Corresponding author: Sarvin Sabet Adler University, Chicago, Illinois, USA Email: sarvin@sabetclinic.com
Active Music-Making, Traumatic Memory, and Dissociation: A Neuropsychoanalytic Model of Containment, Symbolization, and Autobiographical Integration
Adler University, Chicago, Illinois, USA
Abstract
Traumatic experiences may disrupt the integration of emotional, bodily, contextual, autobiographical, and self-referential information, leaving aspects of experience psychologically active while insufficiently connected to conscious meaning and identity. This disruption may be particularly relevant in dissociative presentations of posttraumatic stress, where affective experience can become disconnected from autobiographical and reflective processing. This paper proposes an integrative neuropsychoanalytic model in which active music-making, particularly learning and playing an instrument, may provide conditions that support the organization and psychological integration of difficult experience. Unlike passive listening, instrument playing requires the simultaneous coordination of auditory perception, motor action, attention, prediction, sensory feedback, emotional expression, and voluntary control, thereby situating affect within a structured and agentic activity. Drawing on Bion’s concept of containment, the model proposes that musical structure, repetition, rhythm, and agency may help difficult affect become sufficiently tolerable to remain available for reflection rather than becoming overwhelming or dissociated. Lacanian concepts of symbolization and signification are then used to describe how musical expression may provide an intermediate representational form through which affect can become associated with autobiographical material, language, and personal meaning. The proposed sequence moves from trauma-related fragmentation toward sensorimotor organization, containment, representation, symbolization, and autobiographical integration. The model does not suggest that music directly repairs neural systems or resolves trauma but offers a theoretical framework for understanding how active music-making may bridge neurocognitive organization and psychodynamic meaning-making. It further identifies testable pathways through which embodied musical activity may contribute to the transformation of affect into increasingly integrated personal autobiographical meaning.
Keywords: active music-making; traumatic memory; dissociation; neuropsychoanalysis; containment; autobiographical integration
Introduction
Traumatic experience may disrupt more than recollection. Emotional, bodily, contextual, autobiographical, and self-referential aspects of an event may remain present without becoming integrated into a coherent understanding of what occurred and what it means within the individual’s life. A person may remember an event factually while remaining disconnected from its emotional significance, or experience fear, arousal, numbness, imagery, or behavioral reactions without being able to situate them autobiographically. The difficulty may therefore concern not simply whether an event is remembered, but whether its components can be connected within the individual’s continuing sense of self.
Research on traumatic autobiographical memory supports this emphasis on altered organization rather than simple memory failure. Perl et al. (2023) found that traumatic autobiographical memories in PTSD showed hippocampal representational patterns distinct from ordinary sad memories. Loetscher and Goldfarb (2024) similarly describe memory integration as involving relationships among features, experiences, and broader knowledge structures. Trauma-related difficulties may therefore persist even when vivid or emotionally powerful aspects of an event remain accessible.
This distinction is particularly relevant to dissociation, which may involve altered relationships among emotional experience, bodily awareness, subjective presence, and autobiographical processing rather than an absence of memory or affect. Neurobiological accounts of dissociative PTSD have emphasized emotional overmodulation, including increased prefrontal regulatory influence over limbic responding, compared with the relative under-modulation associated with hyperaroused presentations (Lanius et al., 2010; Nicholson et al., 2015). Different components of experience may therefore remain present while insufficiently integrated.
Psychological integration consequently requires more than memory retrieval or symptom reduction. An individual may narrate what happened without feeling connected to the narrative, or experience intense affective and bodily responses without understanding them autobiographically. Integration involves developing a relationship among what is felt, remembered, understood, and experienced as personally meaningful. It does not imply restoring an unchanged pre-trauma self, but incorporating previously fragmented or insufficiently represented experience into an evolving understanding of the self.
This raises the question of what might support integration before traumatic experience can be fully formulated verbally. Difficult experience may initially appear through bodily sensation, affect, action tendencies, or dissociative states. An intermediate form may therefore be useful—one that allows affect to remain present while providing structure, predictability, bodily engagement, and voluntary control. The present paper considers active music-making as one possible context for these conditions.
Playing an instrument requires continuous coordination of perception and action. Movement is initiated, sensory consequences are anticipated and perceived, and discrepancies between intended and actual outcomes guide subsequent action. At the same time, the performer coordinates timing, rhythm, attention, working memory, sensory feedback, and emotional expression. Pando-Naude et al. (2021) emphasized this ongoing auditory–motor coupling, illustrating how sensory, motor, cognitive, and affective processes operate concurrently during music-making.
Active production also differs from passive listening. Although listening may evoke emotion, memory, imagery, and physiological responses, playing requires the individual to generate and modify the unfolding experience. The performer initiates actions, adjusts tempo and intensity, responds to errors, and determines whether the activity continues. Active music-making therefore establishes a relationship among intention, bodily action, prediction, feedback, consequence, and agency—qualities potentially relevant to trauma, which frequently involves helplessness, unpredictability, and loss of control.
Affect can also occur within this organized activity. Emotional experience may emerge while the individual maintains rhythm, coordinates movement, attends to feedback, anticipates what follows, and retains some voluntary control. For individuals vulnerable to dissociation, this may theoretically provide a position between emotional overwhelm and emotional disconnection. The significance of music-making is therefore not that it removes difficult affect, but that it may alter the conditions under which affect is experienced.
Existing evidence is suggestive but preliminary. Peters et al. (2024) reported an overall effect of heterogeneous forms of musicking on emotion regulation, while Wang et al. (2024) identified potential benefits of music-based interventions for PTSD but emphasized variability across studies. Music-making, listening, instruction, improvisation, and professional music therapy should therefore not be treated as equivalent. Pezzin et al. (2018) demonstrated the feasibility of guitar instruction among veterans with PTSD, while Ophir and Jacoby (2020) described musicking as supporting nonverbal expression and reconstruction of a narrative connecting past, present, and future. These findings do not establish the proposed mechanism but support further examination of musical action, agency, emotion, and autobiographical meaning.
A theoretical gap nevertheless remains between neurocognitive accounts of trauma and musical performance and psychological accounts of how difficult experience becomes representable and meaningful. A neuropsychoanalytic perspective offers one way of connecting these levels. Bion’s concept of containment describes how difficult affect may become sufficiently tolerable to remain available for reflection. Musical structure, repetition, temporal organization, sensory feedback, and voluntary action are not equated with Bionian containment; rather, they are proposed as conditions that may function in a containing manner by allowing affect to remain present within an organized activity.
Containment alone does not explain meaning. Lacanian concepts of symbolization and signification provide a framework for considering how affective and bodily experience may acquire representational form and become associated with memories, relationships, language, and autobiographical meaning. Music is not treated as language in the Lacanian sense, nor are musical features assigned predetermined meanings. Instead, musical expression may provide a form through which the individual’s own associations and signification develop.
The theoretical question emerged partly from a personal experience of returning to the sitar several decades after first playing it during adolescence. Re-engaging with a familiar embodied musical practice raised questions about continuity of self, autobiographical memory, and relationships among bodily, emotional, and symbolic experience across time. This experience is not presented as evidence, but as the experiential starting point for the theoretical question.
The present paper therefore proposes an integrative neuropsychoanalytic model in which active music-making provides an organized, embodied, and agentic context for sensory, motor, cognitive, and affective processes to occur together. Bionian containment conceptualizes the movement from difficult affect toward experience that can remain available for reflection, while Lacanian symbolization and signification describe the subsequent movement toward association, language, autobiographical meaning, and integration. The model does not propose that music repairs neural systems, retrieves traumatic memories, or constitutes an established treatment for PTSD. Rather, it considers how active music-making may provide organization before meaning is fully available, creating a possible embodied bridge between neurocognitive organization and psychodynamic meaning-making.
Conceptual Approach and Literature Search
This paper uses an integrative theoretical approach to examine active music-making in relation to traumatic memory, dissociation, containment, symbolization, and autobiographical integration. Rather than providing a systematic review of all music-and-trauma research, the literature search focused on empirical and theoretical work relevant to the mechanisms proposed in the model, including traumatic autobiographical memory, dissociation, neurocognitive processes in musical performance, emotion regulation and agency, trauma-related music interventions, and psychodynamic theories of containment and symbolization.
Searches were conducted in PubMed, PsycINFO, and Google Scholar, supplemented by reference-list searching. Terms included combinations of trauma, PTSD, dissociation, traumatic memory, autobiographical memory, active music-making, instrument playing, musical improvisation, auditory–motor coupling, sensorimotor integration, prediction, agency, emotion regulation, containment, symbolization, and neuropsychoanalysis. Contemporary empirical studies, systematic reviews, and theoretical papers were prioritized, with foundational sources retained where necessary.
Particular emphasis was placed on active musical production, including instrumental learning, performance, improvisation, and other forms of musicking. Passive listening and formal music therapy were included when relevant but were not treated as mechanistically equivalent, as the model specifically concerns bodily action, prediction, sensory feedback, and agency.
The literature was synthesized around a proposed progression from trauma-related disruption of integration through active music-making, sensorimotor organization and agency, containment, representation, symbolization, and autobiographical meaning-making. The resulting framework is intended to generate testable propositions rather than establish active music-making as an evidence-based treatment for PTSD or dissociation; the complete pathway remains theoretical and requires empirical testing.
Trauma, Dissociation, and the Disruption of Psychological Integration
From a neurocognitive perspective, psychological meaning depends on the coordination of sensory, emotional, bodily, contextual, cognitive, and self-related information. Limbic and paralimbic systems contribute to emotional salience, hippocampal systems support spatial and temporal context, and prefrontal and cingulate regions contribute to attention, regulation, evaluation, and integration. Through their interaction, experience can become situated within an organized autobiographical narrative.
Traumatic experience may disrupt this coordination without necessarily weakening memory itself. In PTSD, aspects of an event may remain vivid, emotionally intense, physiologically active, and intrusive while being organized differently from ordinary autobiographical memories. Lanius et al. (2004) identified altered functional connectivity during traumatic memory recall, while Perl et al. (2023) found that traumatic autobiographical memories showed hippocampal representational patterns distinct from ordinary sad memories. These findings support the possibility that trauma involves altered relationships among emotional intensity, autobiographical content, contextual representation, and broader memory processes.
Remembering an event and psychologically integrating it are therefore not equivalent. An individual may describe what occurred in detail while remaining emotionally disconnected from it, or may experience fear, bodily arousal, numbness, or imagery without being able to place these reactions within a coherent autobiographical context. The central difficulty may lie less in memory retrieval than in the disrupted relationship among affective, bodily, contextual, and cognitive components of experience.
Dissociation provides a particularly relevant example. Aspects of experience may remain psychologically or physiologically active while becoming insufficiently connected with conscious emotional processing, autobiographical context, or the broader sense of self. Neurobiological models of dissociative PTSD have described patterns of emotional overmodulation rather than simple hyperarousal. Nicholson et al. (2015) identified greater connectivity between amygdala subregions and prefrontal areas associated with emotional regulation in dissociative PTSD, consistent with models emphasizing increased regulatory control and emotional distancing (Lanius et al., 2010; Nicholson et al., 2015). Dissociation may therefore involve affective experience becoming separated from conscious emotional and autobiographical processing rather than disappearing.
The psychological task that follows is not simply to recover traumatic material, but to create conditions in which emotional, bodily, contextual, and autobiographical aspects of experience can become sufficiently tolerable to be encountered together. Integration does not require restoration of an unchanged pre-trauma self or complete verbalization of every aspect of the experience. Rather, it refers to developing a more coherent relationship among past experience, present emotional and bodily responses, autobiographical context, and the continuing sense of self.
This raises a further question: what kind of activity might allow affective, bodily, cognitive, and behavioral processes to occur together without immediately overwhelming the individual? Such an activity would need to support present-moment engagement while providing structure, sensory organization, and voluntary participation. Active music-making is particularly relevant because playing an instrument requires auditory perception, movement, timing, prediction, sensory feedback, sequencing, attention, and error correction to operate together within an organized activity.
The significance of active music-making therefore does not initially depend on assuming that music carries a particular therapeutic meaning or directly represents trauma. Its relevance begins with the organization of experience itself. Playing requires bodily action, auditory feedback, temporal structure, attention, and voluntary control to remain coordinated as the activity unfolds. Active music-making cannot be assumed to repair neural systems affected by trauma; rather, it provides a structured context in which sensory, motor, cognitive, and affective processes are repeatedly required to operate in relationship with one another.
Active Music-Making as an Organizing Sensorimotor Activity: Prediction, Timing, and Agency
Active music-making is inherently multisystemic, requiring coordination among auditory perception, motor planning, somatosensory feedback, timing, attention, prediction, error monitoring, and emotional expression. Musical performance therefore depends on continuous auditory–motor interaction and the integration of sensory, motor, and higher-order cognitive systems (Zatorre et al., 2007; Schlaug, 2015; Olszewska et al., 2021; Pando-Naude et al., 2021).
Perception and action operate within an ongoing feedback loop: the performer anticipates an action and its sensory consequence, produces it, evaluates the resulting feedback, and adjusts subsequent behavior. Playing therefore repeatedly involves prediction → action → sensory consequence → evaluation → correction. Evidence for this coupling includes overlapping auditory–motor networks in pianists and motor-region recruitment after non-musicians learned to play novel music (Bangert et al., 2006; Lahav et al., 2007).
Listening is not neurologically passive; rhythm perception can recruit motor-related regions and involve prediction and motor preparation (Chen et al., 2008). Active performance, however, adds an explicit perception–action cycle in which bodily action generates and modifies the sensory event. Musical training is also associated with functional and structural differences in auditory–motor networks (Herholz & Zatorre, 2012; Olszewska et al., 2021; Pando-Naude et al., 2021). These findings do not demonstrate trauma integration or neural “repair”; rather, they show that playing repeatedly requires sensory, motor, attentional, predictive, and executive processes to operate together.
Prediction and timing further organize this activity. Music unfolds temporally, requiring continuous updating of expectations concerning what has occurred and what is likely to follow (Vuust et al., 2022). During performance, these expectations also concern the consequences of the performer’s own actions. Errors or unexpected outcomes can be perceived and used to guide adjustment, allowing the activity to remain structured while open to revision.
This may be relevant to trauma, which often involves unpredictability and diminished control. Active music-making does not reverse trauma-related unpredictability, but it repeatedly links expectation, action, sensory consequence, discrepancy, and adjustment within an organized sequence. Predictive and embodied accounts similarly emphasize relationships among musical action, sensorimotor prediction, feedback, and agency (Dell’Anna et al., 2021; Vuust et al., 2022).
Agency may be particularly significant. Whereas traumatic experiences frequently involve helplessness, instrument playing repeatedly establishes a relationship among intention, action, and consequence. Changes in movement produce perceptible changes in sound, tempo, intensity, or continuation, providing immediate sensory evidence that the performer has influenced what occurred. Unlike listening, performance places the individual within an ongoing cycle of acting, perceiving, evaluating, and choosing what happens next.
Trauma-related music research provides preliminary support for these qualities. Pezzin et al. (2018) demonstrated the feasibility of active guitar instruction among veterans with PTSD; Bensimon et al. (2008) described emotional expression, interpersonal connection, and perceived control during group drumming; and Ophir and Jacoby (2020) described active musicking as supporting psychological safety and reconstruction of personal narratives across past, present, and future. These studies do not establish that agency or music-making causes trauma integration, but they support further examination of bodily participation, perceived control, emotional expression, and autobiographical continuity.
Agency is therefore not proposed as sufficient for psychological integration. Rather, it forms part of a broader organizing context in which rhythm, movement, prediction, attention, sensory feedback, affect, and voluntary action occur together. This provides the basis for considering how difficult affect may remain present within structured action without becoming immediately overwhelming or dissociatively disconnected.
Emotion Within Organized Action
Active music-making is distinctive because emotional experience occurs while the individual remains engaged in organized action. Tension, sadness, anger, vulnerability, excitement, or fear may emerge while the performer continues to coordinate timing, movement, auditory monitoring, attention, prediction, and adaptation. Emotion therefore occurs within, rather than apart from, bodily and cognitive organization.
Research on musical improvisation illustrates this relationship. Limb and Braun (2008) found distributed changes across prefrontal and sensorimotor systems during jazz improvisation, while McPherson et al. (2016) showed that improvising with different emotional intentions altered prefrontal activity and functional connectivity involving limbic and paralimbic regions, including the amygdala and insula. These findings do not demonstrate regulation of trauma-related affect; rather, they show that emotional expression can occur while complex sensorimotor organization is maintained.
This may create a theoretical middle position between emotional overwhelm and emotional disconnection. Difficult affect can emerge while the individual maintains rhythm, coordinates movement, monitors feedback, anticipates subsequent actions, and retains the ability to modify or stop the activity. Affect is therefore experienced within temporal structure, bodily engagement, sensory feedback, and voluntary participation.
Rhythm and repetition may contribute to this organization without being inherently therapeutic. Rhythm provides temporal structure, while predictive models emphasize its role in generating and updating expectations (Chen et al., 2008; Zatorre et al., 2007; Vuust et al., 2022). Repetition similarly combines predictability with variation: a phrase can return while changing in tempo, intensity, articulation, or emotional quality.
During instrumental learning, organization may initially depend on external structure through instruction, rhythmic patterns, notation, and corrective feedback, then become increasingly internalized through practice. Research on musical training describes corresponding behavioral, functional, and structural changes in auditory and motor networks (Herholz & Zatorre, 2012; Olszewska et al., 2021). These findings do not imply psychological integration, but they illustrate how externally supported patterns may become increasingly coordinated and flexible.
The theoretical significance lies in the conditions these processes create rather than in any claim that sensorimotor coordination resolves trauma. Active music-making repeatedly brings bodily action, sensory information, emotion, prediction, attention, and agency into relationship within a structured yet modifiable activity. The next question is how this organization might allow difficult affect to become sufficiently tolerable to remain available for psychological processing. At this point, the neurocognitive account begins to meet the psychodynamic one. Bion’s concept of containment provides the next part of this explanation.
Bion, Containment, and the Transformation of Experience
From a psychodynamic perspective, traumatic experience concerns not only what occurred, but whether its emotional and bodily effects could be psychologically processed. Aspects of trauma may remain influential while avoided, dissociated, unformulated, or insufficiently represented. The difficulty is therefore whether traumatic material can be encountered in a form that permits reflection and psychological elaboration.
Bion’s concept of containment provides a framework for understanding what may need to occur before difficult experience becomes thinkable. Within the container–contained model, overwhelming emotional experience may not initially exist in a form that can be interpreted or understood. The first task is to create conditions in which it can be tolerated sufficiently to remain psychologically available. Ogden (2004), elaborating Bion’s model, describes containment as supporting the processing of lived emotional experience and the capacity to think it. The movement is therefore from experience that cannot adequately be held in mind toward experience that can become available for observation, reflection, and thought.
Containment does not mean suppressing emotion or immediately explaining its meaning. Rather, it alters the conditions under which experience can be encountered. Affect that previously led to avoidance, dissociation, or disorganization may become something with which the individual can remain in contact. This is particularly relevant to trauma because overwhelming or dissociatively distanced experience has limited opportunity to become represented or associated with other aspects of psychological life. Spermon et al. (2009) proposed that symbolic processes may contribute to reintegration in complex trauma and dissociation, but such processes first require sufficient contact with experience. Containment may therefore create conditions from which representation and meaning-making can emerge.
This process need not begin verbally. Salomonsson (2011), discussing containment and communicative musicality, emphasizes nonverbal dimensions such as rhythm, timing, and tone. Active music-making may be relevant because affect occurs within an external and temporally organized medium. Rhythm structures time, repetition creates predictability, musical form establishes boundaries, and bodily action produces audible consequences. The individual can also alter tempo, intensity, repetition, phrasing, or whether the activity continues. Musical structure is not equated with Bionian containment; rather, these features may contribute to conditions that function in a psychologically containing manner.
Active music-making may also provide psychological distance without requiring disconnection. Affect can become bodily movement, movement can produce sound, and sound can be heard, noticed, and responded to. Difficult experience may therefore acquire a perceptible form. This should not be reduced to emotional discharge: expressing fear, sadness, anger, or tension through sound does not mean the experience has been psychologically processed. Its significance lies in expression occurring while the individual remains engaged with rhythm, movement, sensory feedback, prediction, and organization.
Trauma-related music research provides preliminary support for these qualities without demonstrating Bionian containment as a causal mechanism. Ophir and Jacoby (2020) described music-making among adults with war- and terrorism-related PTSD as providing psychological safety, nonverbal engagement, and opportunities for reconstructing personal narrative. Bensimon et al. (2008) similarly described emotional expression, interpersonal connection, and perceived control during group drumming with individuals affected by combat-related PTSD. These findings do not establish that music-making constitutes containment, but they describe qualities consistent with the proposed containing function.
Music may also provide an intermediate form between affect and interpretation. Austin (1996) described psychodynamic improvisation as an immediate form of experience and a medium between conscious and less consciously accessible material, while Kim (2016) conceptualized improvisation as a nonverbal medium through which psychological concerns may be expressed. An individual might initially express tension through repetitive, forceful, hesitant, or restricted playing without knowing what it represents. The first development may simply be that the affect becomes tolerable enough to remain present; reflection may later permit recognition, association, and representation.
Bionian containment therefore describes an important but incomplete stage of the model. It helps explain how difficult affect may become sufficiently tolerable to remain available for psychological processing, but not how it subsequently becomes connected with words, memories, relationships, identity, or autobiographical understanding. Containment makes experience possible to hold; it does not necessarily make it meaningful. This transition from tolerable experience toward representation and meaning provides the basis for the Lacanian component of the model.
From Containment to Meaning: Lacan, Symbolization, and Signification
Containment may allow difficult experience to remain sufficiently tolerable within awareness, but toleration alone does not make it meaningful. An individual may remain in contact with fear, sadness, bodily tension, or vulnerability without yet connecting these experiences with a memory, relationship, loss, or change in identity. A further process is therefore required through which affective and bodily experience acquires representational form. The present model considers this movement through Lacanian concepts of symbolization and signification.
Within a Lacanian framework, subjective experience is organized through systems of signification involving language, relationships, cultural meanings, and representations of self and others. The Symbolic concerns the systems through which experience becomes articulated, while the Real refers, in part, to what resists complete symbolization. Applied cautiously to trauma, this distinction differentiates factual description from representation of an event’s broader psychological significance.
A person may describe what happened while remaining unable to articulate its meaning for identity, relationships, safety, independence, trust, or the future. These dimensions may instead appear through bodily reactions, affective states, avoidance, relational changes, or disconnection. Symbolization concerns the process through which such experience begins to acquire representational form.
Active music-making may be relevant because expression does not initially depend upon language. Music is not equivalent to language in the Lacanian sense, nor do musical features possess predetermined psychological meanings. Rhythm does not inherently represent fear, minor harmony does not automatically signify sadness, and repetition does not necessarily signify trauma. Rather, musical activity may give affect a perceptible form that can later become available for association and signification.
Rhythm, tempo, intensity, repetition, silence, and bodily movement can shape emotional experience before it can be verbally explained. Austin (1996) conceptualized psychodynamic improvisation as an immediate form of experience and a symbolic medium through which psychologically significant material may become available for exploration. The movement is therefore not from music directly to interpretation, but from affect toward form.
An internal state experienced as tension, agitation, numbness, or diffuse distress may become expressed through movement and sound, allowing it to be heard, noticed, and reflected upon. A repetitive or restricted pattern, for example, might initially be recognized only as “feeling stuck” and later become associated with a traumatic event, relationship, loss, or alteration in identity. The musical pattern has not revealed a hidden meaning; expression has provided a form around which recognition, association, language, and autobiographical significance can develop.
Meaning therefore cannot be inferred directly from musical structure. It develops through the individual’s memories, emotions, relationships, metaphors, cultural context, and existing representations of self. The same repetition may signify safety, restriction, persistence, or nothing psychologically significant at all. Reflection allows these associations to emerge without prescribing what the music should mean.
The proposed progression can therefore be understood as:
Bionian containment and Lacanian symbolization describe complementary stages of the model. Containment allows difficult experience to remain psychologically available; symbolization describes how that experience may subsequently become represented and connected with broader psychological meaning. Active music-making may bridge these processes: musical structure, rhythm, repetition, boundaries, and agency may contribute to containing conditions, while expression provides a form through which recognition, association, and signification can develop.
Integrated Neuropsychoanalytic Model of Active Music-Making, Trauma, and Psychological Integration
The neurocognitive and psychodynamic perspectives developed above can be understood as different stages of the same proposed process. Trauma and dissociation may involve disrupted relationships among affective, bodily, contextual, autobiographical, and regulatory processes, while active music-making repeatedly requires sensory, motor, attentional, predictive, emotional, and executive functions to operate together. Psychodynamic theory addresses why this organization may matter: experience must become sufficiently tolerable to remain psychologically available before it can acquire representation, association, language, and autobiographical meaning.
The model begins with trauma-related disruption of psychological integration. Emotional reactions, bodily states, memories, and changes in identity may remain active while insufficiently connected within an autobiographical framework (Lanius et al., 2004, 2010; Nicholson et al., 2015; Perl et al., 2023). Active music-making enters at the level of organization, requiring coordination among auditory perception, movement, timing, prediction, attention, sensory feedback, affect, and behavioral adjustment (Schlaug, 2015; Limb & Braun, 2008; McPherson et al., 2016).
Agency is an important component of this organization. Whereas trauma often involves helplessness or diminished control, playing establishes an immediate relationship among intention, action, and sensory consequence. Preliminary trauma-related studies of guitar instruction and group drumming support consideration of perceived control and active participation within this context (Bensimon et al., 2008; Pezzin et al., 2018).
Within the model, rhythm, repetition, temporal boundaries, bodily engagement, feedback, and agency are not equated with Bionian containment. Rather, they may contribute to conditions in which difficult affect can remain present without becoming immediately overwhelming or dissociatively disconnected. Containment therefore describes the movement through which affect becomes sufficiently tolerable to remain available for reflection.
Containment alone does not produce meaning. Musical expression may give internal experience perceptible form: affect becomes movement, movement produces sound, and sound can be noticed and reflected upon. Psychodynamic accounts similarly describe musical improvisation as a nonverbal medium through which psychologically significant experience may become available for exploration (Austin, 1996; Kim, 2016).
This movement from affect toward form provides the bridge to Lacanian symbolization and signification. Musical features are not assumed to contain predetermined meanings; rather, expression may provide a representational starting point through which the individual’s own associations emerge. These associations may connect experience with memories, relationships, identity, language, and autobiographical meaning.
The complete proposed pathway is:
The model does not propose that active music-making repairs neural systems, automatically resolves dissociation, or causes trauma integration. Rather, it remains a theoretical synthesis requiring empirical testing. Its central proposition is that active music-making may provide organization before meaning: structure may support affective tolerance, expression may provide representational form, and association and signification may contribute to autobiographical integration.
Testable Propositions and Future Research
The proposed model should be evaluated empirically through experimental, longitudinal, clinical, neuropsychological, and qualitative research. One prediction is that active music-making will differ from passive listening in sensorimotor and agentic engagement because performance requires continuous coordination among action, prediction, auditory and somatosensory feedback, attention, and behavioral adjustment (Limb & Braun, 2008; McPherson et al., 2016; Schlaug, 2015). Future studies could examine whether this stronger relationship among intention, action, sensory consequence, and voluntary control is associated with perceived agency, affective tolerance, avoidance, or dissociation, particularly given preliminary findings concerning active musical participation and perceived control in trauma-related populations (Bensimon et al., 2008; Pezzin et al., 2018).
The model also predicts that active music-making may permit affective engagement while preserving present-moment organization. Emotional experience may emerge while the performer maintains rhythm, movement, feedback monitoring, and prediction; McPherson et al. (2016) demonstrated that emotional intention during improvisation alters prefrontal and limbic/paralimbic activity and connectivity. Rhythm, repetition, temporal boundaries, and predictability may therefore contribute to containing conditions, although greater structure is not assumed to be uniformly beneficial. Longitudinal studies of instrument learning could further examine whether movement from externally supported structure toward increasingly independent timing, prediction, and regulation corresponds with changes in agency, self-regulation, distress tolerance, or dissociative responding.
A further prediction is that containment should precede symbolic meaning-making. Difficult experience may first need to become sufficiently tolerable to remain psychologically available before developing into recognition, association, language, and autobiographical meaning. Qualitative and process research could examine the proposed progression of tolerance → expression → recognition → association → language → autobiographical meaning. Consistent with the Lacanian framework, musical features should not be assigned universal meanings; interpretation should instead prioritize the individual’s own associations. Reflection may be particularly important, as Ophir and Jacoby (2020) described musicking in relation to reconstruction of personal narratives across past, present, and future.
Dissociation and autobiographical integration should also be assessed as related but distinct outcomes, since reduced dissociative distancing does not necessarily indicate greater psychological meaning or narrative integration. Future research should therefore distinguish emotional engagement, agency, symbolic representation, narrative coherence, and autobiographical integration rather than relying only on PTSD symptom severity. Studies should also differentiate independent instrument playing, music instruction, improvisation, group musicking, and professional music therapy. Ultimately, the strongest test of the model is whether sensorimotor organization and agency support affective tolerance, whether tolerance permits representation and symbolization, and whether these processes contribute to autobiographical integration.
Discussion
The proposed model integrates neurocognitive and psychodynamic perspectives around a central distinction: traumatic experience may remain emotionally, bodily, and autobiographically active without becoming sufficiently integrated into psychological meaning. The relevance of active music-making therefore lies not in the assumption that music directly treats trauma, but in the possibility that it provides organization before explicit meaning is available. Sensorimotor coordination, prediction, temporal structure, sensory feedback, and agency may support the continued presence of affect; containment may make that affect more tolerable; musical expression may provide representational form; and association and signification may subsequently connect experience with language, identity, and autobiographical understanding.
This formulation extends beyond symptom reduction by distinguishing emotional engagement, dissociation, agency, representation, symbolization, and autobiographical integration. Improvement in one does not necessarily imply improvement in another. A person may become less dissociatively disconnected without understanding the significance of an experience, while another may construct a coherent narrative but remain affectively detached. Remembering, feeling, and integrating are therefore related but distinct processes.
Active music-making must also be distinguished from passive listening and professional music therapy. It may occur independently, through instruction, group activity, improvisation, or within formal treatment, whereas music therapy includes relational, therapeutic, ethical, and clinical processes beyond musical production itself. The present model focuses specifically on bodily action, prediction, auditory feedback, agency, emotional expression, and representational form. Evidence from guitar instruction, group drumming, and qualitative studies of musicking suggests possible relevance to perceived control, emotional expression, psychological safety, and autobiographical continuity, but these forms of engagement are not interchangeable (Bensimon et al., 2008; Ophir & Jacoby, 2020; Pezzin et al., 2018).
One clinical implication concerns the timing of verbal meaning-making. Trauma-related experience may be present as bodily arousal, numbness, fear, or fragmented affect before it can be coherently articulated. Requiring immediate interpretation may therefore ask for meaning before the experience has become sufficiently tolerable or represented. The model instead proposes that organization may precede understanding: affect may first be encountered through rhythm, movement, sensory feedback, and active expression before becoming recognizable, associable, and verbally meaningful.
This distinction reflects the relationship between Bionian containment and Lacanian signification. Active music-making is not equated with containment, but rhythm, repetition, temporal boundaries, bodily engagement, and voluntary control may contribute to conditions in which difficult affect remains psychologically available. For individuals whose traumatic experiences involved helplessness or diminished control, the repeated relationship among intention, action, and sensory consequence may be particularly relevant, although existing findings do not establish agency as a causal mechanism (Bensimon et al., 2008; Pezzin et al., 2018).
Musical expression should likewise not be interpreted as a fixed symbolic code. Repetition, dissonance, forceful playing, or silence do not possess predetermined psychological meanings. Significance develops through the individual’s associations, memories, relationships, metaphors, cultural context, and symbolic world. Where music-making occurs therapeutically, reflection should therefore facilitate the individual’s own associations rather than impose interpretation. This is consistent with psychodynamic accounts of improvisation as an intermediate medium through which psychologically significant material may become available for exploration (Austin, 1996; Kim, 2016).
The degree of musical structure required is also likely to vary. For some individuals, repetition, clear boundaries, or guided exercises may support predictability; for others, excessive structure may feel restrictive and improvisation may permit greater agency. Musical proficiency is not assumed to be necessary, as the theoretical emphasis lies in active participation and coordination rather than skill. At the same time, music-making may evoke frustration, shame, sensory overstimulation, performance anxiety, or trauma-related associations and should not be assumed to be inherently regulating.
These boundaries are important because the framework does not position active music-making as a substitute for trauma-focused psychotherapy or as an established treatment for PTSD or dissociation. Nor should music be used to provoke traumatic recollection or recover presumed hidden memories. Its proposed relevance is more specific: active musical engagement may provide an embodied context in which organization, agency, affect, and expression occur together, creating conditions from which reflection and meaning-making may become possible.
The broader contribution of the model is therefore the proposition that integration may not always begin with language. For experiences that remain primarily bodily, affective, poorly represented, or dissociatively disconnected, active music-making may provide an intermediate pathway between what is felt and what can eventually be represented and understood. Music does not bypass meaning; rather, it may help create the conditions through which meaning can gradually emerge.
Limitations
The proposed model has several important limitations. Most importantly, the complete progression from sensorimotor organization and agency through containment, symbolization, and autobiographical integration has not been empirically demonstrated. Existing research supports individual components of the framework, but this does not establish that they operate sequentially as proposed. The complete pathway therefore remains theoretical.
The evidence base is also heterogeneous, drawing on neuroimaging studies, research with trained musicians, instrumental learning, qualitative studies of musicking, group drumming, guitar instruction, and psychodynamic music therapy. These activities differ in structure, expertise, interpersonal context, therapeutic intention, and opportunities for reflection. Findings from one form of musical engagement therefore cannot be generalized automatically to another, and evidence from formal music therapy should not be assumed to demonstrate the effects of independent instrument playing.
Neurocognitive findings also require cautious interpretation. Much of the research on auditory–motor integration, prediction, improvisation, and training-related plasticity has involved healthy participants or trained musicians rather than individuals with PTSD or dissociative symptoms. These studies demonstrate the neurocognitive complexity of active music-making, but not that such coordination produces psychological integration following trauma. The model therefore does not claim that music directly repairs trauma-related neural systems.
Similar caution applies to the psychodynamic components. The suggestion that musical structure may function in a containing manner is a theoretical extension; rhythm, repetition, and instrumental learning are not equivalent to Bionian containment within the psychoanalytic relationship. Likewise, music is not treated as language in the Lacanian sense. Rather, musical expression is proposed as a representational form around which association and signification may develop. Neuroscientific findings should therefore not be treated as proof of psychoanalytic constructs, nor psychodynamic concepts reduced to neural mechanisms.
Individual differences further limit generalization. Active music-making may evoke regulation and engagement for some individuals but performance anxiety, frustration, shame, sensory overstimulation, or traumatic associations for others. Previous musical experience may also shape the proposed mechanisms, as experienced musicians and beginners differ in the cognitive demands of performance. Agency, structure, and expression may therefore vary according to skill, confidence, prior experience, and the individual’s relationship with music.
Cultural and accessibility factors are also important. Musical meanings, instruments, and expectations are culturally embedded, while physical disability, hearing difficulties, fatigue, pain, financial barriers, and access to instruments or instruction may affect participation. Future research should therefore consider accessible forms of active music-making, including adapted instruments, voice, percussion, and digital technologies, while preserving theoretically relevant elements such as agency, structured action, sensory feedback, and expression.
Trauma and dissociation are themselves heterogeneous. Individuals vary in hyperarousal, emotional overmodulation, depersonalization, derealization, avoidance, bodily awareness, autobiographical memory, and interpersonal functioning. An activity that supports engagement for one person may increase dysregulation for another. Future studies should therefore examine moderators rather than treating trauma-related populations as psychologically homogeneous.
Future research must also address causality and measurement. Longitudinal, experimental, and controlled studies are needed to determine whether changes in agency, affective tolerance, representation, or symbolic processing precede psychological change. Autobiographical integration is also difficult to capture with a single measure and may require combinations of symptom and dissociation measures, assessments of agency and emotional awareness, narrative analysis, qualitative interviews, and longitudinal measures of autobiographical coherence.
These limitations define the boundaries of the present model. Active music-making cannot yet be described as an established mechanism of trauma integration or assumed to be universally beneficial. The framework instead proposes a testable possibility: sensorimotor organization and agency may support affective tolerance; containment may permit expression; expression may enable association and symbolization; and these processes may contribute to autobiographical meaning-making. Determining whether this progression occurs, for whom, and under what conditions remains a central task for future research.
Conclusion
Traumatic experience may disrupt the integration of affective, bodily, contextual, autobiographical, and self-related information, leaving aspects of experience psychologically active while insufficiently connected with conscious meaning or identity. In dissociative presentations, the difficulty may therefore lie not simply in whether an event is remembered, but in whether emotional, bodily, and autobiographical aspects of that experience can be brought into a more coherent relationship.
The central proposition of this paper is that active music-making may provide one possible context for such organization. Playing an instrument requires the coordination of auditory perception, motor action, attention, prediction, sensory feedback, emotional expression, and voluntary control. Within the proposed model, this structured and agentic activity may allow affect to remain present without becoming either immediately overwhelming or dissociatively disconnected.
Bionian containment helps conceptualize how difficult affect may become sufficiently tolerable to remain available for reflection, while Lacanian concepts of symbolization and signification help explain how experience may subsequently move toward representation, association, language, and autobiographical meaning. Music is not treated as a symbolic code with predetermined meanings; rather, musical expression may provide a form through which the individual’s own associations and meanings can gradually develop.
The proposed progression therefore moves from trauma-related fragmentation through active music-making, sensorimotor organization and agency, containment, representation, association, symbolization, and autobiographical meaning toward psychological integration. The model does not propose that music automatically resolves trauma, repairs specific neural systems, or constitutes an established treatment for PTSD or dissociation. Instead, it offers a hypothesis-generating neuropsychoanalytic framework for considering how active music-making might provide organization before meaning is fully available, creating a possible embodied bridge between neurocognitive organization and psychodynamic meaning-making.
Acknowledgments
The author has no acknowledgments to declare.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Disclosure Statement
The author reports there are no competing interests to declare.
Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Declaration of Generative AI Use
ChatGPT (OpenAI; GPT-5.6 Sol) was used after the original manuscript and theoretical argument had been developed to assist with occasional language refinement. Generative AI was not used to generate research data, conduct analyses, or determine the theoretical conclusions of the article. The author reviewed and revised all AI-assisted text, verified the accuracy and appropriateness of citations and references, and takes full responsibility for the originality, accuracy, integrity, and final content of the manuscript. The author has reviewed the tool’s terms of use and confirms its suitability for this purpose.
Ethics, Confidentiality, and Anonymization Statement
This article is theoretical and does not report original research involving human participants, patient data, clinical case material, or identifiable personal information. Accordingly, institutional ethics approval, informed consent, and participant anonymization procedures were not applicable.
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