Conceptual Models or Frameworks for MBIs
A first step in testing a music-based intervention (MBI) is developing a conceptual framework for the proposed intervention; that is, a representation of an expected relationship(s) between or among variables (i.e., the hypothesis). As in the evidence-based medicine PICOS Model (population, intervention, comparison, outcome, study design), the choice of a framework depends on the targeted population, specific intervention, comparison group, outcome measures, and research question, as well as the research stage and study design (e.g., static, mixed methods, adaptive). Below are four examples of models or frameworks (behavioral/experimental medicine, music therapy, neural, and resilience/social science) that can be used in MBI research.
Experimental Medicine Framework
The National Institutes of Health (NIH) Science of Behavior Change (SOBC) program illustrates the experimental medicine approach to identifying and testing hypothesized mechanisms of action of therapies at each stage of intervention development, with the overall goal of improving understanding of mechanisms underlying human behavior change. In SOBC, the focus is on defining the processes or mechanisms that drive the behavior change or effect of an intervention, verifying the intervention target mechanism, and identifying outcome measures of target engagement. For example, in an MBI, the SOBC theoretical model would highlight the components of music that are likely to influence the potential processes or mechanisms (e.g., cognitive, emotional, physiological) that, in the context of a specific study, result in changes in the outcome of interest (e.g., cognitive, emotional, or functional outcomes).
Music Therapy Framework
Many factors influence the guiding framework for music therapists, including the clinical setting, client population, client age, diagnosis, and theoretical orientations of the therapist. Music therapists utilize a combination of various types of frameworks to address the client’s needs, including psychodynamic, humanistic, behavioral, and music-centered approaches.[27, 40–42] For example, therapists may use a humanistic approach to facilitate respect, trust, and engagement with their clients, and further incorporate a behavioral approach that uses music as a cue to redirect focus of attention obtain a desired response. An important consideration for determining which approaches are most appropriate is ensuring that all clients’ needs will be addressed by the chosen combination.
The neuromechanistic framework requires that interventional studies provide a mechanistic conceptual grounding that builds connections between clinical and basic research. Starting from the evidence that music engages many neural systems, including the perception, sensory-motor, memory, attention, and emotion/reward systems (Figure 1), MBIs for a given disorder should consider the alignment of the neural subsystems involved in both the disorder and the intervention. For example, music’s ability to recruit the reward system could be exploited for conditions with motivational problems or anhedonia.[43–45]
The resilience framework utilizes a contextual support model of music therapy that is based on a motivational theory of coping. The framework argues that therapeutic music environments possess structural elements that support autonomy, encourage freedom of expression, and promote interaction of patients with their environment. Music engagement is then used to reduce stressful conditions or mitigate risk situations.[46–48]