Musical improvisation and health: a review

therefore we feel that the literature reviewed here is substantially that which considers improvisation specifically in relation to health. It is a limitation that only literature in English has been considered; however, inclusion of material in other languages was beyond the scope of this article. Explanations in this literature for how improvisation is able to effect health benefits nevertheless provide the basis for a model of how improvisation can influence health and wellbeing. There is an urgent need for the development of testable theory for why improvisation has the effects that are claimed for it; specific improvements to specific health conditions or states within specific populations should be attributable to specific processes of improvisation in isolation from other aspects of musical or clinical involvement. In light of these findings, a model for the relationship between musical improvising and health is proposed (see Figure 1). This model seeks takes account of all routes by which musical improvisation between individuals may influence a given health condition in a given population. A group music-making intervention may involve both improvised activity and non-improvised (such as the maintenance of a groove, or rendition of a given melody). These two elements may have separate effects on health, with effects of non-improvised activity likely to be common to those for music interventions in general. Within group improvisation, four key processes were identified in the review as potentially effective. Since any or all of these may operate within an intervention with differential effects, each is represented in the model as a separate line of influence. Finally, the context of an intervention will have a mediating influence on any effects of improvised or non-improvised activities. For instance objectives and expectations will be very different between performing music in public and learning to do so in a classroom, and emotional expression in each of these settings might have a differing impact as a result. Therapeutic engagement in particular requires that improvisation will be analysed for significance. This goes far beyond interaction in other settings, and is represented here as a further mediating influence between context and outcome separate from the improvisation itself. It should be expected that the relative influence of different routes within this model will vary depending on the condition and population to which the model is applied. For instance, the capacity for emotional expression in a therapeutic context may be most Figure 1 Model for the effects of group music on well-being. MacDonald and Wilson Psychology of Well-Being: Theory, Research and Practice 2014, 4:20 Page 15 of 18 http://www.psywb.com/content/4/1/20 effective in countering depressive symptoms in adults, while that for creative interaction in an educational setting may have unique effects for children with ASD. It is notable that the literature reviewed here examines improvisation only in relation to a limited range of conditions and populations, and only in the context of music therapy. Yet the mechanisms proposed for the therapeutic effects of improvising suggest that this activity could be far more widely applied to benefit our health, and that more associations between the two would be identified with further research looking beyond the therapeutic context. This is not to belittle or undermine the significant improvements that hundreds of music therapists see in their clients following their work with them. The chimeric nature of improvisation is part of its appeal as a therapeutic instrument, yet makes for a highly complex and individualised intervention, one which resists standardisation for the purposes of measurement or examination. Nevertheless work such as that of Erkkilä et al. (2011) shows us that parameters and measures for music therapy interventions can be reached and applied to provide robust evidence. Improvisation is increasingly seen as a central tendency in current musical practice, and new research to help reconsider and revalue the role of this music within education and within everyday life is vital. The excitement improvisation holds for contemporary musicians shows its potential to engage wider populations in accessing the known health benefits of music. Abbreviations ADHD: Attention Deficit Hyperactivity Disorder; ASD: Autistic Spectrum Disorder(s). Competing interests The authors declare that they have no competing interests. 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