Part II: Evidence Update Since October 2025 (Following Part I)
This essay builds on the conceptual and methodological landscape outlined in Part I by synthesizing peer-reviewed publications released after October 2025. It focuses on how subsequent studies extend, qualify, or refine earlier observations regarding the clinical use, integration, and physiological measurement of music therapy in neurotic disorders. The perspective remains descriptive and comparative, without reintroducing pre-October 2025 theoretical or methodological authorities.
1) Clinical Comparison: MELODY Trial (February 2026)
The MELODY (Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety) trial is a large randomized controlled study¹ published in February 2026 in the Journal of Clinical Oncology. The trial directly compares music therapy and cognitive-behavioral therapy delivered via telehealth to cancer survivors with clinically significant anxiety.
1.1 Study Design
The study enrolled 300 adult cancer survivors across Memorial Sloan Kettering Cancer Center and Baptist Health Miami Cancer Institute. Participants were randomized to seven weekly telehealth sessions of either music therapy (n=147) or cognitive-behavioral therapy (n=153), with follow-up assessments conducted through week 26.
Music therapy protocol:
- Sessions 1-3: Guided music listening combined with progressive muscle relaxation. Therapists selected instrumental music and guided attention to breathing and bodily sensations.
- Sessions 4-7: Collaborative songwriting. Patients worked with therapists to create original songs reflecting personal experiences, values, and post-cancer adjustment.
Cognitive-behavioral therapy protocol:
- Psychoeducation on anxiety and the cognitive model
- Cognitive restructuring using thought records
- Worry exposure and structured problem-solving
- Relapse prevention strategies
The primary outcome was change in the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) at eight weeks. A non-inferiority margin of 1.5 points was prespecified.
1.2 Outcomes
Primary outcome results:
- Music therapy: mean change −3.12 (95% CI −3.59 to −2.65)
- Cognitive-behavioral therapy: mean change −2.97 (95% CI −3.45 to −2.50)
- Between-group difference: −0.15 (95% CI −0.78 to 0.49; p<0.001 for non-inferiority)
- Improvements were maintained at 26-week follow-up
- Dropout rates were comparable between groups
Secondary outcomes, including fatigue, depressive symptoms, insomnia, pain, cognitive complaints, and quality of life, showed similar trajectories in both treatment arms.
1.3 Interpretation
The findings support consideration of music therapy as a standalone intervention for anxiety in medically complex populations when delivered using a structured and manualized protocol. Outcomes were within the prespecified non-inferiority margin relative to cognitive-behavioral therapy under telehealth conditions.
2) Integration of Cognitive-Behavioral Principles in Music Therapy (December 2025)
A study published in December 2025 in Frontiers in Psychiatry² examined how principles commonly associated with cognitive-behavioral therapy can be operationalized within music therapy practice while preserving the defining characteristics of musical engagement.
2.1 Conceptual Orientation
The proposed framework emphasizes identification of core therapeutic principles and flexible adaptation of their form, sequence, or medium. Rather than merging treatment models, the approach focuses on translation of principles into music-based methods.
2.2 Application Across Music Therapy Methods
Receptive methods:
- Guided music listening used to support relaxation and somatic awareness.
- Post-listening reflection used to identify and reframe automatic thoughts.
- Use of music as a contextual anchor during exposure-based imagery.
Recreative methods:
- Singing pre-composed songs with adaptive lyrical content.
- Scheduled music performance as a form of behavioral activation.
Improvisational methods:
- Musical interaction used to facilitate emotional expression and regulation.
- Exploration of new musical patterns as behavioral experimentation.
Compositional methods:
- Collaborative songwriting used to externalize and restructure maladaptive cognitions.
- Songs function as retrievable representations of newly articulated perspectives.
2.3 Training Considerations
The framework highlights the need for clinicians to be conversant in both music therapy techniques and cognitive-behavioral principles. Without cross-disciplinary training, integration risks remaining superficial.
3) Heart Rate Variability in Music Therapy Research (November 2025)
Heart rate variability has been proposed as a physiological outcome measure in music therapy research. A systematic review published in November 2025³ evaluates its use and associated methodological constraints across published studies.
3.1 Review Scope
The review examined 28 studies reporting vagally mediated heart rate variability during music therapy interventions, including receptive listening, active music making, and multimodal protocols. A narrative synthesis was conducted using effect direction plots.
3.2 Observed Patterns
Across studies, increases in vagally mediated HRV were frequently observed during or immediately following music therapy sessions. Higher HRV values were often reported alongside reductions in anxiety or improvements in mood, though study heterogeneity limited direct comparison.
3.3 Methodological Constraints
The review summarizes methodological characteristics associated with more interpretable findings, including standardized recording durations, sufficient sampling rates, transparent artifact correction procedures, and explicit reporting of preprocessing steps. Active music-making contexts were noted to introduce respiratory and movement-related confounds.
Insufficient methodological transparency was associated with reduced interpretability of HRV outcomes, independent of intervention content.
4) Synthesis
Publications released after October 2025 provide comparative clinical data, integration-oriented conceptual frameworks, and focused methodological analyses relevant to music therapy in neurotic disorders.
Comparative trial data indicate that structured music therapy interventions can produce anxiety outcomes within prespecified non-inferiority margins relative to cognitive-behavioral therapy in specific clinical contexts. Integration frameworks describe how therapeutic principles can be operationalized within music-based methods without collapsing disciplinary boundaries. Methodological reviews clarify conditions under which physiological measures such as heart rate variability yield interpretable results.
Read in sequence, Part I provides the initial analytical context, while the present update documents how the evidence base has shifted or consolidated in the period following October 2025.
5) Conclusion
Evidence published since October 2025 contributes to a more formally specified research landscape for music therapy in neurotic disorders. Comparative trials, principle-based integration approaches, and focused methodological analyses collectively inform clinical and research considerations without relying on earlier theoretical consensus frameworks.
References
¹Liou, K. T., McConnell, K. M., Currier, M. B., et al. (2026). Music therapy versus cognitive behavioral therapy via telehealth for anxiety in survivors of cancer: A randomized clinical trial. Journal of Clinical Oncology, 44(5), 375–385. https://doi.org/10.1200/JCO-25-00726
²Head, J. H., & Vasquez, N. N. (2025). Integrating cognitive behavioral therapy into music therapy methods using a flexibility within fidelity framework. Frontiers in Psychiatry, 16, 1734508. https://doi.org/10.3389/fpsyt.2025.1734508
³Flater, B., Schneider, B. L., Fachner, J., Sonke, J., & Quintana, D. S. (2025). Music therapy and vagally mediated heart rate variability: A systematic review and narrative synthesis. International Journal of Psychophysiology, 113288. https://doi.org/10.1016/j.ijpsycho.2025.113288
