Anhedonia to music and mu-opioids: Evidence from the administration of naltrexone

Can arts-based interventions improve health? A conceptual and methodological critique

Can art improve health and wellbeing? The claim that there is strong evidence that engaging with art ameliorates symptoms of mental and physical disorders and increases wellbeing is gaining acceptance among researchers and clinicians. This claim deserves thorough scrutiny, as it is used to justify a broad range of arts-based clinical interventions and health policies. Here we show that the evidence cited in favor of the efficacy of arts-based interventions is far weaker than it is claimed to be. First, we examined the methodological and statistical quality of studies that have been cited as proof for the efficacy of arts-based interventions. This analysis found that many of these studies lack key clinical trial features, such as defining the therapeutic agent, randomizing group assignment, controlling for patient or researcher allegiance, controlling for the effects of other concurrent interventions and medications, comparing art-based interventions to other kinds of interventions, or conducting and reporting statistical analyses appropriately. Second, in a broader examination of experiments on arts-based interventions, we looked for the experimental designs that would actually allow demonstrating that the putative health benefits owe to the effect of art. This analysis revealed that (i) most studies fail to define what art is, making it impossible to compare the effects of "art" and "non-art" stimuli and activities on health and wellbeing; (ii) fail to demonstrate that art stimuli and activities elicit a distinct class of art-induced physiological processes capable of modulating the cause of targeted disorders; (iii) and fail to manipulate neural processes believed to be mechanisms of action that could prove that arts-based interventions directly affect the etiology of disorders. These methodological weaknesses and inappropriate experimental designs cast serious doubt on claims that engaging with art can induce physiological changes that improve health and wellbeing. We discuss why arts-based interventions have neglected these problems and the ethical implications for patients who are treated with them.

Group singing and its effect on cortisol, alpha amylase, oxytocin, and pain threshold in patients with Parkinson's disease

Background

Parkinson's disease (PD) is a neurodegenerative disorder that causes motor deficits, including rigidity and tremors. Pain is also a common problem for people with PD that may arise from their dopamine deficit. Some patients with PD experience temporary relief from pain through group singing, which has also been shown to mitigate vocal challenges related to PD. However, no work has been conducted to elucidate the neurochemical mechanisms of action on the pain threshold. Here, we examined whether the effects of group singing on cortisol, alpha amylase, and oxytocin levels are associated with changes in pain thresholds in patients with PD.

Methods

Participants with PD (n = 14) participated in a 12-week singing program involving weekly 45-min group singing sessions in the early afternoon. Data collection, involving saliva samples and pain thresholds, was performed pre- and post-session in the 2nd (Session 1), 7th (Session 2), and 12th (Session 3) weeks of the program. Saliva samples were collected before and after each session by using the passive drool method. The pain threshold was assessed before and after each session by applying pressure to the finger using a dolorimeter. Saliva samples were used to assess salivary cortisol (sCORT), alpha amylase (sAA), and oxytocin (sOXT). Pain threshold, sCORT, sAA, and sOXT change scores were calculated for each session by subtracting the pre-session value from the post-session value.

Results

Three mixed linear model analyses were performed to assess whether sCORT, sAA, and sOXT were associated with increased pain threshold. We found that group singing led to a significant reduction in sCORT and sAA. We also found that reductions in sCORT were significantly related to an increase in the pain threshold (p < 0.05). However, we did not observe any relationship between pain threshold increases and sAA or between pain threshold and sOXT.

Conclusion

Group singing significantly increases the pain threshold in patients with PD, and this increase may be mediated through a reduction in cortisol levels.

Orgasms, sexual pleasure, and opioid reward mechanisms

INTRODUCTION

Sexual activity produces pleasure related to sexual arousal, desire, and genitosensory and erogenous stimulation. Orgasms produce a whole brain and body rush of ecstatic pleasure followed by relaxation and refractoriness. This pleasure results from the activation of neurochemical reward pathways in the brain. This is differentiated by spinal pathways that control climax, the particular motor movements of the pelvic floor and the experience of tension release.

OBJECTIVES

To relate the activation of key neurochemical reward and bonding systems, notably dopamine, oxytocin, and opioids, to the pleasure of sexual activity in general and orgasms in particular.

METHODS

A narrative review of the neurochemical and neuroanatomical mechanisms activated during sexual stimulation and orgasm in rats and humans, and how they are related overall to the generation of sexual pleasure and reward.

RESULTS

Appetitive sexual pleasure involves the activation of dopamine and oxytocin release in hypothalamic and mesolimbic regions that regulate sexual arousal and desire, and are reinforced by localized opioid activity. Orgasms are thought to result in part from a massive release of opioids into these regions that inhibits dopamine and oxytocin transmission, but that initiates molecular changes to sensitize both systems and induce sexually conditioned place and partner preferences. Serotonin is also activated at orgasm and contributes to feelings of satiety and refractoriness. Orgasm disorders are distressing, cause resentment and conflict in a relationship, and diminish overall sexual health and well-being.

CONCLUSIONS

Orgasms are an important component of sexual pleasure for humans and perhaps all vertebrates. Endogenous opioids like β-endorphin that bind to mu opioid receptors are likely responsible for sexual pleasure and reward.

Pleasurable music activates cerebral µ-opioid receptors: a combined PET-fMRI study

PURPOSE

The μ-opioid receptor (MOR) system mediates incentive motivation and the hedonic component of primary rewards such as food and sex. However, there is no direct in vivo evidence for the involvement of the MOR system in pleasure derived from aesthetic rewards such as music.  METHODS: We measured MOR availability with positron emission tomography (PET) and the agonist radioligand [11C]carfentanil with high affinity for MORs during the listening of pleasurable music and neutral baseline condition. Haemodynamic responses associated with dynamic pleasure ratings during listening to music and control stimuli were measured using functional magnetic resonance imaging (fMRI).

RESULTS

The PET results revealed that pleasurable music increased [11C]carfentanil binding in several cortical and subcortical regions, including ventral striatum and orbitofrontal cortex, known to contain "hedonic hotspots". [11C]carfentanil binding in the nucleus accumbens during the music condition was associated with number of pleasurable chills, linking the subjective experience of pleasure to striatal opioid release. Individual variation in baseline MOR tone influenced pleasure-dependent haemodynamic responses during music listening in regions associated with interoceptive, sensorimotor, and reward processing.

CONCLUSIONS

These findings provide the first neuroimaging evidence that pleasurable music modulates MOR system function. The results indicate that the μ-opioid system governs complex aesthetic rewards in addition to biologically essential primary rewards.

Anhedonia as a Core Symptom of Depression and a Construct for Biological Research

Anhedonia is a key psychiatric symptom that has seen significant advances in its understanding in both clinical practice and research over the past few decades. Once considered primarily a feature of depression, recent studies have shown that anhedonia is also a core element of other psychiatric disorders and contributes to considerable morbidity, mortality, and suicidality. Emerging models of psychopathology and illness emphasize the transdiagnostic relevance of anhedonia. At the same time, neuroimaging research has provided deeper insights into its underlying pathophysiology, and several assessment scales with strong psychometric properties have been developed. Various treatment strategies-including psychopharmacology, neuromodulation, and psychotherapy-have demonstrated varying degrees of effectiveness. This review discusses the evolving understanding of anhedonia, its significance as both a symptom and a diagnostic marker, its prevalence, and its pathophysiological underpinnings. Additionally, the authors provide an overview of key assessment tools and explore the range of treatment approaches studied to date.

Effects of music advertised to support focus on mood and processing speed

While music's effects on emotion are widely appreciated, its effects on cognition are less understood. As mobile devices continue to afford new opportunities to engage with music during work, it is important to understand associated effects on how we feel and perform. Capitalizing on potential benefits, many commercial music platforms advertise content specifically to support attentional focus and concentration. Although already in wide-spread use, the effects of such content remain largely untested. In this online behavioral study, we tested the effects of music advertised to support "work flow" and "deep focus" on mood and performance during a cognitively demanding psychological test (the flanker task). We additionally included a sample of popular hit music representing mainstream musical stimulation and a sample of office noise representing typical background stimulation in a social working environment. Our findings show that, despite similar marketing, only the work flow music gave rise to significant and positively correlated improvements in mood and performance (i.e., faster responses over time, with similar accuracy). Analyses of objective and perceived musical features indicate consistency with the "arousal-mood theory" of music's cognitive impact and provide new insights into how music can be structured to regulate mood and cognition in the general population.

Aesthetic processing in neurodiverse populations

Neurodiversity is a perspective on cognition which suggests a non-pathological view of individual cognitive differences. Aesthetics research on neurodivergent brains has generally been limited to neuropsychological cases. Although this research has been integral to establishing the neurological correlates of aesthetic experience, it is crucial to expand this paradigm to more psychologically complex disorders. We offer a review of research on aesthetic preference in neurodivergent brains beyond neuropsychological cases: across populations with psychotic disorder, anhedonia and depression, anxiety disorder, and autism. We identify stable patterns of aesthetic bias in these populations, relate these biases to symptoms at perceptual, emotional, and evaluative levels of cognition, review relevant neurological correlates, and connect this evidence to current neuroaesthetics theory. Critically, we synthesize the reviewed evidence and discuss its relevance for three brain networks regularly implicated in aesthetic processing: the mesocorticolimbic reward circuit, frontolimbic connections, and the default mode network. Finally, we propose that broadening the subject populations for neuroaesthetics research to include neurodiverse populations is instrumental for yielding new insights into aesthetic processing in the brain.

Endogenous mu-opioid modulation of social connection in humans: a systematic review and meta-analysis

Social bonding, essential for health and survival in all social species, depends on mu-opioid signalling in non-human mammals. A growing neuroimaging and psychopharmacology literature also implicates mu-opioids in human social connectedness. To determine the role of mu-opioids for social connectedness in healthy humans, we conducted a preregistered ( https://osf.io/x5wmq ) multilevel random-effects meta-analysis of randomised double-blind placebo-controlled opioid antagonist studies. We included data from 8 publications and 2 unpublished projects, totalling 17 outcomes (N = 455) sourced from a final literature search in Web of Science, Scopus, PubMed and EMBASE on October 12, 2023, and through community contributions. All studies used naltrexone (25-100 mg) to block the mu-opioid system and measured social connectedness by self-report. Opioid antagonism slightly reduced feelings of social connectedness (Hedges' g [95% CI) = -0.20] [-0.32, -0.07]. Results were highly consistent within and between studies (I2 = 23%). However, there was some indication of bias in favour of larger effects among smaller studies (Egger's test: B = -2.16, SE = 0.93, z = -2.33, p = 0.02), and publication bias analysis indicated that the effect of naltrexone might be overestimated. The results clearly demonstrate that intact mu-opioid signalling is not essential for experiencing social connectedness, as robust feelings of connectedness are evident even during full pharmacological mu-opioid blockade. Nevertheless, antagonism reduced measures of social connection, consistent with a modulatory role of mu-opioids for human social connectedness. The modest effect size relative to findings in non-human animals, could be related to differences in measurement (subjective human responses versus behavioural/motivation indices in animals), species specific neural mechanisms, or naltrexone effects on other opioid receptor subtypes. In sum, these results help explain how mu-opioid dysregulation and social disconnection can contribute to disability, and conversely-how social connection can buffer risk of ill health.

Anticipatory and consummatory neural correlates of monetary and music rewarding stimuli

Most of the literature on the neural bases of human reward and punishment processing has used monetary gains and losses, but less is known about the neurophysiological mechanisms underlying the anticipation and consumption of other types of rewarding stimuli. In the present study, EEG was recorded from 19 participants who completed a modified version of the Monetary Incentive Delay (MID) task. During the task, cues providing information about potential future outcomes were presented to the participants. Then, they had to respond rapidly to a target stimulus to win money or listening to pleasant music, or to avoid losing money or listening to unpleasant music. Results revealed similar responses for monetary and music cues, with increased activity for cues indicating potential gains compared to losses. However, differences emerged in the outcome phase between money and music. Monetary outcomes showed an interaction between the type of the cue and the outcome in the Feedback Related Negativity and Fb-P3 ERPs and increased theta activity increased for negative feedbacks. In contrast, music outcomes showed significant interactions in the Fb-P3 and theta activities. These findings suggest similar neurophysiological mechanisms in processing cues for potential positive or negative outcomes in these two types of stimuli.

Musicotherapy mobile applications: what level of evidence and potential role in psychiatric care? A systematic review

Context

In our times of smartphone ubiquity, mobile applications are an inescapable daily life tool, including in health care. Music therapy has already proven its worth, notably in mental health. Hence, we were interested in the mobile app format for this type of therapy, its level of evidence, how to use it in daily psychiatric care and the leads for future research and innovation.

Method

This study carries out a systematic review of scientific literature of this topic on two search engines, PubMed and PubPsych, using these key-words: [(web-application) OR (web-app) OR (smartphone) OR (apps) OR (app)) AND ((music) OR (music therapy) OR (melody)].

Outcome

Out of a total of 282 studies found by keyword, 31 are included in this review. Several outcomes emerge. These studies relate to existing applications like Music Care, Calm or Unwind, on application prototypes or a potential use of music streaming applications on health care. They involve many different populations and clinical situations, including in hospital environments, for patients with chronic illnesses, different age ranges or for the general population. These musical interventions show a significant effect mainly for anxious symptoms, but also for depression, sleep disorders, pain and other psychiatric or psycho-somatic syndromes. These applications have no significant adverse effects.

Conclusion

This review shows that music therapy apps have several potentials for improving mental health care. It could assist psychiatric usual care and could potentially lower medication intake. Nevertheless, the studies on the topic are limited and recent but they open prospects for future research.

The psychophysiology of music-based interventions and the experience of pain

In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.

The aesthetic experience of general beauty and ugly-cute memes: the role of emotion

Generally, beauty has been regarded as an outward expression of elegance and harmony, providing visual pleasure and evoking a sense of aesthetic enjoyment. However, in recent years, a phenomenon called "ugly-cute" has emerged, challenging the conventional standards of beauty by embracing a form of "ugliness" to enhance its appeal. The reasons and mechanisms behind this phenomenon remain largely unexplored so far. This study aims to investigate the role of emotions, such as pleasure, humor, and surprise, in the relationship between ugly-cute characteristics and attractiveness. The findings reveal that general beauty directly generates attractiveness by eliciting pleasurable emotions, whereas ugly-cute memes achieve attractiveness by inducing pleasurable emotions through the mediation of humor. Furthermore, while both "ugly" and "ugly-cute" memes evoke a sense of surprise, that elicited by ugly-cute memes is accompanied by a humorous response, thereby enhancing their attractiveness, whereas the "ugly" memes fail to evoke humor and lack attractiveness. Finally, we discuss the potential implications and practical value of the current research.

A review of psychological and neuroscientific research on musical groove

When listening to music, we naturally move our bodies rhythmically to the beat, which can be pleasurable and difficult to resist. This pleasurable sensation of wanting to move the body to music has been called "groove." Following pioneering humanities research, psychological and neuroscientific studies have provided insights on associated musical features, behavioral responses, phenomenological aspects, and brain structural and functional correlates of the groove experience. Groove research has advanced the field of music science and more generally informed our understanding of bidirectional links between perception and action, and the role of the motor system in prediction. Activity in motor and reward-related brain networks during music listening is associated with the groove experience, and this neural activity is linked to temporal prediction and learning. This article reviews research on groove as a psychological phenomenon with neurophysiological correlates that link musical rhythm perception, sensorimotor prediction, and reward processing. Promising future research directions range from elucidating specific neural mechanisms to exploring clinical applications and socio-cultural implications of groove.

The transformative power of music: Insights into neuroplasticity, health, and disease

Music is a universal language that can elicit profound emotional and cognitive responses. In this literature review, we explore the intricate relationship between music and the brain, from how it is decoded by the nervous system to its therapeutic potential in various disorders. Music engages a diverse network of brain regions and circuits, including sensory-motor processing, cognitive, memory, and emotional components. Music-induced brain network oscillations occur in specific frequency bands, and listening to one's preferred music can grant easier access to these brain functions. Moreover, music training can bring about structural and functional changes in the brain, and studies have shown its positive effects on social bonding, cognitive abilities, and language processing. We also discuss how music therapy can be used to retrain impaired brain circuits in different disorders. Understanding how music affects the brain can open up new avenues for music-based interventions in healthcare, education, and wellbeing.

Biological principles for music and mental health

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.

Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry

SUMMARY

There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.

[Research advances on the application of music therapy in pain management of children with burns]

Pain after burns is a very common problem in children. Severe pain will not only hinder treatment, but also damage children's mental health if not handled in time. Therefore, pain management is very important in treating children with burns. As a safe, effective, and convenient non-drug therapy, music therapy has great advantages in relieving pain and is widely used in a variety of clinical fields. This paper focused on music therapy and its mechanism of pain relief, the current status of research on pain management of pediatric burns, the application and prospect of music therapy in pain management of pediatric burns, etc., to provide reference for clinical application.

The role of opioid transmission in music-induced pleasure

Studies conducted in rodents indicate a crucial role of the opioid circuit in mediating objective hedonic reactions to primary rewards. However, it remains unclear whether opioid transmission is also essential to experience pleasure with more abstract rewards, such as music. We addressed this question using a double-blind within-subject pharmacological design in which opioid levels were up- and downregulated by administering an opioid agonist (oxycodone) and antagonist (naltrexone), respectively, before healthy participants (n = 21) listened to music. Participants also performed a monetary incentive delay (MID) task to control for the effectiveness of the treatment and the specificity of the effects. Our results revealed that the pharmacological intervention did not modulate subjective reports of pleasure, nor the occurrence of chills. On the contrary, psychophysiological (objective) measures of emotional arousal, such as skin conductance responses (SCRs), were bidirectionally modulated in both the music and MID tasks. This modulation specifically occurred during reward consumption, with greater pleasure-related SCR following oxycodone than naltrexone. These findings indicate that opioid transmission does not modulate subjective evaluations but rather affects objective reward-related psychophysiological responses. These findings raise new caveats about the role of the opioidergic system in the modulation of pleasure for more abstract or cognitive forms of rewarding experiences, such as music.

James A, Dupuis K, Cohen D. Developing a music-based digital therapeutic to help manage the neuropsychiatric symptoms of dementia

The greying of the world is leading to a rapid acceleration in both the healthcare costs and caregiver burden that are associated with dementia. There is an urgent need to develop new, easily scalable modalities of support. This perspective paper presents the theoretical background, rationale, and development plans for a music-based digital therapeutic to manage the neuropsychiatric symptoms of dementia, particularly agitation and anxiety. We begin by presenting the findings of a survey we conducted with key opinion leaders. The findings highlight the value of a music-based digital therapeutic for treating neuropsychiatric symptoms, particularly agitation and anxiety. We then consider the neural substrates of these neuropsychiatric symptoms before going on to evaluate randomized control trials on the efficacy of music-based interventions in their treatment. Finally, we present our development plans for the adaptation of an existing music-based digital therapeutic that was previously shown to be efficacious in the treatment of adult anxiety symptoms.

Inpatient suicide in psychiatric settings: Evaluation of current prevention measures

The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.

Beauty and Uncertainty as Transformative Factors: A Free Energy Principle Account of Aesthetic Diagnosis and Intervention in Gestalt Psychotherapy

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change.

COSMOS: Computational Shaping and Modeling of Musical Structures

This position paper makes the case for an innovative, multi-disciplinary methodological approach to advance knowledge on the nature and work of music performance, driven by a novel experiential perspective, that also benefits analysis of electrocardiographic sequences. Music performance is considered by many to be one of the most breathtaking feats of human intelligence. It is well accepted that music performance is a creative act, but the nature of its work remains elusive. Taking the view of performance as an act of creative problem solving, ideas in citizen science and data science, optimization, and computational thinking provide means through which to deconstruct the process of music performance in scalable ways. The method tackles music expression's lack of notation-based data by leveraging listeners' perception and experience of the structures elicited by the performer, with implications for data collection and processing. The tools offer ways to parse a musical sequence into coherent structures, to design a performance, and to explore the space of possible interpretations of the musical sequence. These ideas and tools can be applied to other music-like sequences such as electrocardiographic recordings of arrhythmias (abnormal heart rhythms). Leveraging musical thinking and computational approaches to performance analysis, variations in expressions of cardiac arrhythmias can be more finely characterized, with implications for tailoring therapies and stratifying heart rhythm disorders.

“Sax for Sex”: A Brief Narrative Review Exploring the Music-Sex Connect

Context:

The assertion that music has an impact on sexual performance is a popular one. However, music is seldom used in clinical settings for enhancement of sexual problems and little is known regarding its scientific proof.

Aim:

To explore available literature on: the interplay between sex and music in the human evolution; brain basis for music and sex; and studies using music to therapeutically enhance sexual performance.

Conclusions:

Evidence suggests an evolutionary basis for the relationship between music and sex. There is converging neurobiological understanding that posits both music and sex to have common brain substrates—the reward pathway, diencephalic structures, limbic system, and prefrontal cortex. Psychological mechanisms hypothesized for a positive role of music in enhancing the act of sex need systematic evaluation. The empirical evidence for the use of music as an adjunct strategy in the treatment of sexual dysfunctions, though positive and encouraging, is still sparse.

Music-Induced Analgesia in Healthy Participants Is Associated With Expected Pain Levels but Not Opioid or Dopamine-Dependent Mechanisms

Music interventions accommodate the profound need for non-pharmacological pain treatment. The analgesic effect of listening to music has been widely demonstrated across studies. Yet, the specific mechanisms of action have still to be elucidated. Although the endogenous opioid and dopamine systems have been suggested to play an important role, a direct link has not been established. In addition, the involvement of placebo mechanisms is likely while largely unexplored. We examined the analgesic effect of music in healthy participants (n = 48) using a 3 × 3 within-subjects design with pharmacological manipulations and a matched, auditory control for music. Participants were exposed to thermal pain stimuli while listening to three auditory excerpts: music (active condition), nature sound (matched, auditory contextual condition), and noise (neutral control condition). The participants rated their expected and perceived pain levels in relation to each of the auditory excerpts. To investigate the involvement of the endogenous opioid and dopamine systems, the test session was performed three times on separate days featuring a double-blind randomized oral administration of naltrexone (opioid antagonist), haloperidol (dopamine antagonist), and an inactive agent (control). Our results support an analgesic effect of music. Contrary to current hypotheses, neither of the antagonists attenuated the effect of music. Yet, the participants' expectations for pain relief predicted their perceived pain levels during the auditory excerpts—even when controlling for a gradual learning effect. In conclusion, we demonstrate that the analgesic effect of music is at least partially mediated by expectations of an analgesic effect—a core mechanism in placebo effects—but not by opioid and dopamine-dependent mechanisms.

Music affects functional brain connectivity and is effective in the treatment of neurological disorders

In a million years, under the pressure of natural selection, hominins have acquired the abilities for vocal learning, music, and language. Music is a relevant human activity, highly effective in enhancing sociality, is a universal experience common to all known human cultures, although it varies in rhythmic and melodic complexity. It has been part of human life since the beginning of our history, or almost, and it strengthens the mother-baby relation even within the mother's womb. Music engages multiple cognitive functions, and promotes attention, concentration, imagination, creativity, elicits memories and emotions, and stimulates imagination, and harmony of movement. It changes the chemistry of the brain, by inducing the release of neurotransmitters and hormones (dopamine, serotonin, and oxytocin) and activates the reward and prosocial systems. In addition, music is also used to develop new therapies necessary to alleviate severe illness, especially neurological disorders, and brain injuries.

The effects of music & auditory beat stimulation on anxiety: A randomized clinical trial

Background and objectives

Music and auditory beat stimulation (ABS) in the theta frequency range (4–7 Hz) are sound-based anxiety treatments that have been independently investigated in prior studies. Here, the anxiety-reducing potential of calm music combined with theta ABS was examined in a large sample of participants.

Methods

An open-label randomized controlled trial was conducted with participants taking anxiolytics (n = 163). Participants were randomly assigned using the Qualtrics randomizer algorithm, to a single session of sound-based treatment in one of four parallel arms: combined (music & ABS; n = 39), music-alone (n = 36), ABS-alone (n = 41), or pink noise (control; n = 47). Pre- and post-intervention somatic and cognitive state anxiety measures were collected along with trait anxiety, personality measures and musical preferences. The study was completed online using a custom application.

Results

Based on trait anxiety scores participants were separated into moderate and high trait anxiety sub-groups. Among participants with moderate trait anxiety, we observed reductions in somatic anxiety that were greater in combined and music-alone conditions than in the pink noise condition; and reductions in cognitive state anxiety that were greater in the combined condition than in the music-alone, ABS-alone, and pink noise conditions. While we also observed reductions in somatic and cognitive state anxiety in participants with high trait anxiety, the conditions were not well differentiated.

Conclusions

Sound-based treatments are effective in reducing somatic and cognitive state anxiety. For participants with moderate trait anxiety, combined conditions were most efficacious.

Does self-reported chronic pain influence savoring of aesthetic experiences?

BACKGROUND

Aesthetic experiences elicit a wide range of positive emotions and have a positive impact on various health outcomes. In this context, savoring refers to a cognitive form of emotion regulation used to maintain and extend positive emotional experiences and is considered to contribute to health and well-being. Chronic pain has been linked to reduced reward-seeking behavior. This is the first study to investigate the relationship between self-reported chronic pain and savoring.

METHODS

We conducted an anonymous cross-sectional survey in a large non-clinical sample (opera, theater, and cabaret visitors; n = 322). The variables were assessed with a two-item-questionnaire.

RESULTS

Self-reported chronic pain was significantly negatively correlated with savoring (r = -.547).

CONCLUSION

Altogether, this result helps to develop a better understanding of the effects of chronic pain in humans and to shed light on state-dependent differences in aesthetic experiences.

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

Evaluative judgment across domains: Liking balance, contour, symmetry and complexity in melodies and visual designs

Evaluative judgment-i.e., assessing to what degree a stimulus is liked or disliked-is a fundamental aspect of cognition, facilitating comparison and choosing among alternatives, deciding, and prioritizing actions. Neuroimaging studies have shown that evaluative judgment involves the projection of sensory information to the reward circuit. To investigate whether evaluative judgments are based on modality-specific or modality-general attributes, we compared the extent to which balance, contour, symmetry, and complexity affect liking responses in the auditory and visual modalities. We found no significant correlation for any of the four attributes across sensory modalities, except for contour. This suggests that evaluative judgments primarily rely on modality-specific sensory representations elaborated in the brain's sensory cortices and relayed to the reward circuit, rather than abstract modality-general representations. The individual traits art experience, openness to experience, and desire for aesthetics were associated with the extent to which design or compositional attributes influenced liking, but inconsistently across sensory modalities and attributes, also suggesting modality-specific influences.

'Defrosting' music chills with naltrexone: The role of endogenous opioids for the intensity of musical pleasure

The endogenous opioid system has been implicated during experiences of pleasure (i.e., from food or sex). Music can elicit intense emotional and bodily sensations of pleasure, called 'Chills'. We investigated the effects of an opioid antagonist (50 mg naltrexone) or placebo (40 μg d3-vitamin) while listening to self-selected music or other 'control' music selected by another participant. We used a novel technique of continuous measurement of pleasantness with an eye tracker system, where participants shifted their eyes along a visual analogue scale, in the semblance of a thermometer so that, as the music unfolded, gaze positions indicated the self-reported hedonic experience. Simultaneously, we obtained pupil diameters. Self-reported pleasure remained unchanged by naltrexone, which - however - selectively decreased pupillary diameters during 'Chills'. Hence, the endogenous μ-opioid signaling is not necessary for subjective enjoyment of music but an opioid blockade dampens pupil responses to peak pleasure, consistent with decreased arousal to the music.

How emotional is a banknote? The affective basis of money perception

Previous studies have shown that money possesses affective properties even when it is not at stake within a given task. Smaller economic values are generally perceived as less arousing and neutral in valence, whereas larger ones are perceived as more arousing and positive in valence. Moreover, numerical cognitive processes seem to be less prominent than affective ones in the way we perceive economic values. To shed light on the basic affective components of monetary values, we ran three experiments on the perception of banknotes to test (i) whether banknotes with different values (5€ and 100€) trigger different emotional states, (ii) if values are horizontally mapped based on their valence, rather than on their numerical magnitude, and (iii) whether the lateralized sight (in the left or right visual field) of a positive (higher) monetary value interferes with the classification of a negative stimulus. Results showed a coherent pattern that corroborates the idea that money is indeed an affective stimulus, even when it is not at stake within the task. A higher monetary value was shown (i) to have intrinsic rewarding properties that influence the evaluation of a subsequent target, (ii) to be mentally mapped on the right side, which is related to positive approaching of affective stimuli in right-handers, and (iii) to be in conflict with negative-withdrawing targets, but only when the values were presented on the right-positive side of respondents. Results are discussed considering existing theories of the psychological value of money, highlighting the hedonic characteristics of this special affective stimulus.

Association between anhedonia and suicidal events in patients with mood disorders: A 3-year prospective study

BACKGROUND

As almost all mental disorders are associated with increased suicidal-related behavior, anhedonia might be a trans-diagnostic dimension to target for suicide prevention.

METHODS

For this 3-year-long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow-up, and (b) two groups according to the occurrence or not of suicide attempts during the follow-up. Anhedonia was assessed using a composite score (the French version of the 14-item Snaith-Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion.

RESULTS

Patients with mood disorders and anhedonia at least at one follow-up visit had a 1.4-fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow-up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment.

CONCLUSIONS

The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.

Efficacy, Treatment Characteristics, and Biopsychological Mechanisms of Music-Listening Interventions in Reducing Pain (MINTREP): Study Protocol of a Three-Armed Pilot Randomized Controlled Trial

Background: Pain can severely compromise a person's overall health and well-being. Music-listening interventions have been shown to alleviate perceived pain and to modulate the body's stress-sensitive systems. Despite the growing evidence of pain- and stress-reducing effects of music-listening interventions from experimental and clinical research, current findings on music-induced analgesia are inconclusive regarding the role of specific treatment characteristics and the biopsychological mechanisms underlying these effects. Objective: The overall aim of this pilot randomized controlled trial is to test and compare the differential effects of frequency-modulated and unmodulated music (both researcher-selected) on experimentally induced perception of acute pain and to test the efficacy of the interventions in reducing biological and subjective stress levels. Moreover, these two interventions will be compared to a third condition, in which participants listen to self-selected unmodulated music. Methods and Analysis: A total of 90 healthy participants will be randomly allocated to one of the three music-listening intervention groups. Each intervention encompasses 10 sessions of music listening in our laboratory. Frequency-modulation will involve stepwise filtering of frequencies in the audible range of 50-4,000 Hz. Acute pain will be induced via the cold pressor test. Primary (i.e., pain tolerance, perceived pain intensity) and secondary (i.e., heart rate variability, electrodermal activity, hair cortisol, subjective stress) outcomes will be measured at baseline, post, and follow-up. In addition, intermittent measurements as well as a follow-up assessment and a range of tertiary measures (e.g., music-induced emotions) are included. Discussion: This is the first study to systematically test and compare the effects of music frequencies along with the control over music selection, both of which qualify as central treatment characteristics of music-listening interventions. Results will be highly informative for the design of subsequent large-scale clinical trials and provide valuable conclusions for the implementation of music-listening interventions for the reduction of perceived pain. Clinical Trial Registration: Clinical Trials Database of the U.S. National Library of Medicine: Identifier NCT02991014.

A coordinate-based meta-analysis of music-evoked emotions

Since the publication of the first neuroscience study investigating emotion with music about two decades ago, the number of functional neuroimaging studies published on this topic has increased each year. This research interest is in part due to the ubiquity of music across cultures, and to music's power to evoke a diverse range of intensely felt emotions. To support a better understanding of the brain correlates of music-evoked emotions this article reports a coordinate-based meta-analysis of neuroimaging studies (n = 47 studies with n = 944 subjects). The studies employed a range of diverse experimental approaches (e.g., using music to evoke joy, sadness, fear, tension, frissons, surprise, unpleasantness, or feelings of beauty). The results of an activation likelihood estimation (ALE) indicate large clusters in a range of structures, including amygdala, anterior hippocampus, auditory cortex, and numerous structures of the reward network (ventral and dorsal striatum, anterior cingulate cortex, orbitofrontal cortex, secondary somatosensory cortex). The results underline the rewarding nature of music, the role of the auditory cortex as an emotional hub, and the role of the hippocampus in attachment-related emotions and social bonding.

A meta-analysis of the potential antidepressant effects of buprenorphine versus placebo as an adjunctive pharmacotherapy for treatment-resistant depression

BACKGROUND

Numerous reports have suggested that buprenorphine may have antidepressant effects. Many individuals with depressive disorders don't respond to first-line treatment and are classified with treatment-resistant depression (TRD). Novel therapies for depression are required to better treat this population. This meta-analysis of randomized placebo-controlled trials sought to evaluate the potential antidepressant effects of buprenorphine as an adjunctive pharmacological treatment for individuals with TRD.

METHODS

PubMed, Embase, CINAHL, Web of Science, and ClinicalTrials.gov databases were searched until June 2019 for original peer-reviewed reports of buprenorphine used for the treatment of depression. Standardized mean differences (SMD) were generated from random effects models. Risk of publication bias was assessed using a funnel plot. Potential sources of heterogeneity were explored in subgroup analyses.

RESULTS

In six studies that met inclusion criteria, depression symptom severity in individuals with TRD was not significantly decreased after an adjunctive intervention with buprenorphine when compared to placebo (SMD = -0.07, 95% CI: -0.21-0.06, p = 0.30). Five of the six studies utilized a combination of buprenorphine/samidorphan. In these studies, depression symptom severity was also not significantly reduced after intervention compared to placebo (SMD = -0.08, 95% CI: -0.21 - 0.05, p = 0.23).

LIMITATIONS

Five included studies were performed by the same research group with significant conflicts of interest.

CONCLUSIONS

This meta-analysis did not reveal a significant reduction in depression symptom severity in individuals with TRD after an adjunctive intervention with buprenorphine when compared to placebo. However, more optimal doses of buprenorphine (2 mg/day) and longer treatment lengths should be explored.

Effects of Mu-Opiate Receptor Gene Polymorphism rs1799971 (A118G) on the Antidepressant and Dissociation Responses in Esketamine Nasal Spray Clinical Trials

Background

At ketamine and esketamine doses at which antidepressant doses are achieved, these agents are relatively selective, noncompetitive, N-methyl-D-aspartate receptor antagonists. However, at substantially higher doses, ketamine has shown mu-opioid receptor (MOR–gene symbol: OPRM1) agonist effects. Preliminary clinical studies showed conflicting results on whether naltrexone, a MOR antagonist, blocks the antidepressant action of ketamine. We examined drug-induced or endogenous MOR involvement in the antidepressant and dissociative responses to esketamine by assessing the effects of a functional single nucleotide polymorphism rs1799971 (A118G) of OPRM1, which is known to alter MOR agonist-mediated responses.

Methods

Participants with treatment-resistant depression from 2 phase III, double-blind, controlled trials of esketamine (or placebo) nasal spray plus an oral antidepressant were genotyped for rs1799971. Participants received the experimental agents twice weekly for 4 weeks. Antidepressant responses were rated using the change in Montgomery–Åsberg Depression Rating Scale (MADRS) score on days 2 and 28 post-dose initiation, and dissociative side effects were assessed using the Clinician-Administered Dissociative-States Scale at 40 minutes post-dose on days 1 and 25.

Results

In the esketamine + antidepressant arm, no significant genotype effect of single nucleotide polymorphism rs1799971 (A118G) on MADRS score reductions was detected on either day 2 or 28. By contrast, in the antidepressant + placebo arm, there was a significant genotype effect on MADRS score reductions on day 2 and a nonsignificant trend on day 28 towards an improvement in depression symptoms in G-allele carriers. No significant genotype effects on dissociative responses were detected.

Conclusions

Variation in rs1799971 (A118G) did not affect the antidepressant response to esketamine + antidepressant. Antidepressant response to antidepressant + placebo was increased in G-allele carriers, compatible with previous reports that release of endorphins/enkephalins may play a role in mediating placebo effect.

Trial Registration

NCT02417064 and NCT02418585; www.clinicaltrials.gov

Opioid receptor blockade inhibits self-disclosure during a closeness-building social interaction

Social ties are critical to human health and well-being; thus, it is important to gain a better understanding of the neurobiological mechanisms involved in the development of interpersonal closeness. Prior research indicates that endogenous opioids may play a role in social affiliation by elaborating feelings of social connection and warmth; however, it is not currently known whether opioids mediate affiliative behavior and emerging feelings of closeness in humans at the relationship initiation stage. This randomized, double-blind study examined opioidergic processes in the context of a naturalistic, face-to-face social interaction. Eighty pairs of unacquainted participants (final N = 159 due to removal of one dyad member from analysis) received either 50 mg of the opioid receptor antagonist naltrexone or placebo prior to completing a closeness-building exercise centered on escalating self-disclosure (sharing of personal information about the self). Compared to the placebo group, naltrexone participants held lower social reward expectations prior to the interaction, engaged in less intimacy-fostering behavior (self-disclosure) during the interaction, and reported wanting less closeness with their partner. Feelings of social connection were not significantly lower in the naltrexone group. However, placebo participants experienced improvements in mood after the closeness-building task whereas naltrexone participants did not. These findings suggest that endogenous opioids may contribute to behavioral, affective, and motivational processes related to the development of initial closeness.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

Endogenous opiates and behavior: 2017

This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

Advances in CNS PET: the state-of-the-art for new imaging targets for pathophysiology and drug development

PURPOSE

A limit on developing new treatments for a number of central nervous system (CNS) disorders has been the inadequate understanding of the in vivo pathophysiology underlying neurological and psychiatric disorders and the lack of in vivo tools to determine brain penetrance, target engagement, and relevant molecular activity of novel drugs. Molecular neuroimaging provides the tools to address this. This article aims to provide a state-of-the-art review of new PET tracers for CNS targets, focusing on developments in the last 5 years for targets recently available for in-human imaging.

METHODS

We provide an overview of the criteria used to evaluate PET tracers. We then used the National Institute of Mental Health Research Priorities list to identify the key CNS targets. We conducted a PubMed search (search period 1st of January 2013 to 31st of December 2018), which yielded 40 new PET tracers across 16 CNS targets which met our selectivity criteria. For each tracer, we summarised the evidence of its properties and potential for use in studies of CNS pathophysiology and drug evaluation, including its target selectivity and affinity, inter and intra-subject variability, and pharmacokinetic parameters. We also consider its potential limitations and missing characterisation data, but not specific applications in drug development. Where multiple tracers were present for a target, we provide a comparison of their properties.

RESULTS AND CONCLUSIONS

Our review shows that multiple new tracers have been developed for proteinopathy targets, particularly tau, as well as the purinoceptor P2X7, phosphodiesterase enzyme PDE10A, and synaptic vesicle glycoprotein 2A (SV2A), amongst others. Some of the most promising of these include 18F-MK-6240 for tau imaging, 11C-UCB-J for imaging SV2A, 11C-CURB and 11C-MK-3168 for characterisation of fatty acid amide hydrolase, 18F-FIMX for metabotropic glutamate receptor 1, and 18F-MNI-444 for imaging adenosine 2A. Our review also identifies recurrent issues within the field. Many of the tracers discussed lack in vivo blocking data, reducing confidence in selectivity. Additionally, late-stage identification of substantial off-target sites for multiple tracers highlights incomplete pre-clinical characterisation prior to translation, as well as human disease state studies carried out without confirmation of test-retest reproducibility.

Intense Beauty Requires Intense Pleasure

At the beginning of psychology, Fechner (1876) claimed that beauty is immediate pleasure, and that an object’s pleasure determines its value. In our earlier work, we found that intense pleasure always results in intense beauty. Here, we focus on the inverse: Is intense pleasure necessary for intense beauty? If so, the inability to experience pleasure (anhedonia) should prevent the experience of intense beauty. We asked 757 online participants to rate how intensely they felt beauty from each image. We used 900 OASIS images along with their available valence (pleasure vs. displeasure) and arousal ratings. We then obtained self-reports of anhedonia (TEPS), mood, and depression (PHQ-9). Across images, beauty ratings were closely related to pleasure ratings (r = 0.75), yet unrelated to arousal ratings. Only images with an average pleasure rating above 4 (of a possible 7) often achieved (>10%) beauty averages exceeding the overall median beauty. For normally beautiful images (average rating > 4.5), the beauty ratings were correlated with anhedonia (r ∼−0.3) and mood (r ∼ 0.3), yet unrelated to depression. Comparing each participant’s average beauty rating to the overall median (5.0), none of the most anhedonic participants exceeded the median, whereas 50% of the remaining participants did. Thus, both general and anhedonic results support the claim that intense beauty requires intense pleasure. In addition, follow-up repeated measures showed that shared taste contributed 19% to beauty-rating variance, only one third as much as personal taste (58%). Addressing age-old questions, these results indicate that beauty is a kind of pleasure, and that beauty is more personal than universal, i.e., 1.7 times more correlated with individual than with shared taste.

Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder

There is a critical need for research on clinical features that may influence response to treatment for opioid use disorder (OUD). Given its neurobiology and relevance to opioid use, anhedonia may be one such promising clinical feature. We identified and reviewed 11 studies that measured anhedonia in humans with OUD to characterize the current state of evidence and highlight potential implications for treatment. The majority of studies were cross-sectional, indicating higher anhedonia scores in opioid-dependent samples compared to healthy controls. Rates of participants with clinically significant anhedonia ranged from 21% to 48%. Anhedonia scores were correlated with opioid craving and use, however there are significant knowledge gaps regarding its time course and impact on treatment adherence and outcomes. Repeated assessment of anhedonia early in treatment for OUD is recommended, as it may be a unique predictor of dropout or non-response, and a potential target for behavioral and/or pharmacological intervention.

Musical anhedonia and rewards of music listening: current advances and a proposed model

Music frequently elicits intense emotional responses, a phenomenon that has been scrutinized from multiple disciplines that span the sciences and arts. While most people enjoy music and find it rewarding, there is substantial individual variability in the experience and degree of music-induced reward. Here, we review current work on the neural substrates of hedonic responses to music. In particular, we focus the present review on specific musical anhedonia, a selective lack of pleasure from music. Based on evidence from neuroimaging, neuropsychology, and brain stimulation studies, we derive a neuroanatomical model of the experience of pleasure during music listening. Our model posits that hedonic responses to music are the result of connectivity between structures involved in auditory perception as a predictive process, and those involved in the brain's dopaminergic reward system. We conclude with open questions and implications of this model for future research on why humans appreciate music.

A Pilot Study Investigating the Effect of Music-Based Intervention on Depression and Anhedonia

This study investigated the effect of a music-based intervention on depression and associated symptoms. Twenty individuals formally diagnosed with Major Depressive Disorder and in a current Major Depressive Episode (11 females and 8 males; aged between 26 and 65 years) undertook a 5 weeks intervention consisting of music listening combined with rhythmic sensory stimulation. Participants listened to a set of designed instrumental music tracks embedded with low-frequency sounds (30–70 Hz). The stimuli were delivered for 30 min, 5 times per week, using a portable consumer device with built-in stereo speakers and a low-frequency transducer, which allowed the low-frequency sounds embedded in the music to be experienced as a mild vibrotactile sensation around the lower back. Changes from baseline to post-intervention in measures of depression symptoms, sleep quality, quality of life, anhedonia, and music-reward processing were assessed with clinician-based assessments as well as self-reports and a monetary incentive behavioral task. The study results indicated that there were significant changes from baseline in measures of depression and associated symptoms, including sleep quality, quality of life, and anhedonia. However, individual differences in treatment response need to be considered. These findings corroborate previous evidence that music-based intervention, when added to standard care, is a promising adjunctive treatment for Major Depressive Disorder, and open new avenues to investigate the effect of music-based therapy to ameliorate anhedonia-specific dysfunction in major depressive disorder and other neuropsychiatric disorders.

Music-Enhanced Analgesia and Antiseizure Activities in Animal Models of Pain and Epilepsy: Toward Preclinical Studies Supporting Development of Digital Therapeutics and Their Combinations With Pharmaceutical Drugs

Digital therapeutics (software as a medical device) and mobile health (mHealth) technologies offer a means to deliver behavioral, psychosocial, disease self-management and music-based interventions to improve therapy outcomes for chronic diseases, including pain and epilepsy. To explore new translational opportunities in developing digital therapeutics for neurological disorders, and their integration with pharmacotherapies, we examined analgesic and antiseizure effects of specific musical compositions in mouse models of pain and epilepsy. The music playlist was created based on the modular progression of Mozart compositions for which reduction of seizures and epileptiform discharges were previously reported in people with epilepsy. Our results indicated that music-treated mice exhibited significant analgesia and reduction of paw edema in the carrageenan model of inflammatory pain. Among analgesic drugs tested (ibuprofen, cannabidiol (CBD), levetiracetam, and the galanin analog NAX 5055), music intervention significantly decreased paw withdrawal latency difference in ibuprofen-treated mice and reduced paw edema in combination with CBD or NAX 5055. To the best of our knowledge, this is the first animal study on music-enhanced antinociceptive activity of analgesic drugs. In the plantar incision model of surgical pain, music-pretreated mice had significant reduction of mechanical allodynia. In the corneal kindling model of epilepsy, the cumulative seizure burden following kindling acquisition was lower in animals exposed to music. The music-treated group also exhibited significantly improved survival, warranting further research on music interventions for preventing Sudden Unexpected Death in Epilepsy (SUDEP). We propose a working model of how musical elements such as rhythm, sequences, phrases and punctuation found in K.448 and K.545 may exert responses via parasympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Based on our findings, we discuss: (1) how enriched environment (EE) can serve as a preclinical surrogate for testing combinations of non-pharmacological modalities and drugs for the treatment of pain and other chronic diseases, and (2) a new paradigm for preclinical and clinical development of therapies leading to drug-device combination products for neurological disorders, depression and cancer. In summary, our present results encourage translational research on integrating non-pharmacological and pharmacological interventions for pain and epilepsy using digital therapeutics.