The first analyses of possible mean differences without considering an

impact of sex and age result in significant differences (p<0.001) between
the control samples and the clinical sample for all IAAM scales except
for the AM scale (table 1). In particular significant increased mean values
of the clinical patient group were found for the RX, CP and RA scales,
which assess a modulation of negative emotional states. For FS the gen-
eral findings indicate that especially students attempt to modulate posi-
3. Results 427
tive emotions by music. It must be emphasized, that these results may be

hampered by the influence of sex and age differences. The following
multiple regression analyses displayed except for the scale AM signifi-
cant associations with age and sex of the pooled samples (see table 2).
TABLE 2. Results of the regression analyses with age and sex on the five IAAM-scales
age Sex
scale R F(DF=2) p p(ß) p(ß)
RX 0.17 4.82 0.009 0.121 0.017
CP 0.25 10.75 <0.001 <0.001 0.026
RA 0.26 11.38 <0.001 <0.001 0.335
FS 0.36 24.08 <0.001 <0.001 0.003
AM 0.05 0.42 0.659 0.356 0.972
Legend: RX: relaxation; CP: cognitive problem solving; RA: reduc-
tion of negative activation; FS: fun seeking; AM: arousal modula-
tion; R: multiple regression coefficient; F: F-value; DF: degrees
of freedom; p: significance level; .p(ß): significance level of the
single ß-coefficients for age and sex
Hereby, in the scale RX sex differences were predominant, in contrast to

age differences in the case of RA. These results indicate, that relaxation
by music is more used by females, whereas the reduction of negative
emotional activation by music is mostly used by young persons. How-
ever, the scales CP and FS were found to be sex- and age-dependent.
These strategies are mostly used by young females. Due to these results
all scale values where corrected with respect to sex and age calculating
unstandardized residuals. Table 1 displays descriptive statistical data as
well as the results of ONEWAY analyses: it is recognizable, that except
for the scale FS both uncorrected (RD) and unstandardized residual (UR)
data lead to comparable results. Age and sex are therefore important
covariables, however not influencing the existing group differences. One
exception is the scale FS: the non-significant effect of uncorrected resid-
uals provides evidence, that age and sex are influencing variables, which
contaminate the differences between the three samples. It can be seen in
table 1 that the uncorrected mean of the student sample compared to the
3. Results 428
other samples is located much higher than the unstandardized residual

mean. This finding is in particular important for the interpretation of the
following analyses.
FIGURE 1. IAAM scale means of the unstandardized residuals
Legend figure 1: IAAM scale means of the unstandardized residuals

(adjusted by age and sex) for the three groups (RX: relaxation;
CP: cognitive problem solving; RA: reduction of negative activa-
tion; FS: fun seeking; AM: arousal modulation; (Scheffe-Test:
***: p≤0.001; **: p≤0.01; *: p≤0.05)
3. Results 429
IAAM scale means based on unstandardized residuals
Figure 1 shows mean scores of the unstandardized residuals of the scales

for the three samples. As in table 1 it can be found, that the clinical
patient group use by far more often and pronounced music for modula-
tion of negative somatic (RX), cognitive (CP) and activational (RA)
emotional states compared to the control samples, except for the FS scale
assessing positive stimulation through music. Thus, the question arises
concerning possible differences among the different diagnostic groups of
present mental disorders, because the increased scores of the patient sam-
ple do not necessarily display a general behavioral tendency of all
patients.
3. Results 430
FIGURE 2. IAAM scale means of the unstandardized residuals

(adjusted by age and sex) for the control and patients sub samples
and the results of the ONEWAY-analyses
Legend figure 2: IAAM scale means of the unstandardized residuals

(adjusted by age and sex) for the control and patients sub samples
and the results of the ONEWAY-analyses (F: F-value; p: signifi-
cance level); ICD-10 (International classification of diseases;
Dilling, Mombour & Schmidt, 2004) whereas F1: mental and
behavioral disorders due to psychoactive substance abuse (n=7);
F2: schizophrenia, schizotypical and delusional disorders (n=11);
F3: mood (affective) disorders (n=21); F4: neurotic, stress-related
3. Results 431
and somatoform disorders (n=8); F6: disorders of adult personal-

ity and behavior (n=8)); RX: relaxation; CP: cognitive problem
solving; RA: reduction of negative activation; FS: fun seeking;
AM: arousal modulation (Scheffe-Test: *: p≤0.05).
Figure 2 shows the results of ONEWAY analyses and the unstandardized

residual mean scores for the IAAM scales among each diagnostic group.
With the exception of the scale AM highly significant effects of the
groups were observed. In particular the increased values of the diagnostic
group of “mental and behavioral disorders due to psychoactive substance
abuse” (F1) and „schizophrenia, schizotypical and delusional disorders”
(F2) were conspicuous with the first group showing predominantly
clearly increased scores on the scales RX, CP and RA. Similarly, the
slightly increased RA score in the case of „disorders of adult personality
and behavior“ (F6) on the one hand and the decreased score of the scale
FS in this group on the other hand are impressing.
Altogether, the results suggest already, despite of limited data, that not
just the total study sample of patients suffering from mental disorders is
characterized by an increased emotional modulation by music. In fact,
according to the current state of the first analyses there are rather specific
patient groups which seem to prefer influencing their affects using music,
whereas other patient groups (mood (affective) disorders, neurotic,
stress-related and somatoform disorders) seem to be modest compared to
control samples.
4. Discussion
The results of this first study suggest that some patients with mental dis-
orders clearly tend to use music more for reduction of negative emotional
activation (RA), cognitive problem solving (CP) and somatic relaxation
(RX) compared to the control samples, which show a higher positive
4. Discussion 432
stimulation, in particular at young age (student sample). This finding

indicates that healthy young persons might use music mostly in order to
stimulate themselves positively, whereas patients with mental disorders
might exhibit impairments in this skill. It has to be clarified in further
studies – possibly for each diagnosis separately – whether these impair-
ments play an additional role in the development of mental disorders or
whether they represent an epiphenomenon. Salamon et al. (2003) believe,
that within the general population, many people do not have an adequate
self-understanding regarding what genre of music would best relax them.
Thus, especially these individuals might be at higher risk for failure of a
positive functional modulation of emotional activation processes. Music
might therefore merely be used for influencing the psychic state as best
as possible, e.g. by reduction of negative activation or might even be part
of dysfunctional behavior strengthening psychopathological processes.
Anyway, it is likely that these possible impairments are involved in both
causal and maintaining factors of mental disorder leading in a dialectic
manner towards a pathological process such as a vicious circle. Of
course, not in each individual suffering from a mental disorder music has
a substantial impact on pathological processes – some patients have
never been listened very much to music in their life at all; however,
music represents a valid correlate of the personal affective-cognitive-
activational way of managing the efforts, every subject is exposed, and
should therefore be of high interest for research. Psychotherapeutic expe-
rience suggest that, particularly in patients who deny music effects,
music therapeutic approaches or comparably therapeutic strategies com-
bining cognitive, affective and action-related dimensions (e.g. somatic
psychotherapy) are indicated.
In particular, positive stimulation is reduced in patients with personality

disorders (F6), where a strong reduction of negative activation by use of
4. Discussion 433
music is apparent, probably in order to overcome with strong emotions or

aggression. For example, what concerns patients suffering from border-
line personality disorder, it is well known, that their efforts to downregu-
late high affective activation levels has got a high impact in
psychopathology of these patients; the use of music is therefore a compa-
rably functional skill in order to cope with such tension states and is even
sometimes recommended as therapeutic intervention to avoid more dys-
functional behavior such as suicidal behavior. Additionally it could be
shown, that persons with a high preference for heavy metal represent on
the one hand indeed a personality that is allied with salient personality
characteristics (psychoticism, sensation seeking), but on the other hand
are characterized by a high psychological and somatic health (von
Georgi, Cimbal & von Georgi, 2006a; von Georgi, König & Gebhardt,
2007). Compared to the present clinical sample, healthy persons with a
high preference for hard music show a marked ability to stimulate them-
selves positively by means of music. This finding supports the present
interpretation.
Mostly in patients suffering from addictive disorders (F1), but also

schizophreniform disorders (F2) show high scores for all parameters (see
figure). Accordingly, active listening to music may have a high functional
impact on emotional modulation for some diagnostic groups of mental
disorders – in case of addictive disorders possibly an addictive use of
music in order to aim for a maximum effect on all parameters.
In contrast, patients diagnosed with affective disorders (F3) demonstrate

a lack of RA. Because the study sample did not contain manic patients,
one therapeutic implication is that depressed patients may be instructed
to use music for reduction of negative affects, e.g. aggressions. Patients
suffering from neurotic, stress-related and somatoform disorders (F4)
seem to be mostly comparable with the healthy student sample, however
4. Discussion 434
by far a lower score for FS. Or in other words, though patients suffering
from neurotic, stress-related and somatoform disorders (F4) have nearly
the same level of positive stimulation as the control group of on age 30
years, their levels of the remaining modulation strategies correspond
more to the students group, meaning that there seems to be a disquilibra-
tion, which might refer to impaired psychosocial and therefore agedepen-
dent development stages. Finally, in this study the arousal modulation by
means of music, focusing predominantly on concentration processes
appears to have a lower impact (von Georgi, 2007; von Georgi, Cimbal &
von Georgi in press).
Following the development of modern brain research methods (PET,

firm) it could be demonstrated, that music with its corresponding charac-
teristics (e.g. tuning, dynamics, harmony, timbre etc.) addresses different
cortical and basal structures of the central nervous system, which refer to
positive or negative affects and emotions (Blood, et al., 1999; Blood &
Zatorre, 2001; Tramo, 2001; Juslin & Sloboda, 2001; Panksepp & Ber-
natzky, 2002; Altenmüller et al., 2002; Kreutz et al., 2003). Especially the
finding, that a sudden autonom reaction on negative stimuli can take
place without any exact cortical representation (LeDoux, 2000), high-
lights the fact, that music is able to evoke and modulate emotional states
independent from higher central cognitive processes (Panksepp & Ber-
natzky, 2002; Winkielman & Berride, 2004). Hereby, musical stimuli
have been shown to activate specific pathways in several brain areas
associated with emotional behaviors and corresponding mental disorders,
such as the insular and cingulated cortex, hypothalamus, hippocampus,
amygdale, in ventral striatum, midbrain, orbitofrontal cortex and ventral
medial prefrontal cortex (Blood & Zatorre, 2001; Boso, Politi, Barale &
Enzo, 2006). These brain structures refer to reward/motivation, emotion
and arousal and are known to be active in response to survival-related
4. Discussion 435
stimuli such as food, sex and drugs of abuse. While regions as the
amygdala or the ventromedial prefrontal cortex would be activated in
unpleasant states such as anxiety, music might be able to modulate this
activity and adjust the activity of additional structures known to cause
positive emotions, e.g. structures of the reward system. In addition,
according to neurochemical studies several biochemical mediators, such
as endorphins, endocannabinoids, dopamine, nitric oxide and neurotro-
phins may play a role in the musical experience (see Boso, Politi, Barale
& Enzo, 2006; Angelucci et al., 2007). Thus, there is a link of music with
biologically relevant stimuli via their common recruitment of brain cir-
cuitry involved in pleasure and reward (Blood & Zatorre, 2001).
The above interpretations should be handled with care due to the low
patient sample size of this present study. On the other hand this is the first
study within this field and it should lead to further hypotheses and empir-
ical based studies. However, data clearly show already at this time the
above described tendencies, which are from both a theoretical and a clin-
ical point of view easily comprehensible. These results are encouraging
for continuing the systematic investigation with greater patient samples
on the basis of this methodology.
Conclusion:
To our knowledge, this is the first study providing preliminary hints, that
the functional-receptive use of music for the modulation of emotional
activation processes in patients with mental disorders is quantifiable. In
addition, for the first time differences between the use of music for mod-
ulation of emotions among diagnostic groups of patients suffering from
mental disorders have been assessed. Overall these results suggest that
patients with mental disorders display decreased positive stimulation by
Conclusion: 436
use of music compared to (especially young) healthy probands. This

finding indicates that healthy (young) persons might use music mostly in
order to stimulate themselves positively, whereas (older) patients with
mental disorders might exhibit impairments in this skill. On the other
hand some clinical groups are showing a clear accentuation of the use of
music to modulate negative emotional states. This may be an indication
for the fact that music is used to try to reduce these emotional states.
However, it is still an open question whether this affective behavior of
reducing illness related negative psychological and somatic states really
works. Perhaps it may also lead to a possible enhancement of the existing
disorder.
Music probably represents a valid individual affective-cognitive-activa-

tional correlate and should therefore be of high interest for research. Fur-
ther studies on music reception behavior differentiating according to the
diagnoses of mental disorders on the basis of this approach are urgently
warranted. The aim is to continue to reveal associations between specific
music reception behavior, personality dimensions and diagnoses of men-
tal disorders. In the long-term these findings should result in the develop-
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Author contact
Stefan Gebhardt, M.D.
Department of Psychiatry and Psychotherapy
Philipps-University of Marburg
Rudolf-Bultmann-Straße 8
D-35033 Marburg
Germany
Tel: +49 (0)6421/28-65292 oder -65200
Fax: +49 (0)6421/28-65209
Author contact 444

e-mail: Stefan.Gebhardt@med.uni-marburg.de
Corresponding author:
PD Dr. Dipl.-Psych. Richard von Georgi
Department of Music science and Music education
Justus-Liebig-Universität Gießen
Karl-Glöckner-Str. 21D
D- 5394 Giessen
Germany
e-mail: Richard.v.Georgi@psycho.med.uni-giessen.de
THIS ARTICLE CAN BE Gebhardt, S. & von Georgi, R. (2007) Music, mental disorder and emo-
CITED AS:
tional reception behavior. Music Therapy Today. Vol.VIII (3) December.
available at http://musictherapyworld.net
Author contact 445

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Music, mental disorder and emotional

Article · December 2007

Richard von Georgi

Music, mental disorder and

Gebhardt, Stefan & von Georgi, Richard

arousal. In the current study associations between the functional-recep-

Methods: n=55 patients with addictive, schizophrenic, affective, neu-

Results: Significant differences were found with respect to diagnostic

Discussion: The results suggest that patients with mental disorders

KEYWORDS: music, reception, psychiatric disorders, activation, emotion, arousal mod-

therapy of mental disorders (Sheratt, Thornton & Hatton, 2004; Gebhardt

Investigating the current state of research on the impact of music on psy-

Studies on healthy individuals provide evidence for links between music

relaxation techniques (Pelletier, 2004). It also could be shown that in the

Music in non-psychiatric diseases has been studied predominantly on a

Studies on patients with mental disorders revealed significant effects of

results, possibly due to poor methodological quality of the examined

Apart from such studies evaluating active or passive music therapy,

Altogether, music studies on patients concentrate predominantly on

example mirrored by preference behavior. Studies on the functional-

clearly show the development of personality-dependant strategies to

ASSESSMENT: „Inventory for the assessment of Activation- and Arousalmodulation

TABLE 1. Results of the ONEWAY-analyses of the fife IAAM-Skales

IAAM-Scale Model M SD M SD M SD F(DF=2) p

The first analyses of possible mean differences without considering an

tive emotions by music. It must be emphasized, that these results may be

Hereby, in the scale RX sex differences were predominant, in contrast to

other samples is located much higher than the unstandardized residual

FIGURE 1. IAAM scale means of the unstandardized residuals

Legend figure 1: IAAM scale means of the unstandardized residuals

IAAM scale means based on unstandardized residuals

Figure 1 shows mean scores of the unstandardized residuals of the scales

FIGURE 2. IAAM scale means of the unstandardized residuals

Legend figure 2: IAAM scale means of the unstandardized residuals

and somatoform disorders (n=8); F6: disorders of adult personal-

Figure 2 shows the results of ONEWAY analyses and the unstandardized

stimulation, in particular at young age (student sample). This finding

In particular, positive stimulation is reduced in patients with personality

music is apparent, probably in order to overcome with strong emotions or

Mostly in patients suffering from addictive disorders (F1), but also

In contrast, patients diagnosed with affective disorders (F3) demonstrate

Following the development of modern brain research methods (PET,

use of music compared to (especially young) healthy probands. This

Music probably represents a valid individual affective-cognitive-activa-

Altenmüller, E. Schürmann, K., Lim, V. K. & Parlitz, D. (2002). Hits to

American Psychiatric Association (APA)(1987). Diagnostic and statisti-

cal manual of mental disorders, 3rd ed., revised (DSM-III-R ).

Blood, A. J. & Zatorre, R. J. (2001). Intensely pleasurable responses to

Blood, A. J., Zatorre, R. J., Bermudez, P. & Evans, A. C. (1999). Emo-

Chen, M. J., Miller, B. A., Grube, J. W. & Waiters E. D. (2006). Music,

Dilling, H., Mombour, W. & Schmidt, M.H. (2004). Internationale Klas-

Frese, M. & Sabini, J. (1985): Goal directed behaviour: The concept of

Gebhardt, S. & von Georgi, R. (2007). Untersuchung zur Musikrezeption

Gembris, H. (2002). Grundlagen musikalischer Begabung und Entwick-

lung. 2nd edition. Augsburg: Wißner.

Good, M., Anderson, G.C., Ahn, S., Cong, X. & Stanton-Hicks, M.

Gray, J. A. & McNaughton, N. (2003). The neuropsychology of anxiety:

Hacker, W. (1994). Action regulation theory and occupational psychol-

Iwanaga, M. & Moroki, Y. (1999). Subjective and Physiological

Juslin, P. N. & Sloboda, A. A. (Eds.) (2001). Music and Emotion. Oxford:

Koger, S. M., Chapin, K. & Brotons, M. (1999). Is Music Therapy an

Kreutz, G., Russ, M. O., Bongard, S. & Lanfermann, H. (2003). Zere-