Intra- and inter-brain coupling and activity dynamics during improvisational music therapy with a person with dementia: an explorative EEG-hyperscanning single case study.

Objective: Real-life research into the underlying neural dynamics of improvisational music therapy, used with various clinical populations, is largely lacking. This single case study explored within-session differences in musical features and in within- and between-brain coupling between a Person with Dementia (PwD) and a music therapist during a music therapy session. Methods: Dual-EEG from a music therapist and a PwD (male, 31 years) was recorded. Note density, pulse clarity and synchronicity were extracted from audio-visual data. Three music therapists identified moments of interest and no interest (MOI/MONI) in two drum improvisations. The Integrative Coupling Index, reflecting time-lagged neural synchronization, and musical features were compared between the MOI and MONI. Results: Between-brain coupling of 2 Hz activity was increased during the MOI, showing anteriority of the therapist's neural activity. Within-brain coupling for the PwD was stronger from frontal and central areas during the MOI, but within-brain coupling for the therapist was stronger during MONI. Differences in musical features indicated that both acted musically more similar to one another during the MOI. Conclusion: Within-session differences in neural synchronization and musical features highlight the dynamic nature of music therapy. Significance: The findings contribute to a better understanding of social and affective processes in the brain and (interactive) musical behaviors during specific moments in a real-life music therapy session. This may provide insights into the role of such moments for relational-therapeutic processes.

Music therapy, neural processing, and craving reduction: an RCT protocol for a mixed methods feasibility study in a Community Substance Misuse Treatment Service.

BACKGROUND: Music therapy has been shown to be effective for multiple clinical endpoints associated with substance use disorder such as craving reduction, emotion regulation, depression, and anxiety, but there are a lack of studies investigating those effects in UK Community Substance Misuse Treatment Services (CSMTSs). Furthermore, there is a demand for identifying music therapy mechanisms of change and related brain processes for substance use disorder treatment. The present study aims to evaluate the feasibility and acceptability of music therapy and a pre-test, post-test, and in-session measurement battery in a CSMTS. METHODS: Fifteen participants, from a community service based in London, will take part in a mixed-methods non-blind randomized-controlled trial. Ten participants will receive six-weekly sessions of music therapy in addition to the standard treatment offered by the CSMTS-five of them will receive individual music therapy and five of them will receive group music therapy-while a further five participants will act as a control group receiving standard treatment only. Satisfaction and acceptability will be evaluated in focus groups with service users and staff members following the final treatment session. Moreover, attendance and completion rates will be monitored throughout the intervention. Subjective and behavioral indexes will be assessed before and after the interventions to explore the effects of music therapy on craving, substance use, symptoms of depression and anxiety, inhibitory control, and will be correlated with associated neurophysiological signatures. In-session analysis of two individual music therapy sessions will serve to explore how music and emotion are processed in the brain within the therapy. The data collected at each step will be included in an intention-to-treat analysis basis. DISCUSSION: This study will provide a first report on the feasibility of music therapy as an intervention for participants with substance use disorder engaged within a community service. It will also provide valuable information regarding the implementation of a multifaceted methodology that includes neurophysiological, questionnaire-based, and behavioral assessments in this cohort. Notwithstanding the limitation of a small sample size, the present study will provide novel preliminary data regarding neurophysiological outcomes in participants with substance use disorder that received music therapy. TRIAL REGISTRATION: ClinicalTrails.gov, NCT0518061, Registered 6 January 2022, https://clinicaltrials.gov/ct2/show/NCT05180617.

Neuroplastic Changes in Addiction Memory-How Music Therapy and Music-Based Intervention May Reduce Craving: A Narrative Review.

Recent findings indicate that Music Therapy (MT) and Music-Based Interventions (MBIs) may reduce craving symptoms in people with Substance Use Disorders (SUD). However, MT/MBIs can lead SUD clients to recall memories associated with their drug history and the corresponding strong emotions (addiction memories). Craving is a central component of SUD, possibly linked to relapse and triggered by several factors such as the recall of memories associated with the drug experience. Therefore, to address the topic of what elements can account for an improvement in craving symptoms after MT/MBIs, we conducted a narrative review that (1) describes the brain correlates of emotionally salient autobiographical memories evoked by music, (2) outlines neuroimaging and neurophysiological studies suggesting how the experience of craving may encompass the recall of emotionally filled moments, and (3) points out the role of perineuronal nets (PNNs) in addiction memory neuroplasticity. We highlight how autobiographical memory retrieval, music-evoked autobiographical memories, and craving share similar neural activations with PNNs which represent a causal element in the processing of addiction memory. We finally conclude by considering how the neuroplastic characteristics of addiction memory might represent the ground to update and/or recalibrate, within the therapy, the emotional content related to the recall.

Dyadic nonverbal synchrony during pre and post music therapy interventions and its relationship to self-reported therapy readiness.

Nonverbal interpersonal synchronization has been established as an important factor in therapeutic relationships, and the differentiation of who leads the interaction appears to provide further important information. We investigated nonverbal synchrony - quantified as the coordination of body movement between patient and therapist. This was observed in music therapy dyads, while engaged in verbal interaction before and after a music intervention in the session. We further examined associations with patients' self-reported therapy readiness at the beginning of the session. Eleven neurological in-patients participated in this study. Our results showed an increase in both nonverbal synchrony and patient leading after the music intervention. A significant negative correlation was found between self-reported therapy readiness and nonverbal synchrony after the music intervention. These findings point to the empathic ability of the music therapist to sense patients' therapy readiness. Higher patient leading in nonverbal synchrony after the music intervention may thus indicate that the music intervention may have allowed dyadic entrainment to take place, potentially increasing self-regulation and thus empowering patients.

EEG Hyperscanning and Qualitative Analysis of Moments of Interest in Music Therapy for Stroke Rehabilitation-A Feasibility Study.

Interdisciplinary research into the underlying neural processes of music therapy (MT) and subjective experiences of patients and therapists are largely lacking. The aim of the current study was to assess the feasibility of newly developed procedures (including electroencephalography/electrocardiography hyperscanning, synchronous audio-video monitoring, and qualitative interviews) to study the personal experiences and neuronal dynamics of moments of interest during MT with stroke survivors. The feasibility of our mobile setup and procedures as well as their clinical implementation in a rehabilitation centre and an acute hospital ward were tested with four phase C patients. Protocols and interviews were used for the documentation and analysis of the feasibility. Recruiting patients for MT sessions was feasible, although data collection on three consecutive weeks was not always possible due to organisational constraints, especially in the hospital with acute ward routines. Research procedures were successfully implemented, and according to interviews, none of the patients reported any burden, tiredness, or increased stress due to the research procedures, which lasted approx. 3 h (ranging from 135 min to 209 min) for each patient. Implementing the research procedures in a rehabilitation unit with stroke patients was feasible, and only small adaptations were made for further research.

Neuronal Effects of Listening to Entrainment Music Versus Preferred Music in Patients With Chronic Cancer Pain as Measured via EEG and LORETA Imaging.

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta (6-9 Hz) and low beta (12-16 Hz) power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three clinical cases. Effectiveness of personalized music therapy improvisations (entrainment music - EM) versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM (depicting both "pain" and "healing"), preferred (commercially available) music, and a non-participant's EM as a control. Participants rated their pain before and after the EEG on a 1-10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top-down neural processes associated with active coping for pain.

"Telling me not to worry " Hyperscanning and Neural Dynamics of Emotion Processing During Guided Imagery and Music.

To analyze how emotions and imagery are shared, processed and recognized in Guided Imagery and Music, we measured the brain activity of an experienced therapist ("Guide") and client ("Traveler") with dual-EEG in a real therapy session about potential death of family members. Synchronously with the EEG, the session was video-taped and then micro-analyzed. Four raters identified therapeutically important moments of interest (MOI) and no-interest (MONI) which were transcribed and annotated. Several indices of emotion- and imagery-related processing were analyzed: frontal and parietal alpha asymmetry, frontal midline theta, and occipital alpha activity. Session ratings showed overlaps across all raters, confirming the importance of these MOIs, which showed different cortical activity in visual areas compared to resting-state. MOI 1 was a pivotal moment including an important imagery with a message of hope from a close family member, while in the second MOI the Traveler sent a message to an unborn baby. Generally, results seemed to indicate that the emotions of Traveler and Guide during important moments were not positive, pleasurably or relaxed when compared to resting-state, confirming both were dealing with negative emotions and anxiety that had to be contained in the interpersonal process. However, the temporal dynamics of emotion-related markers suggested shifts in emotional valence and intensity during these important, personally meaningful moments; for example, during receiving the message of hope, an increase of frontal alpha asymmetry was observed, reflecting increased positive emotional processing. EEG source localization during the message suggested a peak activation in left middle temporal gyrus. Interestingly, peaks in emotional markers in the Guide partly paralleled the Traveler's peaks; for example, during the Guide's strong feeling of mutuality in MOI 2, the time series of frontal alpha asymmetries showed a significant cross-correlation, indicating similar emotional processing in Traveler and Guide. Investigating the moment-to-moment interaction in music therapy showed how asymmetry peaks align with the situated cognition of Traveler and Guide along the emotional contour of the music, representing the highs and lows during the therapy process. Combining dual-EEG with detailed audiovisual and qualitative data seems to be a promising approach for further research into music therapy.

Combining EEG, MIDI, and motion capture techniques for investigating musical performance.

This article describes a setup for the simultaneous recording of electrophysiological data (EEG), musical data (MIDI), and three-dimensional movement data. Previously, each of these three different kinds of measurements, conducted sequentially, has been proven to provide important information about different aspects of music performance as an example of a demanding multisensory motor skill. With the method described here, it is possible to record brain-related activity and movement data simultaneously, with accurate timing resolution and at relatively low costs. EEG and MIDI data were synchronized with a modified version of the FTAP software, sending synchronization signals to the EEG recording device simultaneously with keypress events. Similarly, a motion capture system sent synchronization signals simultaneously with each recorded frame. The setup can be used for studies investigating cognitive and motor processes during music performance and music-like tasks--for example, in the domains of motor control, learning, music therapy, or musical emotions. Thus, this setup offers a promising possibility of a more behaviorally driven analysis of brain activity.

Predictive error detection in pianists: a combined ERP and motion capture study.

Performing a piece of music involves the interplay of several cognitive and motor processes and requires extensive training to achieve a high skill level. However, even professional musicians commit errors occasionally. Previous event-related potential (ERP) studies have investigated the neurophysiological correlates of pitch errors during piano performance, and reported pre-error negativity already occurring approximately 70-100 ms before the error had been committed and audible. It was assumed that this pre-error negativity reflects predictive control processes that compare predicted consequences with actual consequences of one's own actions. However, in previous investigations, correct and incorrect pitch events were confounded by their different tempi. In addition, no data about the underlying movements were available. In the present study, we exploratively recorded the ERPs and 3D movement data of pianists' fingers simultaneously while they performed fingering exercises from memory. Results showed a pre-error negativity for incorrect keystrokes when both correct and incorrect keystrokes were performed with comparable tempi. Interestingly, even correct notes immediately preceding erroneous keystrokes elicited a very similar negativity. In addition, we explored the possibility of computing ERPs time-locked to a kinematic landmark in the finger motion trajectories defined by when a finger makes initial contact with the key surface, that is, at the onset of tactile feedback. Results suggest that incorrect notes elicited a small difference after the onset of tactile feedback, whereas correct notes preceding incorrect ones elicited negativity before the onset of tactile feedback. The results tentatively suggest that tactile feedback plays an important role in error-monitoring during piano performance, because the comparison between predicted and actual sensory (tactile) feedback may provide the information necessary for the detection of an upcoming error.

Error monitoring in musicians.

To err is human, and hence even professional musicians make errors occasionally during their performances. This paper summarizes recent work investigating error monitoring in musicians, i.e., the processes and their neural correlates associated with the monitoring of ongoing actions and the detection of deviations from intended sounds. Electroencephalography (EEG) studies reported an early component of the event-related potential (ERP) occurring before the onsets of pitch errors. This component, which can be altered in musicians with focal dystonia, likely reflects processes of error detection and/or error compensation, i.e., attempts to cancel the undesired sensory consequence (a wrong tone) a musician is about to perceive. Thus, auditory feedback seems not to be a prerequisite for error detection, consistent with previous behavioral results. In contrast, when auditory feedback is externally manipulated and thus unexpected, motor performance can be severely distorted, although not all feedback alterations result in performance impairments. Recent studies investigating the neural correlates of feedback processing showed that unexpected feedback elicits an ERP component after note onsets, which shows larger amplitudes during music performance than during mere perception of the same musical sequences. Hence, these results stress the role of motor actions for the processing of auditory information. Furthermore, recent methodological advances like the combination of 3D motion capture techniques with EEG will be discussed. Such combinations of different measures can potentially help to disentangle the roles of different feedback types such as proprioceptive and auditory feedback, and in general to derive at a better understanding of the complex interactions between the motor and auditory domain during error monitoring. Finally, outstanding questions and future directions in this context will be discussed.

Effects of selective attention on syntax processing in music and language.

The present study investigated the effects of auditory selective attention on the processing of syntactic information in music and speech using event-related potentials. Spoken sentences or musical chord sequences were either presented in isolation, or simultaneously. When presented simultaneously, participants had to focus their attention either on speech, or on music. Final words of sentences and final harmonies of chord sequences were syntactically either correct or incorrect. Irregular chords elicited an early right anterior negativity (ERAN), whose amplitude was decreased when music was simultaneously presented with speech, compared to when only music was presented. However, the amplitude of the ERAN-like waveform elicited when music was ignored did not differ from the conditions in which participants attended the chord sequences. Irregular sentences elicited an early left anterior negativity (ELAN), regardless of whether speech was presented in isolation, was attended, or was to be ignored. These findings suggest that the neural mechanisms underlying the processing of syntactic structure of music and speech operate partially automatically, and, in the case of music, are influenced by different attentional conditions. Moreover, the ERAN was slightly reduced when irregular sentences were presented, but only when music was ignored. Therefore, these findings provide no clear support for an interaction of neural resources for syntactic processing already at these early stages.

Processing expectancy violations during music performance and perception: an ERP study.

Musicians are highly trained motor experts with pronounced associations between musical actions and the corresponding auditory effects. However, the importance of auditory feedback for music performance is controversial, and it is unknown how feedback during music performance is processed. The present study investigated the neural mechanisms underlying the processing of auditory feedback manipulations in pianists. To disentangle effects of action-based and perception-based expectations, we compared feedback manipulations during performance to the mere perception of the same stimulus material. In two experiments, pianists performed bimanually sequences on a piano, while at random positions, the auditory feedback of single notes was manipulated, thereby creating a mismatch between an expected and actually perceived action effect (action condition). In addition, pianists listened to tone sequences containing the same manipulations (perception condition). The manipulations in the perception condition were either task-relevant (Experiment 1) or task-irrelevant (Experiment 2). In action and perception conditions, event-related potentials elicited by manipulated tones showed an early fronto-central negativity around 200 msec, presumably reflecting a feedback ERN/N200, followed by a positive deflection (P3a). The early negativity was more pronounced during the action compared to the perception condition. This shows that during performance, the intention to produce specific auditory effects leads to stronger expectancies than the expectancies built up during music perception.

Nobody is perfect: ERP effects prior to performance errors in musicians indicate fast monitoring processes.

BACKGROUND: One central question in the context of motor control and action monitoring is at what point in time errors can be detected. Previous electrophysiological studies investigating this issue focused on brain potentials elicited after erroneous responses, mainly in simple speeded response tasks. In the present study, we investigated brain potentials before the commission of errors in a natural and complex situation. METHODOLOGY/PRINCIPAL FINDINGS: Expert pianists bimanually played scales and patterns while the electroencephalogram (EEG) was recorded. Event-related potentials (ERPs) were computed for correct and incorrect performances. Results revealed differences already 100 ms prior to the onset of a note (i.e., prior to auditory feedback). We further observed that erroneous keystrokes were delayed in time and pressed more slowly. CONCLUSIONS: Our data reveal neural mechanisms in musicians that are able to detect errors prior to the execution of erroneous movements. The underlying mechanism probably relies on predictive control processes that compare the predicted outcome of an action with the action goal.