Music for stress and anxiety reduction in coronary heart disease patients

The right mix of Portuguese instrumentals calms Philadelphia researcher Joke Bradt.

That's what she'd want to hear during a serious medical procedure - that or classical music.

She points out quickly that this is her musical preference. She knows the right music can help her and, as a music therapist, she uses it to help others as well. "If you can relax patients, if you can calm them down a bit, that is only going to be beneficial," says Bradt, who is assistant director of the Arts and Quality of Life Research Center at Temple University.

Bradt and Cheryl Dileo, another Temple researcher, conducted a review of 23 studies that focused on the use of music with 1,461 patients with coronary heart disease. They found that listening to music reduced heart rate, respiratory rate and blood pressure. However, Bradt cautioned that the quality of evidence was not strong and the clinical significance unclear.

The review appears in the latest issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering the content and quality of existing medical trials.

Alleviating stress is important, said Robert Bonow, professor of medicine and chief of cardiology at Northwestern University and a past president of the American Heart Association, although he adds that this review shows there is "no conclusive evidence that this relaxation therapy actually reduces the stress, let alone reducing the outcome of the stress."

Stress and its influence can be a cloudy issue for researchers. "Is it the stress that causes heart attacks?" he asked. Often, people who are under stress are also smoking or eating the wrong things and their blood pressure goes up, he said.

"Exercise is beneficial because it reduces stress, but it also lowers blood pressure," he said, adding that data on the benefits of exercise are irrefutable. This review presents a meticulous study of music therapy, he said, yet it does not make absolute conclusions that it is beneficial.

The reviewers found that if patients chose their music, the effects were greater; however, studies using researcher-selected music had results that were more consistent. Listening to patient-selected music lowered pulse rates by more beats per minute than listening to researcher-selected music. Several studies only offered classical music. Other trials allowed patients to choose from a selection of genres, such as "Fresh Aire" by Mannheim Steamroller or country-western instrumentals.

It did not surprise Bradt that patient-selected music produced a more calming effect than music chosen by a nurse or doctor. "There is a lot of classical music I like or don't like," she said. "So we do know from clinical experience that if people select music they like and the music has sedative qualities such as slow tempo, predictable harmonies and absence of sudden changes, they will be better able to relax to the music."

Patients in the comparison groups had no music and researchers might have asked them to rest quietly, Bradt said. "Researchers would have made sure the patient didn't get interrupted."

In reviewing the studies, she lacked data to determine which music genre - country-western, classical, New Age - helped patients most. "None of the studies ran an analysis on whether one music style was more efficient than another," Bradt says.

Some studies looked at music offered during a cardiac procedure or within 48 hours of hospitalization. Others included three or more sessions during consecutive days. Most of the studies did not use music therapists - trained professionals like Bradt. That's important, she said: Although researchers in these studies knew it was important to use slow music, music therapists are trained specifically to use music interventions that meet the individual's needs.

Music therapists avoid using music that might evoke strong emotional reactions. If a patient likes music, but it reminds him of his belated mother, for example, it could bring about sadness. "We're not going use it because it has too much emotional impact," she said. Music should have a steady, even tempo, kept between 60 and 80 beats per minute.

When she had an MRI not long ago, the technician played classical music. This should have worked for Bradt. The problem was that the MRI was so loud that she could not hear it. The result, she said, was counterproductive. "It annoyed me more than anything else."

Bradt said if she needed a coronary procedure, she would come prepared. "I would make sure I brought an iPod with music I love that had relaxing qualities. Preferably, I would like to have a music therapist in the room."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews 2009, Issue 2.