Music can trigger strong emotions that are accompanied by reactions of the autonomic nervous system and lead to goose bumps, so-called chills, tears in the eyes, and a feeling of a lump in the throat. In this chapter, we will first discuss various definitions of emotions and then present music-making as emotional communication. Strong positive emotions when listening to music are to be expected when surprising structural changes occur in the music that deceive an expectation. The human voice, the beginning of something new, the increase in volume in the high register, the association with positive emotional memories, and a general preference for the genre of music in question are further factors that favor chill reactions. Biologically, these reactions are associated with an increase in arousal and facilitate memory formation. In terms of brain physiology, they are associated with an activation of the dopaminergic reward system in the brain. In music therapy, the positive moods associated with these strong auditory experiences can reduce the joylessness in depression and schizophrenia and trigger biographical memories in dementia through the strong memory-forming function.