Two significant questions come into play when thinking about music, art and nature’s impacts.
Firstly, a clear distinction exists between music and art “therapy” and other music and art interventions for wellbeing. Music and art therapy are very specific designations: psychological, clinical interventions defined by law. Professional bodies exist, in the UK the British Association of Music Therapy and the British Association of Art Therapy. Music and art therapists must register with the Health and Social Care Professions Council, which regulates the sector. Many other initiatives exist which are not defined as “therapy”. These engage with the visual arts or music to improve wellbeing, to build communication and life skills, as a common, shared experience and as a focus for interaction and connection. These initiatives open doors to the arts, boost participation and empower people to draw on art or music to live fuller lives.
The therapy question also relates to nature-based initiatives. Horticultural therapy is a specifictherapy with set clinical goals, undertaken by professionals. But once again this is only part of the picture, with social and therapeutic horticulture (or STH) also active.
And while art, music and nature have specific impacts, they could also weave together. Performing or listening to music outdoors in a natural setting could add a new perspective. Outdoor art or craft sessions could also draw participants closer to their environment (maybe painting the scene around them or crafting using found natural materials). In music, improvisation might draw on visual stimuli, while performance art could connect visual arts and music once again.
Secondly, while tools and methodologies exist, research into the subjective will always be complex. Measuring subjective outcomes is far more fluid, reducing many initiatives’ ability to monitor their impact. Subjective wellbeing is a qualitative data field, while quantitative data is prioritised. Within wellbeing, distinctions between the onjective and the subjective may be blurred. Isolation is objective, for example, as is cognitive decline, but loneliness is subjective. Moreover, studies need to control for related and non-related factors (for example, wellbeing studies control for age to ensure that reported impacts exist independently of participants’ age range).
Other issues create further complexities. Participants’ own conditions may hinder research: dementia patients’ cognitive impairments limit their contributions to research studies into work to improve their wellbeing, as they struggle to communicate well with researchers or complete questionnaires. And where studies do exist, the empirical base may remain patchy with fewer long-term studies and few replicable models to go to scale. The less comprehensive the evidence base, the more likely it is that worthwhile models may be overlooked, and opportunities missed. For instance, strong evidence may exist of a particular art activity’s positive impact on a condition, but there may well be other activities which would prove equally beneficial but which have not been adequately assessed. Research needs to expand across different areas where music, art and nature could clearly contribute even if they are not named directly. By surveying people with autism and those around them, the UK autism research charity Autistica has identified as major priorities more research into interventions to improve mental health and to improve communication for people with autism. While these are wide fields, nature, music and art could have a part to play here as elsewhere for other conditions.
Researchers, universities, charities and others have developed measurement tools and scales specifically designed to assess the subjective. One example would be the UCLA 3-Item Loneliness Scale, which uses the cognitive discrepancy theory of loneliness to focus on the difference between the level of connection participants have and would like to have. There are also observational tools for use in particular settings, like the Chelsea and Westminster/Royal College of Music Arts Observation Tool.
All in all, while research is growing, the evidence remains limited. Provision too, while diverse and exciting, remains patchy. More growth is needed.