Music Therapy for Reduction of Anhedonia: Protocol for a Sequential Mixed Methods Pre-Post Pilot Study

The transdiagnostic symptom of anhedonia, or the loss of pleasure in previously pleasurable things, is common across several chronic physical and mental illnesses. Music therapy has been effective in treating a range of conditions associated with anhedonia, but only 3 cases have been reported that targeted increasing hedonic capacity and all relied on descriptive data (qualitative and quantitative). Functional magnetic resonance imaging (fMRI) evidence demonstrates that pleasure is associated with increased activity in the limbic system, including the anterior cingulate cortex, as well as the prefrontal cortex. As such, changes within these regions may provide objective evidence to explore how music therapy acts to reduce anhedonia symptomatology.

Our primary aim is to examine the feasibility of a music therapy intervention to increase hedonic capacity among individuals with anhedonia. We also aim to examine congruence across psychometric results and interview data to generate estimates of effect size and explore participants' qualitative experiences. In addition, we aim to identify any correspondence between these outcomes and changes in brain activity associated with reward processing during targeted fMRI tasks. This study will generate hypotheses for testing in future studies.

This pilot study uses a sequential mixed methods design to first identify whether there are pre-post changes in the primary outcome measures and then to identify correlations between interview data, psychometric data, and objective measures of brain structure and functioning (fMRI). Participants were 13 adults with high cognitive function who scored within the clinical range for anhedonia on the Dimensional Anhedonia Rating Scale (DARS). Participants were engaged in a 4-month music therapy intervention developed through preliminary case studies, which involved daily independent pleasure-focused music activities and regular contact with a therapeutic guide. The fMRI data acquired include resting-state fMRI and task-based functional paradigms designed to probe musical pleasure (music listening task) and reward prediction (reversal reward learning task). Data will be analyzed using individual general linear models to identify associations with symptom improvement, as well as longitudinal changes in functioning.

The study received internal funding support from the University of Melbourne in September 2024. Data collection commenced in August 2025 and was concluded by mid-2026. As of September 2026, 13 participants have been recruited, and data will be analyzed by the end of 2026, with results expected to be published in 2027.

The results of this pilot study will contribute to knowledge about the effects of this music therapy intervention on reducing anhedonia and introduce a study protocol that could be used in subsequent, more robust studies to explore potential mechanisms.