Musical Pleasure as a Potential Mechanism for Reduction of Anhedonia Following Music Therapy: Protocol for a Pre-Post Pilot Study (Preprint)

BACKGROUND 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 the precise neurobiological mechanisms underpinning music therapy’s efficacy remain unclear. One potential mechanism is musical pleasure, as a re-activator of the pleasure system. Functional Magnetic Resonance Imaging (fMRI) evidence demonstrates that pleasure is associated with increased activity of the limbic system including the anterior cingulate cortex (ACC), as well as the pre-frontal cortex. As such, changes within these regions may be one such mechanism through which music therapy acts to reduce anhedonia symptomatology. OBJECTIVE Our primary objective is to examine indicators of increased pleasure/hedonic capacity in individuals with anhedonia before and after completing a 3 month structured music therapy intervention involving daily music-based activities . We will assess whether musical pleasure mediates the relationship between music therapy and decreased anhedonia symptoms. METHODS We will pilot pre-post testing of a cohort of 9 participants who have scored as symptomatic of anhedonia using the Dimensional Anhedonia Rating Scale (DARS). We will investigate validated psychometrics tools (the DARS and Snaith-Hamilton Pleasure Scale (SHAPS)) and objective measures of brain structure and functioning (fMRI) pre- and post-intervention. fMRI data acquired will include resting-state fMRI and acquisitions during naturalistic listening to music pieces in addition to functional paradigms designed to probe musical pleasure (music listening task) and reward prediction (reversal reward learning task). Data will be analysed using individual general linear models to identify associations with symptom improvement as well as well longitudinal changes in functioning. RESULTS The study received internal funding support from the University of Melbourne in September 2024. Data collection commenced in August 2025 and will conclude by mid-2026. As of December 2025, 9 participants have been recruited, and data will be analysed by the end of 2026 with results to be published in 2027. CONCLUSIONS The results of this study will contribute to knowledge of music therapy and anhedonia and the understanding of musical pleasure as a potential mechanism for improvement. CLINICALTRIAL N/A