Reported mechanisms of change for improvisation-based interventions in music therapy studies: A scoping review

Improvisation is a widely used method in music therapy which over time, has developed into distinct schools of thought, models, and clinical approaches. Despite a wide clinical use in music therapy, no review to date has systematically organized and examined the reported mechanisms of therapeutic change underlying improvisation-based interventions in empirical studies. Identifying therapeutic mechanisms has received increasing attention in the creative arts therapies, including music therapy, as mechanisms of change address the underlying “why” of an intervention’s effectiveness (van Essen et al.,2025) . Identifying how these mechanisms are included in the literature can inform clinical decision-making by clarifying the rationale for selecting specific methods, frameworks, or approaches in practice (de Witte et al., 2021). The purpose of this review is to investigate the nature and extent of reporting on therapeutic mechanisms for improvisation-based interventions in empirical music therapy studies. By comprehensively and objectively reporting available evidence on therapeutic mechanisms of improvisation-based interventions reported in music therapy research using rigorous, pre-defined methods to minimize bias, the aim is to provide a reliable and holistic overview to inform clinical decision-making and support education and training in the field.