Exploring Guided Imagery and Music as a well-being intervention: A systematic literature review

Introduction

Guided Imagery and Music (GIM) is a receptive music therapy method that uses music for the exploration of the psyche, growth and transformation on various levels (Bruscia, Citation2015). It could thus be considered as an intervention within the positive psychology framework.

Although it is used in multiple contexts, it was first implemented after Bonny’s research experiences in the Maryland Psychiatric Research Centre. At the MPRC music was used to support LSD experiments, which had the purpose of enhancing clients’ inner experiences. When the research using LSD was discontinued, Bonny started to experiment with music alone to see if similar experiences would occur. It was found that when music alone was used, the client could recall their experiences during the session much clearer (Bonny & Summer, Citation2002). Sometimes, in a GIM process, difficult emotions are elicited, and traumatic memories and imagery can be evoked. However, the therapist’s knowledge of the client and the ego-strength of the client must be the main consideration. Even in these cases the focus of the therapy is on resolving the problem (Bruscia, Citation2015), which is in line with the theory behind positive psychology. This gives rise to the question whether previous research has explicitly linked GIM to outcomes that are typically associated with the field of positive psychology such as well-being, strengths use and constructs such as hope, efficacy, optimism, and resilience, also known as psychological capital (PsyCap) (Youssef & Luthans, Citation2010).

Positive psychology focuses on the well-being and thriving of people through developing personal strengths (Lopez & Gallagher, Citation2011). According to Cropanzano and Wright (Citation2001), an individual who is resourceful in terms of strengths will perform better and will be happier.

The authors believe that new, more modern and scientifically tested approaches such as GIM, which can focus on personal growth, could be combined with positive outcomes typically associated with positive psychology and might be beneficial for client well-being. To our knowledge, the association between GIM and positive psychology has not yet been summarised in a systematic manner. Although such outcomes have been recorded in previous research, e.g. significant improvement in the quality of life of cancer patients after GIM interventions (Bonde, Citation2005; Burns, Citation2001), we believe that avenues for treatment could be highlighted more clearly if the association between positive effects on patients or clients and the intervention of GIM and its adaptations could be the specific focus of research studies. This was one of the main motivations for this systematic literature review.

Background

Guided Imagery and Music, according to the Bonny method, uses specific pre-selected classical music, mostly from the Western tradition, which allows the client to image, or experience in the imagination, whilst listening. The imagery can include symbols, sensations, memories, and/or feelings that are helpful for working through difficulties in a healing and transformative way (Bonny, Citation2001). A typical GIM session consists of an introductory talk where it is important for the client and therapist to establish what might be explored during therapy. This often helps the client to set a focus for the session (Bruscia, Citation2015). The preliminary talk is followed by an induction where the client is properly relaxed and guided into a focused, altered state of consciousness before the music starts.

Many variations and adaptations that include receptive listening and imaging to music with or without guiding are widely used and recognised. These methods – derived from, but not exactly the same as the Bonny method (BMGIM) – are generally called GIM (Grocke & Moe, Citation2015). However, training is still paramount (Bruscia, Citation2015). Bonny had the vision to allow for such variations and leave the choice of music open to the trained GIM guide (music therapist) in terms of the needs of the specific client (Muller, Citation2017).

The experiences of the client while the music is playing, are guided by an intensively trained GIM therapist (Association for Music and Imagery, Citationn.d.) whose role it is to gently and therapeutically accompany the client on the journey in the music. After the music, the visual images or other experiences that the client has described, are explored in either the drawing of a mandala, or a discussion, or both. The symbolic journey is then linked to reality in terms of the client’s own needs and circumstances (Bonny, Citation2001; Bruscia, Citation2015). GIM as therapy provides opportunities for growth and exploration that certainly includes the promotion of well-being (Ventre, Citation2002). This suggests a good possible compatibility or association between positive psychology constructs and the GIM music therapy intervention outcomes.

Well-being includes the two very important aspects of feeling good (hedonic well-being) and functioning well (eudaimonic well-being). While hedonic well-being can be described as happiness that encompasses high levels of positive affect and satisfaction with life, including positive psychology constructs such as joy, hope, pride, serenity, and gratitude, eudaimonic well-being centres around creating a purposeful and meaningful life where constructs such as engagement, self-actualisation, and authenticity are included (Hefferon & Boniwell, Citation2011). Psychological well-being as defined by Ryff and Singer (Citation1998) is most importantly about engaging in life purposefully and using physical, emotional, social, and intellectual potential. Ryff and Singer's (Citation2006) six-component model includes the following: autonomy, personal growth, acceptance of self and one’s life, the ability to manage the environment one lives in, purpose in life, and positive relationships. Well-being therapy focuses on self-observation, which can include simple practices like keeping of a diary to assist in managing anxiety and thus mood. Such practices will contribute to the improvement of quality of life. Grocke and Moe (Citation2015) suggest that GIM, and various adaptations thereof, can be used in the therapeutic space to improve well-being. Two studies by Körlin and Wrangsjö (Citation2001, Citation2002) which respectively explored the gender differences in the outcomes of GIM therapy (Körlin & Wrangsjö, Citation2001) and different outcomes of GIM therapy on dysfunctional and functional populations (Körlin & Wrangsjö, Citation2002), showed significant improvements on the subscales of Meaningfulness and Manageability of the Sense of Coherence (SOC) scale. Another example is a model that is used in quality of life therapy, namely, Frische’s CASIO model (Circumstances, Attitude, Standards, Importance and Other) which focuses on thinking about, and changing circumstances, attitude, standards (of fulfilment), importance (of overall happiness), and other areas of life (Linley, Joseph, Maltby, Harrington, & Wood, Citation2011).

Psychological capital includes four positive psychology constructs that are directly related to well-being (Youssef & Luthans, Citation2010), and can be linked to strengths needed for recovery from any adverse circumstance. These constructs, or aspects, were originally developed to help with overcoming difficulties and setbacks. The four constructs are hope, efficacy, resilience, and optimism, which, when abbreviated, would spell the acronym HERO. One new way of attaining these character strengths (hope, efficacy, resilience, optimism) might be through the GIM experience. A systematic review of existing literature was considered to be the best way to ascertain whether GIM could be employed as a possible added new alternative for the treatment of clients, particularly though tapping into positive psychology constructs.

A systematic literature review uses explicit systematic methods to critically evaluate selected relevant research. The data from the identified studies are then analysed and summarised in the review (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, Citation2009). The purpose is to review literature around a well-formulated question in order to learn from what has been found in the past and utilising it in the future. It is rigorous enough to be able to stand on its own as a research methodology (Creswell, Citation2014). A systematic literature review is seen as reliable and transparent, as the methodology includes (a) a comprehensive search of primary studies, (b) inclusion and exclusion criteria, and (c) quality of studies. The contexts should be homogenous, but all methodologies should be considered. Systematic reviews should be able to point out effectiveness and meaning or impact, while gaps in the literature should be highlighted (Matney, Citation2018). A systematic literature review is different from a meta-analysis in the sense that it does not attempt to include a statistical analysis (Hanson-Abromeit & Moore, Citation2014). Systematic literature reviews are becoming considerably more important and valuable particularly in health care as they help to keep clinicians up to date with what is pertinent in the research field, which could be applied in practice (Moher et al., Citation2009).

McKinney and Honig (Citation2017) published the first GIM systematic review with the focus on health outcomes. Their review only included studies that utilised the original BMGIM sessions with individuals and a minimum of six sessions. This review included all variations of GIM as well as group GIM formats. Since research in GIM beyond case studies emerged after 1990, this review concentrated the search on publications from 1990 onwards. The aim of this systematic literature review was to find answers to the following research question:

What is the evidence that GIM interventions contribute to the well-being of the individual?

Method

The protocol for systematic reviews that was followed included the five steps as described by Khan, Kunz, Kleijnen, and Antes (Citation2003) and Shenkin (Citation2017). Step 1 is to define the research question(s), followed by a search of the literature (step 2) and evaluating the literature that has been found (step 3). The last steps would be to combine the results (step 4) in order to contextualise and interpret the findings (step 5). These steps are recommended to be used for music therapy systematic literature reviews by Hanson-Abromeit and Moore (Citation2014). Kloda and Bartlett (Citation2013) offer quality assessment models for various types of settings, research goals, and methodologies.

The COPES model is used in various care and health fields (Kloda & Bartlett, Citation2013). This model was used to define and refine the research question as well as the search of literature as demonstrated below:

CO (client-oriented): Who is the client and what is the problem? Studies including all types of clients and settings were considered.

P (practical): What can be done about the problem and are there alternative courses of action? GIM in all its variations was the focus here as an alternative intervention.

ES (evidence search): What needs to be accomplished? Positive outcomes had to be what was accomplished. These were specified in terms of well-being and related positive outcomes.

Peer-reviewed articles as well as masters and doctoral theses on the subject of GIM were considered to ensure that the review was comprehensive. All types of studies, both qualitative and quantitative methodologies, were considered. The following two sets of search terms were used: (a) GIM, or BMGIM, or Guided Imagery and Music, or Imagery and Music, or Imagery in Music, or Music Imagery and well-being; (b) GIM, or BMGIM, or Guided Imagery and Music, or Imagery and Music, or Imagery in Music, or Music Imagery and hope/efficacy/optimism/resilience. Although the search parameters were limited to these four terms and well-being, other related terms were considered and included from the already selected literature according to the research question. This allowed for the expansion and inclusion of related constructs. Other key concepts that were considered included e.g. sense of coherence, quality of life, and resilience.

The inclusion criteria for this study included: (a) Seminal works, here defined as the primary writings that convey the origins, the beginnings or the seeds of a specific subject or theory or method, that contain chapters written by GIM practitioners discussing their work from an interventional point of view and peer-reviewed articles as well as dissertations with a focus on GIM; (b) Material published between 1990 and 2017 to ensure a thorough study, yet practically executable; (c) Articles written in English, German, Dutch, and Afrikaans (i.e. publication language) were included as the authors felt equipped to understand and interpret studies in all of the above-mentioned languages; and (d) A quality review screening with a score of at least 50% was achieved. The quality review is discussed in more detail below under the heading: Quality assessment. Excluded from this review: (a) Case studies, (b) literature reviews, and (c) articles that did not focus on the influence of GIM on the well-being of clients.

The process of determining eligible studies was done according to the PRISMA flow chart (Moher et al., Citation2009). Databases searched included EBSCOhost, Emerald, JSTOR, Scopus, Taylor & Francis, Web of Science, Google Scholar, ProQuest, and other online journals. In order to focus the search on EBSCOhost, academic search premier; eBook collection; E-Journals; Health Source; MasterFILE Premier; Medline; OpenDissertations; PsychARTICLES; and PsychINFO were included.

Figure 1. PRISMA flow chart of this study

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The search term GIM posed a problem, as it also serves as an abbreviation for General Internal Medicine. These records were eliminated first. This search term was then replaced with BMGIM (Bonny Method of Guided Imagery and Music) or the complete phrase: Guided Imagery and Music. A second group of records was excluded as they focused on Guided Imagery but not including music. A third group of records was excluded as they focused on CAM (Complementary and Alternative Medicine) but also not specifically on GIM. For a summary of this process refer to the PRISMA flow chart of this study (Figure 1).

Results

Figure 1 outlines the results according to the PRISMA flow chart. A total of 337 studies published between 1990 and 2017 were retrieved. The researchers accessed 319 articles and dissertations from various databases, and 18 more records were identified through either personal e-mails or reference lists from previously accessed resources. Of all the records found, 91 were removed because of duplication between databases. Where the search result included a dissertation from which an article was derived, both the dissertation and the article were considered, and the best option was included, depending on the quality review score. After meticulously scrutinising for relevance, 151 more records were excluded.

The abstracts and results of the 95 remaining records were then read and re-read, and 25 more records were omitted as they were not deemed eligible in terms of their main focus.

The remaining 70 records were then screened according to the quality reviews (Appendices 1 and 2).

Ultimately, no chapters from seminal works were included. In total, 14 studies adhered to all inclusion criteria and the quality review screening which is set out in numbered Appendix 1 and Appendix 2. These 14 studies formed the focus of the present review and consisted of 10 quantitative studies, 1 qualitative study, and 3 mixed method studies. Of the 14 studies, 7 are post-graduate dissertations and 2 are articles derived from dissertations. It is also interesting to mention that 8 of the 14 included studies were published since 2010, and 11 of the 14 studies were published after 2000 which might be indicative of a renewed interest in research using GIM as an intervention method.

The final 14 studies included between 4 and 10 GIM sessions each representing 312 adult participants across eight different settings. These samples were taken from various settings including cancer patients (n = 3), stroke patients (n = 1), patients with rheumatoid arthritis (n = 1), healthy adults (n = 2), music therapy students (n = 1), people with work stress (n = 1), people with major depressive disorders and schizophrenia-spectrum psychotic disorders (n = 1), and people in addiction treatment (n = 3).

Six of the studies focused on contexts where the population groups have a physical illness. Allen (Citation2010), Bhana (Citation2016), Bonde (Citation2005), and Burns (Citation2001) all researched the possible influence of GIM on cancer patients as population groups while another medical population (persons with rheumatoid arthritis) was chosen in Jacobi (Citation1994) study and stroke patients was the population group chosen by Poćwierz-Marciniak and Bidzan (Citation2017). Three studies involved Substance Use Disorder (SUD) clients as a population group (Heiderscheit, Citation2005; Moe, Citation2012; Murphy & Ziedonis, Citation2016). The population groups included for the remaining five studies are patients with mental health disorders (Lotter, Citation2017), healthy adults (McKinney, Antoni, Kumar, & Kumar, Citation1995; McKinney, Antoni, Kumar, Tims, & McCabe, Citation1997), stressed workers (Beck, Hansen, & Gold, Citation2015), and music therapy students (Bae, Citation2011).

Analysing the chosen studies through thorough reading and re-reading assisted with finding topics and key areas of interests pertaining to this study. All the studies were focused on the effect of Guided Imagery and Music and various adaptations of this method as described by Bruscia (Citation2015). Modifications and various approaches are important for the development of GIM and its interventional applications (McKinney, Citation2015). Two studies – Bhana (Citation2016) and Murphy and Ziedonis (Citation2016) – also mention the possible implementation of GIM as an intervention in their titles.

The key concepts that are of importance for this study, and were researched, include well-being, quality of life, sense of coherence, self-efficacy, self-concept, resilience, and confidence. Although these were not directly included in the research question, room was left for other concepts that might hold importance for positive change: Mood states and positive/negative affect as well as coping were thus also included. A total of 29 variables were researched of which 15 were less related to this study (e.g. anxiety, stress, and depression [Bae, Citation2011; Bonde, Citation2005; Murphy & Ziedonis, Citation2016]) as they were less relevant to the present research question. Similarly, some themes that were identified in the qualitative study will not be discussed in detail, e.g. tensing and un-tensing, and musical expression and music making (Lotter, Citation2017).

The 14 relevant variables measured, ranged from psychological to physical indicators. Well-being, quality of life, and sense of coherence were measured in more than one study, but different measurement instruments were used.

A total of 30 instruments were utilised across the 13 quantitative and mixed-method studies. Even when the same instrument, (e.g. POMS), was used in four studies, the researchers made use of the complete scale in three studies while in one study, the short form was used.

Various measurement instruments were utilised for some of the dependent variables. Well-being was measured using four different instruments across three studies as well as through thematic analyses after interviewing patients in the qualitative study. Quality of life was also measured using three different instruments in the three studies. On the other hand, one instrument was used for measuring sense of coherence (SOC scale) across four different studies, including the three studies with SUD clients as a population. The POMS was the other tool utilised in more than one study (five studies). The Center of Epidemiological Studies Depressed Mood Scale (CES-D) was used to measure mood states in one study. Table 3 represents a summary of all the key concepts as well as the measuring instruments that were utilised and the outcomes for each study.

The research designs of the different studies also varied. This can be summarised as follows: randomised controlled trial (n = 8); non-randomised controlled trial (n = 1); single-group pre-post, mixed methods (n = 1); single group pre-post-follow-up repeated measures (n = 2); and single group, pre-mid-post-follow-up repeated measures (n = 1). The single qualitative study made use of a case study design.

Studies were representative of four countries on three different continents, including America (n = 8), Denmark and Poland in Europe (n = 4) and South Africa (n = 2). Although the original BMGIM was described for individual therapy where a dyad is formed between the client and the therapist (McKinney & Honig, Citation2017), many adaptations are being used and accepted throughout the practice of music therapy. Seven of the studies that were included in this review were GIM interventions in group settings and seven implemented individual sessions. In terms of well-being, positive outcomes were noted across four studies (Allen, Citation2010; Beck et al., Citation2015; Bhana, Citation2016; Lotter, Citation2017), although different measurement instruments were used. Three different population groups (cancer patients, major depressive disorder and schizophrenia-spectrum patients and stressed workers) were involved.

In the three studies where quality of life was measured (Bonde, Citation2005; Burns, Citation2001; Poćwierz-Marciniak & Bidzan, Citation2017) the changes were small to quite substantial. In one study some aspects showed improvement while other outcomes did not show significant change (Poćwierz-Marciniak & Bidzan, Citation2017). All three of these studies used different measurement instruments. The populations of these studies all had physical health problems: two groups were patients with cancer (Bonde, Citation2005; Burns, Citation2001) and the third was patients recovering from a stroke (Poćwierz-Marciniak & Bidzan, Citation2017).

Sense of coherence was evaluated in four different studies of which three studies included the same population, namely, people with SUD (Heiderscheit, Citation2005; Moe, Citation2012; Murphy & Ziedonis, Citation2016) and the other was cancer patients (Bonde, Citation2005). The outcomes across these four studies differed dramatically. In the cancer population, there was an improvement in all measurement subscales after the intervention, which was sustained to follow-up, while Heiderscheit (Citation2005) found that in the Manageability and Comprehensibility subscales, there was a significant difference after intervention while in the Meaningfulness subscale the influence was less significant. Moe (Citation2012) found that an increase in sense of coherence was present in 17 out of the 18 participants while lower scores were noticed by Murphy and Ziedonis (Citation2016), possibly due to the shorter and less sessions than Moe and Heiderscheit (Murphy & Ziedonis, Citation2016).

The variable of mood states was included in six studies (Bae, Citation2011; Beck et al., Citation2015; Burns, Citation2001; Jacobi, Citation1994; McKinney et al., Citation1995, Citation1997). Across all the studies, the results showed positive effects of the intervention on mood states. Therefore, it seemed important to report on the outcome, as four (Bae, Citation2011; Beck et al., Citation2015; McKinney et al., Citation1995, Citation1997) out of the six populations did not have physical illness. This is similar to the SUD population, consisting of clients who are not physically ill, but are often plagued by negative mood states and anxiety (Szalavitz, Citation2016).

Self-efficacy and resilience which are both core constructs of psychological capital were measured in two studies. Bae (Citation2011) measured self-efficacy and positive and negative affect in music therapy students before and after GIM interventions with significant increase in their self-efficacy, but no important changes were recorded for positive and negative affect. Unfortunately, this was the only study measuring these variables and the number of participants was relatively small (N = 20).

Jacobi (Citation1994) made use of the questionnaire that focused on ways of coping which is related to self-efficacy. The results of 18 participants who completed this questionnaire did not show a significant difference between the pre- and post-intervention responses.

Lotter (Citation2017) makes specific mention of the resilience and energy that certain participants experienced through GIM interventions. A population group of 20 was employed in this study.

The last two concepts that were of importance for this study were those of self-concept (Allen, Citation2010; Lotter, Citation2017) and confidence (Murphy & Ziedonis, Citation2016) which were measured quantitatively by one study each. Although, using the Tennessee Self-Concept Scale (TSCS) no noticeable difference was measured on the social and academic subscales, the difference was measurably significant in the subscales of family, and personal and body image (Allen, Citation2010). In all three cases it seems obvious that not enough research has been done for a convincing statement with regards to the value of GIM interventions.

Lotter (Citation2017) was the only qualitative study included in this review. Results and themes were identified separately for the receptive music therapy (GIM) and the active music therapy employed during the research, thus making it possible to ascribe the results for only the GIM section of the study. In this study, Lotter (Citation2017) identifies the theme of well-being with outcomes such as ‘feeling more relaxed’ and ‘acceptance of their circumstances’. The resilience theme included outcomes such as experiencing the self in a new way, e.g. liberated and joyful. The construct self-concept elicited themes like the need for connection and for association with significant others.

Three mixed method studies included themes related to this study such as self-realisation, change in mood, and an experience of well-being (Bhana, Citation2016). Moe (Citation2012) and Bonde (Citation2005) made use of structured questions which were answered on a Likert scale. Bonde (Citation2005) structured the questions around the helpfulness and meaningfulness of the music, and responses on the Likert scale from all respondents ranged between ‘very much’ and ‘to a certain extent’. Moe (Citation2012) also added questions about the therapy and its impact. The responses were overwhelmingly positive. For example, respondents said that the music therapy complemented cognitive therapy very well. Furthermore, it impacted on their psyche, intensifying both negative and positive feelings, and they would continue with GIM after their discharge from the recovery facility.

Discussion

The purpose of this systematic literature review was to identify evidence of improved well-being as a primary focus resulting from the intervention GIM. Studies that suited the inclusion criteria ranged across a broad spectrum of populations, variables researched and outcome measures.

Looking at the results as a whole, it becomes noticeable that, in the research included in this literature review, the population group that was mostly chosen in research around the effects of GIM was cancer patients, and an important concern was their well-being. Two other population groups suffered from a physical condition: one group had rheumatoid arthritis and the other group was recovering from having had a stroke. Mental disorders that were included in this study were patients with depression and patients on the schizophrenia-spectrum, as well as workers who were put on sick leave because of high levels of stress. Two healthy adult groups and a music therapy student group (also healthy population), as well as SUD populations, where there is no physical condition, but often an underlying mental disability (Szalavitz, Citation2016), were also included in research.

It seems, according to this literature review, that most research publications on GIM are found in medical settings, but GIM has also been used for mental health patients with respectable results. Studies show that healthy participants who are seeking growth and transformation also benefitted from GIM. This fact opens possibilities for increased well-being for many different population groups, including population groups that had not previously been exposed to the potential benefits of GIM.

The three studies which included SUD populations (Heiderscheit, Citation2005; Moe, Citation2012; Murphy & Ziedonis, Citation2016) all focused on sense of coherence. The presence of this population in this review is due to the inclusion of all adaptations of GIM and the fact that there was not a minimum number of sessions required.

Although the SOC scale thus seems to be a good measuring tool, other tools directly related to well-being, e.g. the Inventory of Interpersonal Problems (IIP) and the Symptom Checklist 90 (SCL-(90) as used by Körlin and Wrangsjö (Citation2001, Citation2002)) and Jacobi (Citation1994) could also be fruitfully employed in future studies focusing on this population group. It would also be worth looking into future research measuring the mood states of the SUD population.

Murphy and Ziedonis (Citation2016) also did a feasibility study for the implementation of GIM in SUD recovery facilities and of all the studies included in this review, this population group was the largest. They also alluded to the positive feedback of both staff and clients with regard to the feasibility of GIM interventions at the recovery facility. Although the group was large, less than half completed the study due to various reasons, for example discharge, or transfer to other facilities.

The unstable circumstances for SUD clients, both inpatient and outpatient, is an ongoing problem. However, Moe (Citation2012) reports that only 4 out of 18 participants relapsed two and a half years after completing the programme which is a relatively low relapse figure (Meade et al., Citation2015). He thus proposes further research as the finding of this particular study seems very positive. Of course, due to the small sample the findings need to be replicated with a larger sample in order for the result to have any scientific significance.

The fact that positive outcomes from GIM interventions were found using different measuring instruments could mean that this intervention certainly holds promise, also in association with the positive psychology constructs. It further suggests that GIM benefits are multifaceted. It could also mean that GIM interventions are valuable not only in single settings, but quite broadly. Furthermore, mental health conditions, for example depression, anxiety, etc. are often symptoms of physical, particularly terminal illnesses as well as other stress-related conditions which all have a detrimental impact on the general well-being of the patient.

Implications and future research

None of the studies revealed any negative results and the inclusion of GIM interventions seem to be promising across a range of populations and feasible in an array of settings. Similar outcomes of variables across populations seem positive as the effect of the treatment is not restricted to only one population or setting (McKinney & Honig, Citation2017).

McKinney and Honig (Citation2017), who published the first GIM systematic review, alluded to the fact that the quality of life and well-being of specifically cancer patients seemed to be enhanced by a series of GIM sessions. However, they also mentioned that some variables which were replicated with similar outcomes across different populations seemed promising for future implementation and research.

Similarly, this systematic review is clear on the possibilities of GIM in various contexts, with various population groups. This review included adaptations and modifications of the GIM method. Furthermore, group as well as individual GIM sessions were included. GIM for groups might be more feasible in certain settings and is worth considering in future research. Also, this review specifically tried to focus on certain well-being constructs in relation to GIM outcomes. The resilience theme that emerged in the qualitative study (Lotter, Citation2017) might, for example, be a fruitful variable to investigate in future research.

Although the results seem overall positive, further research is necessary in order to replicate results that have been found thus far. The fact that the intervention seems to have a range of positive effects, should become a motivation for researchers to do feasibility studies on various populations with bigger sample sizes.

Although BMGIM was originally created for individual therapy, the possibilities for group therapy in adapted forms seem to be used effectively, particularly where the setting might not be suitable for individual therapy. Studies comparing changes in clients’ well-being in individual sessions and group sessions could be very interesting, as well as comparing different well-being outcomes between GIM sessions and sessions where GIM adaptations are used.

Strengths and limitations

This systematic literature study is the first ever to include modifications and adaptations of GIM in its investigation of positive effects of receptive music therapy on the well-being of participants. One earlier systematic review on the outcomes of GIM exists (McKinney & Honig, Citation2017). This previous review included only BMGIM sessions with individuals who had a series of at least six individual GIM interventions.

The current literature review employed a broad search net of studies over the past 27 years in order to include all possible recent studies in the field thus far, inclusive of grey literature and all methodologies and population groups. The protocol of a systematic literature review followed by the researchers was thorough and scientific. Although these can be viewed as strengths, the result was still that only 14 suitable studies according to the inclusion criteria were found and, even so, the variables ranged vastly with six studies at most that investigated one outcome variable. Studies that employed different methodologies, with and without control groups, and from various population groups were included. This can be seen as a limitation. Another limitation is that only constructs related to well-being were explored, which leaves room for many more positive psychology constructs such as hope, optimism, flow, perseverance, gratitude, etc. The fact that positive outcomes from GIM interventions were found using different measuring instruments could mean that this intervention certainly holds promise. The variety of measuring instruments could be seen as a limitation, but it suggests that GIM benefits are multifaceted and it is a relatively under-explored method, pointing towards future research opportunities.

Conclusions

Through this systematic review of literature, evidence was found that GIM has an influence on the well-being of clients in various settings. Although the settings are varied, and it seems that GIM has been used more in medical settings, the results from different contexts show positive outcomes in mental health settings and even in healthy populations. Populations without any health-related problems seek GIM for personal growth and well-being, which relates to the positive psychology scope. More replication of existing research in a rigorous manner as well as new research should be encouraged to positively influence the development of theory and practice. Findings seem promising in terms of using this kind of intervention in more settings.

Supplementary material

The supplemental data for this article can be accessed here.