Effects of music on patient anxiety - Research

AORN Journal, Feb, 2003 by Esther Mok, Kwai-Yiu Wong

Patients undergoing surgical procedures often experience anxiety in anticipation of events that will be unfamiliar, uncomfortable, or have undesirable results. Even minor surgical procedures can produce anxiety in patients, which can affect their postoperative recovery and risk for physiological complications. Music is an easily administered, nonthreatening, noninvasive, and inexpensive tool to calm preoperative anxiety.

The effect on patients of listening to music before and during surgery has been the subject of a number of studies. Some indicate that music is effective in reducing anxiety before and during surgery. (1) There also are studies, however, that report insignificant results from music intervention. (2) Additional research with rigorous design is needed.

Other than studies with inconclusive findings about the effect music has on reducing preoperative and intraoperative anxiety, music intervention during minor surgery with local anesthesia in a Chinese population has not been tested previously. For this study, researchers assessed the effectiveness of music as a relaxation modality by measuring patients' vital signs and self-reported anxiety before and after surgery. The study design required the use of the Chinese State-Trait Anxiety Inventory (C-STAI) as a principle measure and a physiological measure of procedure-related anxiety. This study also was designed to learn about the broader effects of music by asking patients their perception of listening to music during surgery. The goals of this study are to examine whether music can reduce patients' intraoperative anxiety and sense of isolation effectively and be considered an alternative nursing intervention when planning patient care in the OR.

LITERATURE REVIEW

Music is thought to have many effects on an individual. One researcher believes that music may relieve stress by diverting attention away from or masking annoying noise? One author reveals that music can help achieve a deep state of relaxation, relieve insomnia, enable patients to recall suppressed memories, lower blood pressure, and normalize cardiac arrhythmia. (4) Another author says that music enables the body to synchronize its rhythms with the rhythms of vibrating bodies around it. (5) For example, if an anxious patient with a racing heartbeat listens to slow music, his or her heart rate will slow down and synchronize with the music's rhythm.

Other researchers looked at the lived experience of listening to music during postoperative recovery and evaluated findings from a phenomenological perspective. Three themes emerged from the interview data, including

* comfort from a discomforting condition;

* familiarity in a strange environment; and

* distraction from fear, pain, and anxiety. (6)

Another group of researchers also found that music in combination with relaxation reduces postoperative pain during both ambulation and rest. (7)

Many scientists and researchers have examined music and its ability to reduce anxiety in a variety of health care settings and patients. Music's soothing effects have been demonstrated in patients undergoing chemotherapy or elective surgery under local or regional anesthesia. These effects also have been noted in preoperative and postoperative patients, patients receiving assistance from a ventilator or undergoing flexible sigmoidoscopy, and women in labor. (8)

In the literature, there is some discrepancy about the efficacy of listening to music on patients' anxiety during surgery. One researcher investigated the effect of humorous and musical distraction on preoperative anxiety among patients scheduled for elective nondiagnostic surgery. The results showed no significant differences in self-reported preoperative anxiety among patients who listened to a humorous audiotape, listened to a tranquil music audiotape, or received no intervention. (9) These results were somewhat inconsistent with an earlier pilot study that found same-day-surgery patients who listened to humorous audiotapes reported lower levels of preoperative anxiety than patients who listened to tranquil music, although the difference was not statistically significant. (10) The researcher acknowledged that a preference for listening to music or a comedy routine may have affected some participants' anxiety scores. Several methodological problems also might have contributed to the insignificant results.

Another group of researchers recruited 96 patients undergoing heart surgery and randomly assigned them to one of three groups (ie, music therapy, music-videotape therapy, scheduled rest). Participants in the groups received their assigned 30-minute intervention at two times on postoperative days two and three. The results showed significant improvement in mood among participants in the music intervention group; however, no significant differences were reported for anxiety ratings. There were significant effects over time on heart rate and systolic and diastolic blood pressure, which indicates a generalized relaxation response. (11)