Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers

Bedtime music therapy for college students with insomnia: A randomized assessor-blinded controlled trial

BACKGROUND

Insomnia, a prevalent sleep disorder in contemporary society, frequently coexists with other mental health conditions such as depression, schizophrenia, and obsessive-compulsive disorder. Sleep disorders can compromise daytime functioning and overall quality of life. While music has been explored as an adjunct therapy for insomnia, its efficacy in improving insomnia among students remains unclear.

METHODS

Seventy-five students, aged between 18 and 30 years with an average age of 20.97 years (SD: 1.92), presenting sleep issues were randomly allocated to one of three groups: the classical music group, the jazz music group, and the control group, each with 25 participants. Participants in the classical and jazz music group were instructed to listen to classical or jazz music for a minimum of 30 min preceding bedtime. This was paired with deep breathing and relaxation techniques, practiced two consecutive nights per week from 23:00 to 01:00 over a five-week intervention period. Conversely, participants in the control group were only directed to follow the deep breathing and relaxation techniques before sleep on two consecutive nights weekly. Insomnia severity with the Insomnia Severity Index (ISI), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms with the Beck Depression Inventory-II (BDI- II), and anxiety symptoms with the Self-rating Anxiety Scale (SAS). Measurements were taken at baseline, after the second week of intervention, at the intervention's conclusion (five weeks), and two months post-intervention (follow-up).

RESULTS

1. The music groups showed a significant difference in insomnia severity compared with the control group after five weeks of intervention(p < .05). 2. music groups exhibited significant enhancements in sleep quality relative to the control group after a five-week intervention (p < .05). 3. Regarding mood enhancement, music groups showed significant improvements in depression and anxiety symptoms compared to the baseline after the five-week intervention. Notably, the control group also displayed improvements in these symptoms post-intervention.

CONCLUSION

1. Integrating music into a consistent bedtime routine ameliorates sleep quality and insomnia severity. However, no specific genre of music emerged as the superior choice for pre-sleep listening. 2. While music can considerably enhance mood indicators like depression and anxiety, techniques such as deep breathing and mindfulness also contribute positively. 3. Incorporating music before sleep tangibly elevates overall quality of life and daytime functioning.

TRIAL REGISTRATION

ChiCTR2300073953.

Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases

The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.

Does Vocalization Increase the Positive Valence of Emotion?

PURPOSE

This study aims to determine if the act of voicing can have an effect on mood.

DESIGN

A within-participant reversal paradigm, where each participant served as their own control.

METHODS

Following a baseline condition, 40 participants (8 male, 32 female, none disclosed as other) underwent three experimental conditions: breathing, articulating, and voicing. After each condition, participants underwent a picture-viewing emotion-induction paradigm using the International Affective Picture System followed by rating their current mood and arousal.

RESULTS

Immediately following the articulating condition, aversive pictures were rated as less unpleasant compared with the other conditions. Additionally, arousal levels were rated lower immediately following the articulating and voicing conditions in response to the positive pictures.

CONCLUSIONS

The findings showed that the act of making speech sounds, not simply voicing by itself, may influence the way we process emotions.

Are Art-Based Interventions Effective in Improving Psychological Well-Being Among Informal Caregivers of Cancer Patients? A Systematic Review

Objectives: To systematically synthesize the current evidence on the effects of art-based interventions on improving anxiety, depression, stress, sleep, and well-being of cancer caregivers. Design: A systematic review. Methods: We searched PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases from their inception up to April 2024. Studies exploring the effects of art-based interventions on the psychological symptoms of cancer caregivers were included. We did not restrict the publication to the particular study designs, including randomized controlled trials, quasiexperimental studies, and qualitative studies. Results: Fifteen studies of 607 participants were identified in this systematic review. Overall, the existing studies provided preliminary evidence to suggest that art-based interventions may benefit cancer caregivers in improving anxiety, depression, stress, caregiver burden, and quality of life. However, the relatively low quality of the current evidence limits the efficacy of these findings. Conclusions: According to the existing evidence, the therapeutic benefits of using art-based interventions for improving the psychological well-being of cancer caregivers are uncertain. More high-quality and well-designed studies are still required to confirm the psychological effectiveness of art-based interventions for cancer caregivers in the future.

Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters

People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.

eHealth mindfulness-based music therapy for patients undergoing allogeneic hematopoietic stem cell transplantation: A pilot randomized controlled trial protocol

BACKGROUND

Allogeneic stem cell transplantation (allo-SCT) is the preferred therapy for patients with high-risk or relapsed hematologic malignancies, but may be complicated by psychological distress (e.g., depression, anxiety) and symptom burden (e.g., fatigue, pain). Mindfulness-based music therapy (MBMT), a relatively novel integrative medicine intervention that draws from mindfulness and music therapy principles, has shown promise in improving psychosocial outcomes and symptom burden in cancer patients. We outline an eHealth-based MBMT (eMBMT) intervention protocol examining: (1) feasibility, acceptability, and intended effects of eMBMT in improving HRQOL, symptom burden, and clinical markers of disease activity (e.g., infections), and (2) the extent to which eMBMT music therapy component-associated improvements in HRQOL, symptom burden, and disease activity are mediated by improvements in psychosocial and physiological (e.g., systemic inflammation, immune recovery) adaptation.

METHODS

Participants (n = 60) with a hematologic malignancy undergoing allo-SCT will be randomized to receive eMBMT or an eHealth-based mindfulness meditation (eMM) intervention. eMBMT includes eight 60-min sessions facilitated by a music therapist focusing on mindfulness and music therapy. eMM includes eight 60-min self-led MM practices.

RESULTS

Feasibility, acceptability, HRQOL, symptom burden, disease activity, and mediation effects of psychosocial and physiological adaptation will be assessed at baseline, pre-infusion, and post-engraftment with blood collection at baseline and post-engraftment.

CONCLUSION

The current pilot RCT is the first eMBMT intervention to address the HRQOL and symptom burden of patients who are undergoing allo-SCT. Results will inform a fully powered RCT to establish preliminary efficacy of eMBMT on improvements in HRQOL, symptom burden, and disease activity.

Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease

Background

With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD.

Methods

This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS).

Results

The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group.

Conclusion

Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases.

Clinical trial registration

https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.

A systematic review of change in symptoms, well-being and quality of life with group singing in people with cancer and their caregivers

PURPOSE

This systematic review aimed to assess the impact of group singing on physical function, cancer-related symptoms, well-being (emotional, physical, social, spiritual), and health-related quality of life in individuals with cancer and their caregivers.

METHODS

A search was performed using Ovid MEDLINE, Embase, Scopus and Web of Science from inception to April 2023; key words included cancer, choir, and group singing. Observational cohort, prospective or retrospective studies, randomized controlled studies, and crossover studies were included. Two teams of independent reviewers extracted data and assessed the risk of bias using the Downs and Black Tool.

RESULTS

A total of 6 studies (6 reports) met the inclusion criteria for this review, with a mix of study designs. The overall quality of the studies was poor. Group singing significantly reduced anxiety levels in those with cancer and their caregivers, while the effects on depression were variable and there was no impact on fatigue. Caregivers reported improved well-being, self-efficacy and self-esteem. Both those with cancer and their caregivers had reductions in fear, anger, confusion; and reported improvement in energy, relaxation and connectedness at longer term follow-up compared to no treatment. Those with cancer reported improvements in health-related quality of life domains of bodily pain, vitality and mental health with group singing, though the effects on caregivers were mixed.

CONCLUSIONS

Group singing may have favourable effects on selected symptoms, aspects of well-being, and domains of health-related quality of life specific to vitality, bodily pain, and mental health in individuals with cancer and their caregivers.

Gamma-Aminobutyric Acid in Rice Bran Extract Exerts Antistress Effects in Mouse Models with Depressive-Like Behaviors

Various neurotransmitters are involved in regulating stress systems. In this study, we investigated the effects of gamma-aminobutyric acid-rich rice bran extract (GRBe) in mice stressed by forced swimming and tail suspension tests. Four weeks of oral administration of GRBe (500-2000 mg/kg) reduced the levels of dopamine and corticosterone in the blood and brain while increasing serotonin levels. GRBe was involved not only in stress but also in regulating sleep and obesity-related genes. Modern society experiences diverse and tense lives because of urbanization and informatization, which cause excessive stress due to complicated interpersonal relationships, heavy work burden, and fatigue from the organized society. High levels of stress cause psychological instability and disrupt the balance in the autonomic nervous system, which maintains the body's equilibrium, resulting in cardiovascular and cerebrovascular diseases, hormonal imbalances, and sleep disorders. Therefore, our results suggest that GRBe is a useful substance that can relieve tension by ultimately influencing a depressive-like state by lowering the levels of neuronal substances, hormones, and cytokines involved in stress and sleep disorders.

Multifaceted Music Therapy for Depression in Dementia: A Network Meta-Analysis of Randomized Controlled Trials

This study aimed to assess the efficacy of various music therapy interventions in ameliorating depressive symptoms in dementia patients, utilizing a network meta-analysis approach. We rigorously selected randomized controlled trials focused on music therapy for dementia with depressive symptoms from major electronic databases. The primary outcome measured was the impact on depressive symptoms, with the secondary outcome evaluating dropout rates across different intervention groups and standard care control groups. The research protocol has been duly registered with PROSPERO (Registration ID: CRD42023393059). Our network meta-analysis incorporated 14 randomized controlled trials involving a total of 1080 participants and examined a range of interventions, including active music therapy, listening to music, rhythmic music therapy, singing, and tailored music interventions. The analysis revealed that active music therapy combined with singing emerged as the most effective intervention, demonstrating a significant improvement in depressive symptoms in dementia patients (Standardized Mean Difference [SMD] = -0.89, 95% Confidence Interval [CI]: -1.48 to -0.30). In contrast, listening to music alone showed a smaller effect (SMD = -0.26, 95% CI: -0.71 to 0.20). This study was particularly noteworthy for not showing higher dropout rates compared to standard care, indicating its feasibility and acceptability in clinical settings. The findings of our study indicate that active music therapy combined with singing is an effective approach to reducing depressive symptoms in dementia patients, potentially due to enhanced social interaction. These results offer new perspectives for dementia care, suggesting a promising direction for further research and clinical application.

Cross-sectional associations between patterns of cultural engagement and indicators of biological dysregulation

BACKGROUND

Research has shown that cultural activities may bring about improved health. However, large-scale quantitative analyses on cultural engagement and biomarkers are lacking to date. As a result, the mechanisms through which cultural activities may be associated with health are unclear.

AIM

Test quantitative associations between cultural engagement pattern (including active and passive engagement in arts, sports, and heritage activities) and indicators of biological dysregulation in a large dataset.

SUBJECTS AND METHODS

Understanding Society data were used to conduct cross-sectional linear regression analyses between a data-driven latent class model of cultural engagement and indicators of anthropometric, cardiovascular, metabolic, immune, and neuroendocrine function. Analyses were adjusted for age, gender, ethnicity, childcare responsibility, urbanicity, leisure time satisfaction, capacity-related factors, socioeconomic position, social and economic capital indicators, physical activity, and medication use.

RESULTS

More culturally participants had better indicators of biological health, such as lower waist circumference and fibrinogen blood concentration. Specific associations between cultural engagement pattern and the different biological outcomes were also observed. The associations were explained in part by correlated factors (accounting for around half of the association).

CONCLUSIONS

Cultural engagement is cross-sectionally associated with biomarkers, although the characteristics of people who engage with culture are an important consideration when interpreting these findings.

Biological principles for music and mental health

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.

Effects of choir singing on physiological stress in Japanese older adults: its relationship with cognitive functioning and subjective well-being

BACKGROUND

Leisure activities are believed to contribute to healthy ageing. We compared the effects of choir singing and go playing on cortisol levels in Japanese older adults. We also examined its relevance to the older adults' emotional affect and cognitive performance.

METHODS

Thirty-six older adults participated either in choir or go playing, within a 2 (groups)×2 (time points) design. Dependent measures included levels of salivary cortisol, as well as key psychological, cognitive, and neuropsychological measures.

RESULTS

A significant two-way interaction was observed, showing that levels of salivary cortisol decreased for the choir but increased for the go groups. The decrease in salivary cortisol for the choir group correlated with the participant's negative affect and their degree of cognitive impairment.

CONCLUSION

Choir singing has the potential to reduce Japanese older adults' physiological stress. The decreases can be seen more prominently for people with stronger negative affect and cognitive impairment. Further research is required to replicate these effects.

Music-based environmental therapy and training programme: a qualitative evaluation study, Norway

Various authors have emphasized music's value as beneficial intervention, with few or hardly any side effects. Further studies are called for on how music-based environmental treatment in nursing homes works in practice. The aims of the study are first to explore the subjective experiences, opinions and attitudes of health personnel from nursing homes participating in the 'music-based environmental therapy programme (MB programme); and second, to examine why and how this programme impacts on patients and staff, and how it works in practice. It is the first qualitative study to evaluate the impact of the programme on health personnel's daily practice in nursing homes. The sample was strategically selected by means of convenience sampling, and consisted of 26 (n = 26) nurses, managers, physiotherapists, social workers and carers from 11 nursing homes in the south-east of Norway. Data were collected in autumn 2019 using a methodological triangulation of in-depth interviews, focus groups and passive observation, and the data were analyzed using systematic text condensation. With systematic use of music in daily activities in the nursing homes, users became calmer and less outspoken, and the use of psychotropic drugs was greatly reduced. The MB programme seems to be a successful intervention that provides a unique opportunity to improve patients' health and well-being with minimal adverse effects. This new focus on non-pharmacological approaches makes investigation of alternatives to medication vital.

Protocol and biomarker strategy for a multi-site randomized controlled trial examining biological mechanisms and dosing of active music engagement in children with acute lymphoblastic leukemia and lymphoma and parents

BACKGROUND

Music therapy is a standard palliative care service in many pediatric and adult hospitals; however, most research has focused on the use of music to improve psychosocial dimensions of health, without considering biological dimensions. This study builds on prior work examining psychosocial mechanisms of action underlying an Active Music Engagement (AME) intervention, designed to help manage emotional distress and improve positive health outcomes in young children with cancer and parents (caregivers), by examining its effects on biomarkers of stress and immune function.

METHODS

This two-group randomized controlled trial (R01NR019190) is designed to examine biological mechanisms of effect and dose-response relationships of AME on child/parent stress during the consolidation phase of Acute B- or T-cell Lymphoblastic Leukemia (ALL) and T-cell Lymphoblastic Lymphoma (TLyLy) treatment. Child/parent dyads (n = 228) are stratified (by age, site, risk level) and randomized in blocks of four to the AME or attention control condition. Each group receives one session (30-minutes AME; 20-minutes control) during weekly clinic visits (4 weeks standard risk B-cell ALL; 8 weeks high risk B-cell ALL/T-cell ALL/TLyLy). Parents complete questionnaires at baseline and post-intervention. Child/parent salivary cortisol samples are taken pre- and post-session (sessions 1-4). Child blood samples are reserved from routine draws before sessions 1 and 4 (all participants) and session 8 (high risk participants). We will use linear mixed models to estimate AME's effect on child/parent cortisol. Examining child/parent cortisol as mediators of AME effects on child and parent outcomes will be performed in an ANCOVA setting, fitting the appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach. Graphical plots and non-linear repeated measures models will be used to examine dose-response relationship of AME on child/parent cortisol.

DISCUSSION

During pediatric cancer treatment there are special challenges that must be considered when measuring cortisol and immune function. In this manuscript we discuss how we addressed three specific challenges through our trial design. Findings from this trial will increase mechanistic understanding of the effects of active music interventions on multiple biomarkers and understanding of dose-response effects, with direct implications for clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04400071.

Testosterone, oxytocin and co-operation: A hypothesis for the origin and function of music

Since the time of Darwin, theories have been proposed on the origin and functions of music; however, the subject remains enigmatic. The literature shows that music is closely related to important human behaviours and abilities, namely, cognition, emotion, reward and sociality (co-operation, entrainment, empathy and altruism). Notably, studies have deduced that these behaviours are closely related to testosterone (T) and oxytocin (OXT). The association of music with important human behaviours and neurochemicals is closely related to the understanding of reproductive and social behaviours being unclear. In this paper, we describe the endocrinological functions of human social and musical behaviour and demonstrate its relationship to T and OXT. We then hypothesised that the emergence of music is associated with behavioural adaptations and emerged as humans socialised to ensure survival. Moreover, the proximal factor in the emergence of music is behavioural control (social tolerance) through the regulation of T and OXT, and the ultimate factor is group survival through co-operation. The "survival value" of music has rarely been approached from the perspective of musical behavioural endocrinology. This paper provides a new perspective on the origin and functions of music.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis

Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC.

METHODS

We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI).

RESULTS

Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: -1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, -0.72; 95%CI: -1.31, -0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, -0.8; 95%CI: -1.31, -0.26), anxiety (SMD, -1.02; 95%CI: -1.71, -0.34), and depression (SMD, -1.57; 95%CI: -3.1, -0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89).

CONCLUSIONS

Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Choirs in end-of-life care: a thematic literature review

BACKGROUND

Choirs are an important source of wellbeing for people experiencing palliative and end-of-life care. Threshold choirs are an innovation that could be more widely introduced, as hospital and palliative care settings have become more open to community input.

AIMS

Before such choirs are recommended and encouraged, evidence for their effectiveness and implementation barriers need to be known.

METHODS

A literature review was undertaken in 2019 and 2020 using CINAHL, PUBMED, Medline, ProQuest, Google Scholar and an internet manual search.

FINDINGS

The review identified a total of 26 research and discussion papers relevant to the topic of choir in palliative care settings.

CONCLUSION

Following the review, guidelines were developed that may be useful to assist choirs and service providers to effectively introduce this valuable initiative. Choirs may be a creative, and uplifting arts-based activity to augment and enrich the culture of person-centred care during palliative care processes.

Systematic review of group-based creative arts interventions in support of informal care-givers of adults: a narrative synthesis

Informal care-givers play an important role, with health-care systems relying on the billions of hours of care they provide. Care-givers experience high levels of psychological distress and isolation; however, the efficacy of what support is the best for care-givers is unclear. The primary aim of this systematic review is to determine the effect of group creative arts interventions on informal care-givers of adults. The secondary aim is to understand the impact of group type, the primary outcomes and how they are measured. Given the heterogeneous nature of the included studies, a narrative synthesis approach was taken. Database searches identified 2,587 studies, 25 of which met the full inclusion criteria. Studies included group creative arts interventions for either care-givers only (N = 8) or for care-giver/cared-for dyads (N = 17). The majority of the participants in the studies were older Caucasian females. Group creative arts interventions are beneficial for care-givers and for the person being cared for; however, benefits differ depending on whether the group is for care-givers only or for care-giver/cared-for dyads. Future research will benefit from care-givers being involved in the design of the creative arts intervention to provide input regarding group type and relevant outcome measures. Future research should consider targeting their intervention to care-givers with a low baseline score to increase the ability of the study to demonstrate a significant difference.

Acute effects of singing on cardiovascular biomarkers

Background

Singing is a physical activity involving components of the vagal nerves manifested as changes in cardiac autonomic regulation.

Aims

The aim of this pilot study is to investigate the acute effects of singing on biomarkers of cardiovascular health.

Methods

Adult subjects were recruited from cardiology clinics to participate in a single 90-min study visit. Vascular function was measured at the fingertips with peripheral arterial tonometry (PAT) before and after singing to a 14-min video led by a voice expert. Heart rate variability (HRV) was measured with a chest strap sensor at baseline, during, and after singing. PAT measurements were expressed as reactive hyperemia index (RHI) and Framingham reactive hyperemia index (fRHI). Measures of HRV included root mean square of successive RR interval differences (RMSSD) and standard deviation of NN (or RR) intervals (SDNN).

Results

Sixty subjects completed the study (68% female, mean age 61 ±13 years, mean BMI 32 ± 8). There was a significant increase in fRHI (1.88 ± 0.14 to 2.10 ± 0.14, p = 0.02) after singing with no significant change in the RHI (1.99 ± 0.10 to 2.12 ± 0.09, p = 0.22). There was a reduction in HRV during singing (compared to baseline) (RMSSD: 42.0 ± 5 to 32.6 ± 4, p = 0.004 and SDNN: 54 ± 4 to 33.5 ± 3, p = 0.009). HRV measures trended back toward baseline after singing.

Conclusions

A short duration of singing improved vascular function acutely. Improvements were more substantial in subjects with abnormal baseline endothelial function. HRV patterns were similar to that of light-intensity exercise. Future studies should confirm favorable vascular adaptation to more sustained singing interventions.

Clinical trial registration

ClinicalTrials.gov, identifer: NCT03805529.

Singing lessons as a path to well-being in later life

Seventy-two persons, who had begun voice lessons after 40 years of age, were invited to complete an online survey that focused on the singers' experience, motivation, goals, health and well-being, repertoire, practice, and demographic information; 48 respondents (33 females, mean age 60.81 years, range 48.83-82.08, SD = 6.99) completed the questionnaire. Most participants indicated that enjoyment and personal growth motivated their taking lessons. Over 90% commented on benefits of singing to their physical health (e.g., breathing) and mental health (e.g., mood, less depressive episodes). Despite the solitary aspect of singing lessons, 67% reported positive changes in social relations since taking lessons. Benefits to professional relations were also reported (e.g., confidence, listening to others). Repertoire level was generally high, consistent with a high average university educational level. Cost of lessons and time demands may account for the generally high socioeconomic status of respondents. Given that the singing voice is a musical instrument available to almost everyone, results might motivate older adults to consider taking voice lessons, encourage health care professionals to consider voice lessons as interventions to benefit clients, and persuade governments to subsidize voice lessons for older adults in their jurisdictions. The study provides a foundation for future research on the relative impacts on well-being of vocal lessons versus choral singing in the context of relative investments in the two activities.

Allostatic Load as an Insight into the Psychological Burden after Primary Treatment in Women with Breast Cancer: Influence of Physical Side Effects and Pain Perception

Breast cancer (BC) diagnosis and treatment have become a cumulative long-standing chronic disease impairment, causing stress and turning into an allostatic load (AL) framework. This study aimed to investigate the relationship between physical issues and mental health in patients with BC after medical treatment. We conducted an observational study of 61 female patients with BC, and clinical and psychological markers have been detected. We conducted descriptive statistics, ANOVA analyses, correlations, and mediation analyses to verify the effect of the comorbidity index on psychological dimensions. The findings showed high levels of distress and moderate pain, and 32.8% of the patients showed moderate physical impairment. Significant effects of “age” and “physical issues” were found. The adult group reported a higher incidence of physical issues, and the group of patients reporting moderate physical impairment seemed more depressed than patients with mild physical issues. Finally, the comorbidity condition mediated the presence of signs of depression. Patients with BC seemed to experience negative emotions related to comorbidities associated with compromised activities of daily living. Our findings highlighted allostatic overload as a predictive framework to better understand the mental health of women with BC diagnoses to tailor effective psychological treatments for enhanced recovery.

Endogenous oxytocin, cortisol, and testosterone in response to group singing

Humans have sung together for thousands of years. Today, regular participation in group singing is associated with benefits across psychological and biological dimensions of human health. Here we examine the hypothesis that a portion of these benefits stem from changes in endocrine activity associated with affiliation and social bonding. Working with a young adult choir (n = 71), we measured changes salivary concentrations of oxytocin, cortisol, and testosterone from before and after four experimental conditions crossing two factors: vocal production mode (singing vs. speaking) and social context (together vs. alone). Salivary oxytocin and cortisol decreased from before to after the experimental manipulations. For oxytocin the magnitude of this decrease was significantly smaller after singing compared to speaking, resulting in concentrations that were significantly elevated after singing together compared to speaking together, after controlling for baseline differences. In contrast, the magnitude of the salivary cortisol decreases was the same across experimental manipulations, and although large, could not be separated from diurnal cycling. No significant effects were found in a low-powered exploratory evaluation of testosterone (tested only in males). At a psychological level, we found that singing stimulates greater positive shifts in self-perceived affect compared to speaking-particularly when performed together-and that singing together enhances feelings of social connection more than speaking together. Finally, measurements of heart rate made for a subset of participants provide preliminary evidence regarding physical exertion levels across conditions. These results are discussed in the context of a growing multidisciplinary literature on the endocrinological correlates of musical behavior. We conclude that singing together can have biological and psychological effects associated with affiliation and social bonding, and that these effects extend beyond comparable but non-musical group activities. However, we also note that these effects appear heavily influenced by broader contextual factors that shape social dynamics, such as stress levels, the intimacy of interactions, and the status of existing relationships.

Trauma Healing Club: Utilizing Culturally Responsive Processes in the Implementation of an After-School Group Intervention to Address Trauma Among African Refugees

The State of Tennessee granted appropriations to an urban university in the West Tennessee region to address the needs of at-risk African refugee children and families who have experienced Adverse Childhood Experiences (ACEs). Action oriented research efforts were conducted to address the needs of youth in the local region by developing, implementing, and evaluating a community-based intervention that was not only trauma responsive but culturally competent. The Trauma Healing Club was a treatment package developed and researched for this purpose and offered in an after school support program. This identified intervention utilized an existing evidence-based trauma intervention framework that was adapted to include more culturally responsive processes such as pyramid mentoring and African drumming. This work aimed to evaluate the effectiveness of an integrated trauma-informed practice model for community-based programming and the effectiveness of adapting an existing intervention to better fit the community needs. Results indicated that the adaptation of the trauma-responsive intervention was effective and supportive of the child-participant and his/her family needs -both culturally and as it relates to improved participant functioning post intervention.

Influence of Turn-Taking in Musical and Spoken Activities on Empathy and Self-Esteem of Socially Vulnerable Young Teenagers

This study describes a preliminary test of the hypothesis that, when people engage in musical and linguistic activities designed to enhance the interactive, turn-taking properties of typical conversation, they benefit in ways that enhance empathy and self-esteem, relative to people who experience activities that are similar except that synchronous action is emphasized, with no interactional turn-taking. Twenty-two 12–14 year olds identified as socially vulnerable (e.g., for anxiety) received six enjoyable 1-h sessions of musical improvisation, language games that developed sensitivity to linguistic rhythm and melody, and cross-over activities like rap. The Turn-taking group (n = 11), practiced characteristics of conversation in language games, and these were also introduced into musical activities. This involved much turn-taking and predicting what others would do. A matched control group, the Synchrony group, did similar activities but in synchrony, with less prediction and no turn-taking. Task complexity increased over the six sessions. Psychometric testing before and after the series showed that the Turn-taking group increased in empathy on self-report (Toronto Empathy Questionnaire) and behavioral (‘Reading the Mind in the Eyes’) measures, and in the General subtest of the Culture-Free Self-Esteem Inventory. While more work is needed to confirm the conclusions for relevant demographic groups, the current results point to the social value of musical and linguistic activities that mimic entrained, tightly coordinated parameters of everyday conversational interaction, in which, at any one time, individuals act as equal participants who have different roles.

The Psychological and Biological Impact of "In-Person" vs. "Virtual" Choir Singing in Children and Adolescents: A Pilot Study Before and After the Acute Phase of the COVID-19 Outbreak in Austria

Psychobiological responses to music have been examined previously in various naturalistic settings in adults. Choir singing seems to be associated with positive psychobiological outcomes in adults. However, evidence on the effectiveness of singing in children and adolescents is sparse. The COVID-19 outbreak is significantly affecting society now and in the future, including how individuals engage with music. The COVID-19 pandemic is occurring at a time when virtual participation in musical experiences such as singing in a virtual choir has become more prevalent. However, it remains unclear whether virtual singing leads to different responses in comparison with in-person singing. We evaluated the psychobiological effects of in-person choral singing (7 weeks, from January to March 2020, before the COVID-19 outbreak) in comparison with the effects of virtual choral singing (7 weeks, from May to July 2020, after schools partly re-opened in Austria) in a naturalistic pilot within-subject study. A group of children and young adolescents (N = 5, age range 10-13, female = 2) from a school in Salzburg, Austria were recruited to take part in the study. Subjective measures (momentary mood, stress) were taken pre- and post-singing sessions once a week. Additionally, salivary biomarkers (cortisol and alpha-amylase) and quantity of social contacts were assessed pre- and post-singing sessions every second week. Psychological stability, self-esteem, emotional competences, and chronic stress levels were measured at the beginning of in-person singing as well as at the beginning and the end of the virtual singing. We observed a positive impact on mood after both in-person and virtual singing. Over time, in-person singing showed a pre-post decrease in salivary cortisol, while virtual singing showed a moderate increase. Moreover, a greater reduction in stress, positive change in calmness, and higher values of social contacts could be observed for the in-person setting compared to the virtual one. In addition, we observed positive changes in psychological stability, maladaptive emotional competences, chronic stress levels, hair cortisol, self-contingency and quality of life. Our preliminary findings suggest that group singing may provide benefits for children and adolescents. In-person singing in particular seems to have a stronger psychobiological effect.

Arts engagement facilitated by artists with individuals with life-limiting illness: A systematic integrative review of the literature

BACKGROUND

Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care.

AIM

To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice.

DESIGN

A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes.

DATA SOURCES

PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed.

RESULTS

Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice.

CONCLUSION

Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists' engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.

SHAPER-PND trial: clinical effectiveness protocol of a community singing intervention for postnatal depression

INTRODUCTION

Postnatal depression (PND) affects approximately 13% of new mothers. Community-based activities are sought after by many mothers, especially mothers that prefer not to access pharmacological or psychological interventions. Singing has shown positive effects in maternal mood and mother-child bonding. The Scaling-Up Health-Arts Programmes: Implementation and Effectiveness Research-Postnatal Depression study will analyse the clinical and implementation effectiveness of 10-week singing sessions for PND in new mothers. This protocol paper will focus on the clinical effectiveness of this trial.

METHODS AND ANALYSIS

A total of 400 mothers with PND (with a score of at least 10 on the Edinburgh Postnatal Depression Scale) and their babies will be recruited for this hybrid type II randomised controlled trial. The intervention group will attend 10 weekly singing sessions held at community venues or online, facilitated by the arts organisation, Breathe Arts Health Research (Breathe). A control group will be encouraged to attend non-singing sessions in the community or online for 10 weeks. A package of assessments will be collected from participants for clinical, mechanistic and implementation outcomes, at different stages of the trial. Clinical assessments will include questionnaires and interviews for demographics, mental health and social measures, together with biological samples for measurement of stress markers; the study visits are at baseline, week 6 (mid-trial) and week 10 (end of trial), with follow ups at weeks 20 and 36. Multiple imputation will be used to deal with possible missing data and multivariable models will be fitted to assess differences between groups in the outcomes of the study.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the London-West London and GTAC Research Ethics Committee, REC reference: 20/PR/0813.

TRIAL REGISTRATION NUMBER

NCT04834622; Pre-results.

An Infant's Question on COVID-19 and Music: Should I Attend My Online Classes?

In the last few months, we all have faced a profound challenge to balance our lives amidst fighting the COVID-19 pandemic. The reactions to this coronavirus pandemic have no doubt affected all aspects of our everyday normalcy as they have called for an extended set of measures that have greatly impacted our social interactions and well-being. During this unprecedented global situation, the pandemic has also taken its toll on education, as schools, universities, and other educational institutions have suspended their programs or moved online to retain educational momentum. Among the programs that tried to adapt to this online model was the early years music education. This mini-review article aims to discuss the framework of online existence for the early years music programs amid the COVID-19 crisis, while considering their benefits and character under these extraordinary circumstances.

The Effects of Group Therapeutic Singing on Cortisol and Motor Symptoms in Persons With Parkinson's Disease

The inclusion of music into the treatment plan for persons with Parkinson's disease (PD) may be a viable strategy to target multiple motor symptoms. However, potential mechanisms to explain why music has an impact on multiple motor symptoms in persons with PD remain understudied. The purpose of this study was to examine the acute effects of 1 h of group therapeutic singing (GTS) on physiological measures of stress and clinical motor symptoms in persons with PD. We posit that improvement in motor symptoms after GTS may be related to stress reduction. Seventeen participants with PD completed 1 h of GTS and eight participants completed 1 h of a quiet reading (control session). Cortisol was collected via passive drool immediately before and after the singing and control session. The Unified Parkinson's Disease Rating Scale (UPDRS) Part-III (motor examination) was also video-recorded immediately before and after the singing and control session and scored by two raters masked to time and condition. Secondary outcome measures for quality of life, depression, and mood were collected. Results revealed no significant change in cortisol or motor UPDRS scores, as well as no significant relationship between cortisol and motor UPDRS scores. There was a trend for the singing group to report feeling less sad compared to the control group after the 1-h session (effect size = 0.86), and heart rate increased in the singing group while heart rate decreased in the control group after the 1-h session. These results suggest that an acute session of GTS is not unduly stressful and promotes the use of GTS for persons with PD. Multiple mechanisms may underlie the benefits of GTS for persons with PD. Further exploring potential mechanisms by which singing improves motor symptoms in persons with PD will provide greater insight on the therapeutic use of music for persons with PD.

Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis

BACKGROUND

Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population.

PURPOSE

To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer.

METHODS

Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality.

RESULTS

Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality.

CONCLUSION

This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.

Physiological demands of singing for lung health compared with treadmill walking

Introduction

Participating in singing is considered to have a range of social and psychological benefits. However, the physiological demands of singing and its intensity as a physical activity are not well understood.

Methods

We compared cardiorespiratory parameters while completing components of Singing for Lung Health sessions, with treadmill walking at differing speeds (2, 4 and 6 km/hour).

Results

Eight healthy adults were included, none of whom reported regular participation in formal singing activities. Singing induced acute physiological responses that were consistent with moderate intensity activity (metabolic equivalents: median 4.12, IQR 2.72–4.78), with oxygen consumption, heart rate and volume per breath above those seen walking at 4 km/hour. Minute ventilation was higher during singing (median 22.42 L/min, IQR 16.83–30.54) than at rest (11 L/min, 9–13), lower than 6 km/hour walking (30.35 L/min, 26.94–41.11), but not statistically different from 2 km/hour (18.77 L/min, 16.89–21.35) or 4 km/hour (23.27 L/min, 20.09–26.37) walking.

Conclusions

Our findings suggest the acute metabolic demands of singing are comparable with walking at a moderately brisk pace, hence, physical effects may contribute to the health and well-being benefits attributed to singing participation. However, if physical training benefits result remains uncertain. Further research including different singing styles, singers and physical performance impacts when used as a training modality is encouraged.

Trial registration number

ClinicalTrials.gov registry (NCT04121351).

Mini-review: A possible role for galanin in post-traumatic stress disorder

Several neuroendocrine systems have been implicated in post-traumatic stress disorder, including the mesocortical and mesolimbic dopamine, the norepinephrine, the β-endorphin, the serotonin, and the oxytocin systems. The interaction between these different systems remains, however, largely unknown and a generally accepted unifying theory is thus far lacking. In this review, we suggest that galanergic suppression of dopaminergic neurons in the ventral tegmental may constitute the missing link in a post-traumatic feedback loop. In addition, we address the literature on the negative cross-antagonism in this brain region between the galanin 1 and μ-opioid receptors, which suggests that behavioural patterns which stimulate β-endorphin, a natural μ-opioid receptors ligand, secretion may provide novel avenues for the treatment and prevention of PTSD, as well as for recruitment, training, and leadership processes in high-stress/high-risk professions such as the military, first responders and the police.

Group singing improves both physical and psychological wellbeing in people with and without chronic health conditions: A narrative review

The aim of this narrative review was to establish a link between psychological and physical wellbeing in people with and without chronic health conditions who participated in group singing. Four databases were searched (PubMed, WoS, MEDLINE, and Scopus) using a systematic search method. Articles were screened, yielding 19 suitable articles. In most studies that were included group singing led to an increase in both psychological and physiological wellbeing. The major impacts were on affect and depression and anxiety.Group singing positively affects both physical and psychological wellbeing in people with and without chronic health conditions. No direction of causality could be established.

Group singing improves quality of life for people with Parkinson's: an international study

Objectives: Group singing has been reported to enhance quality of life (QoL) and mental health in older people. This paper explored whether there are differences in the effects of group singing intervention on people with Parkinson's (PwPs) in Australia, UK and South Korea.Methods: The study included PwPs (N = 95; mean age = 70.26; male 45%) who participated in a standardised 6-month weekly group singing programme. Parkinson's health-related QoL measure (PDQ39) and mental health assessment (DASS) were administered at baseline and follow-up. ANOVAs were performed with significance set as p < .05.Results: ANOVAs revealed main effects of Time on the Stigma and Social Support subscales of PDQ39; both showed a small but significant improvement over time. However, the social support reduction was moderated by country; social support was improved only in South Korean participants. The reduction in stigma was greater than previously reported minimal clinically important differences, as was the social support reduction in South Korean participants. In terms of mental health, ANOVAs revealed that the scores of Anxiety and Stress domains of DASS significantly decreased from pre-test to post-test with small effect sizes.Conclusion: This first international singing study with PwPs demonstrated that group singing can reduce stigma, anxiety and stress and enhance social support in older adults living with Parkinson's. The findings are encouraging and warrant further research using more robust designs.

OUP accepted manuscript

This article explores the impact of online Irish traditional singing sessions on health and well-being during the COVID-19 pandemic. Singing sessions are unique facets of Ireland’s music tradition that saw dramatic closure, interruption and digital transition in response to COVID-19 social distancing measures. This study highlights a gap in health promotion literature with regard to traditional singing sessions as a group singing activity and examines the potential for online group singing activities to have positive impacts on the health and well-being of participants. While traditional singing sessions foreground solo performances, they are quintessentially group activities, and include community engagement and active participation from singers and listeners alike. Through an online survey (n = 108), and ethnographic interviews (n = 3), this study explores potential health and well-being implications of online traditional singing sessions, and reveals four main areas of impact: social connection, enjoyment, cognitive motivation and timekeeping. The study suggests that online traditional singing sessions can promote health and well-being in participants, particularly during times of isolation.

This article explores the impact of online Irish traditional singing sessions on health and well-being during the COVID-19 pandemic. Singing sessions are unique facets of Ireland’s music tradition which were forced to move online due to COVID-19 restrictions. This study used an online survey (n = 108), and interviews (n = 3), to explore the impact of these online sessions on the well-being of their participants. Findings showed the impacts to be overwhelmingly positive, particularly in four main areas: social connection, enjoyment, cognitive motivation, and timekeeping. This study highlights the value of traditional singing sessions as group singing activities for the purposes of health and well-being promotion, and suggests that online group singing activities can be beneficial, particularly during times of isolation.

'Singing has empowered, enchanted and enthralled me'-choirs for wellbeing?

Singing in groups is a global phenomenon and there is a growing body of evidence that singing can affect health and wellbeing. This is the first gender-based study to explore how women's perceptions of their own health and wellbeing can be affected by singing in a choir; and also how choral singing may have an impact on social inclusion. Qualitative data was collected from nine choirs in two regions of Norway. The sample consisted of 19 (n = 19) women aged 21-75 (mean age, 51.3.) who had sung in choirs from 6 months to 20 years (mean, 6.2 years). The sample population included those who identified as 'healthy' and those experiencing health issues such as cancer, depression, anxiety or fatigue. Two focus groups and 16 semi-structured interviews were carried out and the data were analyzed using grounded theory. Findings were that choral singing can affect women's perceptions of their wellbeing in four distinct ways: (i) through the joy of singing, (ii) experiencing singing as essential for survival, (iii) group singing as a route to social connection, which enhanced a sense of identity and of belonging, and thereby increased self-confidence and self-esteem and (iv) through promoting social inclusion. In the context of these findings, choral singing can be understood as a 'salutogenic' activity, that is, one that supports health and wellbeing. This has implications for self-care practice, social prescribing programs and public health policy.

The effects of a music and singing intervention during pregnancy on maternal well-being and mother-infant bonding: a randomised, controlled study

Purpose

Stress and impaired mother–infant bonding during pregnancy can lead to adverse effects for the expectant mother and the unborn child. The present study investigates whether a prenatal music and singing intervention can improve maternal well-being as well as mother–infant bonding.

Methods

A total of 172 pregnant women took part in this prospective, randomised, three-armed (music, singing or control group) study. Depressive symptoms, self-efficacy, maternal well-being and mother–infant bonding were assessed with visual analogue scales and questionnaires before the intervention phase (30th week of gestation) and afterwards (36th week of gestation). Additionally, immediate changes regarding experienced stress and mood from before until after the music and singing interventions were explored with questionnaires as well as saliva samples (for cortisol, alpha-amylase and oxytocin determination).

Results

Regarding immediate effects, both interventions showed positive effects on the emotional state, stress (cortisol) and bonding (oxytocin). Additionally, the singing group showed a larger reduction in cortisol and a larger improvement in valence than the music group. Looking at more prolonged effects, significant effects on general self-efficacy and perceived closeness to the unborn child (measured with a visual analogue scale) were found. No significant effects were revealed for the mother–infant bonding questionnaire and for depressive symptoms.

Conclusion

In the present study, promising effects of music and in particular singing on maternal well-being and perceived closeness during pregnancy appeared. Prenatal music and singing interventions could be an easy to implement and effective addition to improve mood and well-being of the expectant mother and support mother-infant bonding.

Trial registration number

DRKS00012822, date of registration: 17.10.2017

Electronic supplementary material

The online version of this article (10.1007/s00404-020-05727-8) contains supplementary material, which is available to authorized users.

An evaluation of workplace choir singing amongst Health Service staff in Ireland

This paper explores the well-being ['well-being' and 'wellbeing' are used interchangeably in the literature. Well-being is used in this paper (except in the reference list where exact wording is maintained)] benefits of participation in a workplace choir for health service staff. A mixed method study, this project combines quantitative measures of work engagement, perceived stress, resilience levels and work absences with qualitative interviews with choir participants. It is the first study of workplace choirs in Ireland and one of very few studies internationally that research health service staff choirs. There is some preliminary evidence of benefits that choir attendance may increase positive perception of workers' mental health as well as effect depression rates. However, evidence is limited quantitatively and difficulties in measuring the health benefits of arts interventions are noted. Qualitative data, however, confirms previous study findings, namely that a workplace choir can promote social connectedness, enjoyment at work and staff engagement. Work place choir was also noted to appeal mainly to a limited demographic of work place staff and people with relatively positive health and well-being. Efforts must be made to engage staff from lower socio-economic backgrounds, diverse cultural backgrounds and male staff in work place health promotion activities, as these groups were found less likely to join a work place choir. Given the low cost and low risk of this activity, and the qualitative benefits reported, it is recommended to continue to develop and evaluate health service workplace choirs.

Oxytocin & well-being as promoters of affect regulation and homeostasis: a neuroscientific review

Neurohormone oxytocin release affects mood and behavior in humans, regulating emotional and physiologic aspects.  Neuroscience associates well-being to oxytocin to characterize a general positive-valenced emotional state.  However, the terms well-being and oxytocin are absent, or present in a limited way, in most indexes of psychological terminology and health science descriptors.  This study aimed at studying how this association occurs in literature, based on a systematic review on oxytocin and well-being in the last five years.  Main results: the neuroscientific context seemed to be the most adequate to the study between oxytocin and well-being; association between psychological and neuroendocrine aspects was unusual; medical templates predominated over psychological references;  oxytocin release and feelings of well-being were associated to stimuli of the affective-sensorial type, to psychiatric interventions, to familiarity; results varied according to age, gender, context and personality.  

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

Absence of a diurnal rhythm of oxytocin and arginine-vasopressin in human cerebrospinal fluid, blood and saliva

PURPOSE

The aims of our study were to determine first circadian influences on central concentrations of the neuropeptides oxytocin and arginine-vasopressin and second to investigate if these central concentrations are associated with those in the peripheral compartments blood and saliva in neurocritical care patients. We therefore included patients with external ventricular drain who attended a neurosurgical intensive care unit and were not exposed to painful or stressful stimuli during the sampling period. For this purpose, blood, cerebrospinal fluid and saliva were collected in a 24-hour-interval at the timepoints 06:00, 12:00, 18:00 and 24:00.

RESULTS

In none of the three body fluids examined, significant time-dependent fluctuations of oxytocin and arginine-vasopressin concentrations could be detected during the 24-hour sampling period. The only exception was the subgroup of postmenopausal women whose oxytocin concentrations in cerebrospinal fluid at 12:00 were significantly higher than at 18:00. Correlations of blood and cerebrospinal fluid and blood and saliva neuropeptide levels were very weak to weak at each timepoint. Cerebrospinal fluid and saliva oxytocin levels showed a moderate correlation at 06:00 but did correlate very weak at the other timepoints.

CONCLUSIONS

Central as well as peripheral oxytocin and arginine-vasopressin concentrations in neurocritical care patients did not show significant diurnal fluctuations. No strong correlations between central and peripheral neuropeptide concentrations could be detected under basal conditions. If investigators even though decide to use saliva concentrations as surrogate parameter for central neuropeptide activity, they have to consider that correlations of cerebrospinal fluid and saliva oxytocin seem to be highest in the early morning.

Influence of perioperative stress on central and peripheral oxytocin and arginine-vasopressin concentrations

Perioperative stress provides not only physical, but also psychic and emotional aspects, which may influence the hypothalamic neuropeptide system. Studies investigating the perioperative course of central neuropeptide activity are missing. Therefore, the present study aimed to determine perioperative fluctuations in central and concomitant peripheral concentrations of the hypothalamic neuropeptides oxytocin (OXT) and arginine-vasopressin (AVP), as well as their impact on perioperative anxiety and depression. Cerebrospinal fluid (CSF), blood and saliva were collected from 12 patients who underwent elective endovascular aortic repair with a routinely inserted spinal catheter. AVP and OXT concentrations were analysed at four timepoints: (i) the evening before the operation; (ii) the operation day immediately before anaesthesia induction; (iii) intraoperatively after the stent was placed; and (iv) on day 1 after the operation. Patients completed the Hospital Anxiety and Depression Scale (HADS) at timepoints 1 and 4. For CSF OXT, the present study showed a significant intraoperative decline, accompanied by a decrease in saliva. OXT blood concentrations before anaesthesia induction were higher than at the evening before the operation. OXT concentrations in CSF and saliva correlated well at timepoints 2-4. AVP concentrations in CSF, blood and saliva did not show any significant changes perioperatively. However, postoperative AVP blood concentrations showed a significant negative correlation with anxiety and depression scores according to the HADS. This pilot study demonstrates perioperative fluctuations in central OXT concentrations, which are better reflected by saliva than by blood. Further studies are required to determine whether OXT and AVP can predict postoperative post-traumatic stress disorder.

Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer: results from a longitudinal controlled study

OBJECTIVE

The mental health challenges facing people who care for somebody with cancer are well documented. While many support interventions focus on provision of information or cognitive behavioural therapy, the literature suggests that psychosocial interventions could also be of value, especially given the low social support frequently reported by carers. Singing is a psychosocial activity shown to improve social support, increase positive emotions, and reduce fatigue and stress. This study explored whether weekly group singing can reduce anxiety, depression and well-being in cancer carers over a 6-month period.

DESIGN

A multisite non-randomised longitudinal controlled study.

SETTING

The Royal Marsden National Health Service Trust in Greater London.

PARTICIPANTS

62 adults who currently care for a spouse, relative or close friend with cancer who had not recently started any psychological therapy or medication.

INTERVENTIONS

On enrolment, participants selected to join a weekly community choir for 12 weeks (n=33) or continue with life as usual (n=29).

OUTCOME MEASURES

The primary outcome was mental health using the Hospital Anxiety and Depression Scale. The secondary outcome was well-being using the Warwick Edinburgh Mental Wellbeing Scale. Using linear mixed effects models, we compared the change in mental health and well-being over time between the two groups while adjusting for confounding variables including demographics, health-related variables, musical engagement and length of time caring.

RESULTS

Participants in the choir group showed a significantly greater decrease in anxiety over time than participants in the control group (B=-0.94, SE=0.38, p=0.013) and a significantly greater increase in well-being (B=1.25, SE=0.49, p=0.011). No changes were found for depression. Sub-group analyses showed carers with anxiety or below-average well-being were most likely to benefit.

CONCLUSIONS

This study builds on previous research showing the mental health benefits of singing for people with cancer by showing that weekly singing can also support anxiety and well-being in cancer carers.

Systematic Use of Music as an Environmental Intervention and Quality of Care in Nursing Homes: A Qualitative Case Study in Norway

Background: The systematic use of music as an environmental intervention in nursing homes shows beneficial effects on patients’ health, safety, and quality of life in a care-related perspective. A county in Norway and a Nursing Education Department in a region of Norway collaborated on the project “systematic use of music as environmental intervention and quality of care in nursing homes” for nursing students. Methods: This study from Norway (2017) had a qualitative and explorative approach. The sample (n = 33) was strategically and conveniently selected. Seven different focus group interviews consisted of nursing students, practice counselors, teachers, and project leaders, representing three nursing homes and healthcare centers. Passive observation lasting two days in each of the six departments was executed in order to observe environmental treatment in practice. Results: The beneficial aspects of using music as an environmental intervention in nursing homes increased among the students, and contributed to improved interaction, communication, and development of care with the patients. Students who participated actively in musical interaction such as improvisation, singing, and music listening with the patients were committed and motivated. The staff and management showed varied enthusiasm for the project. Conclusions: If the systematic use of music as environmental therapy and quality of care in elderly care is to be successful, it seems vital to include this theme early in nursing education. By creating early involvement among nurses, it might influence, inspire, and encourage involvement among employees and management.

Music Is Capable of Inducing Changes in Gene Expression in Gastric Cancer Cells

PURPOSE

Music has recognized beneficial effects on cancer patients; however, very little is known about the molecular processes which produce these benefits. The aim of this work was to evaluate the effect of music on proliferation and gene expression in gastric cancer cells.

METHODS

AGS gastric cancer cells were exposed to metal and classical music, and subsequently cell proliferation and expression of genes associated with apoptosis and cell-cycle control were evaluated.

RESULTS

Proliferation of AGS cells increased when exposed to metal music, but not when exposed to classical music. Gene expression of caspase-3 and 8 and cyclin B1 increased in response to both musical genres; classical music repressed the expression of p53, and metal music repressed the expression of PUMA.

CONCLUSIONS

This is the first study to demonstrate music as a modulator of gene expression in a cancer cell line. Additional experiments are required to better understand the mechanisms of how different musical genres can induce changes in gene expression.

How does the process of group singing impact on people affected by cancer? A grounded theory study

OBJECTIVE

This study aimed to build an understanding of how the process of singing impacts on those who are affected by cancer, including patients, staff, carers and those who have been bereaved.

DESIGN

A qualitative study, informed by a grounded theory approach.

SETTING AND PARTICIPANTS

Patients with cancer, staff, carers and bereaved who had participated for a minimum of 6 weeks in one of two choirs for people affected by cancer.

METHODS

31 participants took part in Focus Group Interviews lasting between 45 min and an hour, and 1 participant had a face-to-face interview.

FINDINGS

Four overarching themes emerged from the iterative analysis procedure. The overarching themes were: building resilience, social support, psychological dimensions and process issues. Following further analyses, a theoretical model was created to depict how building resilience underpins the findings.

CONCLUSION

Group singing may be a suitable intervention for building resilience in those affected by cancer via an interaction between the experience and impact of the choir.