Music therapy is the most studied of the creative arts therapies in schizophrenia, and the evidence base supports its use as an adjunct to medication. It is also one of the few psychological interventions where the evidence specifically favours improvement in negative symptoms — the part of schizophrenia that often responds least to medication.
Music therapy for schizophrenia is a structured therapy delivered by a credentialed music therapist using improvisation, song, and rhythm to support emotional expression, social engagement, and reduction of negative symptoms — recommended as an option by NICE.
What music therapy is — and is not
Music therapy is not the same as listening to music for relaxation. It is delivered by a credentialed music therapist with a graduate-level qualification. In the US, board-certification (MT-BC) is overseen by the Certification Board for Music Therapists and the field is represented by the American Music Therapy Association. In the UK, music therapists are registered with the Health and Care Professions Council and represented by the British Association for Music Therapy.
Sessions can be individual or group. The therapist provides instruments — usually simple percussion, keyboard, voice, sometimes guitar — and the patient is invited to make sound. Often this starts with the therapist playing a holding rhythm and the patient adding to it. No musical training is required. The work is about the experience of being in shared sound, not about performing.
Two main approaches
Active (improvisational) music therapy involves making music together, usually improvising on percussion or simple instruments. This is the most common model in schizophrenia services. Receptive music therapy involves listening to music chosen by the therapist and patient and using it as a focus for emotion, imagery, and reflection.
What the evidence shows
The Cochrane review of music therapy for schizophrenia, most recently updated in 2017, included 18 randomised trials with over 1200 participants. It found that music therapy added to standard care can improve global state, mental state (including negative symptoms), social functioning, and quality of life compared with standard care alone, though effect sizes vary and many trials are small.
The NICE guideline on schizophrenia recommends arts therapies, with music therapy specifically named as an option, particularly for the negative symptoms that other treatments often miss. It is a stronger evidence base than for art or drama therapy individually.
Why it might work
Several mechanisms have been proposed:
- Music engages emotional and motor systems without requiring verbal articulation, which is often impaired during and after psychosis.
- Shared musical activity creates a low-pressure form of social engagement that can reduce isolation.
- Improvising in real time exercises attention, working memory, and impulse control — areas that overlap with cognitive symptoms.
- Receiving music in a containing therapeutic frame can regulate arousal and mood.
What a session looks like
The therapist welcomes the person, sets up instruments, and may begin with a brief check-in. Improvisation often starts simply — the therapist plays a steady beat, the person picks up a drum and joins. Over weeks, the music becomes more elaborate. The therapist will sometimes mirror the person's playing, sometimes contrast it, and may pause to talk about what happened, how it felt, what was noticed. Songs from the person's life are sometimes brought in — a favourite track that means something — and discussed.
Group music therapy
Group music therapy is common in NHS mental health services and US community mental health programmes. Groups are usually 4 to 8 people, weekly. The social dimension is often as important as the music itself. People who find conversation effortful can participate fully without speaking, simply by playing. Many describe group music therapy as one of the few group activities they can tolerate during recovery from a psychotic episode.
Receptive listening and music for symptom relief
Some people find personally chosen music helpful for managing distressing voices — using familiar songs as a grounding anchor or, occasionally, to drown out persecutory commentary. This is not formal music therapy, but it sits in the same neighbourhood. Music therapists sometimes help people develop personal playlists for stability work alongside other coping strategies. See our piece on distraction techniques for voices for the broader frame.
Certain music or session formats consistently worsen voices, paranoia, or sleep — adjustments are part of normal therapy planning.
Who tends to do well
- People with prominent negative symptoms — flat affect, social withdrawal, low motivation
- People with limited language or who find speech effortful
- People who have a personal love of music and find it restorative
- People in inpatient or early-intervention settings looking for engaging non-verbal therapy
Who may find it less useful
- People who dislike music or find it overwhelming
- People in acute paranoia who cannot tolerate group sound
- People whose voices are music-content and worsen with auditory stimuli (this is a minority and is workable with the therapist)
Cost and access
In the UK, music therapy is available within NHS mental health services where commissioning supports it; the Nordoff Robbins charity also offers free or low-cost services in some regions. In the US, some private insurers cover music therapy, particularly when delivered by an MT-BC practitioner; community mental health centres, partial hospitalisation programmes, and some clubhouses run groups. Veterans Affairs offers music therapy in many sites — see VA mental health services.
How to find a music therapist
The AMTA find-a-therapist directory in the US and the BAMT directory in the UK list credentialed practitioners. Ask whether the therapist has experience with psychosis specifically — schizophrenia work has its own pace and texture.
The bigger picture
Music therapy is one of the few interventions where the evidence base, the patient experience, and the clinical guidelines align around a single message: it is a reasonable adjunct, particularly for the negative-symptom side of schizophrenia. It will not replace medication or CBTp. It can sit alongside both, and for many people it is the part of treatment that finally feels like something they can do, not something done to them.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.