The Effect of Music on Pain and Acute Confusion in Older Adults Undergoing Hip and Knee

Surgery

Abstract
The purpose of this study was to examine the effects of music listening in older adults following hip or
knee surgery. Acute confusion and pain after surgery can increase length of stay and reduce function.
Study results demonstrate a reduction in acute confusion and pain and improved ambulation and higher
satisfaction scores in older adults who listened to music.
The purpose of this study was to determine the effect of music listening on 4 outcomes related to
postoperative recovery from hip or knee surgery: (1) pain, (2) cognition, (3) the ability to ambulate after
hip or knee surgery, and (4) patient satisfaction. Hip and knee surgeries are the most common types of
surgery among persons older than 75, affecting survival and quality of life in this population. Nursing
goals for postoperative care in for older adults undergoing hip or knee surgery include restoring
preoperative function and preventing complications. Rehabilitation in older adults following hip or knee
surgery should start in the immediate postoperative period in order to achieve optimal function.
Successful rehabilitation depends largely on the patient's cooperative participation. Participation in
rehabilitation therapies can be hampered after hip or knee surgery by pain and acute confusion.
Therefore, patients whose pain is not under control and/or who experience acute confusion, even if only
for a short time, may delay physical therapy, which can hamper recovery. Recovery is hampered
particularly by postoperative pain.
Pain management is a primary nursing intervention in older adults after hip or knee surgery. Managing
pain is a crucial aspect of perioperative nursing care and, if not effective, can delay rehabilitation.
Duggleby and Lander found that pain intensity, pain distress, and sleep disturbance from pain decrease
the older adult's ability to return to preoperative functional status.
Nurses tend to underestimate pain in older adults and not adequately manage pain in postoperative
patients because of fear of addiction and fear of complications from analgesic medications. Some
analgesic agents have the potential to cause harmful side effects in the older adult population. Therefore,
nonpharmacologic approaches to reduce pain, such as music and art therapies, massage, and cognitive-
behavioral approaches should be investigated for efficacy.
Confusion is a comorbid marker of impaired recovery in older adults undergoing hip or knee surgery.
Thirty to fifty percent of elders experience a period of acute confusion or delirium after hip or knee
surgery and that percentage increases with age. Increased stress of hospitalization, the hip or knee
fracture itself and the accompanying pain, being placed in unfamiliar surroundings, and the prolonged
effects of medications such as anesthetics and analgesics are predisposing.
Rasmussen concluded that elders who experience periods of acute confusion postoperatively have poorer
surgical outcomes, experience higher rates of complications and injury, and demonstrate decreased
functional status for up to 6 months after hospital discharge. Importantly, Rasmussen found that periods
of delirium could be disconcerting and cause fear and anguish to family members who bring their loved
ones to the hospital with no cognitive dysfunction and then see them become confused and anxious.
Common signs of postoperative confusion or delirium identified by nurses include patients' confusion,
disorientation, and altered awareness of where they are and of their own safety needs, aggressive
behavior, and altered ability to interact with others. These common signs of delirium usually subside
once elders recover from the anesthesia and are able to adjust to their surroundings. However,
complications, such as the inability to complete activities of daily living and decrease in executive
function, often last long after the actual period of delirium.
MUSIC LISTENING AS THERAPY
Music listening is a noninvasive, inexpensive, and safe nursing intervention that has been successfully
used in hospital situations.
Music has been shown to decrease postoperative pain and reduce episodes of acute confusion 1922 in
older adults. Cunningham et al found that older adult patients who listened to music in the preoperative
holding area reported less anxiety and had lower blood pressure and pulse rates than those who did not
listen to music. Good et al studied 311 women after gynecologic surgery. All patients in the intervention
groups showed significantly reduced pain in comparison with those in the control group who received
standard care.
PURPOSE OF THE STUDY
The purpose of this study was to evaluate the effect of music listening on pain, acute confusion, ability to
ambulate postoperatively, and patient satisfaction in older adults undergoing hip or knee surgery.
Researchers theorized that the ability to positively affect these outcome measures could reduce recovery
time, patient morbidity, and perception of pain, and increase general satisfaction with the hospital
experience. Therefore, researchers formulated the following research questions.
1. What is the difference in postoperative pain and number of episodes of acute confusion among older
adults undergoing hip or knee surgery between those who listen to music during the postoperative
period and those who do not?
2. Is there a difference in distance ambulated postoperatively after hip or knee surgery in older adults
who listen to music after surgery compared to those who do not?
3. Is there a difference in satisfaction with the postoperative hospital experience after hip or knee
surgery in older adults who listen to music compared to those who do not?
PROCEDURE FOR SUBJECT SELECTION
The study employed a randomized, controlled, clinical trial designed to limit sampling error and to obtain
participants in the control and experimental groups who were homogeneous. Institutional review board
approval was obtained from Florida Atlantic University and the hospital where participants were
recruited. There were 124 qualified subjects aged 65 years and older (M = 75.67, SD = 6.1) who
completed the study. Two participants were dropped from the study because they had cardiovascular
complications during surgery and had to be placed in intensive care units.
The inclusion criteria were as follows:
* elders over 65 years of age
* undergoing elective hip or knee surgery
* alert and oriented to provide consent to surgery and to complete preoperative paperwork
independently
* able to hear music
DATA GATHERING
Data were obtained from the medical records of participants after discharge and a postoperative phone
call to the patient. Two measures were used to evaluate postoperative pain. A scale of 110 (1 being no
pain and 10 the worst possible pain the patient can imagine) is used by nurses every 8 hours to assess
patient pain after surgery. These numerical ratings were used by researchers to determine the difference
between pain levels in the control and experimental groups. The second method used to evaluate pain
was to calculate the number of pain medications received by each patient after the discontinuance of the
patient-controlled analgesia (PCA) pump on the first postoperative day. All patients in both studies used
a PCA pump with morphine on the operative day, which was removed on the first postoperative day,
followed by oxycodone 50100 mg ordered every 6 hours as needed thereafter.
Physical therapists at both hospitals conduct a readiness to ambulate measurement once on the
operative day immediately after the patient is transported to his or her room from the postoperative
recovery unit. The readiness to ambulate score was based on the patient's cognitive status, pain, and
willingness to participate in his or her own recovery. Differences in mean readiness to ambulate scores
between the music intervention group and the standardized care group were measured.
The distance ambulated on each postoperative day was obtained from the physical therapy notes in the
participants' medical record. The differences in the mean distance ambulated in feet between the music
intervention group and the standardized treatment group were calculated.
Patient satisfaction was determined by calling each participant in the study and asking him or her to rate
his or her hospital experience on a scale of 110, with 10 being the highest satisfaction level. This phone
call was made approximately 2 weeks after surgery when the participant had left the rehabilitation
facility.
IMPLEMENTATION OF MUSIC INTERVENTION
After surgery, participants were randomly assigned to rooms on the orthopedic unit of the hospital.
Based on availability room, assignments were made by recovery room nurses who were not aware of
whether the room had been designated as a control group or an experimental group room. Those in the
control group received standard postoperative care, whereas participants in the experimental group, in
addition to receiving standard postoperative care, had a bedside compact disc (CD) player that would
automatically play the compact disc 4 times daily.
The first CD placed on the player was a lullaby musical selection. Table 3 provides a list of other CDs
with varying musical selections that were available to the patients. Patients were able to choose from
any of the CDs on the basis of his or her musical preference. The first CD was played while the patient
was awakening from anesthesia. Each day the minimum time that the CD player was set to play was 1
hour 4 times daily. In addition, the nurses were asked to turn on music each time they walked into the
room, and family members were instructed on how to turn on the CD player. Once patients were
awake and oriented, they were instructed on how to use the CD player so that music could be played at
any time they desired. All CD players were kept at the patients' bedsides and within their reach.
Both groups had access to in-room televisions. No other electronic devices, such as radios, were
provided by the hospital. Importantly, for electrical safety, patients were not permitted to bring any
electronic musical devices into their hospital rooms.
Research assistants visited the orthopedic unit daily to ensure that the CD players were working, that
times for automatic starting of the CD coincided with the patient's preference, and that the CD music
was one that the patient preferred. Research assistants visited with both groups so that the daily visits
and the attention participants received from the research assistants would not influence the outcome of
the study.
Once all of the participants in both the control and experimental groups were discharged, a list of chart
numbers was given to the medical records department. The charts of all participants were identified and
set aside for the researcher. The principal researcher reviewed the nurses' notes, medication
administration records, and the scores for ambulation from the physical therapy notes made on each
chart.
The principal researcher called each patient 10 days after discharge to determine his or her satisfaction
with postoperative experience in the hospital. Again, a scale of 110 was used, 1 being the worst
experience and 10 being the best experience they could imaging.
RESULTS
To answer the first research question, an analysis of variance (ANOVA) was used. Results determined
that there was a significant reduction in the number of pain medications taken postoperatively in those
participants who listened to music when compared with those who did not (f = 26.93, P = .001). In
addition, there was a significant reduction in the patients' rating of their pain in the intervention group in
comparison with the control group on each postoperative day; day 1 (f = 12.69, P = 001), day 2 (f =
25.54, P = .001), and day 3 (f = 35.90, P = .001). Tables 4 and 5 present the means and standard
deviations between groups for pain medication administration and self-rating of pain.
An ANOVA was used to determine the difference in the number of episodes of acute confusion
experienced in each of the study groups. The intervention group experienced significantly fewer episodes
of acute confusion than did the control group, which received standardized care (f = 29.56, P = .001).
Eighty-four patients of the 124 participants had no episodes of acute confusion. Thirty-two patients had
one experience of acute confusion (28 control group and 2 experimental). Six control group participants
had 2 or more episodes of acute confusion noted in the nurse notes. In total, of the 38 participants who
experienced episodes of acute confusion, only 2 were in the experimental group whereas 36 were in the
control group.
Finally the readiness-to-ambulate scores were compared with ANOVA, and it was determined that those
in the interventional group had higher scores than did those in the control group (38.14, P = 001). Table
6 presents the mean, range of scores, and standard deviation for both the interventional and control
groups for readiness to ambulate.
To answer the second research question, the number of feet ambulated was measured each day.
Differences were compared by ANOVA, comparing the mean number of feet walked between the
experimental and control groups. There was a significant difference in the distance ambulated on each
day; day 1 (f = 17.59, P = .001), day 2 (f = 33.68, P = .001), and day 3 (f = 18.84, P = .001). Table 7
provides data on the mean number of feet walked by each group on each day and the standard
deviation.
The third research question was answered by measuring the differences in the means of patient
satisfaction levels on a 110 scale that were obtained during a postoperative phone call. An ANOVA was
used to measure the differences between the mean satisfactions scores of the experimental and control
groups. The experimental group demonstrated a significant increase in mean satisfaction scores in
comparison with the control group (f = 96.00, P = .000). All of the patients in the experimental group
mentioned music as a positive experience during their recovery. Table 8 provides the means, score
ranges, and standard deviation of patient satisfaction scores.
DISCUSSION
From the beginning of modern nursing, one of the most important roles that nurses fulfill is to put the
patient in the best possible condition for nature to restore or preserve health and to prevent or cure
disease or injury. In other words, nurses should create environments in which healing can happen. The
environment full of sound in hospitals can be discomforting and strange to older adults after surgery.
Researchers theorized that music listening could improve the postoperative environment for older adults
after hip or knee surgery and thereby promote healing in this group. The purpose of this study was to
determine the effects of music listening on pain, acute confusion, postoperative ambulation and patient
satisfaction in older adults after hip and knee surgery.
The results of the study demonstrated decreased pain perception, fewer requests for pain medications,
and fewer episodes of confusion and delirium in elders who listened to music during recovery from hip
and knee surgery. Pain and acute confusion negatively affect the ability of elders to recover and
decrease function after hip and knee surgery. Music's ability to decrease the confusion and delirium
episodes and to increase earlier ambulation facilitates better recovery and is a positive finding of this
study.
In addition, the experimental group had higher scores on the readiness-to-ambulate scale and were
actually able to ambulate further distances than the control group. Early ambulation and ability to
ambulate further distances postoperatively has been linked to improved recovery and return to
preoperative functional levels. Finally patients with the music listening intervention rated the hospital
experience more positively than those who had routine recovery care.
The outcomes of this study are consistent with findings from a study by McCaffrey and Good, who
studied the lived experience of using music in the postoperative setting. The researchers found that
patients found the music comforting in a discomforting situation and distracted them from pain. In
addition, the study extends the work of Lukas, who used a survey to determine the use of music in
outpatient surgery and found that participants overwhelmingly felt that music listening was a positive
addition to traditional pain and anxiety management.
Findings in this study are similar to those of Good et al, demonstrating decreased pain after
gynecological surgery, and expand the knowledge that pain is reduced in older adults after hip and knee
surgery as well. Decreases in episodes of acute confusion in this study support the findings of Wong et
al, who found that music assisted in improved cognition among older adults after hip surgery.
The findings of this study suggest that nurses can confidently use music as an intervention for those
older adults undergoing hip or knee surgery to reduce pain and episodes of acute confusion as well as to
better prepare them for postoperative ambulation. Study findings indicate that nurses can also use music
to improve the hospital experience for older adults after hip and knee surgery. Therefore, hospitals
should develop music listening as a nursing intervention in areas where older adults recover from hip or
knee surgery.
To use music listening in order to implement the findings of this study in a clinical situation does not take
special knowledge of music. The researchers in this study selected CDs of various kinds and allowed
patients to choose music they enjoyed. Music can be changed depending on patient preference or mood
by the patient or family as well as the nurse or nursing assistant. Nurses should be encouraged to
develop music listening as an intervention for older adults after hip or knee surgery.
Nursing educators should encourage students to use this type of evidence when preparing to care of
older adults after hip or knee surgery. Students may bring this knowledge to a nursing unit where music
listening had not been tried.
Further research in this area should focus on measuring acute confusion in a more systematic way to
determine whether there was a difference in the number of episodes of acute confusion or whether
patients who experienced the music intervention simply were confused but relaxed and did not exhibit
noticeable signs of acute confusion. Research of the use of music during the postoperative period for
other groups of patients, and after other types of surgery, would also be beneficial.
CONCLUSION
Music is a safe, inexpensive, easy-to-use intervention that can be used by nurses to reduce pain and
episodes of acute confusion and improve recovery in older adults after hip and knee surgery. Music as an
intervention assists nurses in creating environments in which patients are better able to heal. Nurses can
use music as an intervention to promote the establishment of a healing environment for older adults
after hip or knee surgery.
Music listening increases the autonomy of the nurse by providing an intervention that can be used at the
nurse's discretion. Therefore, using music listening as a nursing intervention may improve the ability of
nurses to assist older adults to return to the highest possible functional state after hip or knee surgery.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=667530

McCaffrey, Ruth, and Rozzano Locsin. The Effect of Music on Pain and Acute Confusion in Older Adults
Undergoing Hip and Knee Surgery. Holistic Nursing Practice 20, no. 5 (Sept. / Oct. 2006) : 218-24.
Music affects emotions

DO NOT UNDERESTIMATE the role of music in influencing human behaviour, especially the behaviour of
youth. Let us look at some changes that have taken place during the last 40 to 50 years.
"In the 1960s, the family and family values exercised the greatest influences on teenagers' values and
behaviour. This was followed up by the school, friends, peers and then the church.In the 1990s it is
believed that MTV (music) is the No. 1 influencer of youth, followed by friends and peers; the family at
No. 3;the school at No. 4 and the church at No. 5." Understanding Youth Culture
"Music interprets and defines life for the teens. Music shapes their language, hairstyle, clothing style and
social lifestyle."
"Music affects the emotions as powerfully as drugs."
Music enters the brain through its emotion regions, which include the temporal lobe, and limbic systems.
From there, some kinds of music tend to produce a frontal lobe response that influences the will, moral
worth, and reasoning power.
Other kinds of music, such as rock and rap, evoke very little, if any, frontal lobe response. Instead, they
produce a large emotional response with very little logical or moral interpretation (Kay Kuzma)
Researchers from Bowman Gray School of Medicine studied 518 music videos from fourcable networks:
MTV, BET, Video Hit, and Country Music Television. It was found that a significantly higher
percentage of music videos aired on MTV contained one or more episodes portraying overt violence and
the brandishing of weapons. Rap videos had the highest portrayal of violence, followed by rock videos.
Most videos containing violence showed males as the perpetrators. Fifteen per cent portrayed a child
carrying a weapon.
What effect do these music videos have on behaviour? One study exposed 222 patients on several
months of MTV, followed by five months without it. What happened when the music videos were taken
away? Verbal aggression decreased 32 per cent, aggression against objects decreased 52 per cent, and
aggression against other people decreased 48 per cent.
One conclusion from the study is that the combination of eye-ear, seeing and hearing seems to induce a
more profound shutdown of the analytical processes. Violence results!
So often, adults are concerned about the level of volume but not the content of the music. Perhaps we
concentrate on lowering the noise level. While subliminally the messages are entering, the contamination
of the mind results. To curb the actions without working on a change of mind is to see the actions
repeated.
Popular music is known to contain messages on "sexual violence, substance abuse, rebellion against
God, the occult, satanism, obscene language, rebellion against authority, murder of political figures."
Parents must rise up and demand higher standards of the music from the music selectors.
I hope that it is not too late.

http://www.nationnews.com/editorial/331995513668313.php

Howell, Everette. Music affects emotions. Nation News, 2 April 2006, 9.

Power of music

We listen to music mainly for entertainment. However, modern research shows that music can greatly
enhance relaxation and relieve stress. What is more, a particular piece of music can change our mood. In
most private sector organisations they play background music that keeps the work force in a happy
mood.
Unlike other performing arts, music can be listened to whatever you prefer to do or you can play your
favourite musical instrument as a means of expression.
The great quality about music is that you do not have to be a musician to enjoy it. For instance, when
you go on a trip or when friends meet occasionally, we see how they behave.
One person starts singing and others provide background "music" using broom handles, dustbin lids,
saucepans, plastic bottles filled with pebbles, or any other items that make sound.
Can we condemn such "music"? And then some of us sing in the bathroom tapping on the door. Isn't
music wonderful?
Today, we hear music everywhere. The blaring car radio, joggers carrying a set of personal stereo, air
conditioned buses playing cassette music are evidence.
There are different kinds of music for all tastes - classical, pop, rock, rap, jazz or folk. Each culture has
its own style of music.
Therefore, the effect of music on our life is undeniably great.
Therapy
Researchers have found that those who make music with voice or instrument experience an added
dimension to life. The music produced by them cuts through all barriers such as culture, age and religion.
Meanwhile, music has already become a therapy for millions of people who either, make it or listen to it.
When you go to temple, kovil or church you hear spiritual music that acts like a balm for your tired
nerves.
Film-makers use music to a great extent to affect our mood. For instance, a romantic film will have a
different kind of music from a horror film. Even in the past when silent films were screened a pianist in
the cinema played music to strike the right mood. When you hear a particular piece of instrumental
music on television we know that it is time for our favourite teledrama.
Latest research shows that background music we hear in shopping malls and supermarkets can
encourage us to spend more money than is necessary.
A team of psychologists from Leicaster University has emphasized that music can affect even the
products we buy. For a set period of time they played French music and using a video camera directed at
the wine shelves, showed a significant increase in the number of bottles of French wine being sold. They
then played a German tune which show the same results with German wine. What is significant is that
buyers were quite unaware of the influence of the music.
Mozart
Another finding shows that playing Mozart when studying can increase your IQ. Another recent study has
shown that children who learn a musical instrument are much quicker at developing spatial awareness
and problem solving skills.
A report in the Daily Express headlined "Music to your ears" said, "There are times when we might feel
like taking our temper out on a set of drums, and it would almost certainly help us to feel better.
Relaxation or "New Age" music has a slow rhythm.
Sounds are often synthesised and there may be added natural sounds, such as, whale song, birdsong,
waves or gentle rain to help a feeling of calm and relaxation.
Meanwhile, psychologists say that children who learn music are better at remembering words that those
who do not do so. Music is also said to be beneficial in treating memory loss or language difficulties.
Fast food
McDonalds - world's largest Fast food chain in a research conducted by them have shown that we eat
according to the speed of music being played. Therefore, when a restaurant is full and people are waiting
to enter impatiently, they play fast music ensuring that the customers will eat faster and leave the
restaurant quickly.
Even some schools in London are playing background music in classroom on a trial basis. It has been
found that music helps even unruly children to study better.
I had the fortune of listening to a CD with an unambitious title "Spiritual Healing Sounds" given to me by
V. Thiru of Ideal Marketing Service, 69/6 Galle Road, Dehiwala. The CD carrying Dr. Rishi Kendra's name
is aimed at combining the power of your subconscious with the psychic abilities. After listening to the
music I found it to be a great tool to maintain anybody's equilibrium in peace and calm.
I personally feel it is good to listen to this kind of soothing music early morning and at night before
retiring to bed. A leaflet issued along with the CD advises those who listen to the music to avoid taking
liquor and have adequate sleep. Coupled with such good habits listening to some soothing music can
give us immense pleasure and relaxation.

http://www.dailynews.lk/2004/02/11/artscop17.html

Karunaratne, R. S. Power of music. Daily News, 2 November 2004, n. pag.

Do You Hear What I Hear?

Holiday music is inescapable. Daniel J. Levitin on the ancient drive to listen to familiar songs,
the psychological effects of music and why 'Little Drummer Boy' is so annoying.
December. Joy, goodwill toward men, long lines, the unwanted wet kiss from a drunk co-worker at the
office party. Along with the candy canes and mistletoe, music will be there in the background wherever
we go this month, as sonic wallpaper, to put us in the right festive mood. No holiday music is more
annoying than the piped-in variety at shopping malls and department stores. Can science explain why
the same song we enjoy singing with relatives or congregants drives us to visions of sugar-plum
homicide when it blares across the public-address system Chez Target?
Our drive to surround ourselves with familiar music during life cycle events and annual celebrations is
ancient in origin. Throughout most of our history as a species, music was a shared cultural experience.
Early Homo sapiens coupled music with ritual to infuse special days with majesty and meaning. Before
there was commerce, before there was anything to buy, our hunter-gatherer ancestors sat around
campfire circles crafting pottery, jewelry and baskets, and they sang. Early humans didn't sit and listen
to music by themselves -- music formed an inseparable part of community life. So much so, that when
we sing together even today, our brains release oxytocin, a hormone that increases feelings of trust and
social bonding.
Known in English as "Silent Night," "Stille Nacht" was written by Austrian priest Joseph Mohr and Franz
Gruber. They performed the song at a Christmas mass in 1818 accompanied by guitar, and the tune
later spread across Europe.
"Jingle Bells," copyrighted in 1857 by James Pierpont (uncle of J.P. Morgan), was originally not a holiday
song at all. It was written for a Thanksgiving church service, as legend has it, and was so popular, it was
performed again at Christmas.

Several well-known tunes emerged from films of the 1940s and '50s. Irving Berlin's "White Christmas,"
sung by Bing Crosby in the 1942 "Holiday Inn," has become the most recorded holiday song to date,
with more than 500 versions.
The "Singing Cowboy" Gene Autry initially balked at recording "Rudolph the Red-Nosed Reindeer,"
thinking it didn't fit his image. His wife convinced him otherwise, and the 1949 song became his biggest
seller.
Music is piped into public places in a cultural echo of shared ritual and ceremony. As advertisers have
long known, music can help to oil the wheels of commerce. Songs can stick in our heads, giving the
purveyor of a catchy jingle many more minutes of air time than was originally paid for. Whether our
brains are reminding us that "When the holidays come along, there's always Coca-Cola" or that maybe
we haven't "driven a Ford lately," the jingle rattles around in our synapses in a sometimes endless loop
-- a commercial played out in the most private of venues over and over again.
The fact that music does get stuck in our heads -- the Germans call these Ohrwurms, or "ear worms" --
is a key to understanding how human nature evolved. Evolution selected music as an information-
bearing medium precisely because it has this stick-in-your-head quality; all of us are descended from
ancestors who used music to encapsulate important information. For tens of thousands of years before
there was writing, information -- such as which plants were poisonous or where to find fresh water --
was encoded in song. Early Homo sapiens realized that setting words to music made it easier to
remember them; the internal constraints of music, the accent structure and meter, not to mention poetic
elements such as alliteration and rhyme, made it more difficult to forget the words. Many of us have had
the experience of forgetting the words of a song, but we can usually recreate the missing words because
there simply aren't that many that will fit. So songs are memorable because they are meant to be, no
matter how irritating the alphabet song can become to parents of infants or how likely you are to
strangle the next throat that warbles pa-rum-pum-pum- pum.
But if evolution is so smart, why do holiday carols become annoying? When we like a piece of music, it
has to balance predictability with surprise, familiarity with novelty. Our brains become bored if we know
exactly what is coming next, and frustrated if we have no idea where the song is taking us. Songs that
are immediately appealing are not typically those that contain the most surprise. We like them at first
and then grow tired of them. Conversely, the music that can provide a lifetime of listening pleasure --
whether it's Bruckner 1 or Zeppelin II -- often requires several listenings to reveal its nuances. And the
best music offers surprises with each new listening.

http://online.wsj.com/article/SB122912607004203123.html

Levitin, Daniel J. Do You Hear What I Hear? The Wall Street Journal, 13 December 2006, n pag.

Sound Research
Scientists are discovering new physical and mental benefits to listening to music
Researchers have found that music can affect people, animals and even plants in many ways. Now,
several small-scale studies suggest some surprising benefits of listening to music, from the brain down
to the blood vessels.
A team at Stanford University's School of Medicine found that listening to music might hold an adaptive
evolutionary purpose. The researchers used functional magnetic resonance imaging to gauge activity in
18 people's brains as they listened to obscure 18th-century symphonies. The team found that activity in
the regions of the brain associated with paying attention, making predictions and updating events
peaked during the short periods of silence between movements. Published last year in the journal
Neuron, the study provides a glimpse of how the brain organizes events, says lead author Vinod Menon,
and suggests that listening to music can help sharpen the ability to anticipate events and sustain focus.
Finnish researchers have found that music could help aid cognitive recovery soon after a stroke. The
study, which followed 54 patients and was published February in the journal Brain, found that verbal
memory and focused attention improved significantly more in stroke patients who listened to their
favorite music several hours daily than in those patients who listened to audio books or to nothing at all.
Patients were randomly assigned to the music group and listened to the music for at least an hour daily,
for two months, during their acute recovery phase.
Listening to your favorite music can also promote the functioning of blood vessels, according to a new
study out of the University of Maryland School of Medicine. Researchers found that the diameter of the
average upper-arm blood vessel expanded by 26% when subjects listened to music they had previously
selected for making them feel joyful. The diameter constricted by 6% when subjects listened to music
that made them feel anxious. Blood-vessel expansion indicates nitric oxide is being released, which can
reduce the formation of blood clots and LDL, the so-called bad cholesterol, according to Michael Miller,
the study's principal investigator and director of preventive cardiology at the medical center. The results
were presented in November before the American Heart Association.
Of the 10 participants, several chose country music as their joyful listening selection and several said
heavy metal made them feel anxious. But that says more about the participants than about any inherent
vascular benefits of the genres themselves, says Dr. Miller. "I was listening to Hootie & the Blowfish last
night and I had, I'm sure, a lot of endorphins being released," he says.
A study published in January by the Cochrane Collaboration, a London-based nonprofit that publishes
reviews of health-care interventions, suggests that listening to or making music with trained therapists
can help in treating depression. The group found five randomized studies that examined music therapy;
four reported that depression symptoms lessened more among those who were randomly assigned to
music therapy than those who received treatment that did not involve music. The fifth study reported no
significant change. Further research needs to be done given the small number of credible studies in the
area, the study says.
Other new studies confirm old hunches. A team at Brunel University in England found that certain music
deemed motivational can enhance a recreational athlete's endurance and increase pleasure while
exercising. In blind experiments on 30 participants, tracks from artists like Queen, Madonna and the Red
Hot Chili Peppers increased endurance on a treadmill by up to 15%, says Costas Karageorghis, a reader
in sports psychology at Brunel. Recreational athletes might be served well by picking workout music that
is up-tempo, has "bright, major harmonies" and is studded with encouraging phrases, says Mr.
Karageorghis. "There's a reason Olivia Newton-John's 'Let's Get Physical' was a huge hit" for workouts,
he says.

http://online.wsj.com/article/SB122912678274103169.html

Chung, Juliet. Sound Research:Benefits of Listening to Music. The Wall Street Journal, 12 December
2008, n. pag.
Feeling, Emotion, Affection

AFFECT/AFFECTION. Neither word denotes a personal feeling (sentiment in Deleuze and Guattai).
Laffect (Spinozas affectus) is an ability to affect and be affected. It is a prepersonal intensity
corresponding to the passage from one experiential state of the body to another and implying an
augmentation or diminution in that bodys capacity to act. Laffection (Spinozas affection) is each such
state considered as an encounter between the affected body and a second, affecting, body (Massumi,
Plateaus xvi)
Although feeling and affect are routinely used interchangeably, it is important not to confuse affect with
feelings and emotions. As Brian Massumis definition of affect in his introduction to Deleuze and
Guattaris A Thousand Plateaus makes clear, affect is not a personal feeling. Feelings are personal and
biographical, emotions are social, and affects are prepersonal. In the remainder of this essay, I will
attempt to unpack the previous sentence and provide some examples that will illustrate why the
distinction Ive made between feelings, emotions, and affects is more than pedantry.
A feeling is a sensation that has been checked against previous experiences and labelled. It is personal
and biographical because every person has a distinct set of previous sensations from which to draw when
interpreting and labelling their feelings. An infant does not experience feelings because she/he lacks both
language and biography. Yet, almost every parent will state unequivocally that their child has feelings
and expresses them regularly (what the parent is actually bearing witness to is affect, about which, more
shortly).
An emotion is the projection/display of a feeling. Unlike feelings, the display of emotion can be either
genuine or feigned. The distinction between feelings and emotions was highlighted by an experiment
conducted by Paul Ekman who videotaped American and Japanese subjects as they watched films
depicting facial surgery. When they watched alone, both groups displayed similar expressions. When
they watched in groups, the expressions were different. We broadcast emotion to the world; sometimes
that broadcast is an expression of our internal state and other times it is contrived in order to fulfill social
expectations. Infants display emotions although they do not have the biography nor language skills to
experience feelings. The emotions of the infant are direct expressions of affect.
An affect is a non-conscious experience of intensity; it is a moment of unformed and unstructured
potential. Of the three central terms in this essay feeling, emotion, and affect affect is the most
abstract because affect cannot be fully realised in language, and because affect is always prior to and/or
outside of consciousness (Massumi, Parables). Affect is the bodys way of preparing itself for action in a
given circumstance by adding a quantitative dimension of intensity to the quality of an experience. The
body has a grammar of its own that cannot be fully captured in language because it doesnt just absorb
pulses or discrete stimulations; it infolds contexts (Massumi, Parables 30). Before this gets too
abstract, lets return to the example of the infant.
An infant has no language skills with which to cognitively process sensations, nor a history of previous
experiences from which to draw in assessing the continuous flow of sensations coursing through his or
her body. Therefore, the infant has to rely upon intensities (a term that Massumi equates with affect).
Affects are comprised of correlated sets of responses involving the facial muscles, the viscera, the
respiratory system, the skeleton, autonomic blood flow changes, and vocalisations that act together to
produce an analogue of the particular gradient or intensity of stimulation impinging on the organism
(Demos 19). The key here is that for the infant affect is innate. Through facial expression, respiration,
posture, color, and vocalisations infants are able to express the intensity of the stimulations that impinge
upon them. Thus, parents are correct when they say their children express emotion. On the other hand,
they are incorrect when they attribute feelings to the little tots. Their offspring have neither the
biography nor the language to feel. The transition from childhood to adulthood is one in which we
partially learn how to bring the display of emotion under conscious control. Affects, however, remain
non-conscious and unformed and are aroused easily by factors over which the individual has little
control . . . (Tompkins 54). For the infant affect is emotion, for the adult affect is what makes feelings
feel. It is what determines the intensity (quantity) of a feeling (quality), as well as the background
intensity of our everyday lives (the half-sensed, ongoing hum of quantity/quality that we experience
when we are not really attuned to any experience at all).
One of the simplest ways to understand how affect continues to operate meaningfully in the lives of
adults even after they have gained some conscious control over their emotions is to look at an individual
whose affect system has gone haywire. Neurologist, Oliver Sacks, described his experience with such a
person. She was an elderly patient who had suffered a hip fracture. The fracture resulted in the
immobilisation of her leg for an extended period of time. At the time Sacks began working with her, the
woman hadnt regained feeling in her leg in three years. She was not able to consciously move her leg
and she felt that it was missing. However, when she heard music she would involuntarily tap her foot
to the beat. This suggested the possibility of music therapy ordinary physiotherapy had been of no
use. Using support (a walker, etc.), we were able gradually to get her to dance, and we finally achieved
a virtually complete recovery of the leg, even though it had been defunct for three years (Sacks 170-1).
The woman in the previous story couldnt move her leg via the usual conscious mechanisms because the
leg had become disconnected from her a-conscious awareness of her body, or proprioception.
Proprioception is the continuous but unconscious sensory flow from the movable parts of our body
(muscles, tendons, joints), by which their position and tone and motion are continually monitored and
adjusted, but in a way which is hidden from us because it is automatic and unconscious (Sacks 43).
Affect adds intensity, or a sense of urgency to proprioception which is why music the recollection of
which is partially stored in the body could move this womans leg when will alone could not.
9What is remarkable about the story of the woman whose leg danced all on its own is not so much that
affect trumped will in this particular case, but that this is just one example of the way in which affect
always precedes will and consciousness (Massumi, Parables 29). At any moment hundreds, perhaps
thousands of stimuli impinge upon the human body and the body responds by infolding them all at once
and registering them as an intensity. Affect is this intensity. In the infant it is pure expression; in the
adult it is pure potential (a measure of the bodys readiness to act in a given circumstance). Silvan
Tompkins explains that affect has the power to influence consciousness by amplifying our awareness of
our biological state:
The affect mechanism is like the pain mechanism in this respect. If we cut our hand, saw it bleeding, but
had no innate pain receptors, we would know we had done something which needed repair, but there
would be no urgency to it. Like our automobile which needs a tune-up, we might well let it go until next
week when we had more time. But the pain mechanism, like the affect mechanism, so amplifies our
awareness of the injury which activates it that we are forced to be concerned, and concerned
immediately (Tomkins 88).
Without affect feelings do not feel because they have no intensity, and without feelings rational
decision-making becomes problematic (Damasio 204-22). In short, affect plays an important role in
determining the relationship between our bodies, our environment, and others, and the subjective
experience that we feel/think as affect dissolves into experience.
What does all of this mean for individuals who are interested in media and cultural studies? It means
that describing media effects in terms of the communication of ideology sometimes results in the post
hoc ergo propter hoc (after this therefore because of this) fallacy. This has to do with the second term in
Massumis definitions of affect/affection. Laffection is the process whereby affect is transmitted between
bodies. The transmission of affect means that we are not self-contained in terms of our energies. There
is no secure distinction between the individual and the environment (Brennan 6). Because affect is
unformed and unstructured (unlike feelings and emotions) it can be transmitted between bodies. The
importance of affect rests upon the fact that in many cases the message consciously received may be of
less import to the receiver of that message than his or her non-conscious affective resonance with the
source of the message.
Music provides perhaps the clearest example of how the intensity of the impingement of sensations on
the body can mean more to people than meaning itself. As Jeremy Gilbert put it, Music has physical
effects which can be identified, described and discussed but which are not the same thing as it having
meanings, and any attempt to understand how music works in culture must . . . be able to say
something about those effects without trying to collapse them into meanings. In a lot of cases, the
pleasure that individuals derive from music has less to do with the communication of meaning, and far
more to do with the way that a particular piece of music moves them. While it would be wrong to say
that meanings do not matter, it would be just as foolish to ignore the role of biology as we try to grasp
the cultural effects of music. Of course, music is not the only form of expression that has the potential to
transmit affect. Every form of communication where facial expressions, respiration, tone of voice, and
posture are perceptible can transmit affect, and that list includes nearly every form of mediated
communication other than the one you are currently experiencing.
Let me clarify that the transmission of affect does not mean that one persons feelings become anothers.
The transmission of affect is about the way that bodies affect one another. When your body infolds a
context and another body (real or virtual) is expressing intensity in that context, one intensity is infolded
into another. By resonating with the intensity of the contexts it infolds, the body attempts to ensure that
it is prepared to respond appropriately to a given circumstance. Given the ubiquity of affect, it is
important to take note that the power of many forms of media lies not so much in their ideological
effects, but in their ability to create affective resonances independent of content or meaning.
The power of affect lies in the fact that it is unformed and unstructured (abstract). It is affects
abstractivity that makes it transmittable in ways that feelings and emotions are not, and it is because
affect is transmittable that it is potentially such a powerful social force. This is why it is important not to
confuse affect with feelings and emotions, and why I agree with Brian Massumi that Lawrence
Grossbergs term affective investments doesnt make a whole lot of sense. If, as Massumi proposes,
affect is unformed and unstructured, and it is always prior to and/or outside of conscious awareness,
how is one to invest in it (Parables 260)? Investment presumes forethought and a site for deposit, and
affect precedes thought and is as stable as electricity. This isnt to say that there arent practices where
certain enhancing forms of affect are more prevalent, only that the people who engage in those practices
are not investing in affect, but rather in the hope of being moved. Of course, one of the lessons of
cultural studies is that investing in hope has moved people before.

http://journal.media-culture.org.au/0512/03-shouse.php

Shouse, Eric. "Feeling, Emotion, Affect." M/C Journal 8.6 (2005). 30 Dec. 2008.
The Psychological Effects of Music

Definitions
A sound of a certain, definite frequency is called a pitch. Melody is the main part of a composition, made
up of successive pitches. It is the part of the music that is remembered most specifically. When pitches
are played simultaneously in an organized manner, they create harmony. Rhythm is the pattern of
emphases or stresses that occurs in music. Doroftei (1998) notes that "sometimes rhythm can be
imposed without melody, but the reverse cannot be done" (p. 2). The rate of speed at which a piece of
music is played is called tempo.
Music may be represented graphically by a staff, notes, and rests. A staff is a series of straight lines that
are horizontal, parallel, and equidistant from each other. Notes are written as ovals and their connected
lines whose placement on the staff indicates pitch. Periods of silence are represented by symbols called
rests. Rhythm is indicated by the shape of the notes and rests.
Combinations of pitches that are pleasing are called consonances, while dissonances are not pleasing.
More specifically, dissonance is those combinations of pitches that seem to pull toward resolution to a
more consonant combination. For a combination to be consonant, it must seem to rest there, without
resolution (Randel, 1978). This definition is dependent upon Western tonal music.
Timbre, sometimes called tone color, is one of the most difficult properties of music to define. Simply
stated, it is how we can tell one instrument from another, even if they are playing the same pitch.
Most music is organized into beats (regular emphases occurring throughout the whole piece or a section
of it) Some beats are major (strong) and some are minor (weak). Syncopation is the holding of a note
beginning on a minor beat across a major beat. Closely related is off-beat rhythm, where emphasis is
placed on a beat that normally would not receive as much emphasis. In this paper, syncopation will also
refer to off-beat rhythms.
General Effects of Music
Every new style of music has been greeted with suspicion by some. The Greek philosopher Plato wrote,
"A change to a new type of music is something to beware of as a hazard to all of our fortunes. For the
modes of music are never disturbed without upsetting of the most fundamental political and social
conventions" (p. 333).
Nowhere has this suspicion of new music been more noticeable than in the church. The arrival of Jazz
and its descendants, particularly Rock, beginning in the 1920s, has been a topic of heated discussion in
conservative Christian churches. At first, it was shunned. Then, ever so slowly, it started gaining
acceptance to the point that music today, even in most conservative churches, would seem inappropriate
to those in the 1920s. The above illustrations are only a beginning to the study of the effects of music.
One study that compared two different types of music demonstrated a negative impact upon the
cardiovascular system after listening to Bruckner's Ninth Symphony, which is considered disharmonic,
while Bach's Brandenburg Concerto Number Three had a positive effect on the listener (Melnikov, 1970).
Torres and Torres apply a broad definition to harmonic and disharmonic music. The next five sections will
examine each element of harmonic and disharmonic music as defined by Torres and Torres.
Melody
Melody is the part of music that stands out. It makes the music memorable. Without it, something seems
to be missing. Music that does not have much of a melody often lacks direction.
Harmony
Consonant harmony can produce a wide variety of effects. Consonant harmony can be bright or dark,
cheerful or melancholy, lyrical or disconnected, upbeat or slow. Dissonant harmony, although it
sometimes can have similar effects as consonant harmony, is usually irritating, agitating, or has one of
any number of other negative effects. It is important to note that individual dissonances occur in
consonant harmony, as do consonances in dissonant harmony. This discussion refers to the character of
the harmony as a whole.
Timbre
What makes the difference between a good singer and a bad one, assuming both are able to stay on the
correct pitch? One might have a clear voice, while the other's might be harsh. The clear voice is more
pleasant to listen to, while harsh sounds are agitating. They set the listener on edge.
Words
Although words have a definite effect on the music listener, their main influence is manifested through
rhythm and tempo, which will be discussed later. For now, the disharmonic use of words in music (as
classified by Torres and Torres) includes meaningless phrases and excessive repetition. Words are often
made meaningless by over-repetition or, particularly in religious music, irrelevance to the music or
message. Words in harmonic music have easily understood meaning. They are relevant to the
composition, and are not repeated excessively.
Rhythm and Tempo
Rhythm is the single most influential musical element. Tempo is very closely related. Kelly (quoted in
Douglas, 1987) introduces this topic well: "Everything from the cycle of our brain waves to the pumping
of our heart . . . all work [sic] in rhythms. We're a mass of cycles piled one on top of another, so we're
clearly organized both to generate and respond to rhythmic phenomena" (p. 42) Douglas says in the
same article that everything we do, from conversation to bodily functions, is controlled by rhythm.
Clarke (1999) noted that rhythm has an effect on the listeners' judgment.
Rhythm and tempo have a strong physiological influence on the body. Melkinov (1970) writes that a
certain composition of Domenico Modugnio, which has a fast tempo, raised the heart rate of the subjects
in an experiment by 4.7 beats per minute. It is a commonly acknowledged fact that many people listen
to music, especially rock and its related styles, for the "beat"; in other words, they listen to it for its
rhythm and tempo (Wright, 1999). Obviously, then, they are very influential.
Rhythm is also responded to by the listener. Gabrielsson (1982) places the responses into three
categories: experiential ("various perceptual, cognitive, and emotional variables" [p. 160]), behavioral
(actions performed as a result of the rhythm), and physiological. "In a real life situation," he writes, "the
responding person is usually not aware of the different components of his rhythm response" (p. 160).
More specifically, affected individuals are rarely aware of all of their responses, such as changes in heart
rate or respiration, or even toe tapping. They can become aware if they think about it. But then,
according to Torres and Torres, their responses are usually different.
Rhythm and tempo, used harmonically, are sympathetic to the body. The tempo should usually
correspond to the normal human heart rate range of approximately sixty to 120 beats per minute, with
most music between seventy and eighty beats per minute (Torres & Torres). The rhythm should not
detract from the main beat, and there should be rhythmic variety.
Disharmonic rhythm and tempo are destructive to the body. Disharmonic tempo is outside the range of
sixty to 120 beats per minute. Disharmonic rhythm often includes frequent syncopation (as does almost
all current popular music, and a lot of twentieth-century art [sometimes called Classical] music).
Monotonous rhythm (the same rhythm repeated many times) is also disharmonic.
Overall Psychological Effect of Harmonic and Disharmonic Music
Torres and Torres discuss a study by G. M. Schreckenberg and H. H. Bird (1988) on mice that
demonstrates the widespread effects of music. At birth, 36 mice were divided into three groups:
harmonic, disharmonic, and a control group. Around the clock, the harmonic group was exposed to
harmonic music at eighty to 85 decibels, the disharmonic group was exposed to disharmonic music at
eighty to 85 decibels, and the control group was kept in a relatively quiet environment at 75 decibels.
Two months into the study, four mice from each group were killed and preserved for later study. The
remaining mice were given three weeks of maze training followed by three weeks of rest during which no
training took place. After the rest period, they were tested for another three weeks to determine how
much they remembered, then they, too, were killed and their brains were studied along with the
previous twelve mice's brains. The results demonstrate that "disharmonic music causes 1) brain nerve
damage and 2) behavior degradation"
Several forms of disharmonic music, Rock being one of them, seem to be addictive. In an interview,
Schram (1999), an avid popular music listener, said that he is depressed if he goes too long without his
preferred style of music. Numerous others have reported this same phenomenon. However, they deny
being negatively affected. The "withdrawal" symptoms, such as depression, are probably due largely to
the heightened state of arousal caused by the rhythm and tempo of disharmonic music. When some
people have changed from disharmonic music to harmonic music, they report feeling better overall after
initial withdrawal symptoms.
It is also interesting to note that it is possible to minimize the negative effect that disharmonic music
has, but only while consciously listening critically to the music and forcing it into the conscious mind
(Torres & Torres).
Conclusion
Music has a very strong, very definite physiological and psychological effect on people. Disharmonic
music causes a number of negative behaviors, although according to Torres and Torres those affected
are often "the last to realize it" (p. 23). But the good news is that everyone can choose what music they
listen to. All it requires is a basic understanding of harmonic and disharmonic music.

http://www.scottseverance.us/music/effects_of_music.htm#figure_1

Severance, Scott. The Psychological Effects of Music. Scott Severances Website, 1999, n. pag.
Music 'can reduce chronic pain'

Research has confirmed listening to music can have a significant positive impact on
perception of chronic pain.
US researchers tested the effect of music on 60 patients who had endured years of chronic
pain.
Those who listened to music reported a cut in pain levels of up to 21%, and in associated
depression of up to 25%, compared to those who did not listen.
The Journal of Advanced Nursing study also found music helped people feel less disabled by
their condition.
The patients who took part in the study were recruited from pain and chiropractic clinics.
They had been suffering from conditions such osteoarthritis, disc problems and rheumatoid
arthritis for an average of six-and-a-half years.
Most said the pain affected more than one part of their body, and was continuous.
Some listened to music on a headset for an hour every day for a week, while the rest did not.
Among those who listened to music, half were able to chose their favourite selections, the rest
had to pick from a list of five relaxing tapes provided by the researchers.
Consistent improvements
Researcher Dr Sandra Siedlecki, of the Cleveland Clinic Foundation, said: "Our results show
that listening to music had a statistically significant effect on the two experimental groups,
reducing pain, depression and disability and increasing feelings of power.
"There were some small differences between the two music groups, but they both showed
consistent improvements in each category when compared to the control group.
"Non-malignant pain remains a major health problem and sufferers continue to report high
levels of unrelieved pain despite using medication.
"So anything that can provide relief is to be welcomed."
Professor Marion Good, who also worked on the study, said: "Listening to music has already
been shown to promote a number of positive benefits and this research adds to the growing
body of evidence that it has an important role to play in modern healthcare."
Previous research published in the same journal found listening to 45 minutes of soft music
before going to bed can improve sleep by more than a third.

Complex phenomenon
Dr Cathy Stannard, honorary secretary of the British Pain Society, said other studies had shown
music could have a positive impact on the perception of pain.
But she said the effects tended to be relatively small, and there was doubt as to whether they
were anything other than very short term.
"The perception of pain is very complicated, and is influenced by factors such as emotion,
experience and mood," she said.
"If music makes you feel relaxed and chilled out then one might expect it would affect our
perception of pain."
Dr Stannard said it was possible that music simply provided a distraction which stopped people
concentrating on their pain.
She said it was not surprising that drugs which had a specific action on the body often had a
limited effect on a phenomenon as complex as pain.
"We need to start to think outside the box," she said.

http://news.bbc.co.uk/2/hi/health/5012562.stm

Music 'can reduce chronic pain' News. BBC News Online, 28 May 2006.
The calming effect of music

A few weeks ago I was doing a project on maternal separation anxiety for another course when I came
upon a very interesting article that outlined a study conducted with premature infants in neonatal
intensive care units (NICU) and their mothers. All mothers participated in kangaroo care, an intervention
program for hospital bound infants where mothers and infants have skin-to-skin contact, whereas only
half listened to soothing music concurrently. Those mother-infant dyads listening to music reaped great
benefits: the mothers separation anxiety when leaving her child, as well as general trait anxiety,
decreased while the infants had more quiet sleep and cried less (1). Music seemed to help sooth both the
mother and child during a very anxious time.
Music is undeniably relaxing. As I child, I was absolutely unable to fall asleep unless there was a tape of
my favorite lullabies set to play in my room and even now I often turn up Erik Saties Gnosiennes and
Gymnopedies after a difficult day (for a sample of this music: http://www.youtube.com/watch?
v=WIVp05sEPhE&feature=related). What about music is so soothing? How is it able to make a stress-
ridden person tranquil? How does music affect our brain?
It turns out that music is a relatively common and very traditional therapy used to achieve a calmer
state of being. One mental health clinician, who is also an experienced music therapist, uses music to
help her patients stir up emotional images and claims that the music The vibration in music releases
tension in the cells and organs, thus creating a feeling of relief (2). One musical group has dedicated its
time to playing in nursing and convalescent homes and cite that they have observed their music help the
elderly people living there achieve a feeling of calm (3). Dentists and surgeons also cleverly use music to
decrease their patients worry and increase their pain threshold: the type of music playing in the elevator
and lobby are not accidental and the type of music played during surgery prep is considered part of the
prep itself (2). Biblical David played his harp to assist the mental troubles of king Saul (4) and later King
George commissioned similar musical therapy to aid in stress reduction (5).
When first thinking of music as calming, my first guess was that it serves as a distraction from whatever
it is that is currently making you anxious or upset. However, if this were the case, either all music would
have the same anxiety reducing effect or louder, more attention grabbing music would be the most
affective. However, this is not the case. Hard rock and heavy metal music can in fact have adverse
effects on EEG patterns. Yet just because a certain genre of music is louder or more upbeat does not
necessarily mean that is not calming, as Celtic and Native American music, as well as loud drumming,
were found relaxing. On the other had, some music traditionally created for meditation was just as bad
as hard rock or heavy metal. (4) In one study, only music that gave the participant the chills had any
effect on brain activation as recorded by PET scans. What makes some music more soothing than
others? It seems as though rhythm plays a large role. Choosing music with a rhythm slower than your
natural heart rate (72 beats per minute) is useful to many people, while familiar or cyclical music has
also been found to have great benefits (4).
Perhaps music is relaxing due to the fact that it has been linked to reduced pain perception (6). Could
pain reduction be the third variable mediating the relationship between music and calm? If we perceive
less pain, are we not calmer? Indeed, the reduction of pain perception most likely does play a role in the
leveling of anxiety, but there is evidence within the brain that music in fact does a whole lot.
In one study, where participants underwent a PET scan, the midbrain, ventral striatum, and parts of the
cortex were activated when participants listened to music that gave them the chills (7). Another region
that seems to be affected by music is the limbic system (2). This finding is useful when looking at
musics effects on stress, as the limbic system is home to the hypothalamus, which presides over
emotional behavior and has an important role in hormonal response. The hypothalamus also regulates
the sympathetic and parasympathetic nervous systems (SNS and PSNS, respectively). While the SNS
activates the body into fight of flight responses, the PSNS brings the body back down to calmer levels.
(8) Could calming music thus be affecting the hypothalamus, which in turn both activates the PSNS and
deactivates the SNS? Indeed, this seems like a viable possibility, as music has been observed to reduce
heart rate (4), precisely one of the effects of PSNS activation.
Lets return to the notion that slower rhythms generally work best to sooth. Our body works on rhythm;
from the pattern to which we breathe and walk to the rate our hearts beat and brain waves move. Music
affects our bodys rhythms. Not only does our heart beat more slowly, but our breathing becomes deeper
and our brain waves become smoother with fewer spikes (4). Furthermore, activity in the left and right
hemispheres of the brain becomes more synchronous, an effect with profound ramifications. Surprising
levels of synchrony in the brain has been found in Buddhist monks who meditate for long periods of
time, suggesting that synchrony plays a large role in calm and clear behavior (9). Listening to music
indeed acts as a form of meditation.
Music thus can have an intense effect on our state of being. My only parting question is whether there is
another variable at work. Is it actually the music that calms us down or have we learned that we should
try and make ourselves calm when listening to music. In other words, is our reaction to music truly
something inherent about the rhythm of music, or has our social environment taught us through
conditioning that we should use our own biological calming methods when music starts to play? Since all
cultures around the globe have music, and since musical rhythm does seem to relate to biological
rhythm, the prior explanation appears the closest to correct.

http://media.www.ntdaily.com/media/storage/paper877/news/2001/09/26/UndefinedSection/New-
Study.Points.To.The.Calming.Effects.Of.Music-1882968.shtml

Shane, Simone. The calming effect of music. North Texas Daily, 26 September 2001, n. pag.
The Effects of Music on Pain Perception

The link between music and medicine has existed for many years. Ancient civilization artifacts as well as
Biblical references suggestmusic was considered a powerful influence on physical health andwell-being
(Gfeller, 2003). Also, the historical writings of theEgyptians, Chinese, Indians, Greeks, and Romans
describe music as ahealing medium (Music, n.d.). In the United States, music therapy asa profession did
not begin to develop until World War I and World WarII; professional and amateur musicians went to
veteran's hospitals toplay for veterans suffering both physical and emotional trauma fromwar (American,
n.d.). Hospital doctors and nurses observed thepositive psychological, physiological, cognitive, and
emotionalresponses when veterans actively and passively engaged in musicactivities to relieve pain
(Music, n.d.). Veteran's hospitals beganhiring musicians, thus the need for musicians who had
receivedtraining prior to entering the hospital environment grew (American,n.d.). Colleges and
universities responded by offering programs totrain musicians how to apply music in therapeutic ways
(Music, n.d.). In 1950, music therapists who had worked with veterans, mentallyretarded,
hearing/visually impaired, and psychiatric patients formedthe National Association for Music Therapy
(NAMT) (Music, n.d.). In1998, NAMT joined another music therapy organization to become whatis now
known as the American Music Therapy Association (AMTA).

An estimated 35 to 75 million people in the United States sufferfrom some type of pain problem (Walsh,
Dumitu, Ramanurthy, &Schoenfeld, 1988 as cited in Wade & Hart, 2002). Chronic pain isconsidered one
of the most costly health problems in America,totaling more than $50 billion each year (Brittman, n.d.)
With somany people living with pain, it is not surprising music therapistswork in a variety of
environments including medical hospitals,outpatient clinics, psychiatric hospitals, rehabilitation
facilities,day care treatment centers, residences for developmentally disabledpersons, community mental
health centers, drug and alcohol programs,senior centers, nursing homes, hospice programs,
correctionalfacilities, halfway houses, and schools (Music, n.d.). Such a rangeof work environments
indicates the use of music therapy is notlimited to a particular age group or to people experiencing pain
as aresult of a physical injury. Children, adults, and the elderly withmental health needs, learning and
developmental disabilities, andsubstance abuse problems, and even mothers in labor can benefit
frommusic therapy (American, n.d.). However, most research focusing onmusic and pain examines
individuals who are experiencing primarilyphysical pain as a result of surgery (Roberts, 2002). This does
notmean the psychological/emotional component involved in perceivingpain is ignored; in fact, the
recognition of this component as animportant element in pain perception allows for the modification
ofpain through psychological techniques such as music therapy (Yang,n.d.). Therefore, music therapists
not only assess the physicalhealth but also the emotional well-being, social functioning, and
thecommunication and cognitive abilities and skills of their clients(American, n.d.). This holistic approach
to healing and painmanagement and the lack of adverse side effects often accompanyingdrugs or
surgery are the primary reasons why music therapy is soappealing.

Music therapy as an intervention to address perceived pain due tosurgery can be beneficial to patients
physically and psychologically. Hospitalization can result in physical stress from invasive surgeryand
therapies, as well as emotional stress due to unexpected news,unfamiliar environments, and a sense of
losing control (Music, n.d.).There are several theories about how music therapy positively
affectsperceived pain: (1) music serves as a distracter, (2) music may givethe patient a sense of control,
(3) music causes the body to releaseendorphins to counteract pain, and (4) slow music relaxes a person
byslowing their breathing and heartbeat (Roberts, 2002). It isimportant to recognize interactions
between physical andpsychological responses to pain. For instance, fear of surgeryincreases blood
pressure, prolonging the healing process, enhancingthe perception of pain, and in turn increasing blood
pressure; thecyclical nature of psychology, physiology, and biology in theperception of pain results in
difficulty when measuring pain, becauseit is a subjective experience. Just as music therapy is a
holisticapproach to medicine, the way music functions in reducing perceivedpain encompasses whole
human experience - psychological andphysiological events.

Weisenberg (1994) as cited in Megel, Houser, & Gleaves (1998)suggested distraction can be effective in
moderating pain primarilythrough the cognitive component of the Gate-Control Theory of Pain. Attending
to a pleasant stimulus occupies the capacity of theinformation processing system, disabling the individual
from fullyattending to the pain-causing stimulus (Kwekkeboom, 2003). Livingston(1985) as cited in
Stevens (1990) points out the importance of adistracter for patients undergoing surgery; this distracter
providesan escape through imaginative thought which is important in relievingstress, anxiety, and fear
associated with pain. Melzack & Walls(1965, 1982) as cited in Stevens (1990), suggest pleasant
imageryincreases a sense of control, thereby decreasing anxiety and feelingsof helplessness. Music can
be a strategy for refocusing attentionduring a painful experience (Music, n.d.). By acting as a
competingstimulus to pain or distracter, it can reduce the perceived intensityof pain (Gfeller, 2003).
Simultaneously, it can decrease the senseof loneliness and feelings that the hospital environment
isimpersonal (Stevens, 1990).

Music may also be effective on a physiological level as well. Music with a slow, steady tempo can be used
to cue slower breathingand trigger a relaxation response (Gfeller, 2003). This training iscalled the
entrainment principal. According to Bradt (2002) thisprincipal involves bodies that are vibrating in
slightly differentways that eventually catch up with each other to vibratesimultaneously. Bradt (2002)
states music therapists entrain aclient's heart rate (or respiration) by first matching the music tothe
heartbeat, then slightly altering the music tempo so that theheart rate follows the beat of the music. The
type of music used canentrain the body to respond in different ways. Sedative music canalleviate anxiety
and stress levels resulting in less use of painmedication, shorter recovery periods, and higher
patientsatisfaction, while stimulative music can be physically andpsychologically motivating, which is
beneficial during rehabilitation(Music, n.d.).

Research supporting these four perspectives concerning theusefulness of music therapy in pain
management has varied. Musictherapy has been shown to successfully reduce the reported pain
andnausea experienced by cancer patients who had undergone bone marrowtransplants (Music therapy,
2003). Furthermore, the new bone marrowof patients who participated in music-assisted relaxation
andimagery, took hold faster (13.5 days) than in patients who receivedno music therapy (15.5) days
(Music therapy, 2003). Good,Stanton-Hicks, Grass, Anderson, Lai, Roykulcharoen, & Adler(2001)
explored the effects of music and relaxation on postoperativepain across and between two days and two
activities: ambulation(walking, moving around) and rest. The results of this studyindicated reported pain
significantly decreased from day one to daytwo. Participants used music to both relax and distract and
reportedless pain during ambulation and after recovery than the groups whohad not received music or
relaxation therapy. In a pilot study ofpatients' perceptions of music during surgery, 45% of
participantsranked the helpfulness of music as excellent (Stevens, 1990). Thisresearch referred to
patients describing the music as a relaxationtool, method of distraction, and as direct intervention (the
painended abruptly when the music began). Miluk-Kolasa & Matajek(1996) as cited in Cohen (2001)
indicated dental patients providedwith information about surgery before the surgical procedureexhibited
physiological signs of stress such as changes in heartrate, blood pressure, and skin temperature. The
physiologicalresponses of patients who listened to music returned to their initialstate within an hour,
while those of patients who did not listen tomusic remained at the heightened level throughout the
procedure. Bally, Campbell, Chesnick, & Tranmer (2003), in examining theeffects of music on patient
psychophysiological stress responses tocoronary angiography, found music therapy did not
significantlyaffect anxiety, perceived pain intensity, heart rate, blood pressure,or use of additional pain
medications, yet patients favored havingmusic. Nurses reported the music's calming affect and even
sought itout for patients not participating in the study.

Alternatively, other studies have indicated music has had littleeffect on pain perception and patient
anxiety. In a study by Megel,et al. (1998) children, from three to six years old, assigned to
theexperimental group were given musical intervention (a series oflullabies played through headphones)
during immunizations. Before achild received an immunization, his or her blood pressure and heartrate
were measured and data about his or her distress level werecollected. While this study found no
significant differences inblood pressure, heart rate, or perceived pain between theexperimental and
control groups, total distress scores weresignificantly less for the group that received music
intervention,suggesting the stress/perceived pain associated with immunizationscan be somewhat
alleviated through the use of a distracter such asmusic. Kwekkeboom (2003) compared the effects of
music and adifferent distracter (book on tape) on the perceived pain of cancerpatients, and found no
significant differences in pain between thegroup that received music and the group that received
thebook-on-tape distracter. Additionally, no significant differences inpain perception between the two
distracter groups and the controlgroup were found. Evans (2002) conducted a survey of
researchinvolving the application of music therapy in reducing pain andanxiety in hospital patients. This
review indicated music waseffective in reducing anxiety during normal care delivery, but had noeffect on
select medical procedures and little effect on breathingrate, heart rate, blood pressure, etc. Although
these studiesindicate music has little impact on pain perception, researchersrecommended music be
offered in medical facilities due to thevariance in patient abilities to cope with pain and the
inexpensivenature of music intervention.

Overall, music does have positive effects on pain management. Prior research does not consistently
identify the role music plays asdescribed by the previously listed theories, but does indicate
theconsistent use of vital signs as a measure of stress in response topain. Generally patients report
music intervention positivelyimpacted their experience of pain associated with surgicalprocedures, and
despite the weak findings of some studies,researchers recommend music therapy should be offered to
patients asan additional method of pain management. Music entrainment iscomplementary to pain
medication (Bradt, 2002). Even if playing asecondary role in managing pain, music therapy is non-
invasive, hasno negative side effects, is inexpensive to hospitals and patients,and can be completely
personal, reaching a patient beyond thephysical realm of drug therapies. If a patient chooses his or
hermusic, as is the case with practicing music therapists, they can onlybenefit from the recollection of
pleasant memories, divertedattention, and resulting relaxing physiological responses.

Generally, future research in pain management should focus onholistic medicine. Because pain is a
unique subjective experience,the treatment should also be unique. Additionally, research shouldattempt
to clarify how music and the Gate Control Theory of Pain areintegrated. Perhaps by identifying the
physiological basis for paincontrol, we can better understand the corresponding
neural/emotionalresponse

http://www.laurenscharff.com/courseinfo/SL03/music_therapy2.htm

Greer, Sarah. The Effects of Music on Pain Perception. Stephen F. Austin State University Research
Papers, n. d.
Running in rhythm: Measuring the effect of music on competitive runners

Recent Case Western Reserve University graduate and All-American track champion's research shows
running to music does not lower exertion levels

If it's true that music calms the savage in us, it stands to reason that it should have the same effect on competitive
runners, right? Not according to a recent research project conducted at Case Western Reserve University.

Acknowledging how the synchrony of motion and music has a positive effect on the enjoyment of repetitive
activities, Esther Erb, a May 2008 graduate from Richmond, Va. with a bachelor of science in music and cognitive
science, set out to find whether this positive effect could help reduce runners' perceived exertion levels during
strenuous exercise.

The project subjected athletes to a series of runs while listening to iPods playing a mixture of silence, beat tracks
and music. At the end of the experiment, the runners felt they exerted themselves more while listening to music
than heart monitors actually measured.

No stranger to running, Erb was a track and field and cross country athlete at Case Western Reserve. In May 2008,
she earned a national title in the 10,000-meter run [35:45:01] at the 2008 NCAA Division III Track and Field
Championships in Oshkosh, Wis. She also has a life-long connection to music by beginning cello lessons at age 3,
reading music before she could read words and singing in a choir at age 5.

The hypothesis of the project was that for trained athletes, music would lower perceived exertion during exercise.
This was expected to be particularly true when the tempo of the music (beats per minute) matched that of the
runner's most efficient cadence (rate of foot strikes per minute), causing him to maintain his most efficient cadence
thereby allowing him to extend his limits beyond those he would have without music.

Links were sought between music and exertion as measured by heart rate (HR), performance (time) and self-
assessed perceived exertion based on the Borg Rating of Perceived Exertion (RPE) during a typical workout for
runners.

Thirteen members of the cross country team at the university ran three-mile runs (five male, eight female, age 17 to
20) under three different conditions. Heart rate, performance and RPE were measured for each half-mile run. Each
runner was equipped with heart-rate sensor chest straps, monitor watches, heart-rate data recorders and iPod
Shuffles with headphones.

At the beginning of each run, the subjects started their watches and iPods. As they began half-mile segments
(clearly marked on the route), each runner pressed the "lap" button on their watch and skipped to the next track on
their iPod. After each run, subjects rated the perceived effects of the conditions on their performance, as well as
their RPE for each half-mile segment and for the entire run.

For the first run (control run), the iPods played no music, only occasional voice recordings indicating that the
equipment was operating correctly.

During the second run the playlist consisted of no music for the first half mile. For the remaining five half-mile
segments, the runners skipped to one of five beat tracks, each of a different tempo. At the end of the second run,
each runner selected the tempo that best matched their preferred cadence. The three selected tempos were 87, 90
and 93 beats per minute.

Five songs were selected for each player, each with a tempo to match their selection from the second lap. The five
songs were a mix of indie rock, hip hop and other contemporary genres. As in the previous two runs, a blank track
was played during the first half-mile segment.

At the end of the three runs, Erb found moderate statistical significance between the third run and the control run in
the size of the effect through measures of heart rate, segment times and total times. However, a counterintuitive
significance was found in the size of the effect on RPE.

While there were improvements in performance (time) during the final run, and 12 of the 13 subjects perceived aid
from the music, the hypothesis that music lowers RPE was disproved. While both actual heart rates and RPE
significantly increased in the third run, this could be attributed to the runners naturally trying to beat their previous
times and not to the presence of music. However, in relation to heart rates, RPE was significantly higher in the third
run than in the first two.

Erb cites several implications of the higher RPE levels in the third run. One is that the music allows athletes to work
harder and perform better but not without perceiving the resulting increased level of exertion. Also, the presence of
varying tempos in the second run, particularly those not corresponding to the runners' most efficient cadence, may
have inhibited performance and prompted the athletes to be more conscious of their harder and more consistent
performance in the third run.

Knowledge of their previous times -- and the desire to best them in the third run -- may have influenced RPE rates.
Erb suggests that subject-blind set-ups may provide different data.

The elevated RPE levels could also be due to an increase in the release of endorphins, most commonly associated
with high levels of physical exertion as well as exposure to music. The synchrony of the motion of the runner to the
music may also have been a factor.

Erb does not plan to conduct additional research. In September 2008, she begins teaching English in Vienna on a
Fulbright scholarship.

http://blog.case.edu/case-news/2008/06/25/ipod

Finley, Kimyette. Running in rhythm: Measuring the effect of music on competitive runners. Case Western
Reserve University News Center, 25 June 2008.