Music is omnipresent in our lives, from the womb to the lullabies we hear as babies, in our daily routines, and during special occasions such as birthdays, weddings, religious celebrations, and festivals. Listening to music, playing an instrument, singing in a choir, or composing music provides us with the space to personify all the emotions our mind and soul are experiencing. It is a universal language that connects us to our feelings. It can accompany moments of joy, have a soothing effect through difficult moments, motivate to accomplish tasks, and help to better focus or cope with the harsh reality of the world. 

Since 3,500 B.C., ancient civilizations such as Egypt, China, Greece, the Roman Empire, and the Islamic civilization have left behind a documented legacy of the therapeutic benefits of music.¹ It has been described to treat melancholia, to improve the state of persons suffering from psychological disorders, or to alleviate pain. Music therapy is now defined by the World Music Federation Therapy (WFMT) as the professional use of the music elements (e.g., melody, harmony) in an intervention in medical, educational, and everyday environments. Music therapy is addressed to individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and well-being. Research, practice, education, and clinical training in music therapy are based on professional standards according to cultural, social, and political contexts (2011).²

The beneficial effects of music therapy have been observed by previous civilizations and have been validated through a myriad of research studies showing its effect on reducing anxiety, depression, stress, and pain levels, and expressing feelings, enhancing memory, improving communication, promoting physical rehabilitation and wellbeing.³ Music therapy is integrated in parallel with the conventional treatments to complement them, improve their efficiency, and lessen severe symptoms. It can support children and adults with a wide spectrum of conditions that include, but are not restricted to learning disabilities, depression, anxiety, autism, mood disorders, post-traumatic stress disorder (PTSD), dementia, Parkinson’s disease, cancer, or stroke.^4,5

To do so, music therapists use their musical expertise intricately with their knowledge of psychological and physiological principles. In 1998, Bruscia attempted to define music therapy as: “a fusion of music and therapy, [being] at once an art, a science, and an interpersonal process. As an art, it is concerned with subjectivity, individuality, creativity, and beauty. As a science, it is concerned with objectivity, universality, replicability, and truth. As an interpersonal process, it is concerned with empathy, intimacy, communication, reciprocity, and role relationships.”⁶ By incorporating the elements of musical art, the complex aspects of music therapy exceed the limits of the science and interpersonal skills therapists are required to possess. 

The role of the music therapists, thus, holds great responsibility. They are key to developing a dialogue with the patient and learn about music preferences, past experiences, and goals they can both work towards. The therapeutic plan is then set and adapted throughout the whole therapy accordingly. Many approaches are available according to the needs of the patients and can be summarized into three types: active music therapy (e.g., singing, playing an instrument, doing improvisation) and receptive music therapy (e.g., listening to music), or a mix of both. Sessions are held either individually or in groups, in outpatient clinics, mental health centers, hospitals, and schools.

In Lebanon, music therapy holds promise. For instance, recent studies showed improved teaching verbal expression through a musical strategy for children on the autism spectrum, and a positive effect on the emotional and social functioning of Palestinian refugee children in Lebanon.^10,11 However, music therapy remains scarce, with rather few trained music therapists. Earning a bachelor’s or a master’s degree in music therapy is necessary to become a music therapist, and passing an exam is required to obtain the Music Therapist-Board Certified (MT-BC) credential. Although the Antonine University proposes a bachelor’s degree in music and musicology with a Music Therapy Concentration, there is a large scope of improvement to enrich the field in the region.⁷ The number of academic training programs should increase to train more music therapists. They will ultimately raise awareness on the knowledge and attitudes towards music therapy in the general public and in the medical field to encourage seeking music therapy for people that could benefit, especially in our region.^8,9 

Arab countries in the Middle East have gone through and coped with armed conflict and war for several decades, including the ongoing war and most documented genocide of Gaza.¹² The clinical and psychotherapeutic needs for the survivors are beyond words and new approaches must be undergone to attempt alleviating them. It is also critical to address the bystander consequences on the mental health of those witnessing the political violence traumas. Therefore, there is a dire need for trauma-based services in the Middle East and combining psychotherapy with other approaches, including music therapy, is crucial to optimize its effectiveness.¹³ 

Finally, more local studies are needed to better document the professional therapeutic use of music. This research work would serve to develop specific evidence-based practices tailored to our region and to the unique socio-economic, emotional, and traumatic experiences of our population. Furthermore, even though Arabic music is one of the richest, its benefits during music therapy remain relatively unexplored. Given that Arabic music is an integral part of our cultural heritage, its incorporation into therapeutic practices not only furthers research but also acknowledges the importance of using music that closely resonates with patients. Embracing the use of Arabic music within therapeutic contexts would pave the way to more effective and culturally sensitive interventions in the Middle East. 

References

1. Mohd Sufie, S. N. & Sidik, R. What is Medical Music Therapy in Islamic Civilization? Int. J. Bus. Soc. Sci. 8, 195–199 (2017).
2. About WFMT. Available at: https://www.wfmt.info/about. (Accessed: 25th March 2024)
3. AMTA Official Definition of Music Therapy. Available at: https://www.musictherapy.org/about/musictherapy/. (Accessed: 22nd March 2024)
4. Li, K., Weng, L. & Wang, X. The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis. Front. Psychol. 12, 1–14 (2021).
5. Sciences, H. C. Music and Sound Interventions for Post-Traumatic Stress Disorder.
6. Bruscia, K. E. Defining music therapy. (Spring House Books, 1989).
7. BA in Music and Musicology – Music Therapy. doi:https://ua.edu.lb/en/fmm/ba-in-music-and-musicology-music-therapy
8. Morgan, S., Humphreys, J. & Warner, C. What is music therapy? A survey study of public awareness and perceptions of the profession. 1–35 (2020).
9. Lichtensztejn, M., Benavides, M., Galdona, C. & Canova-Barrios, C. J. Knowledge of students of the Faculty of Health Sciences about Music Therapy. Semin. Med. Writ. Educ. 2, 35 (2023).
10. Attar, N., Al-Hroub, A. & El Zein, F. Effects of Three Music Therapy Interventions on the Verbal Expressions of Children With Autism Spectrum Disorder: A Combined Single-Subject Design. Front. Psychol. 13, 1–13 (2022).
11. Parker Associazione Prima Materia, D., Liliane Younes, I., Orabi, M., Procter, S. & Paulini, M. Music therapy as a protection strategy against toxic stress for Palestinian refugee children in Lebanon: A pilot research study AUTHOR BIOGRAPHIES. Approaches An Interdisciplicary J. Music Ther. 1–23 (2021).
12. Hamadeh, A., El-Shamy, F., Billings, J. & Alyafei, A. The Experiences of People From Arab Countries in Coping with Trauma Resulting From War and Conflict in the Middle East: A Systematic Review and Meta-synthesis of Qualitative Studies. Trauma, Violence, Abus. 25, 1278–1295 (2024).
13. Abdul-Hamid, W., Morgan, S., Hacker Hughes, J. The need for trauma-based services in the Middle East. Available at: https://etq.emdrassociation.org.uk/letter/the-need-for-trauma-based-services-in-the-middle-east/. (Accessed: 23rd March 2024)

Copyedited by Alissar Izrafeel