Guided Imagery and Music modulates neural circuits in mood disorders: a systematic review of mechanisms and clinical efficacy.

Background: Guided Imagery and Music (GIM), as an emerging therapeutic approach, is widely applied in the treatment of Mood disorders (MDs). However, its efficacy and underlying neural mechanisms remain unclear at present. MDs represent one of the leading causes of disability worldwide. Conventional pharmacological treatments, which primarily target single biological pathways, are frequently limited by side effects and demonstrate inconsistent therapeutic efficacy. GIM is a multimodal psychotherapeutic intervention that utilizes music-evoked imagery to facilitate emotional and cognitive processing. By engaging cognitive and emotional processing networks, GIM is regarded as one of the approaches for neuropsychological rehabilitation in mood disorders. However, the underlying neural circuit mechanisms of this approach remain insufficiently systematized and warrant further investigation. Methods: We conducted a systematic review following PRISMA guidelines. A comprehensive literature search was performed in PubMed and Web of Science (2000-2024) to examine the neural mechanisms and clinical efficacy of GIM for MDs, with emphasis on randomized controlled trials (RCTs) and neuroimaging studies. Results: GIM modulates four key neural circuits implicated in MDs: (1) regulates amygdala hyperactivity while enhancing prefrontal-amygdala connectivity; (2) promotes hippocampal neuroplasticity via auditory-driven theta synchronization; (3) reorganizes prefrontal network coordination by strengthening dorsolateral prefrontal connectivity and reducing ventromedial default mode network (DMN) hyperconnectivity; and (4) activates the nucleus accumbens dopaminergic reward pathway to mitigate anhedonia. Clinically, GIM demonstrates significant efficacy in alleviating depressive symptoms, improving cognitive function, and reducing somatic complaints across diverse populations. Conclusion: This study proposes an integrated neural circuit-targeted model for GIM in MDs, bridging multimodal neural modulation with clinical outcomes. The findings establish a neuroscientific basis for GIM as a promising non-pharmacological intervention and support its integration into standard mood disorder treatment protocols. This review presents an integrative neural circuit framework for GIM in MDs, synthesizing existing neuroimaging and clinical evidence, and laying the groundwork for future mechanistic and clinical research.