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The psychoneuroimmunology of music: modulation of psychological state, stress levels and immune response through participatory interventions

Author D.E. Fancourt

Author A. Steptoe

Author L.A. Carvalho

Abstract:

Research into the health benefits of music has rapidly expanded over the last decade with recent studies showing early evidence of the ability of music to alter biomarkers of the neurochemical and neuroendocrine systems. However, it is not clear to what extent music can alter the response of the immune system. This thesis explores psychoneuroimmunological responses to music, in particular focusing on how participatory music interventions can modulate inflammatory responses. The biomarkers investigated include cortisol, a neuroendocrine stress marker, a range of pro- and anti-inflammatory cytokines within the immune system, the social bonding hormone oxytocin and the neuropeptide beta-endorphin. Study 1 involved a six-week drumming intervention for mental health service users, and showed that drumming was associated with short-term increases in positive affect and cytokine activity and reductions in cortisol, and longitudinal improvements in depression, mental and social wellbeing, and reduced pro-inflammatory response. Study 2 replicated study 1 with a control group, showing comparable results at 6 weeks but also showing that if the intervention is extended to 10 weeks, there are also reductions in anxiety and all results are then maintained for 3 months following the end of the intervention. Study 3 aimed to explore the mechanisms of these effects in more detail. A randomised control trial comparing group drumming to three different control conditions showed that drumming, unlike the control conditions, leads to changes in a range of moods and emotions and the accompanying biological responses show signs of being associated with these emotions rather than with the physical parameters of group drumming. Study 4 extended the work of the previous mental health studies to explore how participatory music interventions can interact with the psychobiology of both mental health and physical health by studying patients affected by a chronic disease: cancer. A single session of group singing was found to be associated with reduced levels of cortisol, increased cytokine activity and, surprisingly, reduced levels of both beta-endorphin and oxytocin, again with associations between biological responses and emotions. Given the prevalence of mental health conditions such as depression, either as a primary or secondary diagnosis, and evidence that such conditions are associated with heightened inflammation, participatory music interventions could offer novel opportunities for managing mental health and optimising immune function in patients.

Indexed for UCL by Dragonfly Kingdom Library

https://www.ucl.ac.uk/epidemiology-health-care/study/research-degrees/research-degree-epidemiology-and-health-care/past-phd-titiles/bsh-titles-8

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Abstract

Objective: This experimental study aimed to evaluate the effects of a group music intervention on anxiety and agitation of institutionalized older adults with dementia.

Methods: A total of 60 participants were randomly assigned to an experimental or a control group. The experimental group received a 30-min music intervention using percussion instruments with familiar music in a group setting in mid afternoon twice weekly for 6 weeks, whereas the control group received usual care with no music intervention. The Rating of Anxiety in Dementia scale was used to assess anxiety, and Cohen-Mansfield Agitation Inventory was used to assess agitation at baseline, week 4 and week 6.

Results: Repeated measures analysis of covariance indicated that older adults who received a group music intervention had a significantly lower anxiety score than those in the control group while controlling for pre-test score and cognitive level (F = 8.98, p = 0.004). However, the reduction of agitation between two groups was not significantly different.

Conclusions: Anxiety and agitation are common in older adults with dementia and have been reported by caregivers as challenging care problems. An innovative group music intervention using percussion instruments with familiar music as a cost-effective approach has the potential to reduce anxiety and improve psychological well-being of those with dementia.

Indexed for NIH Pubmed by Dragonfly Kingdom Library

https://pubmed.ncbi.nlm.nih.gov/21823174/

Abstract

Background: Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients.

Objectives: To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to January 2016; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.

Selection criteria: We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adult and pediatric patients with cancer. We excluded participants undergoing biopsy and aspiration for diagnostic purposes.

Data collection and analysis: Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores.

Main results: We identified 22 new trials for inclusion in this update. In total, the evidence of this review rests on 52 trials with a total of 3731 participants. We included music therapy interventions offered by trained music therapists, as well as music medicine interventions, which are defined as listening to pre-recorded music, offered by medical staff. We categorized 23 trials as music therapy trials and 29 as music medicine trials.The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 8.54 units (95% confidence interval (CI) -12.04 to -5.05, P < 0.0001) on the Spielberger State Anxiety Inventory - State Anxiety (STAI-S) scale (range 20 to 80) and -0.71 standardized units (13 studies, 1028 participants; 95% CI -0.98 to -0.43, P < 0.00001; low quality evidence) on other anxiety scales, a moderate to strong effect. Results also suggested a moderately strong, positive impact on depression (7 studies, 723 participants; standardized mean difference (SMD): -0.40, 95% CI -0.74 to -0.06, P = 0.02; very low quality evidence), but because of the very low quality of the evidence for this outcome, this result needs to be interpreted with caution. We found no support for an effect of music interventions on mood or distress.Music interventions may lead to small reductions in heart rate, respiratory rate and blood pressure but do not appear to impact oxygen saturation level. We found a large pain-reducing effect (7 studies, 528 participants; SMD: -0.91, 95% CI -1.46 to -0.36, P = 0.001, low quality evidence). In addition, music interventions had a small to moderate treatment effect on fatigue (6 studies, 253 participants; SMD: -0.38, 95% CI -0.72 to -0.04, P = 0.03; low quality evidence), but we did not find strong evidence for improvement in physical functioning.The results suggest a large effect of music interventions on patients' quality of life (QoL), but the results were highly inconsistent across studies, and the pooled effect size for the music medicine and music therapy studies was accompanied by a large confidence interval (SMD: 0.98, 95% CI -0.36 to 2.33, P = 0.15, low quality evidence). A comparison between music therapy and music medicine interventions suggests a moderate effect of music therapy interventions for patients' quality of life (QoL) (3 studies, 132 participants; SMD: 0.42, 95% CI 0.06 to 0.78, P = 0.02; very low quality evidence), but we found no evidence of an effect for music medicine interventions. A comparison between music therapy and music medicine studies was also possible for anxiety, depression and mood, but we found no difference between the two types of interventions for these outcomes.The results of single studies suggest that music listening may reduce the need for anesthetics and analgesics as well as decrease recovery time and duration of hospitalization, but more research is needed for these outcomes.We could not draw any conclusions regarding the effect of music interventions on immunologic functioning, coping, resilience or communication outcomes because either we could not pool the results of the studies that included these outcomes or we could only identify one trial. For spiritual well-being, we found no evidence of an effect in adolescents or young adults, and we could not draw any conclusions in adults.The majority of studies included in this review update presented a high risk of bias, and therefore the quality of evidence is low.

Authors' conclusions: This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.

Indexed for NIH Pubmed by Dragonfly Kingdom Library

https://pubmed.ncbi.nlm.nih.gov/27524661/