Symphony of healing: Investigating the effects of integrating music therapy with cognitive behavioral therapy (CBT) and dynamic interpersonal therapy (DIT) on depression

Although Dynamic Interpersonal Therapy (DIT) and Cognitive Behavioral Therapy (CBT) are established treatments for depression, the effects of combining them with music therapy, a non-invasive, cost-effective adjunct, remain underexplored. In this multicenter randomized controlled trial (MC-RCT) with a four-arm parallel-group design, participants (n = 230) with DSM-5 MDD criteria from five major Iranian cities were randomized into four groups: Music Therapy + DIT, Music Therapy + CBT, Music Therapy alone, and Low-Intensity Therapy (LIT). Key outcome measures included the Hamilton Depression Rating Scale (HAM-d-17) for depressive symptoms, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and the Stroop Test for cognitive performance. Assessments were performed at baseline, mid-treatment (8 weeks), post-treatment (16 weeks), and at 6- and 12-month follow-ups. Data analysis involved mixed ANOVA and Bonferroni post hoc tests. All active interventions reduced depressive symptoms, improved sleep, and enhanced cognition by week 16. MT+DIT showed the greatest and most sustained gains: 40.85 % symptom reduction, 44.26 % sleep improvement, and marked cognitive enhancements (45.85 % in cognitive flexibility, 40 % in processing speed, 75.05 % in selective attention, and 53.17 % in cognitive inhibition) at the 12-month follow-up. MT+CBT had substantial but less enduring effects. MT alone showed moderate initial improvement that declined at follow-up. These findings support the inclusion of music therapy combined with psychodynamic approaches in mental health treatment protocols, offering a viable, non-pharmacological option for comprehensive depression care.