Arch Psychiatr Nurs. 2009 Apr;23(2):177-9

A review of the evidence for music intervention to manage anxiety in critically ill patients receiving mechanical ventilatory support.

Chlan L.
University of Minnesota, School of Nursing, 5-160 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455, USA

Critically ill patients receiving mechanical ventilatory support experience profound anxiety with this common treatment modality. Music intervention is one adjunctive therapy that can be implemented to allay anxiety. This article reviews the evidence support music as an adjunctive intervention with mechanically ventilated patients.

Air Med J. 2009 Mar-Apr;28(2):88-91

Music reduces patient anxiety during interfacility ground critical care transport.

Stuhlmiller DF, Lamba S, Rooney M, Chait S, Dolan B.
New York Medical College, Valhalla, NY 10595, USA

INTRODUCTION: Interfacility ground critical care transport (CCT) of patients by ambulance may be stressful. This study evaluated whether playing music during CCT reduces patient anxiety and whether objective evidence is manifested by a change in vital signs. SETTING: Urban teaching hospital. METHODS: In this prospective cohort study, music was played for eligible adult patients during CCT while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not. RESULTS: One hundred two patients were enrolled; 23 respondents (22.5%) constituted the study group. Four patients (17.4%) reported CCT as stressful (average response, 4.75). Nineteen (82.6%) rated CCT as not stressful (average response, 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort and relaxation but only a minimal decrease in anxiety. No statistically significant change in vital signs was observed between cohorts; too few patients were enrolled to generate power to detect any difference. CONCLUSIONS: Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety. The small number of patients in this preliminary report limits the strength of any conclusions. Larger studies are needed.

Pediatr Emerg Care. 2008 Dec;24(12):836-8

Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?

Holm L, Fitzmaurice L.
Department of Pediatrics, Division of Emergency Medical Services, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. METHODS: The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. RESULTS: The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). CONCLUSIONS: Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.

Hu Li Za Zhi. 2008 Oct;55(5):35-44

The effectiveness of music therapy in reducing physiological and psychological anxiety in mechanically ventilated patients

Wu SJ, Chou FH.
Department of Nursing, Chuang-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, ROC

Anxiety, a common reaction in patients receiving ventilation therapy, often impacts negatively on patient recovery. Music therapy, a non-invasion intervention, is readily accepted by patients and has been used to relieve patient anxiety with encouraging results. The purpose of this study was to investigate the effectiveness of music therapy on reducing anxiety in patients on mechanical ventilators. An experimental design was used and all cases were collected from a medical center in southern Taiwan. While the experimental group patients took a 30-minute music therapy session, control group patients were asked to rest. Both facility anxiety and anxiety visual scales were used as research tools, with other non-invasive medical instruments employed to measure heartbeat and breathing, blood pressure and blood oxygen saturation in both patient groups. When compared with the control group, patients in the experimental group showed significant improvement in sense of anxiety (Brief Anxiety Scale, BAS, t(29) = -4.80, p < .001; Visual Analogue Anxiety Scales, VAAS, t(29) = -3.38, p = .002), diastolic pressure (t(29) = -2.74, p = .002), mean arterial pressure(t(29) = -2.26, p = .031) and breathing rate (t(29) = -4.84, p < .001). In analyzing data from the two groups, we found that the sense of anxiety (BAS, t(58) = -3.21, p = .002; VAAS, t(58) = -2.90, p = .005) and breathing rate (t(58) = -3.20, p = .002) in the experimental group decreased significantly following music therapy. Study results are hoped to serve as an important reference for clinical nursing staff. Also, it is hoped that the music therapy method may help facilitate achievement of broader humanized nursing goals.

J Health Psychol. 2008 Oct;13(7):912-20

An investigation of the effects of music on anxiety and pain perception in patients undergoing haemodialysis treatment.

Pothoulaki M, Macdonald RA, Flowers P, Stamataki E, Filiopoulos V, Stamatiadis D, Stathakis ChP.
Glasgow Caledonian University, UK

This study aimed to investigate the effects of preferred music listening on anxiety and pain perception in patients undergoing haemodialysis. A two group experimental design was used. Sixty people diagnosed with end stage renal failure undergoing haemodialysis treatment participated in this study. Preferred music listening was applied as an intervention. Anxiety and pain were measured pre-test and post-test. The control group scored significantly higher in state anxiety than the experimental group and experienced significantly higher pain intensity in post-test phase. Findings provide experimental evidence to support the effectiveness of preferred music listening in medical settings.

J Clin Nurs. 2008 Oct;17(19):2654-60

Randomised controlled trial of music on state anxiety and physiological indices in patients undergoing root canal treatment.

Lai HL, Hwang MJ, Chen CJ, Chang KF, Peng TC, Chang FM.
Department of Nursing, Tzu Chi University, Hualien, Taiwan

OBJECTIVES: The purpose of this randomised investigator-blind controlled trial is to examine the effects of music on the state anxiety and physiological indices among patients undergoing root canal treatment. DESIGN: Randomised controlled trial. METHODS: Purposive sampling was used to recruit 44 adult subjects. The subjects were randomly assigned to the treatment and the control group. There were 22 subjects in each group. Subjects in the music group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects worn headphones but without the music. Using a repeated measures design with a single pretest and five posttests, the subjects' heart rate, blood pressure and finger temperature were measured before the study and every 10 minutes until the end of the root canal treatment procedure. Anxiety was measured before the study and at the end of the treatment procedure. RESULTS: The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. However, the subjects in the music group showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14 respectively. RELEVANCE TO CLINICAL PRACTICE: The findings provide evidence for nurses and dentists that the use of soothing music for anxiety reduction in patients undergoing root canal treatment procedures is supported by research findings.

Nurse Educ Today. 2008 Nov;28(8):909-16. Epub 2008 Jul 1

Randomized crossover trial studying the effect of music on examination anxiety.

Lai HL, Chen PW, Chen CJ, Chang HK, Peng TC, Chang FM.
Department of Nursing, Tzu Chi University, Taiwan, ROC

The purpose of this study was to assess the effect of lento music on examination anxiety among nursing students. A randomized crossover classroom-based trial was conducted. Thirty-eight students with a mean age of 19.4 years (SD = .54) were randomly assigned to either a music/silence or a silence/music group sequence. The students in the music group were given a 40-min group-based music intervention in a classroom, whereas the students in the silence group received the regular test without music. Using paired t-tests, there were no significant different in pretest scores for state anxiety, examination anxiety, finger temperature and pulse rate between the two conditions. Nonetheless, the findings indicated that music intervention did effectively decrease examination anxiety and state anxiety as well as reducing pulse rate and increasing higher finger temperature (p = 0.05 to 0.001). In addition, significant differences were detected between the pretest and posttest measures for silence (p = 0.001). The results suggest that lento music is effective at anxiety reduction. This study provides evidence for nursing faculty and clinical educators to foster nursing students' mastering over the anxiety of examination by using lento music.

J Palliat Med. 2008 May;11(4):582-90

The effect of music therapy on anxiety in patients who are terminally ill.

Horne-Thompson A, Grocke D.
Calvary Health Care Bethlehem, Melbourne, Victoria, Australia

BACKGROUND: The literature supporting the use of music therapy in palliative care is growing. However, the number of quantitative research studies investigating the use of music therapy in palliative care, and specifically anxiety, is limited. OBJECTIVE: The aim of this research project was to examine the effectiveness of a single music therapy session in reducing anxiety for terminally ill patients. DESIGN: A randomized-controlled design was implemented and the following hypotheses tested. There will be a significant difference between the experimental and control groups on anxiety levels as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System (ESAS), and heart rate. The experimental group received a single music therapy intervention and the control group received a volunteer visit. SETTING/SUBJECTS: Twenty-five participants with end-stage terminal disease receiving inpatient hospice services were recruited. RESULTS: The first hypothesis was supported. Results demonstrated a significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS (p = 0.005). A post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group, specifically pain (p = 0.019), tiredness (p = 0.024) and drowsiness (p = 0.018). The second hypothesis was not supported. CONCLUSIONS: The study supports the use of music therapy to manage anxiety in terminally ill patients. Further studies are required to examine the effect of music therapy over a longer time period, as well as addressing other symptom issues.

AORN J. 2008 Apr;87(4):780-807

The anxiety- and pain-reducing effects of music interventions: a systematic review.

Nilsson U.
Centre for Health Care Sciences and Department of Anesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden

Musical interventions have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood. This article provides a systematic review of 42 randomized controlled trials of the effects of music interventions in perioperative settings. Music intervention had positive effects on reducing patients' anxiety and pain in approximately half of the reviewed studies. Further research into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress. (c) AORN, Inc, 2008.

Ambul Pediatr. 2008 Mar-Apr;8(2):117-28

Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials.

Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L.
From the Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada

OBJECTIVE: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures. METHODS: We searched 16 electronic databases of published and unpublished studies, subject bibliographies, reference lists of relevant articles, and trials registries. Two reviewers independently screened 4559 citations and reviewed the full manuscript of 393 studies. Nineteen studies met the inclusion criteria: randomized controlled trial, children aged 1 month to 18 years were examined, music was used as an intervention, and the study measured pain or anxiety. Music therapy was considered active if a music therapist was involved and music was used as a medium for interactive communication. Passive music therapy was defined as listening to music without the involvement of a music therapist. RESULTS: The 19 included trials involved 1513 subjects. The methodological quality of the studies was generally poor. Overall, MT showed a significant reduction in pain and anxiety (standardized mean difference [SMD] -0.35; 95% confidence interval [CI], -0.55 to -0.14; 9 studies; N = 704; I(2) = 42%). When analyzed by outcome, MT significantly reduced anxiety (SMD -0.39; 95% CI, -0.76 to -0.03; 5 studies; n = 284; I(2) = 52.4%) and pain (SMD -0.39; 95% CI, -0.66 to -0.11; 5 studies; N = 465; I(2) = 49.7%). There was no evidence of publication bias. CONCLUSIONS: Music is effective in reducing anxiety and pain in children undergoing medical and dental procedures. Music can be considered an adjunctive therapy in clinical situations that produce pain or anxiety.

J Pediatr Orthop. 2007 Oct-Nov;27(7):831-3

A randomized prospective study of music therapy for reducing anxiety during cast room procedures.

Liu RW, Mehta P, Fortuna S, Armstrong DG, Cooperman DR, Thompson GH, Gilmore A.
Department of Orthopaedics, Case Western Reserve University, Cleveland, OH 44106, USA

BACKGROUND: Cast room procedures, such as cast application and removal, pin removal, and suture removal can cause significant anxiety in young children. The use of music therapy in the cast room to decrease anxiety has not been previously reported. METHODS: We performed a randomized, prospective study of soft lullaby music compared with no music in 69 children 10 years or younger undergoing cast room procedures. Heart rates (beats per minute) were recorded in the waiting room and cast room using a pulse oximeter. RESULTS: A total of 28 children were randomized to music and 41 children to no music. The mean rise in heart rate between the waiting room and entering the cast room was -2.7 beats/min in the music group and 4.7 beats/min in the no music group (P = 0.001). The mean difference in heart rate between the waiting room and during the procedure was 15.3 beats/min in the music group and 22.5 beats/min in the no music group (P = 0.05). There were 7 patients in the no music group with heart rate increases of greater than 40 beats/min. No patient in the music group had an increase of this magnitude. CONCLUSIONS: Playing soft music in the cast room is a simple and inexpensive option for decreasing anxiety in young children during cast room procedures. LEVEL OF EVIDENCE: Randomized Clinical Trial, Level II.

Rev Esp Anestesiol Reanim. 2007 Jun-Jul;54(6):355-8

Music versus diazepam to reduce preoperative anxiety: a randomized controlled clinical trial

Berbel P, Moix J, Quintana S.
Departamento de Anestesiología, Reanimación y Clínica del Dolor del Hospital Mutua de Terrassa, Barcelona

OBJECTIVES: To compare the effectiveness of music to that of diazepam in reducing preoperative anxiety. PATIENTS AND METHODS: Patients were randomized to 2 groups to receive diazepam or listen to music on the day of surgery and the previous day. Just before the operation, anxiety was assessed with the State-Trait Anxiety Inventory. Cortisol levels, heart rate, and blood pressure were also recorded. RESULTS: Two hundred seven patients were enrolled. No significant differences in any of the outcome measures (anxiety, cortisol level, heart rate, or blood pressure) were found between the 2 groups (music vs sedative). CONCLUSIONS: Our findings indicate that music is as effective as sedatives for reducing preoperative anxiety.

J Music Ther. 2007 Fall;44(3):242-55

The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment.

Ferrer AJ.
The Florida State University, Tallahassee Memorial HealthCare, USA

The purpose of this study was to investigate the effects of familiar live music on the anxiety levels of patients undergoing chemotherapy treatment. Randomly selected patients were assigned to experimental (n = 25) and control (n = 25) conditions. Pre and posttests consisted of questionnaires and the recording of the patient's heart rate and blood pressures. Subjects in the experimental group received 20 minutes of familiar live music during their chemotherapy treatment. Subjects in the control group received standard chemotherapy. It was assumed that those patients receiving music intervention would: (a) lower their anxiety levels; (b) experience a decrease in heart rate and blood pressure; (c) improve their levels of negative reactions including fatigue, worry, and fear; and (d) improve their levels of positive reactions including comfort and relaxation. Results of the study showed statistically significant improvement for the experimental group on the measures of anxiety, fear, fatigue, relaxation, and diastolic blood pressure. No significant differences between groups were found for heart rate and systolic blood pressure. Descriptive values indicated that, on average, the experimental group was influenced positively by the music intervention, and participants improved their quality of life while undergoing chemotherapy treatment.

Medsurg Nurs. 2007 Feb;16(1):7-14

The effect of music therapy on patients' perception and manifestation of pain, anxiety, and patient satisfaction.

Richards T, Johnson J, Sparks A, Emerson H.
West Virginia University Hospitals, Morgantown, WV, USA

An extensive review and synthesis of current research was completed to identify the clinical benefit of using music therapy in the hospital setting. It demonstrated that music therapy has the potential to improve the hospital experience of patients.

J Vasc Nurs. 2006 Sep;24(3):68-73

A music intervention to reduce anxiety before vascular angiography procedures.

Buffum MD, Sasso C, Sands LP, Lanier E, Yellen M, Hayes A.
VA Medical Center and University of California, School of Nursing, San Francisco, California 94121, USA

Patients scheduled for vascular angiography are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported mixed results for anxiety reduction techniques in other procedures settings, such as education, cognitive-behavioral skills, coping and relaxation skills, combinations of techniques, and music. Music as an intervention for pre-procedural anxiety prior to vascular angiography has not been studied. A randomized controlled trial of 170 patients was undertaken to determine whether 15 minutes of self-selected music reduced pre-procedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred sixty-six men and 4 women comprised the sample with an average age of 66.8 years (SD 9.95, range 37 to 85 years). Patients who listened to music (n=89) reduced their anxiety score from 38.57 (SD 10.46) to 35.2 (SD 9.7), while those who did not listen to music (n=81) reduced their anxiety score from 36.23 (SD 10.54) to 35.1 (SD 10.59); the difference between the groups was statistically significant (t=1.95, df 161, p=0.05). Pulse achieved a statistically significant reduction in the music group (t=2.45, df 167, p=0.02). Music is a noninvasive nursing intervention that patients enjoy and reduces their anxiety and their pulse rate. Further research should address using music to reduce anxiety in other interventional vascular angiography settings with equal numbers of men and women and comparing self-selected versus investigator-selected music.

J Music Ther. 2006 Summer;43(2):136-53

The effects of music therapy on pediatric patients' pain and anxiety during donor site dressing change.

Whitehead-Pleaux AM, Baryza MJ, Sheridan RL.
St. Mary-of-the-Woods College.

The purpose of this study was to assess the effects of music therapy on pain and anxiety in pediatric burn patients during a donor site dressing change. Fourteen subjects were randomly selected to participate in this study. The experiment was conducted in the Reconstructive Unit of Shriners Burns Hospital-Boston. The experimental group's intervention consisted of live music and was compared to a control group whose intervention was verbal interaction. Psychological, behavioral, and physiological data were assessed through the Wong Baker FACES Pain Rating Scale, the Fear Thermometer, the Nursing Assessment of Pain Index, heart rate, and respiration rate. Data were analyzed using the ANCOVA, Mann-Whitney U, and regression analysis. The results were mixed and inconclusive. The members of the experimental group reported anecdotal information about the effects of music on pain and anxiety. An exploration of the limitations of the study and suggestions for further study are discussed.

Taehan Kanho Hakhoe Chi. 2006 Apr;36(2):321-9

The effect of music therapy on anxiety and depression in patients undergoing hemodialysis

Kim KB, Lee MH, Sok SR.
415 College of Nursing Science, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Korea

PURPOSE: The purpose of this study was to determine the effects of music therapy on anxiety and depression in patients undergoing hemodialysis. METHOD: The study was designed using a nonequivalent control group pretest-posttest design. The subjects consisted of 36 patients (Experimental group: 18, Control group: 18) who received hemodialysis in three hospitals located in Seoul. The measures were a Music Preference Questionnaire (MPQ), anxiety measurement, and depression measurement. Data was collected from December 26, 2004 to April 2, 2005 through questionnaires. The collected data was analyzed by the SPSS 10.0 program. RESULT: The first hypothesis that patients undergoing hemodialysis who received music therapy would have less anxiety than patients undergoing hemodialysis who did not receive music therapy was supported (F=8.05, p=.008). The second hypothesis that patient undergoing hemodialysis who received music therapy would have less depression than patients undergoing hemodialysis who did not receive music therapy was supported (F=11.86, p=.002). CONCLUSION: The results of this study suggest that music therapy may be applied as a method of nursing intervention contributing to the improvement of quality of life by reducing their anxiety and depression of patients undergoing hemodialysis.

Pol Arch Med Wewn. 2005 Apr;113(4):314-9

The effect of music therapy on anxiety level in hospitalized asthmatic patients

Nowobilski R, Czyz P, Furgal M, Wegrzyn-Sliwka A, Ptak-Witkowsk A, Kliczewska A, Bochenek G, Adamek L, Polczyk R, Nizankowska-Mogilnicka E, de Barbaro B, Szczeklik A.
II Katedra Chorób Wewnetrznych CM UJ w Krakowie

The role of music therapy as a supportive treatment is not well defined. The music therapy cannot be estimated as the isolated method it is often only the part of the complex therapy. The aim of this study was to evaluate the influence of music therapy on anxiety level in hospitalized asthmatic patients. The patient group was consisted of 36 patients with bronchial asthma (23 women and 13 men). In all patients we evaluated the level of anxiety (attribute and state) according to Spielberger and intensity of dyspnoe according to Borg scale at the first day of examination and after 10 days of rehabilitation program. Moreover we performed spirometry. The respiratory rehabilitation program included: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. The duration of music therapy lasted 15 min. After 10 days rehabilitation with or without music therapy we found the reduction of anxiety (state) (p<0.0001). However we did not observe the difference between two studied groups with or without music therapy in diminishing of anxiety (p = 0.55). In conclusion, we believe that the music therapy can play important role in treatment of somatic disease but our study did not confirm its additive positive meaning in patients with bronchial asthma.