What is Anxiety?
We often hear words like “anxiety” being thrown around in daily conversations that we engage in or even in discussions we overhear. It is important to properly understand what anxiety is before exploring the role of music therapy for anxiety. Anxiety can be an emotional response to certain stressful situations which may cause worry.1 Commonly, individuals may experience some anxiety when they are about to take an important test, for example.1 This can be classified as state anxiety, because the anxiety is brought on by a specific situation and normally subsides when that situation is no longer present.2 However, anxiety can be more than just an occasional expected emotional response. Anxiety Disorder occurs when a person feels anxious but the feeling does not dissipate and can get worse, sometimes to the point where it interferes with daily life such as relationships, jobs, and work.1 Individuals who present with Anxiety Disorder commonly have a higher trait anxiety, which refers to one’s tendency to present with state anxiety.2 Trait anxiety normally does not fluctuate as much - instead it is a part of an individual’s self.2 Researchers claim that the difference between state and trait anxiety is important when assessing individuals, however, this is still quite a new and contested concept in the field.2 Thus, anxiety is incredibly multifaceted and there is definitely more to it than this brief overview, but through understanding some of the many different layers, we can better understand how music therapy could play a role in helping those experiencing anxiety.
Long, Mary. Adobe Stock. Available from: https://www.leafly.ca/news/health/how-to-use-cbd-for-anxiety
What is the relationship between Music Therapy and Anxiety?
Music therapy is a unique form of health care, as it can be used to target all five domains of health: physical, emotional, psychological, spiritual, and social.3 As such, it can provide a multifaceted approach that is necessary when providing mental health care. Music therapy has been utilized effectively in a variety of healthcare settings and with a diverse group of patients, ranging from cancer patients or Alzheimer's patients to women seeking shelter or those struggling with substance abuse issues. Anxiety is commonly experienced alongside additional health issues or difficult life experiences; as such, music therapy can be used to target anxiety to a wide variety of settings and provide a unique healthcare experience. Music therapy may provide unique treatment methods as it is an individualistic approach that has the ability to address the goals and needs of the client in a holistic, effective way.4 Moreover, music can influence the emotion, attention, cognition, behaviour, and communication of an individual.4
Exploring the Literature
Bambach, Matthew. The Globe and Mail. Available from: https://www.theglobeandmail.com/life/health-and-fitness/health/the-power-of-music-to-heal/article18914499/
Based on an unpublished literature review by Zachary Rezler and Sharon Chernyak, there are currently 22 studies that are specifically focused on music therapy, stress and anxiety. We selected 7 of these articles to share with you and explore the findings and applications of this research.
Music Therapy & Anxiety in the Medical World
As previously mentioned, music therapy has the potential to address anxiety in patients who are experiencing other health difficulties. In healthcare, many illnesses or treatments are shown to co-occur with a decline in mental health or experiences of distress and anxiety. This can be classified as a type of state anxiety and is depicted clearly in the literature summaries that will follow in this section. In these summaries, many patients are experiencing a type of state anxiety, which music therapy is helping to address.
First, we will begin with a study that uses music therapy to improve anxiety and stress in Alzheimer’s patients.5 Patients with Alzheimer's disease (AD) have shown a greater prevalence of depression and anxiety. In this study, patients with mild AD received a 60 minute MT session with a credentialed music therapist. Before and after the intervention, each participant’s saliva was acquired to test the level of cortisol in the patient, as cortisol is a hormone associated with stress. The results of this study showed a significant decrease in participants cortisol levels after the MT session, suggesting a decrease in their stress and anxiety. This is important as high stress levels shown by high cortisol levels is one of the known contributors of the development of AD and by using MT to lower stress levels, the progression of the disease could slow down. Additionally, as a non pharmacological approach, MT shows promise to being a supplementary therapy to address anxiety and stress, especially considering that medication adherence can be difficult in Alzheimer's patients.
Another area where MT has shown promise is with addressing anxiety in cancer patients. A trial conducted by Rossetti, et al. recruited patients recently diagnosed with cancer who were to undergo simulation for radiation therapy (RT).6 Simulation for RT is an initial process done at the beginning of all RT and can be quite anxiety-inducing for patients. This first step is also known to set the bar for the rest of the treatment process, thus, patients feeling anxiety here may be more likely to feel anxious throughout the course of their cancer treatment. The researchers were able to collect findings which showed a significant decrease in state anxiety levels for those who received MT while undergoing their simulation for RT. In the group that did not receive MT while undergoing the simulation, there was actually an increase in state anxiety levels. Consequently, this study shows encouraging results for the use of MT as a safe and effective tool to relieve stress in patients in the oncology ward as well as with general symptoms of anxiety or distress.
Lastly, MT can be used to ease distress and anxiety in patients who are being taken off mechanical ventilation in hospitals.7 Mechanical ventilation is a device which is used to help patients breathe when they may not be able to themselves. Such situations occur in medicine when a patient is under general anesthesia, for example. When a patient needs to be weaned off a mechanical vent, it can be incredibly distressing and cause anxiety for the patient, often making it even harder to remove the vent. A study conducted by Hunter, et al. showed that the heart rate and breathing rate of patients who engaged in MT while being weaned off the ventilator was reduced, indicating a more relaxed state.7 The positive results from this study are important as many medications used to help relax patients when removing the mechanical ventilation can end up prolonging the process, leading to a longer hospital stay. Music therapy, being a non-pharmacological approach, can help to combat this, and ultimately lead to patients feeling healthier and being discharged sooner from the ICU.
Music Therapy & Wellbeing
For those who have experienced domestic violence or abuse, a shelter provides a safe place for temporary housing and support services, fostering an environment in which women and children can feel safe and take steps to move forward to violence-free living.8 However, many sheltered women face difficult challenges with employment, finance, legal issues, as well as illnesses, both mental and physical.8 There are added complicating factors when children and their well-being are also involved. Since the prevalence of issues in PTSD, anxiety, and sleep disturbances are high among those living in shelters, MT could potentially benefit sheltered women through lowering anxiety levels and promoting well-being. In 2005, Eugenia Hernandez-Ruiz conducted a study exploring the potential effects of music therapy interventions on anxiety levels and sleep patterns of abused women in shelters.8 The study took place in two domestic violence shelters, and most women were caring for at least one child. The study involved comparing an intervention group who received five half-hour MT sessions, compared to a control group, who did not receive music therapy. The MT intervention consisted of 20 minutes of participant-selected pre-recorded music with a Progressive Muscle Relaxation (PMR) script. The control group instead were told to relax on the couch in the same room, but experienced silence as opposed to the music therapy and PMR. The results showed very promising results; music therapy not only greatly reduced anxiety levels, but also significantly improved the quality of sleep in the experimental group compared to the control. This is an indication that music therapy is a promising therapeutic option for those suffering from or experiencing anxiety in a vast array of experiences, centres, or situations. No matter what someone may have gone through or might be experiencing, music is a core link that can connect us and help us to move forward.
Guided Imagery and Music & Anxiety:
Guided imagery in music (GIM) is a music therapy approach under the umbrella of psychotherapy. It combines music listening, relaxation techniques, and exploration of imagery to work towards a patient’s therapeutic goals. It has been used as an insightful tool when dealing with anxiety, in many different contexts. In one study, conducted by Youngshin Kim, the effects of imagery in combination with a music-assisted muscle relaxation technique were tested to see if it could assist with reducing music performance anxiety among pianists.10 The results were promising, indicating a significant reduction in state anxiety among the performers that received the MT interventions, compared to the control group, in part due to music’s unique ability to promote the physiological relaxation response and increase focus.10 A second study focused specifically on state anxiety and the potential for GIM to reduce general stress levels.11 There was a significant decrease in stress levels among the group as indicated from verbal reports and observations.11 A third study conducted by Bolette Daniels Beck et al. measured the biopsychosocial effects of GIM targeting individuals on sick-leave due to work-related stress.12 Data was collected from 2008-2010, and for a period of 9 weeks within that time frame, the randomized intervention group would receive GIM sessions with a music therapist, whereas the control was wait-listed.12 The results indicated significant improvements among the intervention group in mood disturbances, physical stress and overall well-being as well as a more rapid return to work after treatment, compared to the control.12 A common measurement among all three of these articles consisted of the STAIT (State Trait Anxiety Inventory Tool), as well as self-reported questionnaires or surveys.10,11,12 Beck et al. also explored the physiological signals for stress, such as changing levels of hormones like cortisol, testosterone and melatonin, to provide biological or physical measurements of stress.12
Through examining this literature, music therapy interventions can target the complex biopsychosocial nature of anxiety and stress. Additional research in the domain of music therapy, anxiety and stress among a more diverse range of populations is necessary to assess the full range of benefits that MT can offer to patients moving forward. Music has the unique ability to produce widespread effects across the brain, including the reward system, social system, immune system and stress system.12 More research is required in the field of music and health (& music therapy), but as highlighted here, music shows great potential for future therapies, preventative measures, and mental health care.
Naomi Frazer & Anjali Behal
McMaster University, Health Science Undergraduate Students