The same dictionary defines anxiety as: “1 a: painful or apprehensive uneasiness of mind usually over an impending or anticipated ill b: fearful concern or interest c: a cause of anxiety 2: an abnormal and overwhelming sense of apprehension and fear often marked by physiological signs (as sweating, tension, and increased pulse), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it.”

Feeling anxious after reading the above?

I felt anxious merely trying to understand the definitions of stress and anxiety. I know intuitively what they are. I have experienced them while treating trauma victims, resuscitating cardiac patients, relaying death to family members, and while examining the ear drums of a screaming child in the presence of a frantic parent. I have also felt them performing demanding cello music at auditions and concerts.

What is stress and what is anxiety?

Stresses are forces that act on us and change our behavior and physiology. There are positive and negative stresses. Positive stresses enhance our mood and strengthen our body, such as an aerobic walk in a park on a sunny day. Negative stresses tend to cause anxiety and have detrimental effects on our physiology. Blood vessels constrict, and heart rate and blood pressure increase. Stress may cause palpitations, nausea, shortness of breath, and insomnia. My patients often wonder if their symptoms or physical findings are caused by stress. It is unusual for a shift to pass without someone asking me if his or her heart attack, stroke, infection, allergic reaction, aches and pains, etc., could have been caused by “stress.” Panic attacks represent the sudden, dramatic onset of these symptoms. They are frequently seen in the emergency room and are often so significant they have to be treated with strong sedating medications.

Can music be used to help reduce anxiety?

An effective, inexpensive, non-pharmacological treatment for anxiety with no side effects would be extremely beneficial. Music has been around since prehistoric times and is used by many people to help them relax. Can music be used to help reduce anxiety? It is very difficult for researchers to develop unbiased studies which show that music, and music alone, reduces anxiety.

Let us consider the enormous task at hand. Just what is music? Ask a group from the inner city and they might say “Rap.” Play some Staukhausen and you may find them pardoning themselves as they walk nervously in the opposite direction. Opera has been used in shopping malls to drive people away. Many people, however, have found opera to be the supreme art and are willing to pay handsome prices for their boxes at the Met. In fact, one person’s music could be another person’s noise. There are even variations on that theme. Every performing artist knows that the actual performance is as important as the music itself. It can make or break an audience’s experience. At the time of this writing, a search for Beethoven’s 5th Symphony at TowerRecords.com yields 406 results. Certainly, there has not been a single recording of this masterpiece that has completely appealed to everyone. As a musician, I can attest that certain recordings provoke anxiety in me -- yet other recordings of the same music soothe and inspire me.

The Woody Allen paradox

There are people who actually are perfectly comfortable feeling anxious yet they don’t describe their anxiety in negative terms. Their increased pulse, breathing rate, and adrenaline in response to stress makes them feel “energized” and they may feel more anxious when taken out of their stressful environment. Filmmaker/actor Woody Allen often personifies this in his films. As a physician, I realize that it is extremely difficult to consistently and objectively arrive at meaningful data which describe the effects of music on anxiety.

What studies have been conducted on music and anxiety?

To prepare for this chapter, I searched the medical literature for studies conducted on music and anxiety. I collected available articles from health science, medical, and music libraries at a major university (Case Western Reserve University). In general, most of the studies report that their subjects felt less anxious while listening to self-selected music. There has been conflicting evidence, though, that the physiological indicators of stress, blood pressure, heart rate, breathing rate, and various hormone levels, were reduced while listening to music. All of the studies were small and could not fully control some very significant environmental and patient variables. None of the studies pitted the effects of music to the effects of television, magazines, massage, or a strawberry margarita. As an aside, there is more convincing medical research on positive physiological effects of moderate alcohol consumption than there is on the effect of music.

E.R.’s bottom line:

So what role, if any, does music have as a therapy for stress reduction? My view as a physician and musician is that certain music to certain people played at the right time and place may be as effective as the most effective medicine, and other music to other people may be as ineffective as the most ineffective medicine. I believe that virtually all people are born with the ability to accurately choose music that can consistently reduce their anxiety. Further study is indicated and welcome.

We at E.R. Music are grateful to readers who inform us about new research being published involving music and stress reduction. We will review the studies and incorporate them into this chapter. Please join our mailing list if you would like to be informed of the latest developments.

Copyright 2008, E.R. Music, LLC

Further Reading

Davis, Thaut, “The Influence of Preferred Relaxing Music on Measures of State Anxiety, Relaxation, and Physiological Responses,” Journal of Music Therapy, XXVI (4), 1989, 168-187

Mok, Wong, “Effects of Music on Patient Anxiety,” AORN, J 77 (Feb 2003), 396-410

Iwaki, Tanaka, Hori, “The Effects of Preferred Familiar Music on Falling Asleep,” Journal of Music Therapy, XL (1), 2003, 15-26

Bartlett, Kaufman, et al, “The Effects of Music Listening and Perceived Sensory Experiences on the Immune System as Measured by Interleukin-1 and Cortisol,” Journal of Music Therapy, XXX (4), 1993, 194-209

Rider, Floyd, et al, “The Effect of Music, Imagery, and Relaxation on Adrenal Corticosteroids and the Re-entrainment of Circadian Rhythms,” Journal of Music Therapy, XXII (1), 1985, 46-58

Burns, MS, Labbe, et al, “The Effects of Different Types of Music on Perceived and Physiological Measures of Stress,” Journal of Music Therapy, XXXIX (2), 2002, 101-116

Robb, “Music Assisted Progressive Muscle Relaxation, Progressive Muscle Relaxation, Music Listening, and Silence: A Comparison of Relaxation Techniques,” Journal of Music Therapy, XXXVII (1), 2000, 2-21

Lee, Henderson, Shum, “The Effect of Music on Preprocedure Anxiety in Hong Kong Chinese Day Patients,” Journal of Clinical Nursing, 2004, 13, 297-303

Robb, Nichols, et al, “The Effects of Music Assisted Relaxation on Preoperative Anxiety,” Journal of Music Therapy, XXXII, No. 1, Spring, 1995

Migneault, Girard, et al, “The Effect of Music on the Neurohormonal Stress Response to Surgery Under General Anesthesia,” Anesthesia & Analgesia, 2004;98:527-32

Miluk-Kolasa, Matejek, “The Effects of Music Listening on Changes in Selected Physiological Parameters in Adult Pre-Surgical Patients,” Journal of Music Therapy, XXXIII (3), 1996, 208-218