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It’s long been theorized that music plays a far greater role in human life than simply entertainment. In the past decade there have been numerous studies that now conclusively demonstrate the music plays a role in math, science, medicine and social interaction. We intend to collect this information and present it to visitors in a meaningful (and hopefully interesting way). If you have any input regarding this fascinating topic, please use our Contact Page to share your ideas with us. To become aware of updates to this site, please sign up for our free newsletter.

Music Connections
Music Connections

How Music Affects Health and Well-Being

The relationship between arts participation and health has received significant and growing academic, media, and public attention over the past 10 years. Motivated by a desire to investigate innovative, non-invasive, and economically viable interventions that embrace contemporary definitions of health, practitioners and researchers across the world have been developing and researching arts inventions. The focus of this research has been on activities that not only facilitate the exploration of creativity but are also enjoyable, accessible and have significant impact upon key health indicators.

In many ways, research within the musical domain has been at the cutting edge of this new generation of research investigating the beneficial effects of arts participation. One of the key drivers in this vigorous research milieu is the growth of qualitative research within health care contexts and researchers interested in exploring the potential benefits of musical participation have fully embraced the advances that have taken place in health-related qualitative research. Much of the qualitative research discussed within this article utilized phenomenology as a key theoretical approach. In particular, interpretative phenomenological analysis (IPA) is utilized as an analytical framework. IPA is particularly useful in the context of music and health as it has a focus on personal lived experiences and how participants make sense of their experience.

Music Is For Everyone
Music Is For Everyone

A number of different types of qualitative research projects are presented and these focus on exploring the process and outcomes of music interventions. This article also presents a new conceptual model for music, health, and well-being. The model is also developed with the aim of increasing multidisciplinary dialog across the multitude of professions that are involved in researching the relationship between musical participation and wider health parameters. With music therapists at the vanguard, this group of professions includes psychologists, neurologists, teachers, occupational therapists, medical doctors, and architects.

Music Therapy

When conceptualizing the entirety of interventions that are defined within the music, health, and well-being framework, there are a number of discrete but related areas that can be considered. The first is music therapy, and it is important to acknowledge that while the field of music, health, and well-being is currently experiencing significant interest, the discipline of music therapy has a long history of research dating back to the early part of the 20th century. Indeed, the profession of music therapy within a modern context has been developing practice and producing research for nearly 100 years.


Music and Health

This work has had a significant impact and there are a number of well-established journals dedicated to research within the area of music therapy. Music therapy has many different definitions but for the purposes of this article, a key element of the music therapy process is an emphasis upon the therapeutic relationship between clinicians and clients or participants. Thus, music interventions that fall under the music therapy category will focus on positive psychological and/or physiological benefits for the participants and the interventions will be delivered by qualified music therapists. Also, music therapy interventions neither will have musical developments in terms of increasing technical skills as a primary objective nor will they be primarily concerned with a general increase in artistic activities within the musical domain.

Community Music

Community music in contrast will not have therapeutic effects as a primary concern but may have increased access to artistic activities outside conventional institutional setting as an objective. Community choirs and percussion classes are good examples of community music interventions. Also, there may not be an emphasis on the development of discrete technical skills but the primary objective may be providing an opportunity for creative expression in informal settings. However, and this is an important point, many community music interventions view positive psychological benefits as an important secondary benefit.

For example, a community choir may be seeking to give older adults the chance to enjoy singing together but the enjoyment, freedom of expression, and social support afforded by a choir may bring about developments in self-confidence and self-esteem. Thus, there is an overlap between community music interventions and music therapy interventions. Also, the recent developments in music therapy, discussed above, have reached into community contexts. In these situations, music therapists may facilitate music groups in informal settings and while the aims may still be explicitly therapeutic, the social and musical context may have more in common with community music interventions that what might be considered as a traditional music therapy context (hospital, health center, private practice, etc.).

The field of community music is an exponentially growing area of interest for music researchers and over the past 15–20 years, the increasing output of journal articles has supported its development into a distinct and unique field of practice. It is now an established area of research with a dedicated journal, The International Journal of Community Music and a commission of The International Society for Music Education. Although it appears to have significant and distinct characteristics, it is an area that is difficult to define as there are many overlaps into “general” areas of musical activity.

There are many descriptions of the term “Community Music.” On the one hand, it is practiced throughout the world in formal and informal settings and in some respects all music making can be defined as “community-based” since all music has a social context. However, community music has emerged as a distinct field of practice and as an influential approach to both music education and as a means of increasing access to all types of musical activities. Indeed, a key concern of community music practitioners is to increase access to music making for all members of the public.

Definitions of community music focus upon the practical, activity-based features of community music. They also discuss fluid hierarchies that may exist within community music activities and these definitions also emphasize the process-based nature of community music. The published literature discusses educational issues relating to the training of community music practitioners and also the educational emphasis of community music programs. Finally, many of the published papers within community music discuss the wider benefits of community music activities. These benefits may be for the individual but they also extend to the group and in some cases reach out further to resolve conflicts and develop empathy between different groups.

For example, Bowman discusses how musical engagements in community music settings develop “character, habits, dispositions.” Large-scale community music groups like El Sistema have come to international attention over the past 10 years. Founded in 1975 by economist and musician José Antonio Abreu, El Sistema is a publicly financed voluntary sector community music education program in Venezuela which provides access to music education for thousands of children from disadvantaged backgrounds. There are two significant El Sistema projects running in Scotland, UK.

Can Music Be Of Benefit In Hospital ICUs?

Music is an intriguing but relatively understudied intervention with multiple potential benefits for mechanically ventilated, critically ill patients. As ICU and hospital mortality improve, other patient-centered outcomes such as alleviating pain, discomfort, and anxiety become important to address – not only from a patient care perspective but also due to their role in improving long-term effects, such as post-traumatic stress disorder. Often the response to anxiety and stress amongst patients involves sedation, with common side effects such as bradycardia, hypotension, weakness, and delirium. As a result, the 2013 Society of Critical Care Medicine Guidelines for the Management of Pain, Agitation, and Delirium in the ICU recommend nonpharmacologic interventions, such as music, because they are opioid-sparing, low cost, easy to provide, and safe, while acknowledging that few studies have been published on their effectiveness.

Music Influences
Music Influences

Despite the perceived benefits of music, there are very few studies validating its use in critically ill patients. Those studies that have examined the effect of music have only done so in the course of a single listening session, either by observing a beneficial effect in heart rate and respiratory rate or in overall anxiety. The long-term effects remain more uncertain, as one study noted that the decrease in blood pressure observed during a music listening session was accompanied by a corresponding rise after cessation of treatment. A final study found no effect of music on serum biomarkers of the stress response between patients listening to music and those resting quietly.

No prior studies, however, have prospectively examined the effects of continued music therapy in ICU patients. This study is a three-arm randomized trial examining the effect of patient-directed music (PDM) on anxiety and sedative exposure in mechanically ventilated patients compared with noise-canceling headphones (NCH) and usual care. Sedation exposure was measured both in terms of intensity (weight-adjusted dose given during a 4-hour block) and frequency (the number of 4-hour blocks during which any sedation was administered). Because anxiety is directly related to amount of sedation, results were modeled using a mixed-effects analysis to predict anxiety, sedation frequency, and intensity while adjusting for covariates of interest. Overall, PDM was associated with lower anxiety scores, sedation frequency, and sedation intensity compared with usual care. There was no significant reduction in anxiety or sedation intensity for PDM compared with NCH.

This study took on the challenging task of measuring in a randomized, prospective manner an aspect of patient care that is both often neglected and difficult to quantify. Additionally, the study quantified the endpoint of anxiety while separating out the possible confounding effect of sedation. However, while this study provides a good framework for examining the role of music in the ICU patients, several issues remain. First, the eligibility criteria eliminated over 96% of patients evaluated for the study, as patients were invited to participate if they were alert, participating in their daily care routines, appropriately following commands, cognitively intact to participate in the consent process, and had adequate or corrected vision and hearing.

While including these criteria was probably necessary so that the study arms could be easily compared without confounders such as acute illness and unresponsiveness, the rigidity of the inclusion and exclusion criteria also detracted from the study’s generalizability. Additionally, sedation was not protocolized or standardized, which could potentially decrease the robustness of the main study outcome measure of sedative exposure. Finally, while a decrease in both anxiety and sedation was demonstrated with the use of PDM over usual care, further studies will be needed to delineate the extent of the benefit of PDM, especially as it related to NCHs, because no difference in anxiety scores or sedation intensity was demonstrated between the PDM and NCH groups.

The role that music should play in the care of ICU patients has yet to be defined. For the patient who meets the study’s rigid inclusion criteria, PDM is a compelling option – music is inexpensive with few adverse effects, is easy to administer, and, based on this study, may reduce anxiety and sedation compared with usual care. The findings of this study underscore the importance of addressing behavioral issues in the ICU to improve patient-centered outcomes. Could music play a broader role in the care of critically ill patients? At this point, further study is required – particularly with regards to the effect of music on populations excluded from this study and the long-term cost and feasibility outside a study setting. The cost may be well justified by the overall cost savings, but this will need to be further defined and quantified in further studies.

 

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