Musical pathways to empowerment: Exploring the effects of music therapy with cognitive-behavioral therapy on social anxiety symptoms - a meta analysis

Padma G. Priya; Uma Bhardwaj; Radhamadhab Sahoo; Sudhir Bhandari; Sakshi Sobti; Bharat Bhushan

doi:10.31893/multirev.2025ss0219

Keywords:

Abstract

Social Anxiety Disorder (SAD) is common and debilitating in adolescents, with potentially ongoing social, academic, and emotional problems if not treated. Cognitive-behavioral therapy (CBT) has been established as a standard treatment for social anxiety. In contrast, music therapy (MT) is increasingly known for its effectiveness in facilitating emotional expression and peer interaction. This review synthesis combines current empirical studies that have been published during the period 2019-2025 and explores the impact of CBT, MT, and their combination on diminishing symptoms of social anxiety in adolescents. A total of 20 original, peer-reviewed articles were shortlisted via a systematic search of PubMed, Google Scholar, Scopus, and ScienceDirect, using preset inclusion criteria. The chosen studies were analyzed thematically to detect methodological trends, outcome measures, and treatment patterns of effectiveness. Results indicated that CBT interventions continually decreased fear of negative evaluation, avoidance, and generalized anxiety. MT evidenced robust benefits in improving emotional regulation, social expression, and therapeutic engagement. Integrated CBT-MT models yielded synergistic effects and provided wider and more enduring improvements in emotional, cognitive, and social areas. Several studies have described the long-term efficacy, defined as six months or more after the intervention. Although encouraging, some challenges need to be addressed, ranging from heterogeneity of protocol standardization, sample diversity, and a lack of longitudinal data in most studies. This review adds to the mounting evidence supporting interdisciplinary interventions and encourages the conduct of further research on standardized, scalable CBT-MT models. These findings have important implications for school-based interventions, clinical practice, and mental health policy aimed at adolescent populations.
References
1. Aluh, D. O., Chukwuobasi, T., & Mosanya, A. U. (2019). A cross-sectional survey of Social Media Anxiety among students of the University of Nigeria. Journal of Mental Health and Human Behaviour, 24(1), 51-56.https://doi.org/10.4103/jmhhb.jmhhb_64_19
2. Baartmans, J. M., van Steensel, F. J. A., Klein, A. M., & Bögels, S. M. (2022). The role of comorbid mood disorders in cognitive behavioral therapy for childhood social anxiety. Cognitive Therapy and Research, 46(5), 983-991.https://doi.org/10.1097/CHI.0b013e3181af8216
3. Belmon, A. P., & Auxillia, J. (2023). Music Therapy: A Best Way to Solve Anxiety and Depression in Diabetes Mellitus Patients. In Advances in Speech and Music Technology: Computational Aspects and Applications (pp. 237-247). Cham: Springer International Publishing.https://doi.org/10.1002/14651858.CD004025
4. Belski, N., Abdul‐Rahman, Z., Youn, E., Balasundaram, V., & Diep, D. (2022). The effectiveness of musical therapy in improving depression and anxiety symptoms among children and adolescents–a systematic review. Child and Adolescent Mental Health, 27(4), 369-377. https://doi.org/10.1111/camh.12526
5. Benbow, A. A., & Anderson, P. L. (2019). Long-term improvements in probability and cost biases following brief cognitive behavioral therapy for social anxiety disorder. Cognitive Therapy and Research, 43 (2), 412-418.https://doi.org/10.1007/s10608-016-9820-y
6. Bojorquez, G. R., Jackson, K. E., & Andrews, A. K. (2020). Music therapy for surgical patients: approach for managing pain and anxiety. Critical care nursing quarterly, 43(1), 81-85.https://doi.org/10.1097/CNQ.0000000000000294
7. Bong, S. H., Won, G. H., & Choi, T. Y. (2021). Effects of cognitive-behavioral therapy based music therapy in Korean adolescents with smartphone and internet addiction. Psychiatry Investigation, 18(2), 110. https://doi.org/10.30773/pi.2020.0155
8. Davies, H. (2022). ‘Autism is a way of being’: An ‘insider perspective’on neurodiversity, music therapy and social justice. British Journal of Music Therapy, 36(1), 16-26.https://doi.org/10.1177/13594575221090182
9. Dunning, E. E., Khan, A. N., Becker-Haimes, E. M., & Guzick, A. G. (2025). When Attempts to Help Backfire: Psychosocial Interventions that May Inadvertently Prolong Anxiety Among Youth. Research on Child and Adolescent Psychopathology 53 (1), 1-15. https://doi.org/10.1007/s10802-025-01317-x
10. Egbe, C. I., Ugwuanyi, L. T., Ede, M. O., Agbigwe, I. B., Onuorah, A. R., Okon, O. E., & Ugwu, J. C. (2023). Cognitive behavioural play therapy for social anxiety disorders (SADS) in children with speech impairments. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 41(1), 24-44.https://doi.org/10.1007/s10942-020-00376-x
11. Freitas, C., Fernández-Company, J. F., Pita, M. F., & Garcia-Rodriguez, M. (2022). Music therapy for adolescents with psychiatric disorders: an overview. Clinical child psychology and psychiatry, 27(3), 895-910.https://doi.org/10.1177/13591045221079161
12. Geipel, J., Koenig, J., Hillecke, T. K., & Resch, F. (2022). Short-term music therapy treatment for adolescents with depression–A pilot study. The arts in psychotherapy, 77, 101874.https://doi.org/10.1016/j.aip.2021.101874
13. Hakim, A., Kaldozkhi, S. S. H., Tashakori, A., & Ghanbari, S. (2023). The effect of non-verbal music on anxiety in hospitalized children. BMC pediatrics, 23(1), 279. https://doi.org/10.1186/s12887-023-04101-2
14. Haugland, B. S. M., Haaland, A. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., ... & Wergeland, G. J. (2020). Effectiveness of brief and standard school-based cognitive-behavioral interventions for adolescents with anxiety: A randomized noninferiority study. Journal of the American Academy of Child & Adolescent Psychiatry, 59(4), 552-564. https://doi.org/10.1016/j.jaac.2019.12.003
15. Khan, Z., Zaib, Q., Saeed, K., Khan, B., Pal, H. A., & Zaman, M. (2025). The Effect of Cognitive Behavioral Therapy on Anxiety in Adolescents. Indus Journal of Bioscience Research, 3(1), 217-222. https://doi.org/10.70749/ijbr.v3i1.475
16. Lepage, M., Bowie, C. R., Montreuil, T., Baer, L., du Sert, O. P., Lecomte, T., ... & Malla, A. K. (2023). Manualized group cognitive behavioral therapy for social anxiety in first-episode psychosis: a randomized controlled trial. Psychological Medicine, 53(8), 3335-3344.https://doi.org/10.1017/S0033291721005328
17. Lu, G., Jia, R., Liang, D., Yu, J., Wu, Z., & Chen, C. (2021). Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials. Psychiatry research, 304, 114137.https://doi.org/10.1016/j.psychres.2021.114137
18. Maitre, N. L., & Arnon, S. (2020). Music therapy for neonatal stress and pain—music to our ears. Journal of Perinatology, 40(12), 1734-1735.https://doi.org/10.1038/s41372-020-0719-9
19. Obeid, S., Saade, S., Haddad, C., Sacre, H., Khansa, W., Al Hajj, R., ... & Hallit, S. (2019). Internet addiction among Lebanese adolescents: the role of self-esteem, anger, depression, anxiety, social anxiety and fear, impulsivity, and aggression—a cross-sectional study. The Journal of nervous and mental disease, 207(10), 838-846.https://doi.org/10.1097/NMD.0000000000001034
20. Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S66.https://doi.org/10.29399/npa.27419
21. Pérez-Eizaguirre, M., Dorado, A., Rodríguez-Brioso, M., & Privado, J. (2022). Efficacy of music therapy in the treatment of anxiety among children at social risk and those have committed child to parent violence. Psychology of Music, 50(1), 328-342. https://doi.org/10.1177/0305735621996024
22. Shahrokhian, N., Hassanzadeh, S., Razini, H. H., & Ramshini, M. (2021). The effects of cognitive-behavioral therapy (CBT) in well-being and perceived stress in adolescents with low academic performance during the COVID-19 pandemic. International Journal of Sport Studies for Health, 4(2), 45-52.https://doi.org/10.61838/kman.intjssh.4.2.6
23. Situmorang, D. D. B. (2021). Cognitive behavioral-active music pastoral therapy for millennials’ academic anxiety: how & why?. Journal of Pastoral Care & Counseling, 75(2), 103-111.https://doi.org/10.1177/1542305020988065
24. Ugwuanyi, C. S., Ede, M. O., Onyishi, C. N., Ossai, O. V., Nwokenna, E. N., Obikwelu, L. C., ... & Nweke, M. L. (2020). Effect of cognitive-behavioral therapy with music therapy in reducing physics test anxiety among students as measured by generalized test anxiety scale. Medicine, 99(17), e16406. http://dx.doi.org/10.1097/MD.0000000000016406
25. Witusik, A., & Pietras, T. (2019). Music therapy as a complementary form of therapy for mental disorders. Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego, 47(282), 240-243.https://doi.org/10.002/14651858.CD004025
26. Xiang, C., & Li, X. (2025). Effects of mindfulness, music therapy, and social support on adolescents test anxiety. BMC psychology, 13(1), 1-13. https://doi.org/10.1186/s40359-025-02842-6
27. Zhou, J., Liu, L., & Zheng, L. (2025). Effects of Integrating Music Therapy into Family Support System on Adolescent Depression. Noise and Health, 27(125), 149-157. https://doi.org/10.4103/nah.nah_156_24

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to cite

Priya, P. G., Bhardwaj, U., Sahoo, R., Bhandari, S., Sobti, S., & Bhushan, B. (2025). Musical pathways to empowerment: Exploring the effects of music therapy with cognitive-behavioral therapy on social anxiety symptoms - a meta analysis. Multidisciplinary Reviews, 8, 2025ss0219. https://doi.org/10.31893/multirev.2025ss0219

[1] Aluh, D. O., Chukwuobasi, T., & Mosanya, A. U. (2019). A cross-sectional survey of Social Media Anxiety among students of the University of Nigeria. Journal of Mental Health and Human Behaviour, 24(1), 51-56.https://doi.org/10.4103/jmhhb.jmhhb_64_19

[2] Baartmans, J. M., van Steensel, F. J. A., Klein, A. M., & Bögels, S. M. (2022). The role of comorbid mood disorders in cognitive behavioral therapy for childhood social anxiety. Cognitive Therapy and Research, 46(5), 983-991.https://doi.org/10.1097/CHI.0b013e3181af8216

[3] Belmon, A. P., & Auxillia, J. (2023). Music Therapy: A Best Way to Solve Anxiety and Depression in Diabetes Mellitus Patients. In Advances in Speech and Music Technology: Computational Aspects and Applications (pp. 237-247). Cham: Springer International Publishing.https://doi.org/10.1002/14651858.CD004025

[4] Belski, N., Abdul‐Rahman, Z., Youn, E., Balasundaram, V., & Diep, D. (2022). The effectiveness of musical therapy in improving depression and anxiety symptoms among children and adolescents–a systematic review. Child and Adolescent Mental Health, 27(4), 369-377. https://doi.org/10.1111/camh.12526

[5] Benbow, A. A., & Anderson, P. L. (2019). Long-term improvements in probability and cost biases following brief cognitive behavioral therapy for social anxiety disorder. Cognitive Therapy and Research, 43 (2), 412-418.https://doi.org/10.1007/s10608-016-9820-y

[6] Bojorquez, G. R., Jackson, K. E., & Andrews, A. K. (2020). Music therapy for surgical patients: approach for managing pain and anxiety. Critical care nursing quarterly, 43(1), 81-85.https://doi.org/10.1097/CNQ.0000000000000294

[7] Bong, S. H., Won, G. H., & Choi, T. Y. (2021). Effects of cognitive-behavioral therapy based music therapy in Korean adolescents with smartphone and internet addiction. Psychiatry Investigation, 18(2), 110. https://doi.org/10.30773/pi.2020.0155

[8] Davies, H. (2022). ‘Autism is a way of being’: An ‘insider perspective’on neurodiversity, music therapy and social justice. British Journal of Music Therapy, 36(1), 16-26.https://doi.org/10.1177/13594575221090182

[9] Dunning, E. E., Khan, A. N., Becker-Haimes, E. M., & Guzick, A. G. (2025). When Attempts to Help Backfire: Psychosocial Interventions that May Inadvertently Prolong Anxiety Among Youth. Research on Child and Adolescent Psychopathology 53 (1), 1-15. https://doi.org/10.1007/s10802-025-01317-x

[10] Egbe, C. I., Ugwuanyi, L. T., Ede, M. O., Agbigwe, I. B., Onuorah, A. R., Okon, O. E., & Ugwu, J. C. (2023). Cognitive behavioural play therapy for social anxiety disorders (SADS) in children with speech impairments. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 41(1), 24-44.https://doi.org/10.1007/s10942-020-00376-x

[11] Freitas, C., Fernández-Company, J. F., Pita, M. F., & Garcia-Rodriguez, M. (2022). Music therapy for adolescents with psychiatric disorders: an overview. Clinical child psychology and psychiatry, 27(3), 895-910.https://doi.org/10.1177/13591045221079161

[12] Geipel, J., Koenig, J., Hillecke, T. K., & Resch, F. (2022). Short-term music therapy treatment for adolescents with depression–A pilot study. The arts in psychotherapy, 77, 101874.https://doi.org/10.1016/j.aip.2021.101874

[13] Hakim, A., Kaldozkhi, S. S. H., Tashakori, A., & Ghanbari, S. (2023). The effect of non-verbal music on anxiety in hospitalized children. BMC pediatrics, 23(1), 279. https://doi.org/10.1186/s12887-023-04101-2

[14] Haugland, B. S. M., Haaland, A. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., ... & Wergeland, G. J. (2020). Effectiveness of brief and standard school-based cognitive-behavioral interventions for adolescents with anxiety: A randomized noninferiority study. Journal of the American Academy of Child & Adolescent Psychiatry, 59(4), 552-564. https://doi.org/10.1016/j.jaac.2019.12.003

[15] Khan, Z., Zaib, Q., Saeed, K., Khan, B., Pal, H. A., & Zaman, M. (2025). The Effect of Cognitive Behavioral Therapy on Anxiety in Adolescents. Indus Journal of Bioscience Research, 3(1), 217-222. https://doi.org/10.70749/ijbr.v3i1.475

[16] Lepage, M., Bowie, C. R., Montreuil, T., Baer, L., du Sert, O. P., Lecomte, T., ... & Malla, A. K. (2023). Manualized group cognitive behavioral therapy for social anxiety in first-episode psychosis: a randomized controlled trial. Psychological Medicine, 53(8), 3335-3344.https://doi.org/10.1017/S0033291721005328

[17] Lu, G., Jia, R., Liang, D., Yu, J., Wu, Z., & Chen, C. (2021). Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials. Psychiatry research, 304, 114137.https://doi.org/10.1016/j.psychres.2021.114137

[18] Maitre, N. L., & Arnon, S. (2020). Music therapy for neonatal stress and pain—music to our ears. Journal of Perinatology, 40(12), 1734-1735.https://doi.org/10.1038/s41372-020-0719-9

[19] Obeid, S., Saade, S., Haddad, C., Sacre, H., Khansa, W., Al Hajj, R., ... & Hallit, S. (2019). Internet addiction among Lebanese adolescents: the role of self-esteem, anger, depression, anxiety, social anxiety and fear, impulsivity, and aggression—a cross-sectional study. The Journal of nervous and mental disease, 207(10), 838-846.https://doi.org/10.1097/NMD.0000000000001034

[20] Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S66.https://doi.org/10.29399/npa.27419

[21] Pérez-Eizaguirre, M., Dorado, A., Rodríguez-Brioso, M., & Privado, J. (2022). Efficacy of music therapy in the treatment of anxiety among children at social risk and those have committed child to parent violence. Psychology of Music, 50(1), 328-342. https://doi.org/10.1177/0305735621996024

[22] Shahrokhian, N., Hassanzadeh, S., Razini, H. H., & Ramshini, M. (2021). The effects of cognitive-behavioral therapy (CBT) in well-being and perceived stress in adolescents with low academic performance during the COVID-19 pandemic. International Journal of Sport Studies for Health, 4(2), 45-52.https://doi.org/10.61838/kman.intjssh.4.2.6

[23] Situmorang, D. D. B. (2021). Cognitive behavioral-active music pastoral therapy for millennials’ academic anxiety: how & why?. Journal of Pastoral Care & Counseling, 75(2), 103-111.https://doi.org/10.1177/1542305020988065

[24] Ugwuanyi, C. S., Ede, M. O., Onyishi, C. N., Ossai, O. V., Nwokenna, E. N., Obikwelu, L. C., ... & Nweke, M. L. (2020). Effect of cognitive-behavioral therapy with music therapy in reducing physics test anxiety among students as measured by generalized test anxiety scale. Medicine, 99(17), e16406. http://dx.doi.org/10.1097/MD.0000000000016406

[25] Witusik, A., & Pietras, T. (2019). Music therapy as a complementary form of therapy for mental disorders. Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego, 47(282), 240-243.https://doi.org/10.002/14651858.CD004025

[26] Xiang, C., & Li, X. (2025). Effects of mindfulness, music therapy, and social support on adolescents test anxiety. BMC psychology, 13(1), 1-13. https://doi.org/10.1186/s40359-025-02842-6

[27] Zhou, J., Liu, L., & Zheng, L. (2025). Effects of Integrating Music Therapy into Family Support System on Adolescent Depression. Noise and Health, 27(125), 149-157. https://doi.org/10.4103/nah.nah_156_24

Abstract

References

How to cite