PhD Student Aaron Rodwin Explores Music-Based Interventions to Improve Young People’s Mental Health

In the wake of U.S. Surgeon General Dr. Vivek Murthy’s advisory that highlighted the mental health crisis among the nation’s adolescents and young adults (A-YA), a systematic review lead authored by PhD student Aaron Rodwin found promising evidence that music-based intervention programs can improve engagement in treatment and mental health outcomes among A-YA. This has particular implications for school-based mental health services.

Aaron is a third-year PhD student at NYU Silver and a Research Assistant for the Youth and Young Adult Mental Health Group (YYAMH-G), which is directed by Professor Michelle R. Munson. In addition to Dr. Munson, his co-authors on the paper, titled A Systematic Review of Music-Based Interventions to Improve Treatment Engagement and Mental Health Outcomes for Adolescents and Young Adults, are Rei Shimizu, PhD ’21, Raphael Travis Jr., Clinical Assistant Professor and DSW Program Director Kirk “Jae” James, and PhD student and YYAMH-G member Moiyattu Banya. The paper was published online first in Child and Adolescent Social Work Journal and is part of a forthcoming Special Issue on “Reimagining Supports for Youth Involved with Public Systems in the Transition to Adulthood.” 

The authors synthesized 26 studies that evaluated (e.g., randomized trials) the effects of music-based interventions to improve engagement in treatment and/or mental health outcomes among A-YA aged 13 to 26. Among other results, an innovative typology of music-based interventions emerged, which is characterized by combinations of experiences in three broad categories: 1) Somatosensory (primarily involving bodily, kinesthetic, and sensory elements), 2) Social-Emotional (primarily interpersonal and interactive), and 3) Cognitive-Reflective (primarily involving higher order thinking, reflecting, and analyzing surrounding meaning-making). The typology provides a practical and trauma-informed framework to help clinicians personalize various music-based intervention strategies to meet the presenting needs of clients. 

The authors also found that Hip Hop-based approaches in particular centered cultural relevance, social justice, and health equity. The authors pointed out how this is consistent with Hip Hip culture’s history that evolved from providing an outlet for individual and community empowerment for Black and Puerto Rican youth in response to oppressive environments and inequity. The authors engaged the idea of “reimagining” what mental health services can entail by focusing on research and practice that leverages the empowering dimensions of music to support youth in more authentic, culturally relevant, and youth-oriented ways.

Aaron recently spoke to NYU Silver about the findings of the systematic review and its implications for addressing the youth and young adult mental health crisis.

You and your co-authors wrote that “findings suggest that ‘nontraditional’ approaches that involve creative, dynamic, and multisensory music-based strategies can lead to improvements in engagement and mental health for A-YA across diverse clinical contexts.” What do you mean by non-traditional?? 

Aaron Rodwin: Our mental health system is predominantly oriented around “traditional” talk-based therapies and psychiatric medications. So when I say non-traditional, that captures creative therapeutic approaches that embrace the strengths of and reach beyond these standard approaches that primarily focus on cognitive therapies broadly. Emerging research focused on the neurobiology of trauma highlights the importance of multisensory therapies that have the capacity to engage the brain, mind, and body. Music-based interventions are a promising avenue worthy of further research as it inherently involves multisensory and embodied experiences that can support healing in youth-oriented ways. In addition to music and other creative arts, there are tools like yoga, neurofeedback, and all sorts of things that are beyond the traditional, eurocentric approaches to mental health treatment.

Which types of music-based interventions have the most evidence of being effective for A-YA, and for what outcomes?

AR: It’s hard to make an assertive statement in terms of which types of interventions are more effective for this population. Rather, a novel intervention typology emerged in our review that maps onto Dr. Bruce D. Perry’s Neurosequential Model of Therapeutics. It also builds off research that has captured the multidimensional nature of music and expressive therapies. We found music was used with A-YA in dynamic ways that involved combinations of experiences that were cognitive-reflective, social-emotional, and somatosensory. For example, some interventions were more socio-cognitive and involved experiences such as analyzing song lyrics as a vehicle to establish a therapeutic alliance, bolster engagement, and help young people talk about their mental health in ways that are less stigmatizing. Other interventions were more socio-somatic which involved experiences such as drumming, music-making, and Hip Hop beat making to facilitate processing of traumatic experiences, emotion regulation, and reduce internalizing symptoms (e.g., anxiety, depression).

In terms of outcomes, we found that most of the studies found significant effects for internalizing outcomes such as anxiety, depression, and low self-esteem. There were some but not as many studies in our review that focused on externalizing symptoms like aggression, impulsivity, and conduct issues. It’s a finding in and of itself that fewer studies have evaluated the impact of music-based interventions for addressing externalizing outcomes for A-YA.

Do you expect that music-based interventions will have an impact on externalizing outcomes if studies are designed properly to show that?

AR: Definitely, and we may find that the embodied, somatic approaches are particularly helpful for young people who are struggling with externalizing symptoms. Engaging physically in something can have more of a regulating effect on someone’s emotions and impulsivity than reasoning and reflecting in a more cognitive way. Research shows that patterned and repetitive rhythmic activity can help regulate your stress response system and reduce dysregulation. This is particularly important in the context of A-YA affected by traumatic stress.

Since schools often punish Black and Brown students for externalizing symptoms, do you think they are an important setting in which to test the effects of music-based interventions for externalizing symptoms?

AR: Yes, absolutely. In fact, several of the studies included in our systematic review focused on delivering these interventions within school settings. While these interventions may provide support and important benefits, it is also critical to reach beyond individual-level interventions towards broader approaches that focus on the underlying structural and systematic issues of racism and discrimination that perpetuate these inequities.

Your review notes that “Although music can support well-being, some research also suggests that music can be associated with negative outcomes if used in unhealthy or risky ways.” What are some unhealthy or risky ways of using music?

AR: There are a number of examples. A common critique, particularly in the context of rap music, is that lyrics may glorify violence, drug use, or misogyny. Music can also sometimes trigger negative emotions or make people get stuck in bad memories from the past. It can also serve at times as an avoidant coping strategy and make people ruminate and get stuck in emotion even if they are trying to use music to feel better. There is a whole line of research that has explored these questions. Of note, one of the co-authors on this paper, Dr. Raphael Travis, focuses on navigating risky and empowering influences as part of his research. 

We argue that the solution is not to restrict the type of music that is used in interventions with youth. Instead, it is important for practitioners to have the clinical skills and training to work with risky and potentially unhealthy content in a manner that facilitates positive therapeutic outcomes. For example, if a young person really connects with a song that has a lot of references to drugs or violence, the practitioner can use it as an entry point to understand the young person’s experience and create opportunities for therapeutic engagement.

What are the implications of your systematic review for developing effective and culturally appropriate music interventions for youth and young adults?

AR: A goal of this paper was to understand the evidence that music-based interventions are efficacious specifically for adolescent and young adult mental health. There has been more research on this for adults and for children but those in the transition to adulthood haven’t received as much attention. We can’t just assume that because interventions work for one group they will work for another, especially for young adults, who are in a unique developmental stage.

One of the primary implications of this review is that for the 13-26 age group, there is emerging evidence of the promise of music-based interventions. People have known for years that music can be healing but to empirically show providers that there is some evidence behind it and to show researchers that this is worth further study is an important implication in and of itself. Finally, an important implication relates to our intervention typology (e.g., socio-cognitive, socio-somatic) that emerged, which offers a practical framework to help clinicians personalize various music-based intervention strategies.

What is next for your research in this area?

AR: What I’m really interested in now is how music-based interventions work; that is, what does the use of music as part of a mental health intervention do that in turn has an impact on a mental health outcome? This is also known as an experimental therapeutics approach, which focuses on illuminating how and for whom an intervention works. My interest in this has grown out of the mentorship I have received from Dr. Munson. In our review, we found that most studies focused on if an intervention had an impact while few examined the underlying mechanisms that may explain how change in outcomes occur. Being able to identify, understand, and target those intermediary processes is crucial and can help lead to more effective and targeted interventions.

In December, I submitted a Predoctoral Training Fellowship proposal to the National Institute of Mental Health  to support my dissertation research, which builds upon these findings. My dissertation focuses on understanding how music use (as a self-management strategy) affects mental health recovery among marginalized young adults living with serious mental illnesses. The goal is to identify key targets to initiate a program of research to develop and test interventions that use youth-oriented strategies to enhance recovery for this underserved population.