Music Listening in Stem Cell Transplantation and Acute Myeloid Leukemia: A Randomized Clinical Trial

CONTEXT

Music listening (ML) has been shown to have a beneficial effect on patients with cancer. However, novel intervention approaches are needed.

OBJECTIVES

We aimed to determine whether ML based on the iso-principle, conducted using a mobile application (GloMus), improves symptom burden, quality of life (QoL), anxiety, and depression in patients undergoing stem cell transplantation (SCT) and intensive induction chemotherapy for acute myeloid leukemia (AML).

METHODS

In this randomized controlled clinical trial, we assigned 71 patients to the ML or standard care (SC) groups, stratified by the reason for admission (AML, allogeneic-SCT, or inpatient/outpatient autologous-SCT). Upon admission, participants in the ML groups were invited to undergo daily ML sessions designed to change negative moods into positive ones (iso-principle). The intervention consisted of listening to pre-recorded classical music ordered by beats per minute and tonality. Symptom burden (Edmonton Symptom Assessment System-Revised) was assessed in the ML groups before and after each session. Anxiety, depression (Hospital Anxiety and Depression Scale), and QoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation/Leukemia) were measured weekly in the ML and SC groups.

RESULTS

Symptom burden in both allogeneic- and inpatient autologous-SCT ML groups reduced after the intervention. In all experimental groups, clinically important improvements were observed after ML sessions. No differences were found between the groups (ML vs. SC) at different weeks of admission regarding anxiety, depression, and QoL.

CONCLUSIONS

ML based on our innovative iso-principle strategy, conducted using GloMus, reduced the symptom burden in patients undergoing allogeneic- and inpatient autologous-SCT (ClinicalTrials.gov number, NCT05696457).

Development and validation of audio-based guided imagery and progressive muscle relaxation tools for functional bloating

Mind-body techniques, including Guided Imagery (GI) or Progressive Muscle Relaxation (PMR), may effectively manage bloating. The current study aimed to develop and validate (psychometric and psychological responses) audio-based GI and PMR techniques for bloating. Audio scripts were first developed from literature reviews and in-depth interviews of participants with bloating diagnosed based on the Rome IV criteria. Scripts were validated using psychometric (content & face validity index) and physiological approaches (brain event-related potentials & heart rate variability). 45/63 participants completed the in-depth interview, and ‘balloon’ emerged as the synonymous imagery description for bloating, of which inflation correlated with a painful sensation. The final tools consisted of narrated audio scripts in the background of a validated choice of music. Overall, the content and face validity index for PMR and GI ranged from 0.92 to 1.00. For ERP and HRV, 17/20 participants were analyzed. For ERP, there was a significant difference between GI and PMR for alpha waves (p = 0.029), delta waves (p = 0.029), and between PMR and control for delta waves (p = 0.014). For HRV, GI and PMR exhibited similar autonomic responses over controls (overall p<0.05). The newly developed GI and PMR audio-based tools have been validated using psychometric and physiological approaches.

Applying Meta-Learning and Iso Principle for Development of EEG-Based Emotion Induction System

Music is often used for emotion induction. ince the emotions felt when listening to it vary from person to person, customized music is required. Our previous work designed a music generation system that created personalized music based on participants' emotions predicted from EEG data. Although our system effectively induced emotions, unfortunately, it suffered from two problems. The first is that a long EEG recording is required to train emotion prediction models. In this paper, we trained models with a small amount of EEG data. We proposed emotion prediction with meta-learning and compared its performance with two other training methods. The second problem is that the generated music failed to consider the participants' emotions before they listened to music. We solved this challenge by constructing a system that adapted an iso principle that gradually changed the music from close to the participants' emotions to the target emotion. Our results showed that emotion prediction with meta-learning had the lowest RMSE among three methods (p < 0.016). Both a music generation system based on the iso principle and our conventional music generation system more effectively induced emotion than music generation that was not based on the emotions of the participants (p < 0.016).

The effects of music & auditory beat stimulation on anxiety: A randomized clinical trial

Background and objectives

Music and auditory beat stimulation (ABS) in the theta frequency range (4–7 Hz) are sound-based anxiety treatments that have been independently investigated in prior studies. Here, the anxiety-reducing potential of calm music combined with theta ABS was examined in a large sample of participants.

Methods

An open-label randomized controlled trial was conducted with participants taking anxiolytics (n = 163). Participants were randomly assigned using the Qualtrics randomizer algorithm, to a single session of sound-based treatment in one of four parallel arms: combined (music & ABS; n = 39), music-alone (n = 36), ABS-alone (n = 41), or pink noise (control; n = 47). Pre- and post-intervention somatic and cognitive state anxiety measures were collected along with trait anxiety, personality measures and musical preferences. The study was completed online using a custom application.

Results

Based on trait anxiety scores participants were separated into moderate and high trait anxiety sub-groups. Among participants with moderate trait anxiety, we observed reductions in somatic anxiety that were greater in combined and music-alone conditions than in the pink noise condition; and reductions in cognitive state anxiety that were greater in the combined condition than in the music-alone, ABS-alone, and pink noise conditions. While we also observed reductions in somatic and cognitive state anxiety in participants with high trait anxiety, the conditions were not well differentiated.

Conclusions

Sound-based treatments are effective in reducing somatic and cognitive state anxiety. For participants with moderate trait anxiety, combined conditions were most efficacious.

Emotion Modulation through Music after Sadness Induction-The Iso Principle in a Controlled Experimental Study

Music therapy intervention manuals suggest that individuals who suffer from affective disorders benefit from listening to music according to the iso principle. The iso principle comprises listening to music that matches the current mood of patients at first, and then to gradually shift to music that represents a desired mood. Within the current study, we investigate whether the sequence of music with different emotional valence can modulate the emotional state. All participants were healthy adults who underwent a sadness induction via a movie clip. They were subsequently divided into four experimental groups. Each was asked to listen to two pieces of music according to a specific sequence: sad-sad; sad-happy; happy-happy; happy-sad. Participants were prompt to rate their current emotional state at different stages of the experiment: prior to and after the movie clip, as well as after each of the two pieces of music. The frame used for the assessment was the Positive and Negative Affect Schedule and the Self-Assessment Manikin. The results indicate that the movie clip induced sadness. The group of participants who listened to the sad music first and the happy music afterwards ultimately reported a higher positive affect, a higher emotional valence, and a lower negative affect compared with the other groups. However, not all the between-group differences reached significance. We conclude that the sequence of music with different emotional valence affects the current emotional state. The results are generally in line with the iso principle. Directions for future research are presented.

Effectiveness of Receptive Music Therapy with Imbedded 10 Hz Binaural Beats Compared with Standard Care for Patients with Major Depressive Disorder: A Randomized Controlled Trial

OBJECTIVES

The purpose of this study was to determine the effectiveness of music therapy (MT) with imbedded 10 Hz binaural beats in combination with standard treatment in comparison to standard treatment alone in patients diagnosed with major depressive disorder (MDD).

METHODS

This study was a randomized controlled trial enrolling 18 MDD adult patients aged ≥20 years old with mild to moderate levels of acute phase depression. The intervention group received MT along with standard treatment, while the control group received only standard treatment. 10-Hz binaural beats were embedded into soothing music. The participants listened to the MT via stereo headphones for 20 min at the clinic and were instructed to continue listening to the track at home at least 3 times/week. The primary outcome was depression score using patient health questionnaire depression screening (PHQ-9). The secondary outcomes were quality of life, measured by the Euro Quality of Life Five-Dimension (EQ-5D) rating, and medications adherence, measured by the medication adherence rating scale (MARS). The outcomes were measured at week 0, week 4, and week 8.

RESULTS

At baseline, the primary outcome of PHQ-9 did not differ between the MT group and the control group (13.3 ± 4.4; 13.9 ± 3.37; p-value = 0.77). After a follow-up of 4 and 8 weeks, the PHQ-9 in the MT group was lower than the control group by 1.50 (95 % confidence interval: -4.46 to 1.46). However, this difference was not significant, with p-value = 0.32. As for the secondary outcome, there were no significant differences in terms of EQ-5D and MARS.

CONCLUSIONS

This study concluded that MDD patients who received 10-Hz binaural beat imbedded MT combined with standard treatment had experienced no significant differences compared with control group in terms of depression score, quality of life, and medication adherence. Further studies are suggested to investigate the long-term effect of MT with binaural beats.

Neurophysiological Synchrony Between Children With Severe Physical Disabilities and Their Parents During Music Therapy

Although physiological synchronization has been associated with the level of empathy in emotionally meaningful relationships, little is known about the interbrain synchrony between non-speaking children with severe disabilities and their familial caregivers. In a repeated measures observational study, we ascertained the degree of interbrain synchrony during music therapy in 10 child-parent dyads, where the children were non-speaking and living with severe motor impairments. Interbrain synchrony was quantified via measurements of spectral coherence and Granger causality between child and parent electroencephalographic (EEG) signals collected during ten 15-min music therapy sessions per dyad, where parents were present as non-participating, covert observers. Using cluster-based permutation tests, we found significant child-parent interbrain synchrony, manifesting most prominently across dyads in frontal brain regions within β and low γ frequencies. Specifically, significant dyadic coherence was observed contra-laterally, between child frontal right and parental frontal left regions at β and lower γ bands in empathy-related brain areas. Furthermore, significant Granger influences were detected bidirectionally (from child to parent and vice versa) in the same frequency bands. In all dyads, significant increases in session-specific coherence and Granger influences were observed over the time course of a music therapy session. The observed interbrain synchrony suggests a cognitive-emotional coupling during music therapy between child and parent that is responsive to change. These findings encourage further study of the socio-empathic capacity and interpersonal relationships formed between caregivers and non-speaking children with severe physical impairments.

Music therapy for stress reduction: a systematic review and meta-analysis

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

The effects of inpatient music therapy on self-reported symptoms at an academic cancer center: a preliminary report

PURPOSE

Music therapy has shown benefits for reducing distress in individuals with cancer. We explore the effects of music therapy on self-reported symptoms of patients receiving inpatient care at a comprehensive cancer center.

METHODS

Music therapy was available as part of an inpatient integrative oncology consultation service; we examined interventions and symptoms for consecutive patients treated by a board-certified music therapist from September 2016 to May 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS, 10 symptoms, scale 0-10, 10 most severe) before and after the intervention. Data was summarized by descriptive statistics. Changes in ESAS symptom and subscale scores (physical distress (PHS), psychological distress (PSS), and global distress (GDS)) were evaluated by Wilcoxon signed rank test.

RESULTS

Data were evaluable for 96 of 100 consecutive initial, unique patient encounters; 55% were women, average age 50, and majority with hematologic malignancies (47%). Reasons for music therapy referral included anxiety/stress (67%), adjustment disorder/coping (28%), and mood elevation/depression (17%). The highest (worst) symptoms at baseline were sleep disturbance (5.7) and well-being (5.5). We observed statistically and clinically significant improvement (means) for anxiety (- 2.3 ± 1.5), drowsiness (- 2.1 ± 2.2), depression (- 2.1 ± 1.9), nausea (- 2.0 ± 2.4), fatigue (- 1.9 ± 1.5), pain (- 1.8 ± 1.4), shortness of breath (- 1.4 ± 2.2), appetite (- 1.1 ± 1.7), and for all ESAS subscales (all ps < 0.02). The highest clinical response rates were observed for anxiety (92%), depression (91%), and pain (89%).

CONCLUSIONS

A single, in-person, tailored music therapy intervention as part of an integrative oncology inpatient consultation service contributed to the significant improvement in global, physical, and psychosocial distress. A randomized controlled trial is justified.

Haven: Sharing receptive music listening to foster connections and wellbeing for people with dementia who are nearing the end of life, and those who care for them

This paper reports on research exploring the effects of music played for 12 dyads: a care home resident ('resident') with dementia and someone closely connected to him/her ('carer'). Six individualised music interventions (3 live and 3 pre-recorded) were played by the first author on solo cello within five Scottish non-NHS care homes. All interventions were video-recorded. Semi-structured interviews with carer participants, key staff, and managers explored their responses to interventions. Thick descriptions of video recordings and interview transcripts were thematically coded using Nvivo. A key finding was that structural elements of the interventions combined with characteristics of the music played facilitated an internalised experience of 'haven'; sonically transporting listeners away from their present reality and fulfilling the basic human needs for inclusion, comfort, identity, occupation and attachment.

Intentional music use to reduce psychological distress in adolescents accessing primary mental health care

RATIONALE

Many young people turn to music as a way of exploring and managing their moods and emotions. The literature is replete with studies that correlate music preferences and mental health, as well as a small but increasing interest in uses of music to promote well-being. Recent studies have shown that music use is often unconscious, thus difficult to influence without therapeutic conversations. No study has yet tested whether it is feasible to increase awareness of music use in young people who tend to ruminate with music, and test whether increased awareness can reduce distress.

DESIGN

This feasibility study aimed to determine whether involvement in a brief music-based intervention was engaging and acceptable to a small sample of young people, and whether their levels of distress decreased and insight into music uses increased. A mixed methods approach was adopted, merging scores of distress and self-reported experience of the intervention to foster interpretation.

RESULTS

Convergent analysis of the different data forms suggests that at least some of the measurable decreases in distress captured for all of the participants were related to participation in the sessions, according to the self-report of a number of the young people in interviews. This is demonstrated through descriptive data compiled under two key themes (Agency and Changed Uses) and illustrated through three case examples that were drawn largely from the words of the young people.

CONCLUSION

This feasibility study suggests that young people's relationship with music provides a powerful platform for leveraging engagement in services and improvements in distress, when well timed and carefully scaffolded.

Remini-Sing: A Feasibility Study of Therapeutic Group Singing to Support Relationship Quality and Wellbeing for Community-Dwelling People Living With Dementia and Their Family Caregivers

Background: Living at home following a diagnosis of dementia can be difficult for both the person living with dementia (PwD) and their family caregivers (FCG). Active group music participation may provide an avenue for emotional release, offer psychosocial support to caregivers and stimulate meaningful interaction between caregivers and loved ones with dementia. Therapeutic music interventions also have the capacity to facilitate reminiscence and social engagement and can help to manage challenging symptoms associated with dementia, such as anxiety, apathy, and agitation.

Method: This feasibility study examined the acceptability of a 20-week therapeutic group singing intervention (Remini-Sing) and quantitative research assessments for PwD/FCG dyads living in the community. Quantitative measures for the following outcomes were tested for sensitivity and acceptability: relationship quality (PwD and FCG); life satisfaction, caregiver satisfaction, flourishing, and depression for FCGs; and anxiety, apathy, agitation, and quality of life for PwD. Quantitative assessments were conducted before, during (midway) and after 20 weeks of participation in a therapeutic singing group attended by the PwD and FCG together. The Remini-Sing intervention incorporated vocal warm ups, singing familiar songs, learning new songs, and opportunities for social interaction. Qualitative interviews were conducted with all dyads that completed the intervention.

Results: Twelve PWD/FCG dyads were recruited and enrolled in the study. High participation and retention rates indicated that the intervention was received favorably by participants. There were no statistically significant changes on measures from pre to post intervention. However, favorable baseline scores on relationship quality and wellbeing measures were sustained over the 20-week intervention. The testing of these measures for feasibility also revealed that some were too difficult for PwD and thus yielded questionable results, some were potentially less relevant, and there were likely floor and ceiling effects on several of the measures utilized.

Conclusions: This study demonstrated good feasibility for a research protocol and therapeutic group singing intervention for community-dwelling PwD and their FCGs. Participant reflections and researcher observations yielded useful information guiding the selection of quantitative outcome measures for future research in this area.