Cultural background and instrument timbre shape emotional and EEG responses to a familiar Middle Eastern melody in Maqam Saba: a crossover clinical trial with implications for music therapy.

Music-based interventions are gaining traction in therapeutic settings, yet evidence remains centered on Western music and populations. This gap is particularly important for Middle Eastern populations, where the Maqam Melodic System-a tonal framework traditionally associated with specific emotions-remains unexplored using modern neuroscientific methods. The Maqam Saba, traditionally associated with sadness, contains quartertones absent from Western scales and unfamiliar to non-Arab listeners, raising the question of whether its emotional associations are universal or culturally specific. This study reports findings from the registered clinical trial NCT04573101, the first to investigate the effects of Arab music on EEG activity at specific sites and emotions using self-reported measures. The full trial examined various variables using a randomized crossover design. The present analysis focuses on responses to "Howa Sahih," a well-known composition by Zakaria Ahmed, performed on three traditional instruments-Oud, Ney, and Qanun-by professional musicians at Qatar Music Academy. Forty-two participants from diverse ethnic backgrounds were grouped as Arab or non-Arab. Emotions were assessed using PANAS-X and converted to valence, arousal, and dominance (VAD) scores using the NRC VAD Lexicon. EEG activity was recorded at electrode T7, previously linked to emotional processing. Non-parametric tests were used for within- and between-group comparisons. "Howa Sahih" did not consistently evoke negative emotions. Arab listeners showed significantly reduced valence and dominance alongside increased gamma power at T7, a pattern consistent with sadness and emotional processing. Non-Arab listeners instead showed reduced arousal and dominance with increased beta activity, suggesting a rather calming response. These culturally distinct responses were most pronounced with the Ney, the only instrument producing significant between-group differences in both self-reported emotions and gamma activity. The Oud elicited a calming response in non-Arabs, while Qanun increased arousal across the full sample. These exploratory findings suggest that pooling ethnically diverse participants without accounting for these variables may obscure meaningful effects, potentially explaining conflicting findings in music therapy research. Findings describe the possible implications for music intervention design. Maqam Saba on Ney might be promising for eliciting emotional processing in Arab populations. However, further studies are needed to confirm this claim.