Katrina Skewes McFerran

Background: The transdiagnostic symptom of anhedonia, or the loss of pleasure in previously pleasurable things, is common across several chronic physical and mental illnesses. Music therapy has been effective in treating a range of conditions associated with anhedonia, but only 3 cases have been reported that targeted increasing hedonic capacity and all relied on descriptive data (qualitative and quantitative). Functional magnetic resonance imaging (fMRI) evidence demonstrates that pleasure is associated with increased activity in the limbic system, including the anterior cingulate cortex, as well as the prefrontal cortex. As such, changes within these regions may provide objective evidence to explore how music therapy acts to reduce anhedonia symptomatology. Objective: Our primary aim is to examine the feasibility of a music therapy intervention to increase hedonic capacity among individuals with anhedonia. We also aim to examine congruence across psychometric results and interview data to generate estimates of effect size and explore participants’ qualitative experiences. In addition, we aim to identify any correspondence between these outcomes and changes in brain activity associated with reward processing during targeted fMRI tasks. This study will generate hypotheses for testing in future studies. Methods: This pilot study uses a sequential mixed methods design to first identify whether there are pre-post changes in the primary outcome measures and then to identify correlations between interview data, psychometric data, and objective measures of brain structure and functioning (fMRI). Participants were 13 adults with high cognitive function who scored within the clinical range for anhedonia on the Dimensional Anhedonia Rating Scale (DARS). Participants were engaged in a 4-month music therapy intervention developed through preliminary case studies, which involved daily independent pleasure-focused music activities and regular contact with a therapeutic guide. The fMRI data acquired include resting-state fMRI and task-based functional paradigms designed to probe musical pleasure (music listening task) and reward prediction (reversal reward learning task). Data will be analyzed using individual general linear models to identify associations with symptom improvement, as well as longitudinal changes in functioning. Results: The study received internal funding support from the University of Melbourne in September 2024. Data collection commenced in August 2025 and was concluded by mid-2026. As of September 2026, 13 participants have been recruited, and data will be analyzed by the end of 2026, with results expected to be published in 2027. Conclusions: The results of this pilot study will contribute to knowledge about the effects of this music therapy intervention on reducing anhedonia and introduce a study protocol that could be used in subsequent, more robust studies to explore potential mechanisms.

BACKGROUND The transdiagnostic symptom of anhedonia, or the loss of pleasure in previously pleasurable things, is common across several chronic physical and mental illnesses. Music therapy has been effective in treating a range of conditions associated with anhedonia, but the precise neurobiological mechanisms underpinning music therapy’s efficacy remain unclear. One potential mechanism is musical pleasure, as a re-activator of the pleasure system. Functional Magnetic Resonance Imaging (fMRI) evidence demonstrates that pleasure is associated with increased activity of the limbic system including the anterior cingulate cortex (ACC), as well as the pre-frontal cortex. As such, changes within these regions may be one such mechanism through which music therapy acts to reduce anhedonia symptomatology. OBJECTIVE Our primary objective is to examine indicators of increased pleasure/hedonic capacity in individuals with anhedonia before and after completing a 3 month structured music therapy intervention involving daily music-based activities . We will assess whether musical pleasure mediates the relationship between music therapy and decreased anhedonia symptoms. METHODS We will pilot pre-post testing of a cohort of 9 participants who have scored as symptomatic of anhedonia using the Dimensional Anhedonia Rating Scale (DARS). We will investigate validated psychometrics tools (the DARS and Snaith-Hamilton Pleasure Scale (SHAPS)) and objective measures of brain structure and functioning (fMRI) pre- and post-intervention. fMRI data acquired will include resting-state fMRI and acquisitions during naturalistic listening to music pieces in addition to functional paradigms designed to probe musical pleasure (music listening task) and reward prediction (reversal reward learning task). Data will be analysed using individual general linear models to identify associations with symptom improvement as well as well longitudinal changes in functioning. RESULTS The study received internal funding support from the University of Melbourne in September 2024. Data collection commenced in August 2025 and will conclude by mid-2026. As of December 2025, 9 participants have been recruited, and data will be analysed by the end of 2026 with results to be published in 2027. CONCLUSIONS The results of this study will contribute to knowledge of music therapy and anhedonia and the understanding of musical pleasure as a potential mechanism for improvement. CLINICALTRIAL N/A

The experience of pleasure in music therapy has been underexplored. This paper examines the possibility that pleasure might mediate the effectiveness of music therapy interventions, particularly for individuals experiencing anhedonia (diminished ability to experience pleasure). We theorise this proposition by exploring music therapy processes and findings from two case studies involving people with anhedonia. An interpretive case study approach was employed to generate explanations for observed outcomes. Following ethics approval, three participants meeting clinical criteria for anhedonia were recruited. Over four months, they engaged in tailored daily independent music activities focused on eliciting pleasure, supported by a music therapist. Multiple data sources were collected, including standardized anhedonia measures, daily ratings, interviews, and therapist observations. All three participants showed improvements in anhedonia scores, with two moving into the normal range by study completion. Qualitative data revealed the importance of: 1) accessible and intentional pleasure-focused music activities; 2) therapeutic alliance providing guidance, psychoeducation and motivational support; and 3) participants' existing relationship with music as a historical source of pleasure. Specific therapeutic principles that facilitated outcomes are outlined. Findings suggest musical pleasure may be an important mediator of positive outcomes in music therapy, particularly for anhedonia. By overtly targeting pleasure through tailored music activities and therapeutic support, participants reconnected with musical pleasure, which generalised to improved hedonic capacity. Interacting dimensions of pleasure-focused musicking, the pleasure experience, and therapeutic scaffolding are proposed as key mechanisms. Implications for music therapy practice and future research are discussed.

This study explores the sustained practices of six classroom teachers after their participation in a novel music therapy informed professional learning program, Music for Classroom Wellbeing. Amid growing concerns about student mental health and teacher attrition, effective strategies to promote classroom wellbeing are urgently needed. The program aimed to enhance teachers’ capacity to foster safe and supportive classroom environments through intentional use of musical practices. Using a critical ethnographic approach, data was collected through participant interviews 6 months after the program’s conclusion and inductively analysed to find common themes. Findings revealed that teachers sustained their intentional use of music in three ways: to strengthen relationships, support emotional regulation, and differentiate learning. The study highlights the potential of music-based interventions in promoting both student and teacher wellbeing, as well as supporting inclusive pedagogical practices. Recommendations are made for future innovative approaches to teacher professional learning and classroom wellbeing.

This meta-synthesis investigates the concept of pleasure in music therapy, responding to Stige’s (2006) call for a deeper understanding of its role in therapeutic processes. Drawing on qualitative research studies published between 2010 and 2024, the study analyzes consumer perspectives on pleasurable experiences in music therapy within adult mental health and adolescent mental wellbeing contexts. The research employs an interpretivist approach, utilizing pleasure as a sensitizing concept to guide data extraction and analysis. The methodology involves a systematic review of 26 qualitative studies, focusing on participant interviews that reference pleasurable aspects of music therapy. Data analysis incorporates elements of discourse analysis, thematic categorization, and arts-based interpretation. Findings reveal multifaceted dimensions of pleasure in music therapy, including sensorial experiences, emotional activation, and shared affective states. The analysis distinguishes between experiences of individuals with severe mental illness and those in recovery or with milder psychological distress. The study also explores differences in pleasure descriptions between group and individual therapy settings.

Portable EEG technologies have gained popularity in investigating the effect of music on people’s emotional responses by affective neuroscience, music psychology, and music therapy researchers. This paper provides a brief overview of current literature on music, emotion, and EEG, and a reflection on Kim’s use of one portable EEG technology (Emotiv Insight) to explore distressed young people’s emotional responses during intentional listening of their meaningful songs. Inconsistent results in Kim’s study and across music and emotion research studies revealed the reality of the still-emerging state of EEG technologies and thus, researchers should approach the tool with vigilance and some suspicion. In our experiment, the Emotiv Insight offered distressed young people novel and interesting opportunities to reflect on their emotional distress with a new lens. However, distressed young people did not perceive that the EEG visual data actually represented the complexity of their emotional worlds. Rather, they suggested that listening to their meaningful songs, selecting emotion-related words from self-report scales, and discussing their emotions with someone was more useful to better understand their emotional worlds. Acknowledgements Kyung Min Mindy Kim was supported in conducting this research by Melbourne Research PhD Scholarship. The Emotiv technology was purchased with support from a strategic Faculty of Fine Arts and Music internal grant.