Music/Music Therapy

Music/Music Therapy

PEP Topic 
Caregiver Strain and Burden

Music therapy is the application of music to influence physiologic, psychological, and emotional functioning. It often is used with other behavioral techniques, such as relaxation. Music interventions vary from listening to recorded music and live music to more formal music therapy provided by music therapists. Professional music therapy involves individualization of the intervention, may involve the patient in the music making, and includes a systematic therapeutic process of assessment, treatment, and evaluation. Music and music therapy have been evaluated for their effects in anxiety, chemotherapy-induced nausea and vomiting, depression, dyspnea, pain, fatigue, and caregiver strain and burden.

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Effectiveness Not Established

Research Evidence Summaries

Lai, H.L., Li, Y.M., & Lee, L.H. (2012). Effects of music intervention with nursing presence and recorded music on psycho-physiological indices of cancer patient caregivers. Journal of Clinical Nursing, 21, 745–756.

doi: 10.1111/j.1365-2702.2011.03916.x

Study Purpose:

To compare the effects of music intervention with nursing presence (MINP) and the effects of recorded music (RM) on various psychological and physiologic indices among caregivers of patients with cancer. The recorded indices included the incidence of depression and anxiety, sleep, blood volume pulse (BVP) amplitude, and the low/high frequency ratio component of heart rate variability (HRV).

Intervention Characteristics/Basic Study Process:

Participants were seated on a comfortable chair in their own homes. A photoplethysmograph was worn on the left-hand middle finger to continuously monitor BVP amplitude and HRV.

The intervention groups were MINP versus RM. Interventions were alternated between MINP and RM with an interval of one week between each intervention. Each intervention took place in the participant’s home for 30 minutes and generally after dinner according to participant preference. In the MINP intervention, participants were told to imagine they were attending a concert. During MINP, the primary researcher was present and played music on the erhu (Chinese violin) and recorder without any verbal communication or interruption. The live music included diverse pieces such as Japanese, Chinese, Taiwanese, English, and Czech music. Music selections were well known by participants and expected to create immediate enjoyment, and all had similar musical characteristics and quality. Rhythm ranged from 60–80 beats, and the tempo was slow. In the RM intervention, participants were left alone to listen to 30 minutes of the same music selections prerecorded on a CD. The music volume was adjusted to a comfortable level before the session. Study measurement was obtained pre and post each intervention.

Sample Characteristics:

  • The sample was comprised of 34 female caregivers of patients with cancer.
  • Caregiver mean age was 44.9 years (SD = 9.03).
  • Caregivers cared for patients with head and neck, lung, hematologic, gastrointestinal, or genitourinary cancers.
  • Caregivers' relationship to the patient was 38% spouse, 38% parent, and 23% child.
  • The majority of the sample had completed high school, were married, were employed, liked live music, and did not play a musical instrument.


  • Outpatient
  • Home setting
  • Taiwan, Republic of China

Phase of Care and Clinical Applications:

  • Transition phase (patients diagnosed with cancer less than one year ago)
  • Late effects/survivorship; anxiety; nursing presence

Study Design:

A randomized, crossover, controlled trial design was used.

Measurement Instruments/Methods:

  • Visual analog scale (VAS): Sleep assessment measured (a) ease of getting to sleep, (b) perceived quality of sleep, (c) ease of awakening from sleep, and (d) daytime function. No reliability or validity information was provided.    
  • Taiwanese Depression Scale: Has criterion-related validity with the Center for Epidemiologic Studies–Depression scale and discriminate validity (93.2%); Cronbach’s alpha for the current study at pretest was 0.73. 
  • State-Trait Anxiety Inventory: Cronbach’s alpha for the current study was 0.78.
  • BVP amplitude
  • Low frequency (LF)/high frequency (HF) ratio
  • VAS was also used to assess music evaluation of participants’ subjective experience associated with the musical pieces (i.e., enjoyment, harmony, friendliness, and peacefulness); two-week test-retest reliability in an earlier study was 0.73.


Both MINP and RM interventions had significant beneficial effects on anxiety, depression, and BVP amplitude (p < 0.0001). A treatment effect across different time points was observed in BVP amplitude and LF/HF ratio in both groups, indicating that MINP and RM both have beneficial effects on BVP and LF/HF ratio. There were no significant differences between the two music interventions in terms of participant evaluation of enjoyment and peacefulness, but participants evaluated RM as being more harmonious than live music, and MINP with live music and nurse presence as more friendly. Participants preferred Chinese music, then followed mostly by Czech music. Regarding the four aspects of sleep measured, MINP was found to affect only "ease of getting to sleep” (p < 0.0007).


Both music interventions were beneficial on psychological indices, with a reduction in anxiety and depression scores and a long-term dose effect on BVP. Intervention worked well for a sample having moderate degrees of anxiety and, in some cases, clinical depression in prestudy assessment and for a sample of women who liked Chinese and folk music.


  • The sample was small, limiting generalizability. 
  • The study had no researcher blinding.
  • The study had single time point pre/post measures and was short-term (no range follow-up or impact).
  • The sample was all female.
  • The sample enjoyed the music used in the intervention and scored high on a pretest self-rated anxiety scale to increase receptivity to the intervention.

Nursing Implications:

Music, either live with the nurse present or recorded for 30 minutes, may be beneficial in reducing anxiety and depression in women with cancer as well as their caregivers. Nurses can encourage the use of music as a way of reducing stress throughout the cancer journey. Listening to music appreciated by the caregiver may enhance coping early in the caregiving cycle and prevent negative effects during challenges of cancer treatment and survivorship. Music prescription is an inexpensive intervention and useful for caregivers who prioritize music as part of their culture.