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International Journal of Behavioral Medicine

, Volume 22, Issue 4, pp 498–505 | Cite as

Effects of Music Listening on Pre-treatment Anxiety and Stress Levels in a Dental Hygiene Recall Population

  • Myriam V. Thoma
  • Martina Zemp
  • Lea Kreienbühl
  • Deborah Hofer
  • Patrick R. Schmidlin
  • Thomas Attin
  • Ulrike Ehlert
  • Urs M. Nater
Article

Abstract

Background

Waiting for a medical procedure can exert significant feelings of state anxiety in patients. Music listening has been shown to be effective in decreasing anxiety levels. No study so far examined the potential anxiety and stress-reducing effect of a music intervention on pre-treatment anxiety and stress in patients waiting for dental hygiene treatment. Knowing whether the anxiety-reducing effect of music would also be detectible in the context of preventive routine medical procedures in healthy individuals would widen the area of application of music from the hospital or clinical environment to medical offices in general.

Purpose

Waiting for a medical treatment can induce anxiety and may lead to the experience of stress. We set out to examine the effect of music on pre-treatment anxiety in a healthy patient sample waiting for a dental treatment.

Methods

In a randomized controlled clinical trial, 92 consecutive volunteer patients (mean age, 57 years) waiting for their scheduled dental hygiene treatment were randomly allocated to either an experimental (n = 46, listening to music for 10 min) or a control group (n = 46, waiting in silence). State and habitual anxiety, subjective stress, and mood measures were assessed before and after music listening or silence, respectively.

Results

State anxiety levels in the music group decreased significantly after intervention as compared to the control group (F(1/90) = 8.06; p = 0.006). Participants’ trait anxiety and dental anxiety were not found to moderate this effect.

Conclusions

Listening to music prior to dental hygiene treatment decreases anxiety levels to a greater extent than waiting in silence.

Keywords

Pre-treatment anxiety Music listening Dental hygiene treatment 

Notes

Acknowledgments

This study was supported by a grant from the Young Investigator Grant of the University of Zurich, grant no. 56233208 (MVT). We thank the survey respondents and acknowledge the assistance of Adriana Giaquinto and Regula Bättig in organizing the patient interviews. UMN acknowledges funding by the Volkswagen Foundation.

Conflict of Interest

Myriam V. Thoma, Martina Zemp, Lea Kreienbühl, Deborah Hofer, Patrick R. Schmidlin, Thomas Attin, Ulrike Ehlert, and Urs M. Nater declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing Company; 1984.Google Scholar
  2. 2.
    Pittman S, Kridli S. Music intervention and preoperative anxiety: an integrative review. Int Nurs Rev. 2011;58(2):157–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Gillen E, Biley F, Allen D. Effects of music listening on adult patients’ pre-procedural state anxiety in hospital. Int J Evid Based Healthc. 2008;6(1):24–49.PubMedGoogle Scholar
  4. 4.
    Tripp DA, Neish NR, Sullivan MJ. What hurts during dental hygiene treatment. J Dent Hyg. 1998;72(4):25–30.PubMedGoogle Scholar
  5. 5.
    Spielberger CD, Sydeman SJ. State-trait anxiety inventory and state-trait anger expression inventory. In: Maruish ME, editor. The use of psychological testing for treatment planning and outcome assessment. Hillsdale: Lawrence Erlbaum Associates; 1994. p. 292–321.Google Scholar
  6. 6.
    Jöhren P. Validation of a questionnaire for the detection of dental anxiety. ZWR Das Deut Zahnärzteblatt. 1999;108:104–14.Google Scholar
  7. 7.
    McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Schulkin J, McEwen BS, Gold PW. Allostasis, amygdala, and anticipatory angst. Neurosci Biobehav Rev. 1994;18:385–96.CrossRefPubMedGoogle Scholar
  9. 9.
    Sternberg EM. Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens. Nat Rev Immunol. 2006;6(4):318–28.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Sullivan MJ, Neish N. Catastrophic thinking and the experience of pain during dental procedures. J Indiana Dent Assoc. 2000;79(4):16–9.PubMedGoogle Scholar
  11. 11.
    Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119(1–3):16–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Ozalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand. 2003;47(1):26–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Vaughn F, Wichowski H, Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN J. 2007;85(3):589–604.CrossRefPubMedGoogle Scholar
  14. 14.
    Walker KJ, Smith AF. Premedication for anxiety in adult day surgery. Cochrane Database Syst Rev. 2009;4, CD002192.PubMedGoogle Scholar
  15. 15.
    Nyklicek I, Thayer JF, Van Doornen LJP. Cardiorespiratory differentiation of musically induced emotions. J Psychophysiol. 1997;11(4):304–21.Google Scholar
  16. 16.
    Khalfa S, Bella SD, Roy M, Peretz I, Lupien SJ. Effects of relaxing music on salivary cortisol level after psychological stress. Ann N Y Acad Sci. 2003;999:374–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Nater UM, Abbruzzese E, Krebs M, Ehlert U. Sex differences in emotional and psychophysiological responses to musical stimuli. Int J Psychophysiol. 2006;62(2):300–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Burns JL, Labbé E, Williams K, McCall J. Perceived and physiological indicators of relaxation: as different as Mozart and Alice in Chains. Appl Psychophysiol Biofeedback. 1999;24(3):197–202.CrossRefPubMedGoogle Scholar
  19. 19.
    Blood AJ, Zatorre RJ. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proc Natl Acad Sci U S A. 2001;98(20):11818–23.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Juslin PN, Sloboda J. Handbook of music and emotion. USA: Oxford University Press; 2010.Google Scholar
  21. 21.
    Afzal H, Afzal S, Siddique SA, Naqvi SA. Measures used by medical students to reduce test anxiety. J Pak Med Assoc. 2012;62(9):982–6.PubMedGoogle Scholar
  22. 22.
    Elliott D, Polman R, Taylor J. The effects of relaxing music for anxiety control on competitive sport anxiety. Eur J Sport Sci. 2014;14 Suppl 1:S296–301.CrossRefPubMedGoogle Scholar
  23. 23.
    Good M, Anderson GC, Ahn S, Cong X, Stanton-Hicks M. Relaxation and music reduce pain following intestinal surgery. Res Nurs Health. 2005;28(3):240–51.CrossRefPubMedGoogle Scholar
  24. 24.
    McCaffrey R, Locsin R. The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery. Holist Nurs Pract. 2006;20(5):218–24. quiz 25–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Nilsson U, Rawal N, Unosson M. A comparison of intra-operative or postoperative exposure to music—a controlled trial of the effects on postoperative pain. Anaesthesia. 2003;58(7):699–703.CrossRefPubMedGoogle Scholar
  26. 26.
    Nilsson U, Unosson M, Rawal N. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. Eur J Anaesthesiol. 2005;22(2):96–102.CrossRefPubMedGoogle Scholar
  27. 27.
    Twiss E, Seaver J, McCaffrey R. The effect of music listening on older adults undergoing cardiovascular surgery. Nurs Crit Care. 2006;11(5):224–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain. 2004;112(1–2):197–203.CrossRefPubMedGoogle Scholar
  29. 29.
    MacDonald RAR, Mitchell LA, Dillon T, Serpell MG, Davies JB, Ashley EA. An empirical investigation of the anxiolytic and pain reducing effects of music. Psychol Music. 2003;31(2):187–203.CrossRefGoogle Scholar
  30. 30.
    Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J. 2008;87(4):780–807.CrossRefPubMedGoogle Scholar
  31. 31.
    Allen K, Golden LH, Izzo Jr JL, Ching MI, Forrest A, Niles CR, et al. Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Psychosom Med. 2001;63(3):487–92.CrossRefPubMedGoogle Scholar
  32. 32.
    Cooke M, Chaboyer W, Hiratos MA. Music and its effect on anxiety in short waiting periods: a critical appraisal. J Clin Nurs. 2005;14(2):145–55.CrossRefPubMedGoogle Scholar
  33. 33.
    Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg. 2002;94(6):1489–94.PubMedGoogle Scholar
  34. 34.
    Lee D, Henderson A, Shum D. The effect of music on preprocedure anxiety in Hong Kong Chinese day patients. J Clin Nurs. 2004;13(3):297–303.CrossRefPubMedGoogle Scholar
  35. 35.
    Cooke M, Chaboyer W, Schluter P, Hiratos M. The effect of music on preoperative anxiety in day surgery. J Adv Nurs. 2005;52(1):47–55.CrossRefPubMedGoogle Scholar
  36. 36.
    Hayes A, Buffum M, Lanier E, Rodahl E, Sasso C. A music intervention to reduce anxiety prior to gastrointestinal procedures. Gastroenterol Nurs. 2003;26(4):145–9.CrossRefPubMedGoogle Scholar
  37. 37.
    El-Hassan H, McKeown K, Muller AF. Clinical trial: music reduces anxiety levels in patients attending for endoscopy. Aliment Pharmacol Ther. 2009;30(7):718–24.CrossRefPubMedGoogle Scholar
  38. 38.
    Buffum MD, Sasso C, Sands LP, Lanier E, Yellen M, Hayes A. A music intervention to reduce anxiety before vascular angiography procedures. J Vasc Nurs. 2006;24(3):68–73. quiz 4.CrossRefPubMedGoogle Scholar
  39. 39.
    Haun M, Mainous RO, Looney SW. Effect of music on anxiety of women awaiting breast biopsy. Behav Med. 2001;27(3):127–32.CrossRefPubMedGoogle Scholar
  40. 40.
    Yung PM, Chui-Kam S, French P, Chan TM. A controlled trial of music and pre-operative anxiety in Chinese men undergoing transurethral resection of the prostate. J Adv Nurs. 2002;39(4):352–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Lee KC, Chao YH, Yiin JJ, Chiang PY, Chao YF. Effectiveness of different music-playing devices for reducing preoperative anxiety: a clinical control study. Int J Nurs Stud. 2011;48(10):1180–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Lee KC, Chao YH, Yiin JJ, Hsieh HY, Dai WJ, Chao YF. Evidence that music listening reduces preoperative patients’ anxiety. Biol Res Nurs. 2012;14(1):78–84.CrossRefPubMedGoogle Scholar
  43. 43.
    Berbel P, Moix J, Quintana S. Music versus diazepam to reduce preoperative anxiety: a randomized controlled clinical trial. Rev Esp Anestesiol Reanim. 2007;54(6):355–8.PubMedGoogle Scholar
  44. 44.
    Bringman H, Giesecke K, Thorne A, Bringman S. Relaxing music as pre-medication before surgery: a randomised controlled trial. Acta Anaesthesiol Scand. 2009;53(6):759–64.CrossRefPubMedGoogle Scholar
  45. 45.
    Lahmann C, Schoen R, Henningsen P, Ronel J, Muehlbacher M, Loew T, et al. Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc. 2008;139(3):317–24.CrossRefPubMedGoogle Scholar
  46. 46.
    Rayman S, Dincer E, Almas K. Managing dental fear and anxiety. N Y State Dent J. 2013;79(6):25–9.PubMedGoogle Scholar
  47. 47.
    Gadbury-Amyot CC, Williams KB. Dental hygiene fear: gender and age differences. J Contemp Dent Pract. 2000;1(2):42–59.PubMedGoogle Scholar
  48. 48.
    Thoma MV, La Marca R, Bronnimann R, Finkel L, Ehlert U, Nater UM. The effect of music on the human stress response. PLoS One. 2013;8(8):e70156.PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    Laux L, Glanzmann P, Schaffner P, Spielberger CD. Das State-Trait-Angstinventar. Theoretische Grundlagen und Handanweisungen. Weinheim: Beltz; 1981.Google Scholar
  50. 50.
    Steyer R, Schwenkmezger P, Notz P, Eid M. Der Mehrdimensionale Befindlichkeitsfragebogen (MDBF): Handanweisung. Göttingen: Hogrefe; 1997.Google Scholar
  51. 51.
    Vasey MW, Thayer JF. The continuing problem of false positives repeated measures ANOVA in psychophysiology: a multivariate solution. Psychophysiology. 1987;24:479–86.CrossRefPubMedGoogle Scholar
  52. 52.
    Greenhouse JB, Junker BW. Exploratory statistical methods, with applications to psychiatric research. Psychoneuroendocrinology. 1992;17(5):423–41.CrossRefPubMedGoogle Scholar
  53. 53.
    Kirk RE. Experimental design: procedures for the behavioral sciences. 3rd ed. Pacific Grove: Brooks/Cole; 1995.Google Scholar
  54. 54.
    Lee YY, Chan MF, Mok E. Effectiveness of music intervention on the quality of life of older people. J Adv Nurs. 2010;66(12):2677–87.CrossRefPubMedGoogle Scholar
  55. 55.
    Robb S, Nichols R, Rutan R, Bishop B, Parker J. The effects of music-assisted relaxation on preoperative anxiety. J Music Ther. 1995;32(1):3–12.CrossRefGoogle Scholar
  56. 56.
    Levenson RW. The search for autonomic specifity. In: Ekman P, Davidson RJ, editors. The nature of emotion. New York: Oxford University Press; 1994. p. 252–7.Google Scholar
  57. 57.
    Bulfone T, Quattrin R, Zanotti R, Regattin L, Brusaferro S. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holist Nurs Pract. 2009;23(4):238–42.CrossRefPubMedGoogle Scholar
  58. 58.
    Mitchell LA, MacDonald RA, Brodie EE. A comparison of the effects of preferred music, arithmetic and humour on cold pressor pain. Eur J Pain. 2006;10(4):343–51.CrossRefPubMedGoogle Scholar
  59. 59.
    Pothoulaki M, MacDonald RAR, Flowers P, Stamataki E, Filiopoulos V, Stamatiadis D, et al. An investigation of the effects of music on anxiety and pain perception in patients undergoing haemodialysis treatment. J Health Psychol. 2008;13(7):912–20.CrossRefPubMedGoogle Scholar
  60. 60.
    Davis WB, Thaut MH. The influence of preferred relaxing music on measures of state anxiety, relaxation, and physioloigcal responses. J Music Ther. 1989;26:168–87.CrossRefGoogle Scholar
  61. 61.
    Menon V, Levitin DJ. The rewards of music listening: response and physiological connectivity of the mesolimbic system. Neuroimage. 2005;28(1):175–84.CrossRefPubMedGoogle Scholar
  62. 62.
    Juslin PN, Västfjäll D. Emotional responses to music: the need to consider underlying mechanisms. Behav Brain Sci. 2008;31:559–621.CrossRefPubMedGoogle Scholar
  63. 63.
    Knight WE, Rickard NS. Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. J Music Ther. 2001;38(4):254–72.CrossRefPubMedGoogle Scholar
  64. 64.
    Mok E, Wong KY. Effects of music on patient anxiety. Aorn J. 2003;77(2):396–7. 401–6, 9–10.CrossRefPubMedGoogle Scholar
  65. 65.
    Allen K, Blascovich J. Effects of music on cardiovascular reactivity among surgeons. JAMA. 1994;272(11):882–4.CrossRefPubMedGoogle Scholar
  66. 66.
    Mitchell LA, MacDonald RA. An experimental investigation of the effects of preferred and relaxing music listening on pain perception. J Music Ther. 2006;43(4):295–316.CrossRefPubMedGoogle Scholar
  67. 67.
    Kim YK, Kim SM, Myoung H. Musical intervention reduces patients’ anxiety in surgical extraction of an impacted mandibular third molar. J Oral Maxillofac Surg. 2011;69(4):1036–45.CrossRefPubMedGoogle Scholar
  68. 68.
    Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr. 2008;8(2):117–28.CrossRefPubMedGoogle Scholar
  69. 69.
    Lehrner J, Marwinski G, Lehr S, Johren P, Deecke L. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol Behav. 2005;86(1–2):92–5.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2014

Authors and Affiliations

  • Myriam V. Thoma
    • 1
    • 2
  • Martina Zemp
    • 1
  • Lea Kreienbühl
    • 1
  • Deborah Hofer
    • 3
  • Patrick R. Schmidlin
    • 3
  • Thomas Attin
    • 3
  • Ulrike Ehlert
    • 3
  • Urs M. Nater
    • 4
  1. 1.Clinical Psychology and PsychotherapyUniversity of ZurichZurichSwitzerland
  2. 2.Health PsychologyBrandeis UniversityWalthamUSA
  3. 3.Clinic of Preventive Dentistry, Periodontology and CariologyUniversity of Zurich, Center of Dental MedicineZurichSwitzerland
  4. 4.Department of PsychologyUniversity of MarburgMarburgGermany

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