Pulse
Soothing Tunes
University of Minnesota researchers are studying the stress-reducing effect of music on ICU patients.
Vivaldi will never be a substitute for Valium. But a University of Minnesota research team is studying whether listening to one’s favorite music can help alleviate anxiety in ICU patients.
Linda Chlan, Ph.D., R.N., associate professor in the University of Minnesota’s School of Nursing, and music therapist Annie Heiderscheit, Ph.D., MT-BC, are midway through a four-year, multisite study examining the anxiety-reducing potential of “tailored music intervention” for intensive care patients on ventilators. Other studies—including some by Chlan—have shown that music can significantly reduce stress. It’s the “tailored” part of their study that distinguishes it: They’re looking at whether honoring patients’ musical preferences enhances the beneficial effects of music. “This is really about what the patient finds comforting,” Chlan says.
To measure stress levels, Chlan, Heiderscheit, and their team of researchers are using two self-reporting instruments to track patients’ perceived anxiety levels and collecting urine samples every 24 hours to check for the level of cortisol, a stress hormone. The study, funded by the National Institutes of Health, involves some 200 patients who are on mechanical ventilatory support in nine intensive care units across the Twin Cities. One-third receive tailored music therapy, a third get noise-canceling headphones, and another third receive no audio intervention.
A Harmonious Partnership
A pianist and former flautist, Chlan became intrigued by the calming power of music when she was working on her graduate degree in nursing education. “I was thinking about these patients on ventilators that I’d been caring for for years,” she recalls. “They get so anxious, and you give them medications, and they get more anxious and more agitated, and you give them more drugs until you give them so much they’re just not moving anymore. And you think there has to be something else we can do.”
As part of her master’s program, Chlan did a pilot study on the feasibility of a music therapy intervention protocol for these patients. She discovering that Heiderscheit shared her interest in using music as an adjunctive intervention to reduce stress, and the collaboration was launched.
Truly Customized Therapy
Chlan and Heiderscheit believe their idea’s promise lies not just in the soothing effect of the music itself but also in the patient-directed nature of the protocol they’ve designed. The patients in the study cannot speak because of the ventilator, and many have limited energy and thus are unable to do much for themselves. “It may seem really small, but it gives [patients] a locus of control at a time when they have precious little,” Heiderscheit explains. “That is really significant.”
Typically, Heiderscheit says, music therapists offer patients only a handful of choices, sort of musical variations on beige: instrumental, New Age-type offerings that tend not to offend anyone. “If you only have five CDs to choose from, that, to me, is not giving you full rein over what is your preference,” Heiderscheit says. “You may say, ‘I don’t really like any of them, but I guess I’ll take that one.’”
In this study, Heiderscheit conducts a music preference assessment. She asks patients what type of music they prefer, what type of instrumentation they enjoy, which artists they like, and how big of a role music has played in their lives. She also asks them what kind of music they don’t like. Once she has that information, she puts together CDs that fit their musical taste.
Heiderscheit says the same patient may well prefer different music today than she did last week. “What we’ve found so interesting is how their preferences change over the course of their hospitalization. We like different music at different times. ... The music that might be mood-lifting wouldn’t necessarily help them sleep.”
Although Heiderscheit aims to accommodate patients’ preferences, each musical selection must adhere to a few criteria. Past studies have identified that tempos ranging from 60 to 80 beats per minute (bpm) are optimal for relaxation and anxiety reduction. “That’s not to say that for a certain individual listening to punk rock with 90 bpm can’t be relaxing,” she adds. “But the research doesn’t support that at this point.” Still, even within those guidelines, she can usually find workable tracks from a favorite artist. For a patient who loves Jimi Hendrix, for example, the song “Manic Depression” wouldn’t induce relaxation, but “The Wind Cries Mary” might.
Questions and Answers
Although they won’t have conclusive findings for another two years, Chlan says the study is already raising new questions and showing promise for tailored music intervention. The optimal frequency and length of listening time, for example, is one aspect of the treatment protocol that needs further exploration. Chlan says they know when and how much patients are listening because the headphones they use are connected to a data logger, which marks the time and date each time the headphones go on an off. But they don’t know what the appropriate regimen should be.
“Everyone is so individual,” she says. “Some patients really [want] it after visiting hours, when the visitors go home and it’s kind of lonely. That’s when feelings of powerlessness can be most acute. You’re laying there and you’re essentially held captive in this bed, and this machine has taken over a very basic function of life. You’re really confronted with your own mortality.”
They also wonder what effect music that a patient dislikes might have on their stress level. “I love classical music,” Chlan says. “But if you brought me Stravinsky, I would abhor it. It’s going to stress me out.”
So far, nurses and families have liked what they’ve seen in terms of outcomes. “We had a few skeptics when we first started, but we’ve won a lot of them over,” Chlan says. “We’ve had comments from nurses and families like, ‘That is the most relaxed I’ve ever seen him.’”
Heiderscheit describes one patient who was moved to tears by the CD she’d brought. “It touched him more than you’d have imagined. Music can do that.”—Susan Maas