Music Therapy modulates Craving, Inhibitory Control, and Emotional Regulation: EEG, Psychometric, and Qualitative Findings from a Pilot RCT in a Community Outpatient Service

Background. Music therapy (MT) has been shown to be effective for multiple clinical endpoints in clients with Substance Use Disorder (SUD). However, a gap remains in understanding the impact of MT interventions in community services, primarily due to the lack of studies that combine neural measures (e.g., EEG), psychometric tests, and semi-structured interviews. Methods. This pilot study is a three-arm, non-blinded, mixed-methods randomized trial. Sixteen participants with Substance Use Disorder (SUD) were recruited from a community service in London. Ten of these participants received six weekly group or individual music therapy (MT) sessions in addition to the standard treatment (ST) provided by the community outpatient service. The remaining six participants received only the ST. Pre-/post-intervention as well as in-session measures have been collected utilizing EEG in addition to psychometric tests and semi-structured interviews addressing craving, depressive, and anxiety symptoms, inhibitory cognitive control, and participants’ perceptions on the music-therapeutic process. An intention-to-treat approach was employed. Results. Fourteen participants completed the study. Results showed (1) lower beta frequency band related to craving arousal post-MT intervention as compared to ST; (2) lower subjective evaluation of craving intensity after MT sessions; (3) different impact of MT and ST on frontal alpha asymmetry related to affective processing; (4) enhanced neural mechanisms (i.e., P3d in a Go/NoGo task) related to sensorimotor response inhibition following MT; (5) qualitative themes reflecting absence of craving, reluctance towards craving discussions, narratives on experiences, emotions, and the therapeutic process. Conclusions. MT might facilitate lower post-intervention arousal related to craving as compared to ST. While this effect is evident at the neural level, the conscious perception of the decrease emerges only after MT sessions and not after the entire intervention. The differential brain asymmetry may represent higher emotional regulation and introspection associated with MT compared to ST. MT may facilitate neuromodulation that boosts inhibitory cognitive control functions. Themes emerging from semi-structured interviews highlight the transformative potential of MT in alleviating craving and stimulating reflection. Findings from this pilot study are promising but further research through a larger clinical trial is necessary to confirm and expand upon this pilot. Trial registration. NCT05180617.