Sound has been used to settle the body and quieten the mind for a long time, and in the last two decades researchers have begun to measure what happens when it does. This page is arranged by instrument, in the order we work with them, so that you can read what is known about the one you came for. The honest summary is that the evidence is not spread evenly: there is a great deal of research on drumming, a growing amount on singing bowls, very little on gongs and almost none at all on the rattle. We have said so in each section rather than letting the layout imply a balance that does not exist.

After the four instruments comes the much larger body of research into music-based interventions in healthcare, which includes several Cochrane reviews drawing on thousands of participants. It is kept separate because it is not the same thing, and it would be misleading to present it as though it were.

Every entry below opens in bold with the kind of study it is, because that is what tells you how much weight a finding can carry. A randomised controlled trial and a small observational study are both useful and they are not equivalent. Where a study is a systematic review or a meta-analysis, it is drawing together many trials at once, which makes it the strongest evidence available. Nothing here says that sound therapy treats any condition. Research of this kind describes associations and effects on measures such as anxiety scores, heart rate variability and sleep quality; it does not establish a cure, and the authors of these papers say so themselves, most of them ending with a call for larger trials.

Drum

The largest evidence base of the four, and the broadest. Group drumming has been studied for mental health, for stress and burnout at work, in Parkinson’s and dementia care, and for what it does to the immune system. Drumming is also the only one of our instruments whose use in journeying has been measured directly.

Brain activity during drum-induced trance, 2021

Controlled EEG study. Twenty-four experienced shamanic practitioners and twenty-four controls wore high-density EEG through rest, shamanic drumming and classical music listening, and then completed an assessment of altered states of consciousness. The practitioners differed significantly from the controls across several domains of that assessment, with scores comparable to or exceeding those recorded in an earlier study of healthy volunteers under the influence of psychedelics. During drumming specifically, and not during the classical music, practitioners showed increased gamma power that tracked the elementary visual alterations they reported. The authors conclude that the shamanic state overlaps with the psychedelic state without being the same thing.

Read the full study in Frontiers in Human Neuroscience · the Consciousness and Healing Initiative: Shamanic state of consciousness

The heart through a shamanic journey, 2025

Single case report. One participant wore a continuous ECG through shamanic journeys and, separately, through Qigong meditation. The start of the drumming slowed the heart and raised several measures of heart rate variability compared with rest. At the reported moment of shapeshifting, heart rate and two variability measures rose together. Qigong raised variability as well, and moved a different set of measures by different amounts, which is the point of the comparison. One person is one person, but this is the only study located that timestamps the phases of a journey against cardiac data.

Read the full study in Frontiers in Psychology

Ten weeks of group drumming for mental health service users, 2016

Controlled trial. Mental health service users took ten weeks of group drumming against a non-music control group. By week six, depression had fallen and social resilience had risen; by week ten both had improved further, alongside significant improvements in anxiety and mental wellbeing. Every significant change was still present at three-month follow-up. The study also sampled saliva, on the basis that many mental health conditions carry an underlying inflammatory immune response.

Read the full study in PLOS ONE · the Royal College of Music’s write-up of the study

Group drumming and the neuroendocrine-immune system, 2001

Randomised controlled trial. One hundred and eleven age and sex matched volunteers took part in a facilitated group drumming protocol. It produced increased dehydroepiandrosterone-to-cortisol ratios, increased natural killer cell activity and increased lymphokine-activated killer cell activity, with no change in plasma interleukin 2, interferon-gamma, or the Beck anxiety and depression inventories. The authors describe the effect as moving these markers in the opposite direction to the classic stress response.

Read the full study in Alternative Therapies in Health and Medicine · The Clinician: Drumming enhances immune function

Drumming against burnout in long-term care workers, 2003

Randomised controlled trial. One hundred and twelve employees took a six-session protocol built around group drumming and keyboard accompaniment, aimed at support, communication and interdisciplinary respect. Burnout and mood were measured with the Maslach Burnout Inventory and the Profile of Mood States, and both improved significantly across multiple dimensions. An independent consulting firm modelled the economic effect and projected savings of 89,100 US dollars for a single typical hundred-bed facility.

Read the full study in Advances in Mind-Body Medicine · Yamaha: Long term care workers find stress relief in music

Why group drumming helps, in participants’ own words, 2016

Qualitative study. The companion question to whether drumming helps is why, and this study asked it of thirty-nine mental health patients and carers who had already shown recovery after a djembe programme. Three things came out of the interviews: the drumming itself, described as non-verbal communication, a connection with life through rhythm, and a grounding that both generates and liberates energy; the group, as a space of belonging, acceptance, safety and new social contact; and the learning, as an inclusive activity in which the idea of a mistake dissolves.

Read the full study in Psychology of Well-Being · the Sound Body Brain research group: Making music for mental health

Group drumming for service users and their carers, 2018

Qualitative study. Thirty-nine people took part in community drumming programmes and were assessed through interviews and focus groups. Emotional, psychological and social wellbeing emerged for service users and for carers alike, across six themes including positive feeling and pleasant physical effects, a sense of initiative and control, accomplishment, engagement and flow, and a redefinition of self. The carer findings are the distinctive contribution: the caring role is usually studied as a burden rather than as something a session can address directly.

Read the full study in International Journal of Qualitative Studies on Health and Well-being · The study’s record at the Royal Northern College of Music

Drum circles for people with Parkinson’s, 2016

Controlled pilot trial. Ten people with Parkinson’s disease attended twice-weekly West African drum circle classes for six weeks, against ten pairwise-matched controls who had no intervention. Quality of life on the PDQ-39 improved significantly in the drumming group and was unchanged in the controls. Walking was significantly faster for controls at baseline, and after six weeks of drumming that difference was no longer significant. The authors call the improvement reversible and ask for larger trials against established interventions such as physiotherapy.

Read the full study in Movement Disorders Clinical Practice · Johns Hopkins’ own account of the drum circle trial

A drum communication programme in nursing homes, 2020

Pilot randomised controlled trial. Forty-six nursing home residents needing high levels of care were randomly assigned, and the intervention group took thirty minutes of a drum communication programme three times a week for three months. Most of them used wheelchairs and all had started with low cognitive scores. Cognitive function improved significantly on both measures used, and the active range of motion of the wrist and shoulder improved. Body composition moved the other way, with falls in skeletal muscle mass index, total body protein and muscle mass in the loaded hand, which the authors report alongside the gains rather than around them.

Read the full study in Frontiers in Aging Neuroscience · The Senior: Drum therapy helps people with dementia in aged care with speech

Percussion with familiar music in dementia care, 2012

Randomised controlled trial. Sixty institutionalised older adults with dementia were randomly assigned to a thirty-minute group session using percussion instruments with familiar music, twice weekly for six weeks, or to usual care. Anxiety was significantly lower in the music group once pre-test scores and cognitive level were controlled for. Agitation, the other outcome measured, did not differ significantly between the groups, and the paper says so plainly.

Read the full study in International Journal of Geriatric Psychiatry

Gong

Very little clinical research exists on the gong. One study treats it as the intervention in its own right; the rest of what is known is physics, and it is genuinely interesting physics, because a gong does not behave like an instrument that simply gets louder when struck harder.

Gong meditation, stress and burnout in nurses, 2022

Controlled intervention study. Nurses in Taiwan working through the COVID-19 pandemic took part in gong meditation sessions and were compared with a control group. The gong group showed significant improvements in perceived stress and in occupational burnout. This is the only study found that treats the gong on its own as the intervention rather than as one instrument among several.

Read the full study in the Journal of Nursing Management

Gongs, shared flow and the sense of time, 2025

Mixed-methods study. Four Javanese gamelan ensembles, thirty-six players in all, performed under three conditions while researchers collected focus group discussion, validated scales and each player’s own estimate of how much time had passed. The work is about shared flow rather than therapy, and it is included because the distortion of time during sustained gong sound is one of the things people most often describe after a session.

Read the full study in PLOS ONE

How a gamelan gong sends its sound into a room, 2023

Acoustic measurement study. High-resolution directivity measurements of two kinds of Balinese gamelan gong. The instrument’s structural modes shape where the sound actually goes: the lowest modes radiate in two opposing directions, higher modes produce more complex patterns with several lobes, and the rim turns out to matter a great deal. This is the physical reason a gong sounds different depending on where you are sitting.

Read the full study in the Journal of the Acoustical Society of America

Why a gong’s pitch climbs as it sounds, 2018

Acoustic study. Chinese opera gongs are shaped so that striking them harder does not simply make them louder. The geometry produces a pitch glide, the rising shimmer that builds after the strike. This study shows that modelling that glide with a single vibrational mode fails once the instrument is genuinely played, because several modes fall into resonance with one another.

Read the full study in the Journal of the Acoustical Society of America

What happens when you damp a gong, 2017

Acoustic study. An attempt to change a xiaoluo gong’s sound by actively damping one of its vibrational modes. Damping that single mode changed not only itself but the distortion and internal resonances bound up with it, and at large amplitudes it did not remove the pitch glide at all. A useful demonstration that a gong is not a set of separable notes.

Read the full study in the Journal of the Acoustical Society of America

Rattle

There is no clinical research on the rattle. We searched for it properly and found none: no trials, no observational studies, nothing measuring what a rattle does to a person. What follows is archaeology rather than medicine, and it is here because it is true and because the rattle’s long ceremonial history is worth knowing. Nothing in the drumming section above should be read as transferring to it.

Turtle shell rattles in the archaeological record, 2018

Experimental archaeology. Turtle shell rattles are percussion instruments used by Indigenous peoples of the Americas in ceremonial contexts to keep rhythm, and complete and partial examples have been recovered from burial sites in the southeastern United States dating from around 8000 BC through to around AD 1500. Fragmentary turtle remains found elsewhere have traditionally been read as food waste. The researchers made rattles themselves and recorded the manufacturing marks, wear and breakage patterns that resulted, so that those fragments can be tested against what rattle-making actually leaves behind.

Read the full study in PLOS ONE · ScienceDaily: Turtle shells served as symbolic musical instruments

Singing bowls

Studies of the instruments themselves, of what people report after a session, and of what can be measured in the body while the sound is happening.

Tibetan singing bowl sounds and the relaxation response, 2023

Randomised controlled trial. Fifty people with high state anxiety were randomly assigned to a session of Tibetan singing bowl sound, a session of progressive muscle relaxation, or a waiting-list control. The researchers recorded self-reported anxiety, heart rate variability and EEG activity at baseline and again at fifteen, thirty and forty-five minutes. From the thirty-minute mark onwards the singing bowl group showed increased heart rate variability and reduced alpha power compared with the other two groups, alongside a greater fall in self-reported anxiety. The authors concluded that singing bowl sound could be a useful acute intervention in stressful situations.

Read the full study in the European Journal of Investigation in Health, Psychology and Education · the Universitat Autònoma de Barcelona’s own account of the trial

Singing bowl sound meditation, mood and tension, 2017

Observational study. Sixty-two adults took part in a single hour-long sound meditation using Tibetan singing bowls, crystal bowls, gongs and bells. Afterwards they reported significantly less tension, anger, fatigue and depressed mood, and a significant increase in feelings of spiritual well-being. People who had never done this kind of meditation before showed the largest reduction in tension, which the authors noted may make it particularly useful for newcomers.

Read the full study in the Journal of Evidence-Based Complementary and Alternative Medicine · the International Sound Therapy Association’s write-up of the study

A Himalayan singing bowl before relaxation practice, 2014

Randomised crossover trial. Fifty-one people each attended two sessions, one beginning with twelve minutes of Himalayan singing bowl and one beginning with twelve minutes of silence, both followed by the same directed relaxation. Blood pressure and heart rate fell further after the singing bowl than after silence, and the difference in heart rate was clear. The author suggested the bowl works well as a way into a relaxation practice rather than as a replacement for one.

Read the full study in the American Journal of Health Promotion

Fourteen studies of Tibetan singing bowls reviewed together, 2025

Systematic review. This review gathered fourteen quantitative studies of Tibetan singing bowl interventions in adults. Most reported meaningful reductions in anxiety and in depressive symptoms; several found increased heart rate variability and lowered heart rate, and some recorded increases in delta and theta brainwave activity, the patterns associated with deep rest. The authors concluded that singing bowl work may serve as a complementary therapy in both clinical and everyday settings, while noting that the studies so far are small and varied in design.

Read the full review in Healthcare

Singing bowl sound before a hospital procedure, 2025

Controlled clinical study. Sixty patients waiting for coronary angiography were divided between usual care and usual care plus a singing bowl session an hour before the procedure. Anxiety measured on the State-Trait Anxiety Inventory was significantly lower afterwards in the group who had the sound session. The authors noted that the physiological measures they took did not differ between the groups, and recommended that these be studied further.

Read the full study in the Journal of PeriAnesthesia Nursing

Singing bowls and tuning forks combined with meridian massage, 2026

Randomised controlled trial. Forty-six university students with mild psychological distress were randomly assigned to a combined sound and massage intervention using Tibetan singing bowls and tuning forks, or to one of two active comparison groups: calming music, or a spoken audio story. Compared with both comparison groups, the sound intervention produced significant reductions in depression, anxiety, stress, localised pain, heart rate and systolic blood pressure, and significant improvements in life satisfaction and spiritual well-being. Notably, the comparison here was not silence but other pleasant listening, which makes the difference more informative than a simple before-and-after.

Read the full study in Explore

Singing bowls in a nursing home, 2026

Qualitative study. Researchers observed forty-one individual singing bowl sessions with twenty-five nursing home residents aged between fifty-nine and ninety-seven, living with dementia and with physical illness. The sessions drew predominantly positive responses, including from residents whose speech was very limited. Four themes emerged from the observations: emotional resonance, relaxation, connectedness and positive affect. The authors noted that residents who could not easily join in with other activities were able to take part in this one in their own way.

Read the full study in Tijdschrift voor Gerontologie en Geriatrie

An overview of the singing bowl research so far, 2024

Review. A summary of what the singing bowl studies have found and what might explain it. The authors gather findings on reduced negative mood and increased positive mood, and on changes in blood pressure, heart rate and respiratory rate, and discuss the proposed explanations, including changes in brainwave activity and the effect of the vibration itself. They describe singing bowl sound meditation as a low-cost, low-technology approach, and are clear that the long-term effects have not yet been established.

Read the full review in Explore

Brain activity and breathing during a singing bowl massage, 2022

Prospective cohort study. Thirty-four people had EEG, heart activity and respiration recorded before, during and after a singing bowl massage. Overall EEG power fell during the sound and fell further afterwards, with reductions in the beta and gamma bands associated with alert, effortful thinking. Heart rate was significantly lower after the session. Ninety-seven per cent of participants reported feeling more balanced and ninety-one per cent more integrated. The authors interpreted the pattern as a shift towards a more meditative state.

Read the full study in Medicina · a plain-language explanation of what the EEG study found

Tibetan singing bowls and heart rate variability, 2025

Small physiological study. Eight young adults were monitored through a ten-minute rest followed by a thirty-minute singing bowl meditation. Overall heart rate variability improved significantly, as did a second measure associated with the body’s restful state, which the authors read as increased parasympathetic activity. The sample is very small, and the authors present the work as a demonstration that the effect is measurable rather than as an estimate of its size.

Read the full study in the Annual International Conference of the IEEE Engineering in Medicine and Biology Society

Brainwaves following the beat of a singing bowl, 2023

Experimental study. Seventeen people listened to a singing bowl producing a beat at 6.68 Hz while their brainwaves were recorded. Activity at that beat frequency increased markedly, more than at any other frequency band measured. Because that frequency sits in the theta range associated with relaxed, meditative states, the authors suggest this synchronisation may be part of how singing bowl sound supports meditation.

Read the full study in the International Journal of Environmental Research and Public Health

Vibration, sound and the body

One study, and a small one, but it earns its own section because it is the only entry here where the sound is not so much heard as felt. Everything else on this page measures what listening does. This measures what vibration does when it is put through the body directly.

Low frequency sound and chronic back pain, 2018

Pilot study. Twenty-three people with long-standing shoulder or lower back pain received low frequency sound stimulation passively through the hands and feet over twelve weeks. Pain fell by an average of three and a half points on a ten-point scale, with roughly two thirds of participants improving by at least three points, and scores for pain-related disability and physical quality of life improved as well. As a pilot study with no control group this is an early finding rather than a settled one, and the authors present it as a basis for larger trials.

Read the full study in the Journal of Back and Musculoskeletal Rehabilitation · Health and Bass: Treating chronic pain with low frequency sound

Reviews and overviews

The broadest evidence on this page, and the strongest. These are systematic reviews and meta-analyses drawing together hundreds of trials between them, which is why they sit on their own rather than under any one condition. Two of the four are Cochrane reviews, which are about the most conservative summaries medicine produces.

Music interventions for people with cancer, Cochrane review, 2021

Cochrane systematic review. Eighty-one trials with 5,576 participants. The reviewers found that music interventions may have beneficial effects on anxiety, depression, hope, pain and fatigue in adults with cancer, with a large effect on anxiety and a moderate effect on pain. One finding is worth drawing out: for several outcomes, sessions delivered by a trained music therapist produced consistent results across studies where recorded music alone did not.

Read the full review in the Cochrane Database of Systematic Reviews · The ASCO Post’s summary of the review

Music before an operation, Cochrane review, 2013

Cochrane systematic review. Twenty-six trials with 2,051 participants waiting for surgery. Listening to music reduced anxiety by a meaningful margin compared with standard care, and the reviewers concluded that music may offer a viable alternative to sedatives for reducing anxiety before an operation. Small improvements in heart rate were also found. The authors were careful to note methodological weaknesses in many of the trials.

Read the full review in the Cochrane Database of Systematic Reviews

Listening habits, emotional well-being and thinking, 2026

Systematic review and meta-analysis. Thirty-two studies were pooled, half looking at ordinary music listening and half at structured music-based interventions, covering anxiety, depression, stress, well-being and several measures of cognition. Almost no study reported anything getting worse, and both listening and structured programmes produced small to moderate benefits for state anxiety, depressive symptoms and emotional well-being, with slightly larger effects for the structured programmes.

Read the full review in Frontiers in Psychology

Music and heart rate variability across twenty-four trials, 2026

Systematic review and meta-analysis of randomised controlled trials. Twenty-four randomised trials with 1,295 participants were pooled to test whether music intervention changes heart rate variability. It did, shifting the balance towards the restful side of the autonomic nervous system. The largest improvements were seen in people with stress, anxiety, fear or sleep difficulties, which is to say in the people who had the most room to improve.

Read the full review in Frontiers in Psychology

Anxiety and stress

Anxiety is the outcome music has been measured against most often, and the one where the findings are most consistent. The three reviews here run from intensive care to adolescence to the year around birth, which is about as wide a spread of circumstances as this research offers.

Music therapy in intensive care, 2026

Systematic review and meta-analysis of randomised controlled trials. Fifteen randomised trials with 1,552 intensive care patients. Music therapy roughly halved the incidence of delirium, shortened time on mechanical ventilation and reduced length of stay in intensive care, alongside improvements in anxiety, depression and sleep. The authors describe it as a safe, low-cost intervention while calling for larger multi-centre trials before it becomes routine.

Read the full review in Frontiers in Medicine

Music and anxiety in adolescents, 2026

Systematic review. Twenty studies covering 1,912 young people aged twelve to eighteen, fifteen of them randomised trials. Most reported reductions in anxiety following music-based work, with active forms of engagement such as singing, playing an instrument or improvising producing more robust and longer-lasting effects than passive listening. Several studies also recorded improvements in depressive symptoms and stress regulation.

Read the full review in Frontiers in Psychology

Support around pregnancy and birth, 2026

Network meta-analysis. A comparison of non-drug approaches to perinatal mental health across 153 randomised trials, ranking them against each other rather than only against usual care. Music therapy ranked highest for depression after birth, and music-based approaches were the most effective of those compared for preventing both postnatal depression and postnatal anxiety.

Read the full review in Current Psychiatry Reports

Sleep

Two reviews, both concerned with the quality of sleep rather than the amount of it. The Cochrane review is the more cautious and is worth reading as much for what it says it cannot yet conclude as for what it can.

Listening to music for insomnia, Cochrane review, 2022

Cochrane systematic review. Thirteen studies with 1,007 participants. The reviewers found moderate-certainty evidence that listening to music improves sleep quality in adults with symptoms of insomnia, an improvement they describe as substantial. They were clear that the evidence on other aspects of sleep, and on the daytime consequences of insomnia, is not yet strong enough to draw conclusions from.

Read the full review in the Cochrane Database of Systematic Reviews · American Family Physician: Insomnia therapy, listening to music

Music and sleep quality in older adults, 2026

Systematic review and meta-analysis of randomised controlled trials. Fourteen randomised trials with 1,730 older adults. Music-based interventions significantly improved sleep quality on the Pittsburgh Sleep Quality Index, and also improved depressive symptoms, anxiety and cognitive function. The authors put it forward as a safe, non-invasive addition to the management of sleep and mental health in later life.

Read the full review in Frontiers in Psychiatry

Dementia and older adults

The longest established use of music in healthcare, and the place where the reviews are most careful to separate what is known from what is hoped. The third of these looks at ordinary listening rather than at formal sessions, which makes it a useful counterweight to the other two.

Music-based therapeutic interventions for people with dementia, Cochrane review, 2025

Cochrane systematic review. The reviewers found that at least five sessions of a music-based therapeutic intervention probably improves depressive symptoms compared with usual care, and may improve overall behavioural problems. Compared with other activities, music-based work may improve social behaviour. The review is careful about what it cannot say: no conclusion could be reached on anxiety, and there was no evidence of long-term effects after treatment ended.

Read the full review in the Cochrane Database of Systematic Reviews · Cochrane’s own plain-language write-up of the review

Music therapy in Alzheimer’s disease, 2026

Systematic review and meta-analysis of randomised controlled trials. Twenty-four randomised trials with 2,316 participants. Music therapy improved cognition, reduced neuropsychiatric symptoms and anxiety, improved quality of life and eased the burden carried by carers. The review also looked at what makes a difference in practice, finding better results from more than three sessions a week, sessions under forty minutes, and a programme running twelve weeks or longer.

Read the full review in the Journal of Alzheimer’s Disease

Music listening and well-being in later life, 2026

Systematic review. Thirteen studies from eight countries examining what passive music listening does for the emotional, psychological and social well-being of people aged sixty and over. The review brings together randomised trials and qualitative work, and its interest is in everyday listening rather than clinical treatment, which makes it a useful counterpart to the studies of formal sessions.

Read the full review in BMC Public Health

Cancer care

Four reviews, between them drawing on more than twenty thousand participants. Anxiety runs through all four as the outcome most reliably affected, and one of them ranks approaches against each other rather than against usual care, which is a harder test to pass.

Creative arts therapies in cancer care, 2026

Systematic review and meta-analysis of randomised controlled trials. Sixty-seven randomised trials with 6,259 patients, of which four out of five were music-based. The analysis found positive effects on anxiety at several points in time, from within the first week through to two and three months afterwards, along with improvements in depression and quality of life.

Read the full review in Psycho-Oncology

Ranking mind-body therapies for people with cancer, 2026

Systematic review with network meta-analysis. A ranking of mind-body therapies drawn from 182 studies and 16,835 participants. For anxiety symptoms, music therapy was among the approaches showing a statistically significant large effect compared with usual care, alongside yoga, mindfulness-based interventions, physical relaxation and qigong. A network analysis of this kind is useful precisely because it compares the options against each other rather than each against nothing.

Read the full review in Current Oncology Reports

Music therapy in breast cancer, 2024

Systematic review and meta-analysis of randomised controlled trials. Thirteen randomised trials with 1,326 participants, assessed as being of good methodological quality overall. Music therapy improved both anxiety and depression in people being treated for breast cancer, and the authors offer the results as a basis for clinical practice.

Read the full review in Scientific Reports

Cancer-related fatigue, 2024

Systematic review with network meta-analysis. Seventy-seven studies comparing twelve different approaches to the fatigue that follows cancer treatment. Music interventions were among the approaches that reduced fatigue more than the control condition, and were second only to relaxation exercises for improving sleep quality on the Pittsburgh index.

Read the full review in Frontiers in Oncology

Where this sits in our own work

We keep this page because the research informs how we work, not because it endorses it. Nothing here was written about our sessions, and none of it should be read as a claim about them.

Jane is a psychotherapist and sound practitioner, and James is a psychotherapist, sound practitioner and trainer. We work from Newton Abbot in South Devon, and between us we offer one-to-one sessions, group sound experiences, Sacred Womb Healing, and training in sound-based practice. Where the evidence is thin, as it is for the gong, and absent, as it is for the rattle, we would rather say so than borrow confidence from studies of something else.

This page is offered as a reading list, not as medical advice. Sound work of the kind we offer is not a treatment for any condition and is not a substitute for medical care. If something here is relevant to a health problem you are living with, please talk to your GP or specialist about it.