It was the late 2000s. The Apple iPhone had recently been introduced and on-demand music libraries were becoming popular. Jamie Pabst worked in finance and was looking for ways to manage her stress and anxiety. The two main options: medications and talk therapy.
Pabst wanted something different. She turned to music as a way to self-regulate—something humans have been doing for ages. But not all songs are created equal.
“I started realizing quite quickly not all music was quite helpful,” Pabst told Fierce Healthcare. Though fun, some songs might be distracting or too stimulating. But what if it were specially composed by experts in a scientifically informed way?
Because her sister had studied it, Pabst knew about music therapy, where a credentialed professional uses music interventions within a therapeutic relationship to address healthcare and educational goals. A profession that requires extensive academic, clinical and musical training, it is not widely practiced and is often inaccessible. Pabst wondered if she could leverage technology to bring the therapeutic benefits of music to more people.
“There's pretty big gaps in the mental healthcare space, and there was clearly a burgeoning need and potential for a digital approach to music therapy,” Pabst said.
After years of preparation, Pabst launched Spiritune in 2020. The app does not deliver music therapy but is grounded in the profession’s principles and research. Built by music therapists, composers and neuroscientists, its evidence-based library of music aims to improve listeners’ mood and overall mental wellbeing.
Launching during the COVID-19 pandemic was challenging, Pabst said, but an important time to offer mental health support. Employers were looking for low-cost, engaging ways to support their workers, Pabst said. At the same time that music was being studied for its potential to reduce pandemic loneliness, a survey found three-quarters of remote workers listened to music while working. Spiritune saw an opportunity with the enterprise market.
Today, the company’s employer clients include DexCare, Mixbook, Crunch Fitness and Galileo Health. It is available to members of Blue Star Families, a national nonprofit supporting military families, and the organizations are working together on a VA-funded suicide prevention pilot for veterans. Nearly all participants in the pilot, which includes various other resources, use Spiritune daily for stress relief and to be more productive.
Galileo Health, a provider serving employers, also offers Spiritune as part of its behavioral health program. It has found that including Spiritune in treatment over six weeks improved patient mental health scores by 30%.
Recent research investigated Spiritune’s impact as a standalone tool. In a peer-reviewed study published this month, led by researchers at Stanford and New York University, Spiritune was tested for its effects on mood and task performance. The study found listening to Spiritune for just 10 minutes improved 76% of participants’ mood.
While completing a cognitively demanding task, participants listened to either Spiritune, a deep focus Spotify playlist, Hot 100 Billboard hits or simulated office noise. Many of the nearly 200 participants had reported baseline moderate to severe levels of depression, anxiety or stress. The study found Spiritune was four times as effective at reducing negative emotional states and was the only one to improve speed of processing during the task.
Part of what makes Spiritune’s music unique is that it is genre-agnostic, helping it appeal to a wide audience. “This study shows that it’s more important maybe to think about the musical or acoustic features of the songs that you’re listening to, as opposed to what the genre is,” Pablo Ripollés, PhD, the study’s co-author, assistant professor of psychology and associate director of the Music and Audio Research Laboratory at NYU, told Fierce Healthcare.
Still, a quarter of the participants listening to Spiritune did not see a change in their mood. “It’s going to be almost impossible to find something that works for everybody, but that’s okay,” Ripollés noted.
Spiritune has raised nearly $2 million in funding to date. Pabst hopes to collect more data on clinical improvements, and longitudinal data demonstrating Spiritune’s impact, in the future. While Spiritune has considered the path to become a prescription digital therapeutic, lagging reimbursement, provider adoption and commercial challenges remain big questions in the field, per Pabst. For now, the company is focused on proving out its business model and demonstrating strong user engagement.
The state of music therapy today
Music therapists work in a variety of settings, from schools to hospitals to nursing homes, and on a number of goals. They can focus on social, cognitive, physical and emotional needs, singing and playing instruments for or alongside patients.
“We’re treating the whole person, not just the one clinical thing,” Judy Simpson, MT-BC, director of government relations at the American Music Therapy Association, told Fierce Healthcare.
“There’s a growing acceptance, even in the medical field, that treating symptoms isn’t always the best course of action,” echoed Concetta Tomaino, D.A., MT-BC, LCAT, co-founder and executive director of the Institute for Music & Neurologic Function.
Instead, healthcare professionals like music therapists take a holistic approach that aims to understand and address complex influences, like social determinants, on health. Tomaino, widely regarded as a pioneer in the field, is also Spiritune's lead music therapy advisor.
Music therapy has become more widely known as neuroscience research on the connections between music and brain function has grown. Rep. Gabby Giffords, who nearly died after being shot in the head, famously recovered with the help of music therapy, which according to experts also helped put the field on the map.
Today, music therapists practice both in-person and virtually. The modality is highly personalized, driven by the therapeutic relationship between the provider and patient. Whether treatment involves creating or listening to music depends on the patient’s goals.
“One of the big things that’s driven home in our training is there is not one size or one prescription of music that fits all,” said Kathleen Summers, MT-BC, a music therapist with a private practice in Pennsylvania.
There are about 10,500 music therapists in the U.S., a relatively small figure. Because demand for mental healthcare is high, experts say, there is a need for innovative tools to help broaden access.
“That’s why we need new approaches that leverage the technology,” said Daniel Bowling, Spiritune's lead neuroscience advisor, co-author of the latest study and instructor at Stanford University School of Medicine. “People are using music to modulate their mental health all the time.”
“Because we don’t have a music therapist working in every single healthcare environment that we would love to see… it’s a wonderful thing to be able to lean on technology,” said Kerry Devlin, PhD, LPMT, BT-MC, senior music therapist at Johns Hopkins Center for Music & Medicine.
When co-founding Charlie Health, being creative with tech was on the mind of Caroline Fenkel, DSW, LCSW. As a virtual mental health provider for teens and adults, the company’s mission is to bring high-acuity mental healthcare to areas that don’t have it. But the population can be challenging to engage in therapy. “They can oftentimes be guarded and can struggle expressing themselves,” Fenkel, also Charlie Health’s chief clinical officer, told Fierce Healthcare.
As someone who previously practiced experiential therapies, like equine-assisted therapy with horses, Fenkel had seen how grounding they can be. “It’s simply about getting out of your head and into your body. And music can do that,” Fenkel said. Ultimately, such therapies are core to Charlie Health. Patients participate in either music therapy, arts therapy or movement therapy as part of the intensive outpatient program.
Offering modalities as rare and traditionally expensive as music therapy in a virtual setting enhances accessibility, Fenkel argues. Clinicians can get cross-licensed to treat more widely. “You are a very, very privileged person to be able to get music therapy in person,” she said. Charlie Health’s intensive outpatient program, including music therapy, is also reimbursed by most major payers, including commercial and Medicaid.
Meanwhile, hospitals interviewed for this story deliver music therapy in person, including in units as delicate as the ICU or NICU. Some research suggests medically stable infants benefit from the treatment. Music therapists working with such vulnerable patients have additional specialized training.
“The closer you are to the patient, the more training you should have,” Simpson of the AMTA said.
Devlin, the senior music therapist at Johns Hopkins, works in the neuro ICU. She uses music to stabilize patients’ vital signs like heart rate and to stimulate the brain for quicker recovery. “It’s not a concert. It’s a clinical and therapeutic encounter that is goal-directed and is impacting and addressing health outcomes,” Devlin said.
For some music therapists, it is not uncommon to feel misunderstood. James Lavino, MT-BC, LAPC, a music therapist at hybrid therapy and psychiatry provider Thriveworks, experienced this first-hand while training to get his license. At his internship and practicum placements, he experienced "a devalue or disregard for music therapy, as if, ‘that’s nice for everyone to have their music time, but we’re going to do some real work now with the social workers or with the psychiatrists,'” Lavino said. “It really is somewhat shameful. This is a real therapeutic practice.”
One way to help prevent this is being integrated with the rest of the clinical teams. When music therapists are visible to other providers, “there is understanding and mutual respect,” Devlin said.
Like at Johns Hopkins, music therapists at Illinois-based Endeavor Health focus on stabilizing severe-acuity patients and coordinate with the rest of the care team. Music therapy is also offered as part of the health system’s outpatient rehab program.
While patients may spend two weeks at the inpatient behavioral health program, they still need support post-discharge.
“There are a lot of ways to use music for therapeutic purposes and that has therapeutic effects that are not ‘music therapy,'” Madeleine Brawley, MT-BC, a music therapist working in the inpatient setting at Endeavor, said. “I can’t prescribe you a specific type of music to feel a certain way… but you can make intentional choices with something like music.”
Some health systems even offer music therapy to staff. During COVID, AdventHealth music therapists provided environmental music at shift changes to help relieve worker burnout. They offer several programs to staff today, available by request, meant for burnout and grief support.
To tackle stress, short musical experiences are paired with reflective prompts and breathing techniques. A 2023 survey of 168 AdventHealth workers found a 1.59 average point decrease in stress levels after such an experience.
Focusing on something creative “allows them to have a moment to reflect, to let go, to breathe,” said Rich Moats, M.A., MT-BC, director of integrative & creative arts therapies at AdventHealth’s Central Florida Division. The health system’s grief support experiences for staff involve collaboration between music therapists, chaplains and mental health consultants.
“It’s quite a wide range of applications in the clinical settings, and it is in partnership with different healthcare professionals,” Moats said.
The health system has offered music therapy since 2005 and has nearly two dozen music therapists. “The philosophy of our organization and our mission… is truly a belief in caring for the whole person,” Moats said. “Music therapy is a true expression of that.”
AdventHealth also has its own all-employee orchestra, which recently performed at the Kennedy Center in Washington, D.C.
Other music-based interventions
It would help music therapists and other professional artists to collaborate on advocacy, some experts say. Doing so would help others understand each of their distinct roles and how they are complementary.
“There are other fields, which are reinforcing and complementing and supporting music therapy,” Sarah Hoover, associate dean for innovation in the arts & health at the Peabody Institute, a music conservatory at Johns Hopkins University, told Fierce Healthcare. “In an ideal world, our collective work would create a spectrum of care.”
One such adjacent field is arts in health, which uses the arts for creative engagement and expression to support wellbeing. The Peabody Institute offers several arts in health programs. Its professional musicians, selected through rigorous criteria, play at hospital patients’ bedsides to provide comfort and companionship. Student musicians also offer concerts in public spaces at Johns Hopkins Hospital.
Though they go through a special training, Peabody bedside musicians are not music therapists and do not play for all patients. Severe-acuity patients are best served by music therapists and are typically referred for the service by their physician team. Devlin and Hoover work together with clinicians to determine what patients need which service.
“There are not enough music therapists to meet the demand,” Hoover said. “There is more than enough work for all of us.”
While music therapy as a practice has national standards, arts in health does not. The field would benefit from nationalized standards, Hoover said, as well as additional research.
Like Spiritune, other tech-enabled companies are using music with the goal of improving lives. SingFit helps elderly patients sing by prompting them with lyrics. Singing can help improve memory and speaking ability for some Alzheimer’s patients. “What you want is for them to have an immersive experience and not fail,” Rachel Francine, CEO and co-founder, told Fierce Healthcare.
The app is used by speech and occupational therapists, hospice workers or activities directors in senior living facilities. Because the tool is engaging, SingFit helps patients achieve their goals sooner, per Francine, ultimately helping therapists get reimbursed. The tool itself is reimbursed by Longevity Health Plan.
MedRhythms, a digital therapeutics company, combines sensors, software and music to improve things like mobility and other functional outcomes for patients with neurological conditions. In the past, it has collaborated with Massachusetts General Hospital on a clinical trial. It has also partnered with Universal Music Group to offer its catalog of music as a prescription to patients.
Meanwhile, Toronto-based Lucid makes a platform that uses AI-personalized music to target mental health outcomes in older adults. The prescription digital therapeutic is reimbursable through Medicare. It has partnered with the University of Southern California to study the potential of one of its products for people with dementia.
Reimbursement is a primary barrier
Funding music therapy remains a major challenge, music therapists agree. It is not a regularly reimbursed service. It might be better in certain states and for certain conditions.
“It’s not a given, as many other therapies are,” said Laurie Keough, MT-BC, LCAT, clinical professor of music therapy & music therapy program director at Nazareth University. “That makes music therapy less accessible than we would like it to be for people.”
It can be indirectly covered under Medicare via a program like inpatient rehab, according to Simpson at the AMTA. Hospitals might bill for music therapy under their partial hospitalization programs, and in some cases, music therapists may use the same codes as physical therapists or occupational therapists. But because of insurer limits, they must be careful not to exceed a certain number of codes used per day or year.
It can also vary by state. Music therapists in Illinois will soon be able to bill Medicaid, per Simpson, barring any changes to the program under the Trump administration. At Endeavor Health, expressive therapies are bundled into its inpatient, partial hospitalization and intensive outpatient programs.
Other states reimburse music therapy as part of their Medicaid waivers. Private payer reimbursement varies, though NICUs, autism care providers and outpatient rehab programs might have better luck, Simpson said.
In order to increase reimbursement, more data on music therapy’s benefits is needed. “The insurance companies want to know whatever they’re providing is in the long run going to help reduce the tendency on high-cost medical procedures,” Tomaino said.
On top of patchy reimbursement, credentialing is itself not uniform. AMTA’s professional standards require that all practicing music therapists be board-certified. But not every state legally recognizes this standard. About a dozen states offer music therapy licensure. Elsewhere, anyone can call themselves a music therapist, which is a risk to the public, per Simpson.
“We’ve had stories of harm that was done by people that are not qualified,” Simpson said.
Depending on the state and in what setting they wish to practice, a music therapist may need to get a separate certification. For instance, to practice music therapy in the psychotherapy setting in New York, a clinician needs a creative arts therapy license, Keough said. That license requires a master’s degree, even though music therapists don’t need a master’s degree to become board-certified.
Summers, the private practice music therapist in Pennsylvania, does not take insurance. “It’s a bit of a tricky thing to navigate at times,” she said. Unlike some other states, Pennsylvania does not offer music therapy licensure, an option she thinks would help with reimbursement. Some of her work is currently supported by nonprofits.
Similarly, Johns Hopkins’ music therapy services are supported by philanthropic funds. In 2022, Maryland introduced state licensure for music therapists. While an important step in the right direction, “we do have a ways to go in terms of being a reimbursable service,” said Devlin, of the university's Center for Music & Medicine.
Summers relies on referrals from community-based providers. It would be greatly helpful to private practice music therapists if health systems would refer patients, she said.
“It would be wonderful if a music therapist could have an opportunity to present to bigger healthcare networks,” Summers said, “and explain what it is we could be providing.”