Friday, November 2, 2007

Research: Chapter 2: The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

Chapter II

Literature Review

Music to Reduce Anxiety

Research using music to reduce anxiety has not provided conclusive evidence regarding the efficacy of specific kinds of music used in certain protocols. Peretti and Swenson (1974) examined female and male music and non-music majors and their galvanic skin responses to induced anxiety. They found that, although the anxiety level of all of the college students decreased when listening to background music, the decrease in anxiety was significantly greater for females and music majors than for males and non-music majors.

Standley’s (1996) meta-analysis of music used in medical/dental treatment found that music has a greater effect when some kind of pain is present, although results are more varied when different diagnoses are compared or when pain increases during a procedure. Standley also found that preferred music had the greatest effect on anxiety levels when it was compared to nonpreferred music.

Hanser (1985) found that preferred music was more effective than the use of “sedative” or “sad” music in interventions trying to induce relaxation. She warned that slow, arrhythmic music that is otherwise categorized as sedative may sound foreign or frightening to some listeners. It may also elicit feelings of sadness or loneliness that might have deleterious effects on attitude or mood. Researchers must be careful, therefore, not to generalize choices of musical selections. Subject’s preferences should always be a consideration when studying the effects of music on anxiety.

Preferred Music

Robb, et al. (1995) provided a choice of music to pediatric patients before surgery. The researchers used the patient preferred music to assist relaxation protocols, which included deep breathing, progressive muscle relaxation, and imagery. Robb, et al. found a significant decrease in state anxiety scores for the group receiving music assisted relaxation.

Kaempf and Amodei (1989) used recorded classical music defined as “sedative”, because it had no percussion and a minimum of rhythmic activity. The researchers played this music in the background for 33 patients undergoing arthroscopic surgery. The results of a state anxiety inventory indicated significantly lower anxiety scores for the group of patients who listened to music when compared to those who did not. In general, the study indicated that sedative music as defined for the study was somewhat therapeutic in reducing anxiety without harmful side effects.

Augustin and Hains (1996) used patient preferred music combined with preoperative teaching to reduce anxiety in ambulatory surgery patients. Their study indicated that preoperative instruction alone is not as beneficial in reducing state anxiety as music listening combined with pre-operative instruction. The researchers emphasized, however, that the patient must desire to listen to music and must have a choice in the music that is played.

The research on using music to influence anxiety clearly shows that patient preferred, sedative music is the most effective method of reducing anxiety. Instruction on relaxation and music listening techniques may increase the effectiveness of the music on reducing anxiety. Some researchers have used this knowledge to help patients who were having surgical procedures or were hospitalized for cardiac problems.

Studies Related to Using Music in Medical Settings

Chetta’s (1981) study used music directly before surgery with pediatric patients. Music listening and singing were combined with preoperative instruction while pediatric patients received injections of preoperative medication. The researcher found that the children who received music therapy just prior to surgery were rated as less anxious according to observed behaviors than children who did not receive music therapy or received music therapy the night before surgery.

Such research findings led to the goal of this study, to ascertain the effect of preferred, sedative music on the state anxiety levels of patients undergoing surgery in the unique circumstances of wakefulness during a surgical procedure to correct life threatening heart muscle and circulatory abnormalities. One previous study was conducted to determine the effects of music on a similar high-risk population, one in which patients with cardiac problems were admitted to intensive care for treatment of myocardial infarction (MI). In this study, Bolwerk (1990) hypothesized that state anxiety scores of MI patients who listened to relaxing music would be less than state anxiety scores of MI patients who did not listen to relaxing music. Relaxing music was defined as, “music of a sustained melodic nature, with strong rhythmic and percussive elements largely lacking” (p. 64). Each of the 40 MI patients completed a state anxiety scale upon admission to intensive care and underwent tests on the third and fourth day of admission. Each patient in the experimental group was given music listening periods during their stay. The results showed an overall decrease in anxiety for both the control group and the experimental group. Although there was a significant decrease in state anxiety levels for both groups, the post-treatment mean score in the group receiving music was significantly lower when compared with the non-music group.

No literature specifically related to using music with adult cardiac patients during cardiac surgical procedures was found. Yet some studies have examined the effect of music on anxiety during medical and surgical procedures. Davis (1992), studied the effects of music and relaxation on the anxiety and pain of women undergoing gynecological procedures. Although the self-reported anxiety for the music listening experimental group was lower than the anxiety of the control group, this difference was not significant. The control group did have significantly higher respiratory rates and overt pain scores than the experimental group.

In another study during a medical procedure, Corah et al. (1981), concluded that music during dental procedures acted as a placebo effect to reduce patient anxiety. They described this effect as similar to that which occurs after the administration of an inactive drug that produces beneficial effects in some patients some of the time.

Two additional studies involved the use of music during surgery. Working with 31 hospitalized subjects, Metzler & Berman (1991) used sedative music during a bronchoscopy. The investigators recorded data consisting of a blood pressure, heart rate, and respiratory rate, just before and five minutes after the procedure. Each subject received a post-procedure oral interview. Subjects in the experimental group listened to 45 minutes of classical and semi-classical instrumental selections. The control group did not listen to any music.

The control group experienced a significant percentage increase between the pre and post mean beats per minute for heart rate levels. The experimental group, however, did not experience a significant increase in beats per minute for heart rate levels, indicating less anxiety. A majority of the experimental group also replied positively to interview questions regarding the music’s effects on self-observed anxiety.

Stein (1991) conducted a study involving music used during a surgical procedure to reduce patients’ anxieties during cesarean births. Thirty patients rated their anxiety on a visual analog scale before, during and after the surgery. One experimental group (N=10) listened to “soft, soothing, and melodious music.” A second experimental group (N-10) listened to white noise during the procedure, while the third group (N=10) served as a control group and heard no music. According to data taken during the surgery, the music listening experimental group had significantly lower anxiety scores than the control group or the white noise group. There were no significant differences among the groups at other observation times.

The literature reviewed suggests a great interest in studying music’s effects on reducing anxiety, as indicated by both physiological and psychological measures. The literature indicates that music listening consistently affects state anxiety levels, as reported through interviews or other patient self-reporting methods. This effect has been demonstrated in varied settings, including schools, doctors’ offices, in-patient hospital units and operating rooms. Some of the most stressful situations in hospitals include those where the patient is awake during invasive surgical procedures. These situations are good places to further study the efficacies of using music to reduce unwanted anxiety.

The negative effects of anxiety on cardiac physiological functioning further emphasize the need for more research in the use of music during stressful surgical procedures. Therefore, the purpose of this study was to determine the effect of subject preferred, sedative music during pacemaker implant and heart catheterization on the state anxiety level of male subjects between the ages of 40 and 90 years. This study determines whether or not there is a significant difference between the pre-surgery and post-surgery anxiety levels between a control group and a music listening group.

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