Sedative Music and Its' Effect on Anxiety in College Students
Music has unique properties that address physiological and psychological responses (Robb, 2000). It is a non-verbal means of expression, and can create an atmosphere of play, in which tension is released and negative emotions are decreased (Wu, 2002). Music therapy is often used to relieve stress in both clinical and non-clinical populations (Jones, 2006; Pelletier, 2004; Silverman, 2008). With a variety of stressors, college has been a back-drop for many studies concerning anxiety and music (Barger, 1979; Landreth and Landreth, 1974; Lata and Dwivedi, 2001; Madsen, Standley, and Gregory, 1991; Robb, 2000; Smith and Morris, 1976; Rohner and Miller, 1980; Wu, 2002).
Stress is a major factor in the everyday life of a college student. Worries include being smart enough, getting along with roommates, making friends, missing home, handling the party scene, having sex, financial concerns, and being safe (Shayley and Johnson, 2008). Further, other studies have been conducted in community populations addressing stressors that affect college students, such as pregnancy and heart disease (a potential problem for nontraditional students) (Hanser, Larson, O’Connell, 1983, Suda, Morimoto, Obata, Koizumi and Maki, 2008; Webster, 1983).
In terms of the effects of music therapy on anxiety, the most simplistic research designs involve playing recorded music to college students that is believed to have sedative effects without introducing a stressor or prescreening for high anxiety subjects (Barger, 1979; Madsen & Standley, 1991; Robb, 2000). Results of these studies are mixed in terms of the effectiveness of supposedly sedative music. When compared to what researchers deem as stimulative music, sedative music significantly lowered heart rate in only one of two studies on college students, with the other study finding no significant difference in heart rate when sedative and stimulative music was played (Landreth & Landreth, 1974; Madsen & Standley, 1991). In another study, sedative music significantly lowered self-reports of anxiety, but was no more effective at relaxing participants than other relaxation methods, or even no treatment at all, with a participant simply waiting quietly (Robb, 2000). Since there was no assurance that participants were indeed stressed within these studies, a floor effect for the impact of music therapy on anxiety cannot be ruled out. That is, participants in some of these studies had fairly low pre-test levels of anxiety, and so it would be difficult for them to further lower their stress levels. Finally, these studies did not operationally define what sedative or stimulative music is. We will address each of these limitations in turn.
To address the problem of potential floor effect when studying sedative music, some studies have induced stress in college participants (Barger, 1979; Smith & Morris, 1977; Suda, et al. 2008). The stressors presented to university students included solving math problems. Generally, researchers find that subjects are responsive to the stressor, meaning that anxiety levels increased after presentation of the stressor (Barger, 1979; Smith & Morris, 1977; Suda, et al. 2008). Two of the studies, using within-group designs, found that sedative music significantly lowered self-reports and physical indicators of stress (Smith & Morris, 1977; Suda et al., 2008), whereas, more stimulative music did not lower stress levels. Further, participants reported enjoying the sedative music more than the stimulative music (Smith & Morris, 1977). However, in a between-groups study, sedative music was no more effective than verbal suggestions of relaxation, or even no treatment at all, in relaxing participants after they attempted to solve math problems (Barger, 1979). Interestingly, all groups showed significant reductions in anxiety, even the control group, in this study. This might suggest that the stressors are superficial, as once they are removed, even sitting quietly will lower anxiety. While subjects’ anxiety increased during presentation of the stressor, it quickly decreased as soon as treatment ended. Also, external validity is called into question as the types of stressors induced are not very applicable outside of a laboratory setting.
Some researchers have used more realistic stressors while testing the effects of sedative music (Lata & Dwivedi, 2001; Rohner & Miller, 1980; Wu, 2002). In these studies, researchers pre-screen for high-anxiety, allowing only college students that scored above the mean into the experiment. Two studies used longer treatments (i.e., greater than 20 minutes) as would be found in actual music therapy sessions, and found significant reductions in anxiety (Lata & Dwivedi, 2001; Wu, 2002). Though one of these studies assessed only within-group differences (Lata,& Dwivedi, 2001), the second study found that a two hour music therapy treatment, once a week for ten consecutive weeks, lowered self-report anxiety more than a no-treatment control, and these differences were maintained at a two month follow-up. A third study that included high anxiety subjects used only 8.5 minutes of either stimulative or sedative music as an intervention, and this yielded no significant change in anxiety (Rohner & Miller, 1980). These results lend credit to the idea that a longer sedative music treatment is needed to effectively lower stress-in essence, a dosage effect. If participants have higher levels of anxiety, if makes sense that their treatment will need to be of longer duration. Nonetheless, it appears that for real-life stressors, such as people experiencing high anxiety in their lives, musical interventions of sufficient duration can reduce stress.
Another limitation to the research is that sedative music is rarely defined (Barger, 1979; Hanser et al. 1983; Lata & Dwivedi, 2001; Rohner & Miller, 1980; Webster, 1973; Wu, 2002). A few studies have attempted to clarify what forms of music are most relaxing (Landreth & Landreth, 1974; Rohner & Miller, 1980; Suda et al., 2008). For instance, music played in a major key has been found to be more relaxing than music in a minor key (Suda et al. 2008) Further, music with a slower tempo has been found to be more sedative. For instance, in a within-group study, lower tempo segments of Beethoven’s Fifth Symphony significantly reduced college students’ heart rate compared to faster tempo portions of the composition (Landreth & Landreth, 1974). Interestingly, Rohner and Miller (1980) found that familiarity with a musical piece did not significantly change anxiety in college students. It has been theorized that sedative music contains eminent changes in rhythm, texture, and dynamics (Bradt, 2001; Landreth & Landreth, 1974) but this has not been tested yet. Overall, it appears that sedative music contains a slower tempo, in major keys, with possibly eminent changes in song structure.
To further calculate the benefit of sedative music on stress, sedative music has been compared to other forms of relaxation, such as verbal suggestions to relax (Barger, 1979) progressive muscle relaxation (Robb, 2000), and Lamaze breathing techniques (Hanser et al., 1983). Relaxation methods significantly lowered anxiety in all conditions. However, music therapy worked more effectively than other relaxation methods only in one study - when the stress presented was more natural [mothers giving birth (Hanser et al., 1983)]. Music therapy was just as effective as other methods of relaxation when the stressor was superficial [math problems (Barger, 1979)] or no stressor was present (Robb, 2000). At the very least, sedative music is just as effective as other forms of relaxation
Recently, some music therapists have suggested that sedative music can have a more relaxing effect if the principle of entrainment is incorporated into music interventions (Hoffman, 1995). Entrainment is a process in physics, whereby two previously out of step oscillators (systems that vibrate) lock into phase with one another replacing the vibrational frequency of one system with that of another (Bradt, 2001). Entrainment was discovered by a Swiss clock-maker who set two grandfather clocks together and noticed that they became synchronized. It is theorized that for entrainment to occur, vibration with a certain frequency must be acted upon by another vibration with a similar frequency, a process known as periodicity. Further, rhythms in the environment can be synchronized to the internal rhythms of a human being, because chemical and electrical responses have rhythm (Bradt, 2001). This process is known as bio-feedback, a form of complementary/alternative medicine in which a person learns to control his/her bodily functions- such as heart-rate- by incorporating information from other devices in the environment. Musical bio-feedback involves matching one's heart-beat and breathing rate to the slow, steady beat of music (Hoffman, 1995). So, for example, if an anxious music therapy client hears music that is sixty beats a minute and he or she has a heart rate of ninety beats a minute, the sedative effects of music on that individual vibrationally (physiologically) are diminished, because the two vibrations are so different and unable to synchronize. Anecdotal evidence from clinical sessions by music therapists indicates that music incorporating the process of entrainment-starting at eighty beats per minute and slowing to fifty beats-per-minute effective at calming anxious clients (Hoffman, 1995). However, no systematic research has been performed on the theory of entrainment.
The current study will test the effectiveness of entrainment by playing music for anxious college students that starts at 80 beats-per-minute and slows to 50 beats-per-minute. This sedative treatment music will comply with the aforementioned research that has found sedative music to be a slower tempo, in a major key, lasting for 30 minutes, which should allow enough time for periodicity to occur. This entrainment procedure will be tested against music played at 50 beats-per-minute in a comparison group of anxious college students. It is predicted that the self-report and physical markers of anxiety will be more significantly reduced in the experimental (entrainment) group [music starting at 80 beats-per-minute and slowing to 50 beats-per-minute (Hoffman & Smiley, 2001)] then in the standard sedative music group [music tempo at 50 beats-per-minute for the duration (Hoffman, 1997)].
A sample of Introduction to Psychology students (N=122) was reduced to 110 (57 in the experimental group) due to confounds such as being under the influence of recreational drugs or taking medication for a pre-existing medical condition, falling asleep, texting or performing other physical tasks during treatment, and completing post-treatment measures before treatment had ended. Participants average age was 23.0 (SD = 6.7), and 57% were female. Other descriptions of the sample can be found in Table 1.
*Insert Table 1 here*
Physiological indicators of stress in the current study were blood pressure and heart rate. Blood pressure and heart rate were measured using two Automatic Blood-Pressure Monitors, Model MF-46(Mark of Fitness Inc).
The State and Trait Anxiety Inventory form Y (STAI) (Spielberger, Gorsuch, Lushene, Vagg, Jacobs, 1983) was used to assess students’ self reports of stress. The STAI contained two subsets, I and II (see appendix A). Form YI contained twenty items that indicated a participant's nervousness in the moment - a measure of state anxiety. Each of the twenty items was rated on a Likert scale from 1-4 (1 being not at all, 4 being very much so). Subset YII contained an additional twenty items to rate trait anxiety, or how a participant generally feels. A Likert scale was used to measure trait anxiety as well (1 being almost never, 4 being almost always). The STAI has good internal reliability, with Cronbach's alpha coefficients above .80 (Andrade, Gorenstein, Filho, Tung, and Artes, 2001), as well as good construct validity, with a Pearson's R coefficient of over .85 when compared to the Hospital Anxiety and Depression scale (Mystakidou, Tsilika, Parpa, Sakkas, & Vlahos, 2009).
Additional measures were included, to help mask our general research question between anxiety and music (see Appendix B). The Daily Spiritual Experiences Scale - Short Form (Fetzer, 1999) was used to assess students' encounters with and feelings toward God (or a Higher Power) for that particular day. The scale consisted of six questions rated on a six-point scale (1 being "Did Not at All Experience", 6 being "Experienced A Lot"). The Existential Well-Being Subscale, which is part of the Spiritual Well-Being Scale (Paloutzian & Ellison, 1982), is a ten-question survey that assessed meaning and purpose in life. A six-point Likert scale (1 being "Strongly Agree", 6 being "Strongly Disagree") was used in this scale. Finally, The Depression Subscale of the Brief Symptom Inventory (Derogatis & Melisaratos, 1983) is a six- question survey that assessed the level of bother and distress experienced by subjects over the past week. This measure implemented a five-point Likert scale, asking participants how much they have been bothered by each symptom (1 being: Not at All", 5 being "Extremely"). The references provided include information demonstrating the validity and reliability of these measures.
The experimental group listened to Hoffman & Smalley’s (2001) Musical Biofeedback II Album, played on Microsoft Windows Media Player 11 (which starts at 80 beats-per-minute and ends at 50 beats-per-minute). For the comparison group, Hoffman's (1997) Musical Acupunture album was played on Microsoft Windows Media Player 11, which consistently has a tempo of 50 beats-per-minute.
Instructors for introductory psychology classes were provided with a consent forms and copies of the STAI forms Y (subsets I and II) in class. Each consent form had a number on it that corresponded to the STAI. Students were instructed to turn in their consent forms and STAI surveys separately to their instructor (which did not have contact information) and the informed consent form (which asked for contact information) only if they wished to participate in the study. Students were then instructed to turn in the consent forms and STAI surveys separately to their instructor. Once the items on the STAI have been scored, willing participants that scored above the mean (avg. 38) on the trait anxiety sub-scale were invited to participate in the second phase of the experiment by sending them an e-mail, contacting them by phone, and making a general announcement in class.
Eligible participants navigated to a confidential online website to sign up for a time to participate in the musical part of the study. When students came for the musical intervention, they were randomly assigned to one of two treatments: the comparison group listened to music at 50 beats-per-minute in one room, and the experimental group listened to music that started at 80 beats-per-minute and slowed to 50 beats-per-minute in another room. One researcher was in charge of leading each group. A brief instruction to listen actively and not passively was read verbatim to each group before the music was played (see Appendix C). Prior to the music starting, participants completed demographic information (see Appendix B), the STAI, the Daily Spiritual Experiences Scale, the Existential Well-Being Subscale, and the Depression Subscale of the Brief Symptom Inventory, while they had their blood pressure and heart rate recorded. After the music was finished, participants again completed the STAI, The Daily Spiritual Experiences Scale, The Existential Well-Being Subscale, and the Depression Subscale of the Brief Symptom Inventory and had their heart rate and blood pressure taken.
Two 2x2 Mixed Design ANOVAs were calculated to examine the effects of type of treatment (Entrainment or Consistently Slow Music) and Time (Pretest and Post-test) on heart rate and STAI scores. A significant Time x Group interaction was present (F (1,108) = 4.60, p = .034, ES = 0.04) for heart rate but not for STAI (F (1,108) = 0.58, p = .45, ES = 0.01). In addition, the main effect for Time was significant for both heart rate (F (1,108) = 58.91, p < .001, ES = 0.35) and STAI (F (1,108) = 65.3, p < .001, ES = 0.38). The main effect for treatment was not significant for either pulse (F (1,108) =1.13, p = .29, ES = 0.01) or STAI (F (1,108) = 0.12, p = .73, ES = 0.0). Table 2 provides descriptive information for STAI and pulse across time and groups.
To examine the significant interaction between Group x Time, simple main effects were conducted while using a pooled error term for the between-groups analysis. Repeated measures one-way ANOVAS were calculated comparing pulse before and after treatment. A significant effect was found for both Group 1 (F (1, 52) = 18.65, p < .001, ES = 0.26) and Group 2 (F (1, 56) = 41.92, p< .001, ES = 0.43), meaning that both groups had significant reductions in pulse (see Figure 1). One way ANOVAS were calculated comparing pre-test pulse rates between groups, and post-test pulse-rates between groups. There was not a significant difference between groups at pre-test (F (1,124.9) = 2.56, p = .11) or post-test (F (1,124.9) = 0.20, p = .66). To compare the size of reduction in heart rate across groups, a new dependent variable was created, subtracting pre-test pulse scores from post-test pulse scores. A one-way ANOVA revealed a significant difference in the reduction of heart rate (F (1,108) =4.60, p = .034), with consistently slow music having a significantly greater reduction (M = -6.67, SD = 7.77) than entrainment music (M = -3.75, SD = 6.33) (see Figure 1).
*Insert Figure 1 here*
*Insert Table 2 here*
The goal of the current study was to determine if entrainment works better than a consistently slow tempo in sedating anxious persons. The hypothesis was not supported, as we found some evidence that sedative music with a consistently slow tempo might be optimal for reducing anxiety. There was a greater reduction of pulse in this group than the entrainment group. Overall, however, both groups showed significant decreases in both self-report anxiety and pulse rate after listening to a half hour of music.
One explanation for these results is that the conditions for entrainment were not optimal. The entrainment music started at 80 BPM, yet most participants’ heart rate were initially below that, with an average heart rate of 76.8 at pretest. Though only participants who scored above the sample mean for trait anxiety were allowed to participate, these students still were not anxious enough to have a resting heart rate of 80 BPM.
Future designs might include a clinically anxious sample to assure participants are indeed stressed (i.e., have a resting pulse of > 80 BPM). Although university life is full of potentially stressful situations, a clinical population should assure that the entire sample will have a minimal heart rate of 80 beats-per-minute. Hanser et al. (1983), for example, discovered a significant reduction in birth-anxiety, both physiologically and on self-reports, in expecting mothers when a traditional music therapy was compared to the Lamaze technique in a hospital setting. Future research on entrainment could be conducted in a mental health facility or with cardiovascular disease patients at a hospital. Given that a clinical population might have an average resting heart rate above 80 BPM, (as an average resting heart rate is 70-80 BPM), t would be interesting to include entrainment music that started at a higher tempo than 80 BPM.
Further, future designs might include a control group to ensure that entrainment music works better than nothing at all (i.e., that participants wouldn’t simply become calmer over time without treatment). Though some studies have already found sedative music at a consistent beat is more effective than no treatment at all (Wu, 2002), other studies have not found such music to work better than no treatment (Bargar, 1979; Robb, 2000). Future research could compare entrainment and consistently slow music with a wait-list control group. Also, a no-treatment control group could sit in a waiting area while given magazines to read, or a television to watch, to determine if these everyday activities would work as well as sedative music. Entrainment music could also be compared to other forms of relaxation therapy,to ensure such interventions are equally effective. Indeed, consistently sedative music. has performed at least as well or better than Lamaze (Hanser et al., 1983), autogenic relaxation (Barger, 1979), and progressive muscle relaxation (Robb, 2000). Finally, researchers might combine various forms of relaxation treatment to determine if the sedative effects are better than one intervention alone.
Finally, the current study included only two musicians in the sample (both in the comparison group). The current literature review showed evidence that an individual with a high level of music knowledge has a heightened physiological response to the music because they can critically analyze the tempo, mode, dynamics, and rhythm of a musical piece with greater insight than the average non-musician (Landreth & Landreth, 1974). Theoretically, this means that all music, even sedative music, can have a stimulative effect on a well-trained musician. Research suggests that musicians vary such attributes as tempo, dynamics, and attack to express different emotions (Krumhansl, 2002). A future design should include a musically knowledgeable group for comparison, to show the overall stimulating effect of all types of music on musicians.
Music is a non-verbal means of expression, and can create an atmosphere of play, in which tension is released and negative emotions are decreased (Wu, 2002). It also provides a back-drop that complements other forms of relaxation. An individuals’ emotional response to noise and music is indeed a cognitive and emotive phenomenon (Krumhansl, 2002), with therapeutic properties.
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