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IMPACT: International Journal of Research in Applied, 
Natural and Social Sciences (IMPACT: URANSS) 
ISSN(E): 2321-8851; ISSN(P): 2347-4580 
Vol. 2, Issue 3, Mar 2014, 41-54 
© Impact Journals 



THE EFFECT OF MUSIC INTERVENTION ON PSYCHOLOGICAL DISTRESS OF 
CARDIOVASCULAR PATIENTS AND CANCER PATIENTS 

ROSHAN ANIE ALEX 

Post Doctoral Fellow, Department of Psychology, Kerala University, Kerala, India 

ABSTRACT 

The study was intended to find out the effect of music intervention on the psychological distress of cardiovascular 
patients and cancer patients. The sample under study for music intervention was 30 female cardiovascular patients and 
30 female cancer patients selected from various hospitals in Kerala. The patients were selected based on their willingness 
to attend the intervention program. The tools used were DASS 21 and music CD recorded with seven songs based on 
Indian ragas like Hindolam, Abhogi, Hamsadhwani, Sree Ragam, Sreeranjini, Sivaranjani, Revathi, pre-recorded with the 
help of an expert musician. The results indicated that there were significant differences in their level of depression, anxiety, 
stress and total psychological distress in both cardiovascular and cancer patients before and after music intervention. 
Cardiovascular and cancer patients after music intervention had significantly lower level of depression, anxiety, stress and 
total psychological distress compared to their score on depression, anxiety, stress and psychological distress before music 
intervention. The results clearly indicated that music have a significant effect on the psychological distress of 
cardiovascular and cancer patients. 

KEYWORDS: Cardiovascular Disease, Cancer, Music Intervention 
INTRODUCTION 

Music washes away from the soul the dust of everyday life. 

-Berthold Auerbach, 1856 

The modern world of medicine is finally catching on to this hundred years old theory that was first referenced in 
the ancient writings of the scholars Plato and Aristotle who both noted the healing qualities and influences music had on 
both humans and animals. The immense potential of the power of Shabda (cosmic flow of sound) hidden in music was well 
recognised by the ancient Indian sages and they had devised several musical patterns emanating from the "Omkara" 
for chanting of the Vedic hymns and for distinct spiritual effects. The Shastric schools of music discovered musical octave 
(sa, re, ga, ma, pa, dha, ni, sa) indwelling in the subtle sounds of Nature and invented the basic classical ragas for activating 
specific streams of natural powers and effects; a wide variety of musical compositions were generated consequently. 
Ever since then music has been an integral part of human culture with varied applications and forms. 

According to an ancient Indian text, Swara Sastra, the seventy-two melakarta ragas (parent ragas) control the 
72 important nerves in the body. It is believed that if one sings with due devotion, adhering to the raga lakshana (norms) 
and srutishuddhi, (pitch purity) the raga could affect the particular nerve in the body in a favourable manner. 
According to the Vedic Philosophy, yoga and music both are part of Nada Vidya. Yoga deals with realisation of anahata 
nada the sublime sound (extrasensory vibrations) of the eternal force of cosmic consciousness. Music pertains to the 



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42 



Roshan Anie Alex 



perception and expression of the infinite spectrum of the rhythmic flow of the ahata nada (perceivable sonic currents) 
pervading in Nature. Both have direct impact on the shat chakras hidden along the endocrine column and hence affect our 
physical as well as subtle bodies. 

The seven basic swaras (musical notes) of the musical octave have a one-to-one correspondence with these 
chakras (nuclei of subtle energy). The lower most (in the kava equina region along the erect endocrine column), viz., 
the Muladhara Chakra is associated with the swara "sa"; that means, the practice of chanting this particular musical note 
will have impact on awakening or activation of this particular chakra. Similarly, the chakras successively upwards in this 
direction namely, the Swadhisthana, Manipura, Anahata, Vishuddha, Agya and the top-most Sahastrara Chakra have 
correspondence respectively with the swaras "re", "ga" "ma", "pa", "dha" and "ni". Significantly, the order of the 
compositions of these swaras in the "aroha" (ascending) and "avaroha" (descending) patterns of the Shastric musical tunes 
also match with the top-down (from Sahastrara to Muladhara) and bottom-up (from Muladhara to Sahastrara) directions of 
the flow of energy. Music has been used throughout human history to express and affect human emotion. 

In biblical accounts, King Saul was reportedly soothed by David's harp music, and the ancient Greeks expressed 
thoughts about music having healing effects as well. Many cultures are steeped in musical traditions. It can change mood, 
have stimulant or sedative effects, and alter physiologic processes such as heart rate and breathing. The apparent health 
benefits of music to patients in Veterans Administration hospitals following World War II lead to it being studied and 
formalized as a complementary healing practice. 

EFFECTS OF MUSIC ON BODY AND MIND 

Research has shown that music has a profound effect on your body and psyche (Elizabeth Scott, 2011). 
The following are some of effects of music: 

Brain Waves 

Music with a strong beat can stimulate brainwaves to resonate in sync with the beat, with faster beats bringing 
sharper concentration and more alert thinking, and a slower tempo promoting a calm, meditative state. The change in 
brainwave activity levels that music can bring can also enable the brain to shift speeds more easily on its own as needed, 
which means that music can bring lasting benefits to your state of mind, even after you've stopped listening. 

Breathing and Heart Rate 

With alterations in brainwaves, changes in other bodily functions occur. Those governed by the autonomic 
nervous system, such as breathing and heart rate can also be altered by the changes music can bring. This can mean slower 
breathing, slower heart rate, and an activation of the relaxation response, among other things. This is why music and music 
therapy can help counteract or prevent the damaging effects of chronic stress, greatly promoting not only relaxation, 
but health. 

State of Mind 

Music can also be used to bring a more positive state of mind, helping to keep depression and anxiety at bay. 
This can help prevent the stress response from wreaking havoc on the body, and can help keep creativity and optimism 
levels higher, bringing many other benefits. 



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Reducing Blood Pressure 

By playing recordings of relaxing music every morning and evening, people with high blood pressure can train 
themselves to lower their blood pressure - and keep it low. According to research reported at the American Society of 
Hypertension meeting in New Orleans, listening to just 30 minutes of classical, Celtic or raga music every day may 
significantly reduce high blood pressure (Teng et al., 2007). 

Medicine for the Heart 

Music is good for heart. Research shows that it is musical tempo, rather than style. Bernardi et al., 
(2006) recruited young men and women, half of whom were trained musicians. The participants slipped on head phones 
and listened to six styles of music, including rap and classical pieces, with random two-minute pauses. As the participants 
kicked back and listened, the researchers monitored their breathing, heart rates and blood pressure. The participants had 
faster heart and breathing rates when they listened to lively music. 

When the musical slowed, so did their heart and breathing rates. During the musical pauses, heart and breathing 
rates normalized or reached more optimal levels. Whether or not a person liked the style of music did not matter. 
The tempo, or pace, of the music had the greatest effect on relaxation. 

Speeds Post-Stroke Recovery 

A daily dose of one's favorite pop melodies, classical music or jazz can speed recovery from debilitating strokes. 
When stroke patients listened to music for a couple of hours each day, verbal memory and attention span improved 
significantly compared to patients who received no musical stimulation, or who listened only to stories read out loud 
(Sarkamo et al., 2008). 

Music Boosts Immunity 

Music can boost the immune function. Scientists explain that a particular type of music can create a positive and 
profound emotional experience, which leads to secretion of immune-boosting hormones (Kuhn, 2002). 
This helps contribute to a reduction in the factors responsible for illness. Listening to music or singing can also decrease 
levels of stress-related hormone Cortisol. Higher levels of Cortisol can lead to a decreased immune response 
(Le Roux, et al., 2007., Kreutz et al., 2004). 

Chronic Headaches & Migraine Remedy 

Music can help migraine (Oelkers-Ax et al., 2008) and chronic headache (Risch et al., 2001) sufferers reduce the 
intensity, frequency, and duration of the headaches. 

Music Enhances Intelligence, Learning and IQ 

The idea that music makes us smarter received considerable attention from scientists and the media. Music has the 
power to enhance some kinds of higher brain function such as reading and literacy skills (Besson, et al., 2007., Register., 
2001., Overy, 2003), spatial-temporal reasoning (Jausovec, Jausovec, Gerlic, 2006; Sarnthein, et al., 1997) and 
mathematical abilities (Schmithorst, Holland., 2004 ; Rauscher et al., (1997). Even children with attention 
deficit/hyperactivity disorder benefit in mathematics tests from listening to music beforehand. 

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I 44 Roshan Anie Alex | 

Emotional Intelligence 

Earlier it has been thought that listening to classical music, particularly Mozart, enhances performance on 
cognitive tests. However, recent findings of Schellenberg, Hallam, (2005) show that listening to any music that is 
personally enjoyable has positive effects on cognition. 

Music Improves Memory Performance 

The power of music to affect memory is quite intriguing. Mozart's music and baroque music, with a 
60 beats per minute beat pattern, activates the left and right brain. The simultaneous left and right brain action maximizes 
learning and retention of information. The information being studied activates the left brain while the music activates the 
right brain. Also, activities which engage both sides of the brain at the same time, such as playing an instrument or singing, 
cause the brain to be more capable of processing information. 

Listening to music facilitates the recall of information Researchers have shown that certain types of music are a 
great "keys" for recalling memories. Information learned while listening to a particular song can often be recalled simply 
by "playing" the songs mentally (Mammarella, Fairfield, Cornoldi, 2007). Musical training has even better effect than just 
listening to classical music. There is clear evidence that children who take music lessons develop a better memory 
compared with children who have no musical training (Ho YC, Cheung, Chan, 2003). 

Music Improves Concentration and Attention 

Easy listening music or relaxing classics improves the duration and intensity of concentration in all age groups 
and ability levels. It's not clear what type of music is better, or what kind of musical structure is necessary to help, 
but many studies have shown significant effects (Patston, et al., 2007). 

Music Improves Physical Performance 

Choosing music that motivates us will make it easier to start moving, walking, dancing, or any other type of 
exercise that we enjoy. Music can make exercise feel more like recreation and less like work. Furthermore, music enhances 
athletic performance. The four central hypotheses explaining music's facilitation of exercise performance include reduction 
in the feeling of fatigue, increase in levels of psychological arousal, physiological relaxation response and improvement in 
motor coordination (Simpson, Karageorghis, 2006., Edworthy, Waring 2006., Copeland, Franks, 1991). 

Music Improves Body Movement and Coordination 

Music reduces muscle tension and improves body movement and coordination 
(Bernatzky, et al., 2004., Rosenkranz et al., 2007). Music may play an important role in developing, maintaining and 
restoring physical functioning in the rehabilitation of persons with movement disorders. 

Music as Fatigue Fighter 

Listening to upbeat music can be a great way to find some extra energy. Music can effectively eliminate 
exercise-induced fatigue (Jing, Xudong, 2008) and fatigue symptoms caused by monotonous work 
(Ladenberger - Leo, 1986). 



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Music Improves Productivity 

Many people like to listen to music while they work. Whilst there may be many reasons for wishing to listen to 
music in the workplace, it really improves productivity (Fox, Embrey, 1972). According to a report in the journal, 
Neuroscience of Behaviour and Physiology (Pavlygina et al., 1999) a person's ability to recognize visual images, 
including letters and numbers, is faster when either rock or classical music is playing in the background. 

Relaxing Music Induces Sleep 

Relaxing classical music is safe, cheap and easy way to beat insomnia (Harmat et al., 2008). Many people who 
suffer from insomnia find that Bach music helps them. Researchers have shown that just 45 minutes of relaxing music 
before bedtime can make for a restful night. Relaxing music reduces sympathetic nervous system activity, 
decreases anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation 
and distraction from thoughts. 

Music Reduces Stress and Aids Relaxation 

Listening to slow, quiet classical music, is proven to reduce stress (Labbe et al., 2007). 
Physical Relaxation 

Music can promote relaxation of tense muscles, enabling us to easily release some of the tension we carry from a 
stressful day. 

Aids in Stress Relief Activities 

Music can help us get "into the zone" when practicing yoga, self- hypnosis or guided imagery, can help us feel 
energized when exercising and recover after exercising, help dissolve the stress when we are soaking in the tub. 

Reduces Negative Emotions 

Music, especially upbeat tunes, can take our mind off what stresses us, and help us feel more optimistic and 
positive. This helps release stress and can even help us keep from getting as stressed over life's little frustrations in the 
future. Khalfa et al., (2003) discovered that music can decrease the amount of the Cortisol, a stress-related hormone 
produced by the body in response to stress. 

Music Improves Mood and Decreases Depression 

Music's ability to "heal the soul" is the stuff of legend in every culture. Many people find that music lifts their 
spirits. Modern research tends to confirm music's psychotherapeutic benefits (Maratos et al., 2008). Bright, cheerful music 
(e.g. Mozart, Vivaldi, bluegrass, Klezmer, Salsa, reggae) is the most obvious prescription for the blues. 

MUSIC AS A THERAPY 

Music has been used in medicine for thousands of years. Ancient Greek philosophers believed that music could 
heal both the body and the soul. The therapeutic benefits of music can be traced back in time to ancient shamanistic rituals. 
Throughout the history of human development, music in some form has been used as an important aid to healing. 
Schullian and Schoen describe references to the divine alliance of music and medicine in classical antiquity and the healing 
function of music among primitive peoples. Beneficial effects of music have been recognized by the ancient Greeks and 



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Roshan Anie Alex 



Romans, including Pythagoras, Democritus, Aristotle, Galen, and Celsus, and Plato, Cicero, and Seneca all believed that 
music profoundly affected the behaviour of entire societies and that the state should regulate the performance of certain 
types of music. Similarly, traditional Chinese medicine refers to the qualities of specific instruments and sounds and their 
beneficial effects on various organs of the body. From these early beginnings to the present day, interest in music as an 
adjunct to the healing or therapeutic experience has been sustained. Music as a healing touch used during age old times, as 
a means of therapy. 

Music Therapy is a comparatively newer concept of alternative medicine to fight with many diseases. 
Music therapy is based on the associative and cognitive powers of the mind. Sound creates vibrations on the eardrum, 
which is picked up by the auditory nerve and sent to the brain and redistributed throughout the neuron network. 
Music therapy has the potential for multidimensional influence on the physical, psychological, social and spiritual aspects 
of a patient's life. Physically it promotes muscular relaxation, helps to relieve pain and facilitates physical participation. 
Psychologically it can alter the patient's mood including the easing of anxiety and the lessening of depression. It provides a 
nonverbal means of expressing feelings. 

Music enhances communication and helps the patient to recall past significant events. Socially it provides an 
opportunity to participate in a group and to lessen isolation. It can be used as a bond promoting a sense of community with 
family members and others. It can also promote healing during the family's grief process. Spiritually it provides an avenue 
to search for the meaning of life and helps the patient to accept the dying process by easing the fear of death. Music can 
inspire hope. Music therapy has a great deal of potential for meeting the needs of the terminally ill and their families. 
In the future, music therapy is expected to be used more widely and more effectively not only in terminal care but also in 
the field of psychosomatic medicine (Cicely Saunders, 1993). The studies reviewed found that music have a significant 
effect on mind and body. This study was taken up to execute an intervention technique like listening to music and to find 
out the effect of music on the level of depression, anxiety, stress and total psychological distress of the cardiovascular and 
cancer patients. 

METHODOLOGY 
Sample 

The sample under study for music intervention was 30 female cardiovascular patients and 30 female cancer 
patients selected from various hospitals in Kerala. The patients were selected based on their willingness to attend the 
intervention program. 

Tools 

The tools used for collecting the data were DASS 21 and music CD. The Depression Anxiety Stress Scales 21 
(DASS-21) developed by Lovibond and Lovibond is a set of three self-report scales designed to measure the negative 
emotional states of depression, anxiety and stress. Each of the three DASS 21 scales contains seven items, divided into 
subscales with similar content. The Depression scale assesses dysphoria, hopelessness, devaluation of life, 
self-deprecation, lack of interest / involvement, anhedonia, and inertia. The Anxiety scale assesses autonomic arousal, 
skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The Stress scale is sensitive to 
levels of chronic non-specific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, 
irritable/over-reactive and impatient. The reliabilities of the DASS-21 scales were .88 for Depression, .82 for Anxiety, 

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The Effect of Music Intervention on Psychological Distress of Cardiovascular Patients and Cancer Patients 



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.90 for Stress, and .93 for the Total scale. The validities of the DASS- 21 for depression, anxiety and stress subscales were 
337, 328 and 347, respectively. The music cd used was recorded with seven songs pre-recorded with the help of an expert 
musician. The songs were based on Indian music ragas like Hindolam, Abhogi, Hamsadhwani, Sree Ragam, Sreeranjini, 
Sivaranjani, Revathi. 

MUSIC INTERVENTION PROCEDURE 

The group for intervention program was selected from the main sample under study. 30 patients from each patient 
category were selected based on their willingness to undergo the music intervention program. The intervention group was 
given an awareness program about the scientific basis of music intervention. Care was taken to clear all their doubts. 
The selected group had to listen to a cd with particular ragas which were pre- arranged with the help of an expert musician. 

The cd consists of seven songs based on ragas like Hindolam, Abhogi, Hamsadhwani, Sree Ragam, Sreeranjini, 
Sivaranjani, Revathi. The selected patients were divided into 5 groups (representation in each group ranging from 4-6) in 
each patient group according to their convenience of attending the program. A room was arranged at the hospital for music 
intervention. The patients were requested to reach the place by 10 am. The participants were asked to sit in a comfortable 
position and avoid any distraction such as reading, using mobile etc. They were instructed to listen to the music for 
20 minutes. The intervention was given for 25 days continuously. The depression, anxiety, stress and total psychological 
distress scores of the patients were collected using DASS before and after the intervention programme. 
After data collection, the data were consolidated and scoring was done. The data were analysed using SPSS version 17. 

STATISTICAL TECHNIQUE USED FOR INTERVENTION 

The statistical technique used for analyzing the data was paired t-test. 

RESULTS AND DISCUSSIONS 

The paired t test was done with the scores obtained on DASS before and after music intervention program, 
to find out whether cvd patients and cancer patients differ significantly in the level of depression, anxiety, stress and 
total psychological distress before and after music intervention. The details are given in Table 1 . 

Table 1: Paired t Test Analysis of the Scores Obtained on the DASS by the Two Groups 
(Cvd and Cancer Patients) before and after Music Intervention 



Group 


Variable before and 
after Music Intervention 


N 


Mean 


Std. 
Deviation 


t 


Cvd 


Depression 1 


30 


19.0667 


5.27148 


16.589** 


Depression 2 


30 


15.5333 


5.15774 


Cancer 


Depression 1 


30 


11.0667 


6.72070 


7.172** 


Depression 2 


30 


9.2667 


5.96503 


Cvd 


Anxiety 1 


30 


9.7333 


5.40072 


7.913** 


Anxiety 2 


30 


7.9667 


5.18940 


Cancer 


Anxiety 1 


30 


6.7333 


2.75347 


8.500** 


Anxiety 2 


30 


5.6000 


2.32824 


Cvd 


Stress 1 


30 


11.9333 


4.37811 


12.022** 


Stress 2 


30 


9.0667 


4.02521 


Cancer 


Stress 1 


30 


13.5333 


4.53898 


15.577** 


Stress 2 


30 


10.6667 


3.85364 



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Roshan Anie Alex 



Table 1: Contd. 



Cvd 


Total psy distress 1 


30 


40.7333 


9.20994 


20.493** 


Total psy distress 2 


30 


32.5667 


9.05418 


Cancer 


Total psy distress 1 


30 


31.3333 


7.20791 


17.953** 


Total psy distress 2 


30 


25.5333 


6.30672 



Note: ** The t value is statistically significant at 0.01 level 



The t values shown in table 1, indicated that there were significant differences in their level of depression, anxiety, 
stress and total psychological distress in both cvd and cancer patients before and after music intervention. 
The mean scores showed that cardiovascular and cancer patients after music intervention had significantly lower level of 
depression, anxiety, stress and total psychological distress compared to their score on depression, anxiety, stress and 
psychological distress before music intervention. The results clearly indicated that music have a significant effect on the 
psychological distress of cardiovascular and cancer patients. 

The following studies supported the findings of the study: 

First described in palliative care over three decades ago (Munro and Mount, 1978), music therapy has since 
become a widely accepted discipline that can promote resilience, control, comfort, and peace among people affected by 
life-threatening illnesses, including patients and their families, friends, and staff caregivers 
(Dileo and Loewy, 2005., Hilliard, 2005., O'Callaghan, 2006a., Rykov and Salmon, 2001). Music therapy in oncology and 
palliative care can be described as the professionally informed and creative use of music within a therapeutic relationship 
with people who have been identified as needing psychosocial, physical, or spiritual help or who desire further 
self-awareness, enabling increased life quality. Lisa Gallagher (2006) assessed the effect of music therapy on patients with 
advanced disease. Two hundred patients with chronic and/or advanced illnesses were prospectively evaluated. 
The effects of music therapy on these patients are reported. All improvements were statistically significant. Most patients 
and families had a positive subjective and objective response to music therapy. 

Moradipanah (2009) examined the effect of music on the levels of anxiety, stress, and depression experienced by 
patients undergoing coronary angiography. Differences in pre- and post-intervention scores demonstrated that there were 
significant decreases in mean scores of state anxiety, stress and depression in the intervention group, who listened to 
20 minutes of relaxing music, as compared with the control group who had 20 minutes of bed rest. Individuals with 
coronary heart disease often suffer from severe distress putting them at greater risk for complications, including sudden 
cvd death. The findings of a related research study suggest that music listening may have a beneficial effect on blood 
pressure and heart rate in people with coronary heart disease. Music listening also appears to be effective in reducing 
anxiety in myocardial infarction patients. No evidence for anxiety-reducing effects of music was found for patients 
undergoing cvd procedures. This may be due to the fact that anxiety was measured after the completion of the procedure 
rather than during it. The vast majority of the studies examined the effects of patient's listening to pre-recorded music. 
More research is needed on the effects of music offered by a trained music therapist (Bradt Dileo, 2009). 

Some music may reduce heart rate, respiratory rate, and blood pressure in patients with coronary heart disease, 
according to a 2009 Cochrane review of 23 clinical trials. Benefits included a decrease in blood pressure, heart rate, 
and levels of anxiety in heart patients. However, the effect was not consistent across studies. Music did not appear to have 
much effect on patient's psychological distress (Joke Bradt and Cheryl Dileo, 2008). Shui-Tao Hu (2007) examined 
effectiveness of application music therapy on cardiovascular patients in intensive Care unit (ICU). The subject group 

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The Effect of Music Intervention on Psychological Distress of Cardiovascular Patients and Cancer Patients 



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consisted of 60 cardiovascular patients. The subjects were divided into two groups, 30 subjects in each group. 
The subjects in the experimental group received music therapy and another subjects in the control group received the 
routine care. Results lead researchers to conclude that implementing music therapy could effectively decrease anxiety on 
cardiovascular patients in intensive Care unit. 

Kathy Bally et al., (2003) examined patient's response to music during operative procedures involving spinal, 
epidural, or local infiltration anesthesia: 75% of the patients rated the music as helpful, relaxing, and supportive. 
Participants stated that listening to music helped counterbalance the feeling of depersonalization associated with being in 
the hospital environment. They also reported the effect of music on patient's anxiety during flexible sigmoidoscopy. 
They found that music was an effective anxiolytic; state anxiety scores were significantly less in the group of patients who 
listened to self-selected tapes during procedures than in patients who received the standard protocol. Conversely, music in 
combination with muscle relaxation was ineffective in reducing anxiety in patients admitted to a coronary care unit with 
unstable angina or acute myocardial infarction. 

Forsch Komplement armed (1999) conducted a study on the influence of musical rhythm on synchronisation and 
co-ordination of heart rate. The sample was 28 patients with chronic cancer pain in a stable phase of the disease. 
14-day training of a relaxation therapy designed for improving the falling asleep, including a 30-minute lullaby-like, 
rhythmically dominated music with gradually decreasing tempi. No training in the control group. Relaxation therapy led to 
an improvement of falling asleep and to a decrease in consumption of analgesics. Lullaby-like music within a special range 
of tempi can induce attainable synchronisation of heart rate, functionally associated with the formation and intensity of a 
relaxation reaction. 

Lucanne Magill et al., (201 1) piloted a program with 39 critically ill cancer patients. Pre-therapy and post-therapy 
scores were obtained with the Distress Thermometer, a well-validated 10-point Likert scale for measuring cancer distress. 
The mean distress score before the intervention was 4.6. After intervention it dropped to a mean + SD of2.5 + 1.5, 
representing a 46% improvement. This was statistically significant (95% confidence interval of 1.6-2.9, p=.001). 
A qualitative thematic analysis encompassed the following topics: faith, hope, family, meaning in life, creativity, 
hopelessness, abandonment, and fear of death. 

This feasibility study suggests a unique approach to behavioural activation for critically ill cancer patients by 
using combined music therapy and CBT. In addition to the therapeutic value of music, lyrics are used to generate coping 
statements, which are often based on memories that can be used to sustain the patient through his or her current adversity. 
Huang (2007) examined the effect of music on cancer pain using a two group pre-test post-test experimental design and to 
examine relaxation and distraction as the mediating variables. This study tested a proportion from the Good and Moore 
theory that non-pharmacological interventions reduce pain. The results extended the Good and Moore acute pain theory, 
to include the effect of music on chronic cancer pain, and identify explanatory mechanisms. Nurses can offer soft music to 
supplement analgesic mediation for cancer patients with pain. Future researchers can study the effects of music for pain 
and other symptoms in people with specific types of cancer. 

Music therapy was found to reduce mood disturbance in cancer patients undergoing autologous stem cell 
transplantation, a procedure known to cause significant psychological distress. Music alleviates pain and anxiety in 
breast cancer patients in those receiving chemotherapy and radiation therapy, and improves the quality of life in people 



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Roshan Anie Alex 



with terminal cancer. Music also reduces pain and anxiety, and increases comfort in hospitalized children with cancer. 
Women undergoing colposcopy reported reduced anxiety and pain perception after listening to slow-rhythm music. 
Because music therapy is noninvasive and free of side effects, it is being integrated into the standard care in major cancer 
hospitals to help relieve pain and other physical and psychological discomfort (Boso et al., 2006). Cancer patients reported 
that songwriting was a pleasurable, helpful, unique, calming, and easy experience that allowed them to express themselves 
and record significant life events (O'Brien, 2005). 

Music Therapy programme was conducted to improve a cancer patient's physical and emotional well-being by 
providing a distraction during treatment, thus decreasing stress, pain, and anxiety levels. 

CONCLUSIONS 

The conclusions are engaging cancer patients in music therapy appear to have a positive effect on their emotional 
and physical well-being. One hundred percent (100%) of program participants somewhat or strongly agreed that music 
therapy decreased their stress, as well as anxiety levels, and 69% somewhat or strongly agreed that participating in the 
program decreased their pain level. Cancer patients who participate in music therapy seem to largely benefit from the 
program. One hundred percent (100%) somewhat or strongly agreed the music therapy program was beneficial / valuable 
to them, and all would participate again if given the chance (Clements-Cortes, 2004). 

There have been studies showing that music therapy can help people who've had cancer to feel less anxious, 
more relaxed, and to feel less pain. In a very preliminary 2001 British study of music therapy in 29 cancer patients, 
participants felt a higher sense of well-being and less tension during one session. Researchers measured improvements in 
immune function and decreases in the amount of the stress hormone Cortisol. 20 patients awaiting breast biopsy showed 
that, when some of the patients had a 20-minute music therapy session while in the pre-operative waiting room, 
their anxiety and respiratory rates were much lower than those of the patients who did not have a music therapy session 
(Demmer, 2004). Sahler (2003) was done a study with 42 patients on the bone marrow transplant unit at the James Wilmot 
Cancer Center. 

Patients ranged in age from 5 to 65 years of age, most were being treated for various types of cancer, including 
leukemia, lymphomas, and solid tumours. The patients who met twice each week for music-assisted relaxation and imagery 
reported significantly less pain and nausea - on average, they rated both their pain and nausea 'severe' before sessions, 
but 'moderate' after sessions. Their new bone marrow took hold faster, too. The average time until patients began 
producing their own white blood cells was 13.5 days in the group receiving music therapy, compared to 15.5 days in the 
control group. The length of this span of time, when patients are most vulnerable to infection, is crucial. Most music and 
oncology studies, however, have examined the effects of receptive interventions such as music listening, music and 
imagery, or a combination of music therapy interventions (receptive and interactive) on outcomes such as decreasing pain 
and nausea, improving mood, increasing family communication, and improving quality of life 
(Sahler, Hunter, and liesveld, 2003). 

The high prevalence and associated increase in morbidity and mortality justifies future research regarding the 
management of depression, anxiety and stress in both cardiovascular diseases and cancer. Current evidence suggests that 
multi-faceted interventions such as alternative therapies like music therapy along with mainstream medicine may offer the 
best hope for improving outcomes for psychological distress and may improve well-being and quality of life of patients 



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51 



who are experiencing stress due to their severe/chronic medical conditions like cardiovascular diseases and cancer. 
Music therapy has a great deal of potential for meeting the needs of the terminally ill and their families. In the future, 
music therapy is expected to be used more widely and more effectively not only in terminal care but also in the field of 
psychosomatic medicine. 

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