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Music therapy combined with cognitive restructuring could provide a mechanism to improve patients’ sense of control over emotional distress. This study evaluates the effect of music therapy combined with cognitive restructuring therapy on emotional distress in a sample of Nigerian couples.The participants for the study were 280 couples in south-east Nigeria. Perceived emotional distress inventory (PEDI) was used to assess emotional symptoms. Repeated measures with analysis of variance were used to examine the effects of the intervention. Mean rank was also used to document the level of changes in emotional distress across groups. Effect sizes were also reported with partial η2.There were no significant baseline differences in emotional distress level between participants in the music therapy with cognitive restructuring group and waitlisted group. Significant decreases in the level of emotional distress were observed in the music therapy with cognitive restructuring group, but the waitlisted group demonstrated no significant change in their score both at posttreatment and 3 follow-up assessments.Our findings suggest music therapy with cognitive restructuring therapy is effective for reducing emotional distress of couples. In addition, the positive effect of the music therapy with cognitive restructuring therapy program can persist at follow-up. Therefore, therapists have to continue to examine the beneficial effects of music therapy with cognitive restructuring therapy on emotional distress level of couples both in Nigeria and in other countries.