Ann. N.Y. Acad. Sci.

ISSN 0077-8923

A N N A L S O F T H E N E W Y O R K A C A D E M Y O F SC I E N C E S
Issue: The Emerging Science of Consciousness: Mind, Brain, and the Human Experience

Creativity and improvisation as therapeutic tools within

music therapy
Concetta M. Tomaino
Institute for Music and Neurologic Function, CenterLight Health System, Bronx, New York

Address for correspondence: Concetta M. Tomaino, D.A., MT-BC, LCAT, Institute for Music and Neurologic Function,
612 Allerton Ave., Bronx, New York 10467. ctomaino@bethabe.org

The neuroscience of creativity and music improvisation is a fascinating topic and one with strong implications
for clinical music therapy. Music therapists are trained to use musical improvisation as a means to bring their
clients into deeper therapeutic relationship as well as free up any inhibitions or limitations that may block re-
covery. Could recent fMRI studies of jazz musicians showing areas of brain activation during music improvi-
sation provide a new framework to understand underlying mechanisms at work with neurologically impaired
individuals?

Keywords: music; improvisation; music therapy; music and brain; neurological function

The neuroscience of creativity and music impro-
visation is a fascinating topic and one with strong
implications for clinical music therapy. The Ameri-
can Music Therapy Association defines music ther-
apy as “the clinical and evidence-based use of mu-
sic interventions to accomplish individualized goals
within a therapeutic relationship by a credentialed
professional who has completed an approved mu-
sic therapy program.” The important phrase here is
“within a therapeutic relationship,” a relationship
often formed through improvised musical interac-
tion between the client and music therapist in real
time. The field of music therapy has been an es-
tablished profession in the United States since the
1950s. Since then music therapists have researched
and shown the efficacy of the clinical applications
of music and the components of music, for ex-
ample, rhythm, vibration, melody, harmony, and
song to affect cognitive, physical, and psychosocial
function in all ages and across all need areas, in-
cluding medicine, early child development, neuro-
rehabilitation, and psychotherapy.1 It is only in the
past 15 years or so that neuroscience has been able to
help answer some questions about how music is pro-
cessed in the brain and possibly shed some light on
how and why music perception influences various
brain networks. One of the challenges in researching
the impact of music therapy on various conditions
is that there are limited interventions that can be
done in a controlled double-blind study. The type of
dynamic, interactive, personalized engagement that
is a fundamental part of music therapy requires a
different research paradigm and integration of neu-
roscience findings to truly understand how and why
music therapy is effective in these cases. Looking at
the neuroscience of music improvisation may pro-
vide some insight. In his text Improvisational Models
of Music Therapy, Kenneth Bruscia explains,
In a music therapy context, improvising . . . is
inventive, spontaneous, extemporaneous, re-
sourceful, and it involves creating and playing
simultaneously. It is not always an “art” how-
ever, and it does not always result in “music”
per se. Sometimes it is a “process” which results
in very simple “sound forms.” Music therapists
strive to improvise music of the highest artistic
quality and beauty, however, they always ac-
cept the client’s improvising at whatever level
it is offered, whether consisting of musical or
sound forms, and regardless of its artistic or
aesthetic merit.2
Music therapists often refer to “ability in the
moment”—when the patient who is engaged in an

doi: 10.1111/nyas.12224
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Tomaino
improvization is able to do something that was not
possible outside of the musical interaction, such as
moving a weak arm or speaking a word that could
not be previously recalled. Music therapists may call
this a moment of “release” or “flow” or “connec-
tion.” But is the active engagement in music mak-
ing contributing to the release of something that
was inhibited outside of the music? I think a lot of
this has to do with the arousal of subcortical ar-
eas and neural networks that stimulate action and
inhibit self-monitoring. People who have suffered
a brain injury or neurologic disease often have to
think hard about how to move a paretic arm or leg;
similarly a person who has suffered a stroke may
have trouble with word retrieval but may find the
word easier to retrieve after singing a song. Those
with some type of brain injury, whether by trauma,
disease, or stroke, often have trouble with multi-
step planning, attention, and mental flexibility—
all part of executive function. Understanding what
the improvising brain looks like can offer some in-
sights as to why a patient with impaired executive
function shows the ability when engaged in sponta-
neous activity. Can this be related to inhibition in
the prefrontal cortex? In her article, “Inner Spark:
Using Music to Study Creativity” (Scientific Amer-
ican, May 20113 ), Alicia Anstead highlights some
of the findings in the neuroscience of creativity
and quotes Charles Limb on his research on music
improvisation.
Limb says his studies have revealed that “cre-
ativity is a whole-brain activity. When you’re
doing something that’s creative, you’re engag-
ing all aspects of your brain. During impro-
visation, the prefrontal cortex of the brain un-
dergoes an interesting shift in activity, in which
a broad area called the lateral prefrontal region
shuts down, essentially so you have a signifi-
cant inhibition of your prefrontal cortex . . . .
These areas are involved in conscious self-
monitoring, self-inhibition, and evaluation of
the rightness and wrongness of actions you’re
about to implement . . . . In the meantime,
we saw another area of the prefrontal cortex—
the medial prefrontal cortex—turn on. This is
the focal area of the brain that’s involved in self-
expression and autobiographical narrative. It’s
part of what is known as a default network. It
has to do with sense of self.
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Creativity and improvisation as therapeutic tools
It is interesting that the medial prefrontal cortex
has been identified by Limb as an area involved in
autobiographical narrative, as this area has also been
indicated in research on music and memory.4
A leading researcher in this area is Petr Janata of
U.C. Davis, whose functional magnetic resonance
imaging (fMRI) studies on music and memory show
an area of convergence in the medial prefrontal cor-
tex when people listen to music that has connections
to self, important others, and important times and
places.5 Janata’s research has implications for under-
standing why people with dementia have the abil-
ity to recognize a personally significant song even
when other areas of recognition have been dam-
aged. Could this be because several processes con-
verge in the medial prefrontal cortex and/or other
active monitoring processes are inhibited to allow
for the processing of this sensory input? Determin-
ing which areas of the brain are engaged and disen-
gaged during creative music making may shed some
light on why function becomes enabled under these
circumstances.
Our skills, musical and non-musical, are devel-
oped over time and our brains learn to apply our
repertoire in an infinite array of possible outcomes.
Basic motor skills can be applied to everyday tasks
like walking and dressing but can also be used for
more advanced skills like playing the violin or com-
peting in gymnastics. The more advanced our skills
the more enriched the number of networks and
brain areas that are used to produce the given out-
come. Mental processes like fear and uncertainty in-
hibit the freedom with which we apply these skills.
Similarly, head trauma and disease can interfere with
ability as well. So it is no wonder that an activ-
ity that allows for disinhibition of self-monitoring
produces increased ability in those with neurologic
deficits.
I am reminded of a woman in her early twenties
who had been admitted with a left-arm paralysis
and possible diagnosis of multiple sclerosis. She had
been admitted to long-term care after undergoing
procedures to unlock her contracted knee joints.
She had good range of motion in her right arm and
hand. She was emotionally withdrawn and not able
to benefit fully from traditional physical rehabili-
tation. She was referred to music therapy because
she had an interest in music. (Patients do not need
to have an interest in music to benefit from mu-
sic therapy—but physicians often see the interest in
85

Creativity and improvisation as therapeutic tools
music as a means to get a marginal patient involved
in therapy.) Though she was reluctant at first she
started to attend because I mentioned that I had an
instrument she could play with only her right hand.
As the sessions progressed, I observed that her left
arm would move while she was fully engaged in
playing/improvising along with me. I shared this
observation with her and she denied that the arm
could move. I engaged her in longer musical interac-
tions, and tilted the instrument so if she moved her
left hand it would touch the instrument and pro-
duce a sound. This would be proof that she could
move her arm. This did happen, and when she heard
herself make the sound she stopped playing, looked
are her limp left arm and then slowly started to
move it. This was a turning point in her therapy.
Up until then she had shared minimal information
about herself. Moving her left arm, she told me of
how her mother would hit her. I relayed this to her
social worker and medical team as it seemed that
what was thought to have been multiple sclerosis
may have been a hysterical paralysis. We were able
to get her the psychological help she needed and
soon she recovered full use of her left side. It was in
the context of being fully engaged in music making
that she was able to move her left side for the first
86 Ann. N.Y. Acad. Sci. 1303 (2013) 84–86 
17496632, 2013, 1, Downloaded from https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.12224 by Colorado State University, Wiley Online Library on [22/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Tomaino
time. Could this disinhibition be similar to the lack
of self-monitoring exhibited in the jazz musicians?
Understanding the mechanisms by which this re-
lease is made possible would provide additional sup-
port of the efficacy of music therapy in trauma cases
as well as for those with neurological impairments
from disease, stroke, and head injury. What Charles
Limb and others are finding in their studies is very
important because it may bring new understand-
ing of why our patients with brain injury do better
during musical improvisation.
Conflicts of interest
The author declares no conflicts of interest.
References
1. Tomaino, C.M. 1993. “Music and the limbic system.” In Cur-
rent Research in Arts Medicine. F.J. Bejjani, Ed.: Illinois: A
Cappella Books.
2. Bruscia, K.E. 1987. Improvisational Models of Music Therapy.
pp. 5–6. Springfield, IL: Charles C. Thomas.
3. Anstead, A. 2011. Using music to study creativity. Sci. Am.,
May 2011.
4. Barrett, F.S., K.J. Grimm, R.W. Robins, et al. 2010. Music-
evoked nostalgia: affect, memory, and personality. Emotion
10: 390–403.
5. Janata, P. 2009. The neural architecture of music-evoked au-
tobiographical memories. Cereb. Cortex 19: 2579–2594.
C 2013 New York Academy of Sciences.