Tracing change during music therapy for depression: Toward a markers-based understanding of communicative behaviors

This article focuses on behavioral markers—changes in communicative behaviors that reliably indicate the presence and severity of mental health conditions. We explore the potential of behavioral markers to provide new insights and approaches to diagnosis, assessment, and monitoring, with a particular focus on music therapy for depression. We propose a framework for understanding these markers that encompasses three broad functional categories fulfilled by communicative behaviors: semantic, pragmatic, and phatic. The disordered interactions observed in those with depression reflect changes in many types of communicative behavior, but much research has focused on pragmatic behaviors. However, changes in phatic behaviors also seem likely to be important, given their crucial role in facilitating interpersonal relationships. Given the strong phatic element of music-making, music represents a fertile context in which to explore these behaviors. We argue here that the uniquely multimodal and profoundly interactive environment of music therapy in particular allows for the identification of changes in pragmatic and phatic communicative behaviors that reliably indicate depression presence/severity. By identifying these behavioral markers, we open the door to new ways of assessing depression, and improving diagnosis and monitoring. Furthermore, this markers-based approach has broad implications, being applicable beyond depression and beyond music therapy.