Neurocognitive research has the potential to identify the relevant effects of music therapy. In this study, we examined the effect of music mode (major vs. minor) on stress reduction using optical topography and an endocrinological stress marker. In salivary cortisol levels, we observed that stressful conditions such as mental fatigue (thinking and creating a response) was reduced more by major mode music than by minor mode music. We suggest that music specifically induces an emotional response similar to a pleasant experience or happiness. Moreover, we demonstrated the typical asymmetrical pattern of stress responses in upper temporal cortex areas, and suggested that happiness/sadness emotional processing might be related to stress reduction by music.

Neuroreport. 2008 Jan 8;19(1):75-8. Suda M, Morimoto K, Obata A, Koizumi H, Maki A. Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. miyuki@envi.med.osaka-u.ac.jp

Aims and objectives. The purpose of this study was to examine the effects of music therapy on stress, anxiety and depression in Taiwanese pregnant women. Background. The value of music therapy is slowly being realized by nurses in various clinical areas, including obstetrics. Previous studies have demonstrated a high prevalence of psychological stress during pregnancy. Few studies have examined the effects of music therapy on reducing psychological stress during pregnancy. Design. A randomized experimental study design was developed and implemented. Methods. Two hundred and thirty-six pregnant women were randomly assigned to music therapy (n = 116) and control (n = 120) groups. The music therapy group received two weeks of music intervention. The control group received only general prenatal care. Psychological health was assessed using three self-report measures: Perceived Stress Scale (PSS), State Scale of the State-Trait Anxiety Inventory (S-STAI) and Edinburgh Postnatal Depression Scale (EPDS). Results. In a paired t-test, the music therapy group showed significant decrease in PSS, S-STAI and EPDS after two weeks. The control group only showed a significant decrease in PSS after two weeks. This decrease was not as substantial as in the experimental group. An ancova test with the pretest scores as the control revealed that the changes in PSS, S-STAI and EPDS after two weeks were significantly decreased in the experimental group compared with the control group. Conclusions. This controlled trial provides preliminary evidence that two-week music therapy during pregnancy provides quantifiable psychological benefits. Relevance to clinical practice. The findings can be used to encourage pregnant women to use this cost-effective method of music in their daily life to reduce their stress, anxiety and depression. Further research is needed to test the long-term benefits.

J Clin Nurs. 2008 Feb 19 Chang MY, Chen CH, Huang KF. National Tainan Institute of Nursing, Taiwan, and College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.

The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures. METHODS: We searched 16 electronic databases of published and unpublished studies, subject bibliographies, reference lists of relevant articles, and trials registries. Two reviewers independently screened 4559 citations and reviewed the full manuscript of 393 studies. Nineteen studies met the inclusion criteria: randomized controlled trial, children aged 1 month to 18 years were examined, music was used as an intervention, and the study measured pain or anxiety. Music therapy was considered active if a music therapist was involved and music was used as a medium for interactive communication. Passive music therapy was defined as listening to music without the involvement of a music therapist. RESULTS: The 19 included trials involved 1513 subjects. The methodological quality of the studies was generally poor. Overall, MT showed a significant reduction in pain and anxiety (standardized mean difference [SMD] -0.35; 95% confidence interval [CI], -0.55 to -0.14; 9 studies; N = 704; I(2) = 42%). When analyzed by outcome, MT significantly reduced anxiety (SMD -0.39; 95% CI, -0.76 to -0.03; 5 studies; n = 284; I(2) = 52.4%) and pain (SMD -0.39; 95% CI, -0.66 to -0.11; 5 studies; N = 465; I(2) = 49.7%). There was no evidence of publication bias. CONCLUSIONS: Music is effective in reducing anxiety and pain in children undergoing medical and dental procedures. Music can be considered an adjunctive therapy in clinical situations that produce pain or anxiety.

Ambul Pediatr. 2008 Mar-Apr;8(2):117-28. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. From the Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada.

I portray health-related research outcomes in an arts-informed representation that disrupts the traditional discursive-scholarly format of journal writing to privilege better the participants' accounts and communicate these experientially. The representation uncovers meaning through alternative ways of communicating and conveys the ineffable quality of music in a manner that may be understood through and beyond words. This expands the convention of health-related research outcomes, including ways of knowing, what can be known and how this can be represented. I elaborate my intentions for this experiential report, discuss theoretical underpinnings of this methodology and describe a music therapy support group model.

J Health Psychol. 2008 Mar;13(2):190-200. Rykov MH. PO Box 142, Station C, Toronto, Ontario, M6J 3M9, Canada. info@musictherapyservices.org.

Migraine is very common in school-aged children, but despite a number of pharmacological and non-pharmacological options for prophylaxis, randomized controlled evidence in children is small. Evidence-based prophylactic drugs may have considerable side effects. OBJECTIVE: This study was to assess efficacy of a butterbur root extract (Petadolex) and music therapy in primary school children with migraine. DESIGN: Prospective, randomized, partly double-blind, placebo-controlled, parallel-group trial. METHODS: Following a 8-week baseline patients were randomized and received either butterbur root extract (n=19), music therapy (n=20) or placebo (n=19) over 12 weeks. All participants received additionally headache education ("treatment as usual") from the baseline onwards. Reduction of headache frequency after treatment (8-week post-treatment) as well as 6 months later (8-week follow-up) was the efficacy variable. RESULTS: Data analysis of subjects completing the respective study phase showed that during post-treatment, only music therapy was superior to placebo (p=0.005), whereas in the follow-up period both music therapy and butterbur root extract were superior to placebo (p=0.018 and p=0.044, respectively). All groups showed a substantial reduction of attack frequency already during baseline. CONCLUSION: Butterbur root extract and music therapy might be superior to placebo and may represent promising treatment approaches in the prophylaxis of paediatric migraine.

Eur J Pain. 2008 Apr;12(3):301-13. Epub 2007 Jul 30. Oelkers-Ax R, Leins A, Parzer P, Hillecke T, Bolay HV, Fischer J, Bender S, Hermanns U, Resch F. Department of Child and Adolescent Psychiatry, University of Heidelberg, Blumenstrasse 8, D-69115 Heidelberg, Germany. rieke_oelkers@med.uni-heidelberg.de

Depression is a highly prevalent disorder associated with reduced social functioning, impaired quality of life, and increased mortality. Music therapy has been used in the treatment of a variety of mental disorders, but its impact on those with depression is unclear. OBJECTIVES: To examine the efficacy of music therapy with standard care compared to standard care alone among people with depression and to compare the effects of music therapy for people with depression against other psychological or pharmacological therapies. SEARCH STRATEGY: CCDANCTR-Studies and CCDANCTR-References were searched on 7/11/2007, MEDLINE, PsycINFO, EMBASE, PsycLit, PSYindex, and other relevant sites were searched in November 2006. Reference lists of retrieved articles were hand searched, as well as specialist music and arts therapies journals. SELECTION CRITERIA: All randomised controlled trials comparing music therapy with standard care or other interventions for depression. DATA COLLECTION AND ANALYSIS: Data on participants, interventions and outcomes were extracted and entered onto a database independently by two review authors. The methodological quality of each study was also assessed independently by two review authors. The primary outcome was reduction in symptoms of depression, based on a continuous scale. MAIN RESULTS: Five studies met the inclusion criteria of the review. Marked variations in the interventions offered and the populations studied meant that meta-analysis was not appropriate. Four of the five studies individually reported greater reduction in symptoms of depression among those randomised to music therapy than to those in standard care conditions. The fifth study, in which music therapy was used as an active control treatment, reported no significant change in mental state for music therapy compared with standard care. Dropout rates from music therapy conditions appeared to be low in all studies. AUTHORS' CONCLUSIONS: Findings from individual randomised trials suggest that music therapy is accepted by people with depression and is associated with improvements in mood. However, the small number and low methodological quality of studies mean that it is not possible to be confident about its effectiveness. High quality trials evaluating the effects of music therapy on depression are required.

Maratos AS, Gold C, Wang X, Crawford MJ. Central and Northwest London Foundation NHS Trust, Arts Therapies, Greater London House, Hampstead Road, London, UK, NW1 7QY. anna.maratos@nhs.net

In the last decade, a considerable number of studies have been made on the cognitive processing of music. A patient with pure amusia due to the infarction of anterior portion of bilateral temporal lobes revealed the disturbance of the discrimination of chords. Using positron emission tomography, these regions were activated when musically naive normal subjects listened to the harmony compared to the rhythm of identical music. So, we concluded that anterior temporal portion might participate in the recognition of chords. Several articles reported that the musician's brain was different from nonmusicians' functionally and anatomically. This difference was considered to be caused by the musical training for a long time. Recent studies clarified that the reorganization might occur by musical training for a few months. Melodic intonation therapy (MIT) is a method aimed to improve speech output of aphasic patients, using short melodic phrase with a word. The literatures of mental processing of music suggested that right hemisphere might participate in the expression of music, namely singing and playing instrumentals. So, it was supposed that MIT utilized the compensational function of right hemisphere for damaged left hemisphere. We also reported that mental singing improved the gait disturbance of patients with Parkinson's disease. Music therapy is changing from a social science model based on the individual experiences to a neuroscience-guided model based on brain function and cognitive processing of the perception and expression of music.

Rinsho Shinkeigaku. 2007 Nov;47(11):868-70. Satoh M, Takeda K, Kuzuhara S. Mie St. Cross Hospital.

PROBLEM: When coupled with the often debilitating side-effects of pharmacological interventions, chronic cancer pain may elicit feelings of anxiety and depression and therefore adversely affect patient well-being and quality of life. PURPOSE: This review article is a systematic assessment of the published literature related to music and cancer pain management. METHOD: A comprehensive systematic evaluation of the data based literature was undertaken and analyzed using matrix analysis. RESULTS: As an adjunctive form of pain management, music therapy has been shown to address some of these hardships by providing patients with an alternative effective means by which to reduce their subjective experiences of pain. Studies investigating the efficacy of music therapy during invasive cancer procedures and chemotherapy demonstrated the role that attention states play in distracting patients from, and therefore minimizing their experience of, the pain associated with such treatments. Other studies examining diverse outpatient populations revealed similar findings, illustrating well the cognitive-affective dimensions of pain perception. Although these findings fail to adequately address the ambiguity surrounding music therapy's role in cancer pain management, music therapy has nonetheless been shown to significantly reduce anxiety and, in so doing, indirectly lessen the intensity of pain while improving patient quality of life.

Hawaii Med J. 2007 Nov;66(11):292-5. Igawa-Silva W, Wu S, Harrigan R. Stanford University, USA.

Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy interventions be aligned with evidence-based information and that accepted standards be established by the music therapy discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design pediatric practice guidelines in the application of music therapy.

J Pediatr Nurs. 2007 Dec;22(6):448-56. Stouffer JW, Shirk BJ, Polomano RC. Department of Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA 19104, USA.

Schizophrenia is one of the most serious mental disorders. Music therapy has only recently been introduced as a form of treatment. The aim of this study was to examine the effect of music therapy for schizophrenic in-patients needing acute care. METHOD: Thirty-seven patients with psychotic disorders were randomly assigned to an experimental group and a control group. Both groups received medication and treatment indicated for their disorder. Additionally, the experimental group (n = 21) underwent group music therapy. RESULTS: Significant effects of music therapy are found in patients' self-evaluation of their psychosocial orientation and for negative symptoms. No differences were found in the quality of life. CONCLUSION: Musical activity diminishes negative symptoms and improves interpersonal contact. These positive effects of music therapy could increase the patient's abilities to adapt to the social environment in the community after discharge from the hospital.

Acta Psychiatr Scand. 2007 Nov;116(5):362-70. lrich G, Houtmans T, Gold C. Rhenish Clinic Bedburg-Hau, Bedburg-Hau, Germany. gunnarulrich@tiscali.nl

Music therapy has been shown to be efficacious in experimental studies. However, there is little empirical research knowledge about what elements of music therapy influence its effectiveness in clinical practice. Children and adolescents with psychopathology (N=75) were assessed before and after participating in individual music therapy with 1 out of 15 music therapists in the Vienna region. Relationships between outcomes (as evaluated by parents) and therapy contents (as reported by therapists) were examined using general linear modelling. Results indicated that clients' symptoms and burdens on their social environment showed greater improvement when music therapy was limited to discipline-specific music therapy techniques and did not include other media such as play therapy elements. The findings indicate the importance of being aware of a therapy method's specific strengths and limitations. More research on the indicated specific ingredients of music therapy intervention is needed.

Psychol Psychother. 2007 Dec;80(Pt 4):577-89. Gold C, Wigram T, Voracek M. University of Bergen, Unifob Health, Bergen, Norway. christian.gold@grieg.uib.no

There are few researches on the effects of music therapy on the recovery from exercise-induced fatigue worldwide. The aim of this study was to evaluate the effects of relaxing music on aerobic exercise-induced fatigue. The authors' hypothesis is that relaxing music can effectively eliminate aerobic exercise-induced fatigue. METHODS: Thirty healthy male college students were randomly assigned to either no-music group or music group. All the subjects maintained the pedal cadence of 50 revmin-1 on a cycle ergometer until fatigue. Then subjects in music group listened to relaxing music for 15 minutes, while subjects in no-music group had a 15-minute rest without music. Heart rates, jump height, blood glucose, blood lactic acid, urinary protein, simple reaction time and ratings of perceived exertion (RPE) were determined before and after the 15-minute treatment for each group. RESULTS: The results showed that heart rates, urinary protein and RPE decreased significantly after the application of relaxing music (P<0.01), and these decreases were greater than those without music. CONCLUSION: The results suggest that relaxing music has better effects on the rehabilitation of cardiovascular, central, musculoskeletal and psychological fatigue and the promotion of the regulatory capability of the kidneys.

J Sports Med Phys Fitness. 2008 Mar;48(1):102-6. Jing L, Xudong W. Department of Human Sports Science, Nanjing Institute of Physicial Education, Nanjing, Republic of China lijing197512@163.com.

Music performance is both a natural human activity, present in all societies, and one of the most complex and demanding cognitive challenges that the human mind can undertake. Unlike most other sensory-motor activities, music performance requires precise timing of several hierarchically organized actions, as well as precise control over pitch interval production, implemented through diverse effectors according to the instrument involved. We review the cognitive neuroscience literature of both motor and auditory domains, highlighting the value of studying interactions between these systems in a musical context, and propose some ideas concerning the role of the premotor cortex in integration of higher order features of music with appropriately timed and organized actions.

Nat Rev Neurosci. 2007 Jul;8(7):547-58. Zatorre RJ, Chen JL, Penhune VB. Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada. robert.zatorre@mcgill.ca

Music has been used for therapeutic purposes since the beginning of cultural history. However, despite numerous descriptions of beneficial effects, the precise mechanisms by which music may improve human well-being remain unclear. METHODS: We conducted a randomized study in ten critically ill patients to identify mechanisms of music-induced relaxation using a special selection of slow movements of Mozart's piano sonatas. These sonatas were analyzed for compositional elements of relaxation. We measured circulatory variables, brain electrical activity, serum levels of stress hormones and cytokines, requirements for sedative drugs, and level of sedation before and at the end of a 1-hr therapeutic session. RESULTS: Compared with controls, we found that music application significantly reduced the amount of sedative drugs needed to achieve a comparable degree of sedation. Simultaneously, among those receiving the music intervention, plasma concentrations of growth hormone increased, whereas those of interleukin-6 and epinephrine decreased. The reduction in systemic stress hormone levels was associated with a significantly lower blood pressure and heart rate. CONCLUSION: Based on the effects of slow movements of Mozart's piano sonatas, we propose a neurohumoral pathway by which music might exert its sedative action. This model includes an interaction of the hypothalamic-pituitary axis with the adrenal medulla via mediators of the unspecific immune system

Crit Care Med. 2007 Dec;35(12):2709-13. Comment in: Crit Care Med. 2007 Dec;35(12):2858-9. Conrad C, Niess H, Jauch KW, Bruns CJ, Hartl W, Welker L. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. cconrad1@partners.org

Psychophysiological studies with music have not examined what exactly in the music might be responsible for the observed physiological phenomena. The authors explored the relationships between 11 structural features of 16 musical excerpts and both self-reports of felt pleasantness and arousal and different physiological measures (respiration, skin conductance, heart rate). Overall, the relationships between musical features and experienced emotions corresponded well with those known between musical structure and perceived emotions. This suggests that the internal structure of the music played a primary role in the induction of the emotions in comparison to extramusical factors. Mode, harmonic complexity, and rhythmic articulation best differentiated between negative and positive valence, whereas tempo, accentuation, and rhythmic articulation best discriminated high arousal from low arousal. Tempo, accentuation, and rhythmic articulation were the features that most strongly correlated with physiological measures. Music that induced faster breathing and higher minute ventilation, skin conductance, and heart rate was fast, accentuated, and staccato. This finding corroborates the contention that rhythmic aspects are the major determinants of physiological responses to music.

Emotion. 2007 May;7(2):377-87. Gomez P, Danuser B. Institut Universtitaire Romand de Sante au Travail, Lausanne, Switzerland. patrick.gomez@hospvd.ch

Language and music share a number of characteristics. Crucially, both domains depend on both rules and memorized representations. Double dissociations between the neurocognition of rule-governed and memory-based knowledge have been found in language but not music. Here, the neural bases of both of these aspects of music were examined with an event-related potential (ERP) study of note violations in melodies. Rule-only violations consisted of out-of-key deviant notes that violated tonal harmony rules in novel (unfamiliar) melodies. Memory-only violations consisted of in-key deviant notes in familiar well-known melodies; these notes followed musical rules but deviated from the actual melodies. Finally, out-of-key notes in familiar well-known melodies constituted violations of both rules and memory. All three conditions were presented, within-subjects, to healthy young adults, half musicians and half non-musicians. The results revealed a double dissociation, independent of musical training, between rules and memory: both rule violation conditions, but not the memory-only violations, elicited an early, somewhat right-lateralized anterior-central negativity (ERAN), consistent with previous studies of rule violations in music, and analogous to the early left-lateralized anterior negativities elicited by rule violations in language. In contrast, both memory violation conditions, but not the rule-only violation, elicited a posterior negativity that might be characterized as an N400, an ERP component that depends, at least in part, on the processing of representations stored in long-term memory, both in language and in other domains. The results suggest that the neurocognitive rule/memory dissociation extends from language to music, further strengthening the similarities between the two domains.

Neuroimage. 2007 Nov 1;38(2):331-45. Miranda RA, Ullman MT. Brain and Language Laboratory, Department of Neuroscience, Georgetown University, New Research Building, 3970 Reservoir Road, NW, Washington, DC 20057, USA; Interdisciplinary Program in Neuroscience, Georgetown University, USA.

Throughout history and across cultures, humans have created music using pitch intervals that divide octaves into the 12 tones of the chromatic scale. Why these specific intervals in music are preferred, however, is not known. In the present study, we analyzed a database of individually spoken English vowel phones to examine the hypothesis that musical intervals arise from the relationships of the formants in speech spectra that determine the perceptions of distinct vowels. Expressed as ratios, the frequency relationships of the first two formants in vowel phones represent all 12 intervals of the chromatic scale. Were the formants to fall outside the ranges found in the human voice, their relationships would generate either a less complete or a more dilute representation of these specific intervals. These results imply that human preference for the intervals of the chromatic scale arises from experience with the way speech formants modulate laryngeal harmonics to create different phonemes.

Proc Natl Acad Sci U S A. 2007 Jun 5;104(23):9852-7. Ross D, Choi J, Purves D. Center for Cognitive Neuroscience and Department of Neurobiology, Duke University, Durham, NC 27708, USA.

The purpose of this study was to analyze the existing quantitative research evaluating the influence of music upon the symptoms of psychosis. A meta-analysis was conducted on 19 studies. Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis (d = +0.71). However, there were no differing effects between live versus recorded music and between structured music therapy groups versus passive listening. Nor were there differing effects between preferred versus therapist-selected music. Additionally, classical music did not prove as effective as nonclassical music in reducing psychotic symptoms. This supports the therapeutic potential of popular music while dispelling the theory that classical music provides the form and structure that can contribute to mental health and well-being. Further quantitative research is recommended and strongly warranted to refine unique aspects of music therapy interventions effective for those with psychotic symptoms.

J Music Ther. 2003 Spring;40(1):27-40. Silverman MJ. The Florida State University, USA.

The purpose of this study was to investigate the effects of familiar live music on the anxiety levels of patients undergoing chemotherapy treatment. Randomly selected patients were assigned to experimental (n = 25) and control (n = 25) conditions. Pre and posttests consisted of questionnaires and the recording of the patient's heart rate and blood pressures. Subjects in the experimental group received 20 minutes of familiar live music during their chemotherapy treatment. Subjects in the control group received standard chemotherapy. It was assumed that those patients receiving music intervention would: (a) lower their anxiety levels; (b) experience a decrease in heart rate and blood pressure; (c) improve their levels of negative reactions including fatigue, worry, and fear; and (d) improve their levels of positive reactions including comfort and relaxation. Results of the study showed statistically significant improvement for the experimental group on the measures of anxiety, fear, fatigue, relaxation, and diastolic blood pressure. No significant differences between groups were found for heart rate and systolic blood pressure. Descriptive values indicated that, on average, the experimental group was influenced positively by the music intervention, and participants improved their quality of life while undergoing chemotherapy treatment.

J Music Ther. 2007 Fall;44(3):242-55. Ferrer AJ. The Florida State University, Tallahassee Memorial HealthCare, USA.

Due to the assistant characteristic of the emergency service, the health professional experiences countless situations that generate anxiety. This study aimed to learn the professionals' perception about the presence of classical music in the working environment. The sample was composed of 49 professionals of the adult emergency department of a medium sized private hospital. The data were collected through a questionnaire to evaluate the professional's perception. The results showed that 78% of the professionals noticed alteration in the atmosphere when the music was present, 41% believed that the music altered their personal performance; 85% believed it altered their performance in a positive way and 15% in a negative way. Regarding the musical repertoire, 61% of the individuals affirmed they enjoyed the selection, 96% believed that the ambient music should be kept, while 76% of the interviewees suggested other musical genres.

Rev Lat Am Enfermagem. 2007 May-Jun;15(3):377-83. Gatti MF, da Silva MJ. Adult Emergency Medical Services, Hospital Samaritano, and University of São Paulo, College of Nursing, Brazil. maria.gatti@samaritano.com.br