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Music Listening to Facilitate Relaxation and Promote Wellness:

Integrated Aspects of Our Neurophysiological Responses to Music

Article  in  The Arts in Psychotherapy · December 2007

DOI: 10.1016/j.aip.2006.11.001

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 The Arts in Psychotherapy 34 (2007) 134–141

Music listening to facilitate relaxation and promote wellness:

Integrated aspects of our neurophysiological responses to music
Robert E. Krout, EdD, MT-BC ∗
Department of Music Therapy, Division of Music, Meadows School of the Arts, Southern Methodist University,
P.O. Box 750356, Dallas, TX 75275-0356, United States

Abstract
Wellness as a movement for both healthy persons and those with diagnosed diseases has been growing in both popularity and
acceptance by consumers and the health industry. Wellness in part includes an individual’s positive attitude towards, and active
engagement in the health environment in which they function. A focus of wellness can include techniques and methods that people
can use in their lives to combat stress and facilitate relaxation. Music as a sound medium has been used as part of wellness programs in
a variety of ways, including as a sonic background for relaxation experiences. In this article, the role of music listening to positively
affect neurophysiological and emotional responses related to relaxation is examined. Neurological bases of music listening and
sound processing are reviewed, with emphasis on how music is processed by the limbic and related biological systems, including
endocrine and hormonal responses. Suggestions for how consumers may use music listening in their own wellness and relaxation
regimens are provided, including descriptions of which music to consider, where to obtain it, and how to use it.
© 2006 Elsevier Inc. All rights reserved.

Keywords: Listening; Music; Neurophysiological; Relaxation; Wellness

As noted by Taylor (2004), Harvey in 1987 described the interrelationship of music, mind, and medicine in what
would become known as biomedical music therapy, stating: “1) The center of control for the human organism is the
brain; 2) Music is processed by the brain and through the brain, after which it can then affect us in many ways; 3) Music
can have a positive effect upon both neural functions and hormonal activity and, as such, can facilitate the healthy
functioning of the body’s own immune and regenerative processes” (Harvey, 1987, pp. 73–74).
One aspect of healthy functioning is wellness. Wellness has been described in part as a positive attitude towards,
and active engagement in, one’s personal health environment (Benson & McDevitt, 1989; Corbin, Welk, Corbin, &
Welk, in press). It has been suggested that a positive attitude and state of mind may enhance wellness and a sense of
well-being, in turn positively affecting one’s physical health (Ghetti, Hama, & Woolrich, 2004; Pinel, 2006). Well-
ness involves the creation of homeostasis for the individual by finding a balance between both internal and external
environments (Edlin & Golanty, 1992). As a lifestyle model, it has become an important aspect of the contempo-
rary health movement, with consumers, health providers, insurers, and entire communities becoming involved in its
acceptance and growth (Patel, Koegel, Booker, Jones, & Wells, 2006; Sharon & Donahue, 2006; Smith & Llloyd,
2006).

∗ Tel.: +1 214 768 3175; fax: +1 214 768 4669.

E-mail address: rkrout@smu.edu.

0197-4556/$ – see front matter © 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.aip.2006.11.001
 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141 135

The uses of music therapy to positively affect physiological functioning as included in a wellness model have been
discussed and reviewed by a number of authors (Crowe, 2004; Crowe & Scovel, 1996; Dileo, 1999; Hanser, 1999;
Hanser & Mandel, 2005; Harvey, 1992; Hirsch & Meckes, 2000; Keegan, 2003; Lane, 1994; Maranto, 1992; Scheve,
2004; Standley et al., 2005; Taylor, 1997, 2004). Music therapy as a professional health treatment modality may require
that services be provided by a credentialed music therapist (Bruscia, 1998; Hanser, 1999; Maranto, 1992). However,
consumers may also benefit from using music on their own as part of their personal wellness routines and practices
(Ghetti et al., 2004). In addition, allied professionals such as creative arts therapists, nurses, music practitioners, and
others may also use music in various ways to help their clients derive wellness benefits from engaging in music-based
experiences (Pratt, 2004; Roskam, 1993).
One focus of wellness is often stress management and relaxation (Corbin et al., in press). This can be the case whether
the consumer is relatively healthy or has a diagnosed medical condition (Deng & Cassileth, 2005; Fouladbakhsh,
Stommel, Given, & Given, 2005; Mandel, 1996; Patel et al., 2006; Sagar, 2006; White, 1992). Music-based interventions
related to wellness, stress reduction, and relaxation can include a variety of experiences ranging from active and
expressive activities such as singing and playing instruments to receptive and passive activities such as music listening
(Davis, Gfeller, & Thaut, 1999; Hanser, 1999; Hanser & Mandel, 2005; Maranto, 1992; Scheve, 2004). The focus of
this article is the receptive use of music listening to help the client consumer derive wellness benefits by facilitating
relaxation, regardless of their existing state of health. The purpose of this article is to give these consumers and allied
health professionals such as creative arts therapists a basic overview of how music listening can positively affect human
physiology related to relaxation and stress management as part of an overall wellness model.

The roles of music listening

Davis, Gfeller, and Thaut (1999) described a number of ways in which music listening may enhance relaxation.
One use is listening to music as a masking agent to cover over unwanted environmental stimuli, such as background
sounds in a hospital, that might induce stress or prevent relaxation (Curtis, 1986; Radocy & Boyle, 2003). Another use
is to provide distraction from other foci of awareness such as existing stress or physical pain (Clair, 1996; Dileo, 1999;
Evans, 2002; Good, 1995; Krout, 2000; Kwekkeboom, 2003; Robb, 2003; Standley et al., 2005). Both of these effect
areas (masking and distraction) may co-exist with physiological effects of music listening, and may be beneficial to
the listener in enhancing their own relaxation process. For example, some recordings designed for relaxation combine
nature sounds such as ocean waves with music, with the nature sounds designed to mask existing ambient noise (Krout,
2005).
Another function of music listening may be to provide competing stimuli for other peripheral nerve impulses such
as those related to pain that may travel to, and be processed by, the brain via the spinal cord. This is related to what
has been termed the gate control theory of pain (Albert, 2002; Melzak & Katz, 2004; Moreno, 2004; Padhi, 2005;
Schwoebel, Coslett, Bradt, Friedman, & Dileo, 2002). This theory suggests that pain impulses travel from the site
of an injury via the spinal cord to the brain, where the actual pain perception is processed (Melzak & Wall, 1982).
Neural gates in the spinal cord may be opened or closed to varying degrees, thus letting more or fewer of those pain
impulses through to the brain (Sarafino, 2005). If gates are closed as a result of several factors, then the perception of
the pain may not be as great. One of these factors in closing gates may be messages descending from the brain through
the spinal cord through what are termed efferent (descending from the brain) pathways. These descending messages
may include the effects of processes in the brain resulting from listening to relaxing music. As a result, a positive and
relaxed state of mind enhanced by music listening may therefore result in fewer pain impulses reaching our conscious
awareness (Crowe, 2004).

Music and emotions—an introduction

When we consider the relationship of the mind and body in terms of wellness and desired physiological states
such as relaxation, we are in part delving into the science of psychoneurimmunology (Crowe, 2004; Scartelli, 1987).
As noted earlier, it has been postulated that music stimuli processed by and through the brain can have a positive
effect upon both neural functions and hormonal activity, including emotional responses involved in these processes
(Schneck & Berger, 2006). Indeed, the neurological pathways for sound sensation that carry the music impulses from
the environment through the hearing system to the brain and our conscious awareness also allow music to have an
136 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141

effect on structures most responsible for emotional behavior, the limbic system (Taylor, 2004). In fact, by the time
a person becomes consciously aware of the music to which they are listening, the music may already be stimulating
the production of reinforcing impulses and biochemical substances within the brain via the limbic system (Radocy
& Boyle, 2003). These limbic structures can also inhibit negative emotional reactions which can delay or otherwise
interfere with healthy functioning, relaxation, and wellness (Taylor, 1997).

The role of the limbic system

Our emotional and physiological responses to music may in part be mediated by the structures of the limbic system
working together with cortical networks of cognition and conscious thought (Jourdain, 1997). The limbic system is a
group of interconnected neural structures that surrounds midline surfaces of our cerebral hemispheres, and lies atop
the brainstem in what has been described as a border-like manner (Schneck & Berger, 2006). The limbic system is
located in the temporal lobes of the brain, close to the auditory cortex where music and sound are processed (Lemonick,
2003). It is thought to use motivation and emotion to bring maximum benefit to the listener by stimulating impulses
and substances that produce sensations of reward or punishment (Altenmüller, 2004; Pinel, 2006).
Often termed “the emotional brain,” the limbic system can in part be activated by environmental stimuli such
as sound and music vibration (Altenmüller, 2004). The limbic system includes a number of structures such as the
thalamus, amygdala, hypothalamus, and others (Pinel, 2006). Of special importance is the amygdala, which is in
part responsible for behavioral reactions to objects or stimuli perceived to the individual to be of special biological
significance (Englert, 2004). The amygdala receives information from temporal regions of the cortex, which gather
information from visual, auditory, and somatosensory association areas of the brain. It has been described as being well
informed about what is occurring in the surrounding environment, which again is important when that environment
includes music (Altenmüller, 2004). The limbic system also includes the hippocampus, which plays a major role in
memory. This can be important and useful when the music being listened to is associated by the brain with previous
feelings of being relaxed (Schneck & Berger, 2006).
In addition to the actual music being listened to, cortical and cognitive responses to music can include conscious
thoughts and elicited imagery, which in turn can positively affect the limbic system (Rider, 1997). With music listening,
imagery can be produced and provided by the listener or can be the result of imagery suggestions such as those found
in music and imagery recordings designed specifically to facilitate relaxation (Krout, 2005). Some music relaxation
recordings also include instructions for deep breathing and relaxation techniques such as those involved with progressive
muscle relaxation. The listener’s responses to these narrated relaxation instructions may also be considered cognitive
responses which may affect the limbic system (Krout, 2005).

The role of the autonomic nervous system and release of hormones

Stress can have a negative effect on wellness by preventing a person from being able to relax (Robb, Williams,
Duvivier, & Newham, 2006). For example, during a stressful emotional response to internal stimuli such as pain, tension,
or worry, the sympathetic (arousing) branch of the autonomic nervous system (ANS) increases activity (Scartelli, 1987).
At the same time, the parasympathetic (inhibiting) branch of the ANS decreases activity (Pinel, 2006). As a result,
heart rate increases and blood vessels dilate or constrict to move blood toward skeletal muscles and away from the
digestive system (LeDoux, 1998). Hormonal secretions of epinephrine (adrenaline) and norepinephrine can further
increase blood flow to the muscles and, along with cortisol, cause glycogen stored in the muscles to be converted to
glucose (Society for Neuroscience, 1991).
Cortisol serves to conserve blood glucose by helping to break down protein and converting it to glucose, thus
increasing blood flow (Pinel, 2006). Cortisol is secreted by the adrenal cortex, which is stimulated by the release of
adrenocorticotropic hormone (ACTH) by the pituitary gland (Scartelli, 1987). What is termed the adrenal cascade can
be initiated by mental activity such as anxiety, stress, depression, and feelings of hopelessness (Corbin et al., in press).
This stress can cause the hypothalamus to produce corticotrophin releasing factor (CRF), which in turn stimulates the
pituitary to produce ACTH. Again, listening to calming music may inhibit this adrenal cascade and release of hormones
(Kulkarni, O’Farrell, Erasi, & Kochar, 1998).
The thalamus, mentioned earlier as an important part of the limbic system, also affects the ANS. Its responses to
musical rhythms are especially important in facilitating relaxation, and they may be able to what is termed “entrain”
 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141 137

rhythmic physiological movements within the body (Rider, 1997). Entrainment has been described as the natural
predisposition for the human body and its physiologic processes to respond to and synchronize with both its internal
and external environments, including sound and rhythm (Schneck & Berger, 2006). Entrainment via the nervous system
may allow information from both the auditory (peripheral) and cortical (central) systems to interact with autonomic
nerve pathways and facilitate a relaxation response, in part via the previously described parasympathetic nervous
system (Schneck & Berger, 2006). Engagement of the parasympathetic nervous system can facilitate relaxation by
positively affecting heart rate, respiration, oxygen consumption, and blood pressure (Collinge, 1998; Crowe, 2004).
It has been demonstrated that slow or meditative music may induce these relaxing effects via interactions with the
autonomic nervous system (Bernardi, Porta, & Sleight, 2006; Chafin, Roy, Gerin, & Christenfield, 2004; Kemper &
Danhauer, 2005).

The interrelated roles of neurotransmitters, hormones, and the endocrine system

A central component of the complex human biological response to stress is the interaction of the neurological,
endocrine, and immune systems, which interact to support homeostasis (Bittman et al., 2005). When musical impulses
are transmitted through the brain, neurotransmitter substances are released (Altenmüller, 2004). Neurotransmitters,
neuromodulators (released in larger amounts to travel further than the next adjacent neuron), hormones (released by the
endocrine glands to travel throughout the body via the blood stream), and pheromones (released into the environment
through sweat, urine, or specialized glands) control the behavior of individual cells, organ systems, and the entire
person (Pinel, 2006). The two types of hormones, peptides and steroids, are detected by two different types of neuron
receptors. One important category of peptides includes the endogenous opioids and morphines, whose release while
listening to music may enhance a relaxation experience. In addition, an increased level of certain hormones, such as
immunoglobulin A (IgA), can be a marker for enhanced immune functioning (an aspect of wellness), and may be
positively affected by listening to music (Brennan & Charnetski, 2000; Hucklebridge et al., 2000; Rider & Weldin,
1990).
Of the approximately 50 different neurotransmitters identified to date, the most widely known is acetylcholine
(ACh) which affects movement and is also involved in learning, memory, and sleep behavior (Scartelli, 1987). Other
neurotransmitters include the subcategory of monoamines known as catecholamines. These include the previously
mentioned epinephrine and norepinephrine, as well as dopamine, a very important neurotransmitter that controls
arousal levels in many parts of the brain and can stimulate a feeling of pleasure (Taylor, 1997). The monoamine
serotonin, which is enhanced by the medication Prozac, plays a role in mood (sedation-relaxation) and helps control
eating, sleep, arousal, and pain regulation (Englert, 2004). Endorphins and enkephalins are opoids that play an important
role in feelings of pleasure, as well as modulating pain, reducing stress, and facilitating a feeling of calm (Lemonick,
2003). Music, which can affect our overall mood, may stimulate the production of these natural endorphins (Goldstein,
1990). Another group of neurotransmitters is the amino acid group, the most common class of transmitter substances
in the central nervous system (Scartelli, 1992). One of their effects is to raise or lower thresholds for excitation of
action potentials (Englert, 2004). An example is gamma-amino butyric acid (GABBA). Barbiturates affect the brain
by depressing its activity, in part by increasing GABBA receptor sensitivity. Music may allow brain cells to be more
receptive to GABBA, slowing down neuronal activity sufficiently to result in a relaxation response (Lemonick, 2003).
As discussed before, stress can cause increases in the secretion of substances that may directly suppress immune
system activity (Lemonick, 2003). One major goal of music listening for wellness can be to reduce stress and thus
enhance immune functioning (Rider & Weldin, 1990). Listening to calming music may have independent influences on
structures that control the immune system (Hirokawa & Ohira, 2003). For example, over 80% of the brain is composed
not of neurons, but of cells of immune derivation. These are called glial cells, and they provide structural support
for neurons and nerves (Crowe, 2004). Both branches of the ANS, the sympathetic and parasympathetic trunks, also
interact with and stimulate immune tissues (Scartelli, 1991).
The immune system works through the production of white blood cells. Although highly effective under normal
circumstances, the immune system can become compromised over time if stress-related hormones such as cortisol are
present (Scartelli, 1992). Music may help to restore effective functioning in the immune system partly via the actions
of the previously discussed amygdala and hypothalamus (Scartelli, 1992). As the activity levels of neurons in the
central nucleus of amygdala decrease in response to claming effects of music, there may be corresponding reductions
in the signals being sent to other parts of the brain (Spintge, 1999). The hypothalamus in turn may then reduce its
138 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141

level of stimulation of the pituitary and endocrine glands, including the adrenal medulla, which secretes epinephrine
and norepinephrine, and the adrenal cortex, which secretes cortisol (Englert, 2004). With less cortisol to impair white
blood cell activity, the immune system may be free to recover its normal functions. As such, music may be able to
calm neural activity in the brain, resulting in an increase of healthy white cell activity (Khalfa, Bella, Roy, Peretz, &
Lupien, 2004; Taylor, 1997).

Summary and recommendations

As discussed above, listening to music may help facilitate a relaxation response in part because of the integrated
ways that it is processed by the brain and body (Watkins, 1997). One important consideration is what music to use for
listening. The music may be chosen by the consumer or be selected or “prescribed” by a creative arts therapist or other
health practitioner. The issue of who selects the music (therapist or listener) has been explored by a number of authors
in music therapy (Clark et al., 2006; Crowe, 2004; Davis & Thaut, 1989; Hanser, 1985, 1999; Pelletier, 2004; Schneck
& Berger, 2006; Smith & Joyce 2004; Standley, 2000; Standley et al., 2005; Taylor, 2004).
In general, it has been observed that music that is preferred by the listener may have the most beneficial effects
on the relaxation and stress reduction responses of that listener (Hanser, 1999; Pelletier, 2004; Smith & Joyce, 2004).
However, in a meta-analysis of 22 research articles on the effects of music on decreasing arousal due to stress, Pelletier
(2004) observed that when paired with other relaxation techniques, music pre-selected by the researcher had a greater
effect than music selected by the listener, possibly due to the listener’s distraction when listening to preferred music.
The author pointed out that this conclusion seems to differ from other areas of music therapy research where preferred
music is usually the most effective. The author did conclude that the more the listener is exposed to specific music,
the greater their relaxation response. Pelletier (2004) observed that preferred selections, after repeated listening, may
not be as distracting and would more effectively decrease arousal, concluding that consideration of music preference
is vital.
Thus, the preference for the music may be an important factor in choosing what music to listen to as part of a
relaxation experience or regimen (McCraty, Barrios-Choplin, Atkinson, & Tomasino, 1998). This aspect of individual
listener preference is especially important to consider, because music which is perceived to be soothing or relaxing to
one person may not be so for another (Clair, 1996). However, there are some common elements of what is considered
by many to be relaxing or sedative music which may be helpful to keep in mind when selecting music for listening.
These musical elements which are perceived by many listeners to be relaxing include a slow and stable tempo (pace
or speed), low volume level and soft dynamics, consistent texture (combination of sounds and instruments), absence
of percussive and accented rhythms, gentle timbre (sound or tone color), legato (connected) melodies, and simple
harmonic or chord progressions (Radocy & Boyle, 2003; Staum & Brotons, 2000; Wigram, Pederson & Bonde, 2002).
These elements are often found in music composed for relaxation, as well as music classified as new age and classical,
which may be why selections representing these music styles have been used in commercial recordings marketed for
relaxation (Burns, Labbe, Williams, & McCall, 1999). It should be noted that, while classical music is often used for
relaxation, it is a very broad style and descriptor, and can also include music that is very arousing in one or more of
the above musical elements (Radocy & Boyle, 2003).
In addition to these overall elements, having control over selecting the specific music recording to use for a relaxation
experience at any particular time is also important. Consumers may wish to have a selection of recordings from which
to choose so that one selection or piece does not become too repetitive and tedious with repeated listening. They may
also wish to have selections of varying tempi and activity levels ranging from faster and more active to slower and
less stimulating. It is often helpful to initially match a recording to existing levels of activity and stress in terms of the
tempo of the piece and its musical complexity. These aspects of the music may then gradually change to slower and
less active or arousing. Matching music to exiting levels of activity and then gradually moving in a desired direction
such as more relaxed has been referred to in music therapy as the iso-principle (Davis, 2003).
The length of the recording is also important to consider. Many recordings produced specifically for relaxation
purposes are 20–30 min long, which may be a good target length for a relaxation experience. Recordings of shorter
pieces may also be used, but the transitions from one recording or track to another may not be smooth, and the relaxation
process may be interrupted because of this. Another consideration is whether or not to select recordings with narration
(or music compositions with words) as opposed to selecting instrumental-only compositions. Commercially produced
relaxation recordings often have narrations which lead the listener through breathing and muscle relaxation exercises
 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141 139

followed by pleasant imagery to help facilitate relaxation. This can be beneficial for the listener, and it has been shown
that combining techniques such as progressive muscle relaxation, body-awareness techniques, and cognitive cues such
as those involved with imagery may beneficially enhance the relaxation experience (Pelletier, 2004; Scheufele, 2000).
However, if the imagery is distracting to the listener, then the relaxation experience may actually be inhibited. Music
compositions such as songs or classical vocal works such as art songs, operas, or choral pieces may also be used, but the
lyrics or words may again be distracting. In addition, processing of the meanings of the lyrics or word texts may actually
arouse cortical responses and stimulate emotional responses, which again may be counterproductive considering the
goal of relaxation and inhibition of the sympathetic nervous system response.
If the consumer would like suggested recording titles for listening use, there are a variety of sources which may be
helpful. For instance, on-line music distributors such as Amazon.com may be searched by style of music. A recent Ama-
zon.com search using the words “relaxing music” yielded over 50 results, many available as used CD titles for reduced
prices. A number of these titles could also be previewed for no charge. Additional websites specializing in music record-
ings for relaxation that also allow for free previewing include New World Music (http://www.newworldmusic.com),
Serenity Music (http://www.serenitymusic.com, Relaxation CD’s (http://www.relaxation-cds.com), and The Relax-
ation Company (http://www.therelaxationcompany.com). On-line music download stores such as iTunes are also good
sources. A recent iTunes search using the term “relaxing” yielded over 60 CDs, which again could be previewed
for free. One on-line site, Relaxing Music Downloads (http://www.relaxingmusicdownloads.com), has over 100,000
relaxation music MP3s to download, again with free previews. At this site, a one-time fee ($29.95 at the time of this
article) allows the consumer to download as many MP3s as they like, with no additional fees. Retail music stores can be
good resources as well. Many feature listening stations where CDs can be previewed for free, and most larger retailers
have sections marked “new age” or “relaxation” where relevant titles are kept.
Being able to design a personalized music listening and relaxation routine that can be used when, where, and how
the consumer desires can empower and allow them to actively take part in their own wellness initiatives. This routine
may be enhanced when the consumer combines the music listening experience with a preferred and relaxing listening
environment. This might consist of a quiet room with an absence of intrusions from other people, phones, cell phones,
or pagers. If living with others, the consumer might want to put a note or sign on the room door to let others know
not to disturb them. A comfortable chair or recliner, soft lighting, or scented candles might also contribute to this
environment. If taking a break at work or on the go, the consumer might want to use a personal music device such
as an MP3 (e.g., iPod) or portable CD player. An MP3 player also allows the listener to customize play-lists, which
could include various sequences of music for relaxation from which to select at any given time. Over the ear (as
opposed to in-ear) headphones may help keep out unwanted environmental noises. Noise-cancelling headphones offer
the additional advantage of reducing ambient environmental noises. An eye mask such as those used on airplanes may
help to create a personalized environment and block out visually distracting stimuli.
In summary, the aspect of having a positive attitude towards one’s own health is an essential component of wellness
(Benson & McDevitt, 1989). Choosing to listen to music on a regular basis to combat stress and enhance relaxation
can be an important aspect of such an attitude (Wago & Kasahara, 2004). With the above information in mind, it is
hoped that consumers, creative arts therapists, and other allied health professionals may be better educated as to the
physiological effects of music listening as they relate to facilitating relaxation as part of an ongoing wellness initiative
and lifestyle.

References

Albert, R. E. (2002). The effect of guided imagery and music on pain and anxiety during laceration repair (Doctoral dissertation, Case Western
University, 2002). Dissertation Abstracts International, 62(11-B), 5030.
Altenmüller, E. O. (2004). The music in your head. Scientific American, 14(1), 24–31.
Benson, E. R., & McDevitt, J. Q. (1989). Home care and the older adult: Illness care versus wellness care. Holistic Nursing Practice, 3(2), 30–38.
Bernardi, L., Porta, C., & Sleight, P. (2006). Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians
and non-musicians: The importance of silence. Heart, 92(4), 445–452.
Bittman, B., Berk, L., Shannon, M., Sharaf, M., Westengard, J., Guegler, K. J., et al. (2005). Recreational music-making modulates the human stress
response: A preliminary individualized gene expression strategy. Medical Science Monitor: International Journal of Experimental and Clinical
Research, 11(2), 31–40.
Brennan, F. X., & Charnetski, C. J. (2000). Stress and immune system function in a newspaper’s newsroom. Psychological Reports, 87(1), 218–222.
Bruscia, K. E. (1998). Defining music therapy (2nd ed.). Barcelona: Gilsum, NH
140 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141

Burns, J., Labbe, E., Williams, K., & McCall, J. (1999). Perceived and physiological indicators of relaxation: As different as Mozart and Alice in
chains. Applied Psychophysiology and Biofeedback, 24(3), 197–202.
Chafin, S., Roy, M., Gerin, W., & Christenfield, N. (2004). Music can facilitate blood pressure recovery from stress. British Journal of Health
Psychology, 9(3), 393–403.
Clair, A. A. (1996). Therapeutic uses of music with older adults. Baltimore: Health Professions Press.
Clark, M., Isaacks-Downton, G., Wells, N., Redlin-Frazier, S., Eck, C., Hepworth, J. T., et al. (2006). Use of preferred music to reduce emotional
distress and symptom activity during radiation therapy. Journal of Music Therapy, 43(3), 247–265.
Collinge, W. (1998). Subtle energy. New York: Warner Books.
Corbin, C. B., Welk, G. J., Corbin, W. R., & Welk, K. A. (in press). Concepts of fitness and wellness (7th ed.). New York: McGraw-Hill.
Crowe, B. J. (2004). Music and soul making: Toward a new theory of music therapy. Lanham, MD: Scarecrow Press.
Crowe, B. J., & Scovel, M. (1996). An overview of sound healing practices: Implications for the profession of music therapy. Music Therapy
Perspectives, 14(1), 21–29.
Curtis, S. (1986). The effect of music on pain relief and relaxation of the terminally ill. Journal of Music Therapy, 23(1), 10–24.
Davis, W. B. (2003). Ira Maximilian Altshuler: Psychiatrist and pioneer music therapist. Journal of Music Therapy, 40(3), 247–263.
Davis, W. B., Gfeller, K. E., & Thaut, M. H. (1999). An introduction to music therapy: Theory and practice (2nd ed.). Boston: McGraw-Hill.
Davis, W. B., & Thaut, M. H. (1989). The influence of preferred relaxing music on measures of state anxiety, relaxation, and physiological responses.
Journal of Music Therapy, 26(4), 168–187.
Deng, G., & Cassileth, B. R. (2005). Integrative oncology: Complementary therapies for pain, anxiety, and mood disturbance. CA: A Cancer Journal
for Clinicians, 55(2), 109–116.
Dileo, C. (1999). Music therapy and medicine. Silver Spring, MD: American Music Therapy Association.
Edlin, G., & Golanty, E. (1992). Health and wellness: A holistic approach. Boston: Jones & Bartlett.
Englert, H. (2004). Sussing out stress. Scientific American, 14(1), 56–61.
Evans, D. (2002). The effectiveness of music as an intervention for hospital patients: A systematic review. Journal of Advanced Nursing, 37(1),
8–18.
Fouladbakhsh, J. M., Stommel, M., Given, B. A., & Given, C. W. (2005). Predictors of use of complementary and alternative therapies among
patients with cancer. Oncology Nursing Forum, 32(6), 1115–1122.
Ghetti, C. M., Hama, M., & Woolrich, J. (2004). Music therapy in wellness. In A. A. Darrow (Ed.), Introduction to approaches in music therapy
(pp. 127–141). Silver Spring, MD: American Music Therapy Association.
Goldstein, A. (1990). Thrills in response to music. Physiological Psychology, 8(2), 126–129.
Good, M. (1995). Relaxation techniques for surgical patients. American Journal of Nursing, 95(1), 38–42.
Hanser, S. B. (1985). Music therapy and stress reduction research. Journal of Music Therapy, 22(3), 193–206.
Hanser, S. B. (1999). The new music therapist’s handbook. Boston: Berklee Press.
Hanser, S. B., & Mandel, S. E. (2005). The effects of music therapy in cardiac healthcare. Cardiology in Review, 13(1), 18–23.
Harvey, A. W. (1987). Utilizing music as a tool for healing. In R. Pratt (Ed.), The fourth international symposium on music: Rehabilitation and
well-being (pp. 73–87). Basel, Germany: Editiones Roches.
Harvey, A. W. (1992). On developing a program in MusicMedicine: A neurophysiological basis for music as therapy. In R. Spingte, & R. Droh
(Eds.), MusicMedicine (pp. 71–79). St. Louis: MMB Music.
Hirokawa, E., & Ohira, H. (2003). The effects of music listening after a stressful task on immune functions, neuroendocrine responses, and emotional
states in college students. Journal of Music Therapy, 40(3), 189–211.
Hirsch, S., & Meckes, D. (2000). Treatment of the whole person: Incorporating emergent perspectives in collaborative medicine, empowerment,
and music therapy. Journal of Psychosocial Oncology, 18(2), 65–77.
Hucklebridge, F., Lambert, S., Clow, A., Warburton, D. M., Evans, P. D., & Sherwood, N. (2000). Modulation of secretory immunoglobulin A in
saliva; response to manipulation of mood. Biological Psychology, 53(1), 25–35.
Jourdain, R. (1997). Music, the brain, and ecstasy. New York: Avon Books.
Keegan, L. (2003). Therapies to reduce stress and anxiety. Critical Care Nursing Clinics of North America, 15(3), 321–327.
Kemper, K. J., & Danhauer, S. C. (2005). Music as therapy. Southern Medical Journal, 98(3), 282–288.
Khalfa, S., Bella, S. D., Roy, M., Peretz, I., & Lupien, S. J. (2004). Effects of relaxing music on salivary cortisol level after psychological stress.
Annals of the New York Academy of Sciences, 999, 374–376.
Krout, R. (2000). Hospice and palliative music therapy: A continuum of creative caring. In American Music Therapy Association (Ed.), Effectiveness
of music therapy procedures: Documentation of research and clinical practice (3rd ed., pp. 323–411). Silver Spring, MD: American Music
Therapy Association.
Krout, R. E. (2005). Calmwaves relaxation and imagery (compact disc recording). Grapevine, TX: Prelude Music Therapy.
Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M. S. (1998). Stress and hypertensions. WMJ: Official Publication of the State Medical Society of
Wisconsin, 97(11), 34–38.
Kwekkeboom, K. L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. Oncology Nursing Forum, 30(3),
433–440.
Lane, D. (1994). Music as medicine. Grand Rapids, MI: Zondervan Publishing.
LeDoux, J. (1998). The emotional brain: The mysterious underpinnings of emotional life. New York: Simon & Schuster.
Lemonick, M. D. (2003). The power of mood. Time, 44–49.
Mandel, S. E. (1996). Music for wellness: Music therapy for stress management in a rehabilitation program. Music Therapy Perspective, 14(1),
38–43.
 R.E. Krout / The Arts in Psychotherapy 34 (2007) 134–141 141

Maranto, C. D. (1992). A comprehensive definition of music therapy with an integrative model for music medicine. In R. Spingte, & R. Droh (Eds.),
MusicMedicine (pp. 17–29). St. Louis: MMB Music.
McCraty, R., Barrios-Choplin, B., Atkinson, M., & Tomasino, D. (1998). The effects of different types of music on mood, tension, and mental
clarity. Alternative Therapies in Health and Medicine, 4(1), 75–84.
Melzak, R., & Katz, J. (2004). The gate control theory: Reaching for the brain. In T. Hadjistavropoulos, & K. D. Craig (Eds.), Pain: Psychological
perspectives (pp. 13–34). Mahwah, NJ: Lawrence Erlbaum Associates.
Melzak, R., & Wall, P. D. (1982). The challenge of pain. New York: Basic Books.
Moreno, J. (2004). Music therapy and pain management: A multicultural perspective. Hrvatska Revija Za Rehabilitacijska Istrazivanja, 40(2),
175–181.
Padhi, K. (2005). Pain and psychological approaches to its management—The gate control theory of pain. Social Science International, 21(2),
121–130.
Patel, K. K., Koegel, P., Booker, T., Jones, L., & Wells, K. (2006). Innovative approaches to obtaining community feedback in the Witness for
Wellness experience. Ethnicity & Disease, 16(1, Suppl. 1), 35–42.
Pelletier, C. L. (2004). The effect of music on decreasing arousal due to stress: A meta-analysis. Journal of Music Therapy, 41(3), 192–214.
Pinel, J. P. J. (2006). Biopsychology (6th ed.). Boston: Pearson–Allyn and Bacon.
Pratt, R. R. (2004). Art, dance, and music therapy. Physical Medicine and Rehabilitation Clinics of North America, 15(4), 827–841.
Radocy, R. E., & Boyle, J. D. (2003). Psychological foundations of musical behavior (4th ed.). Springfield, IL: Charles C. Thomas.
Rider, M. (1997). The rhythmic language of health and disease. St. Louis: MMB Music.
Rider, M. S., & Weldin, C. (1990). Imagery, improvisation, and imagery. Arts in Psychotherapy, 17(3), 211–216.
Robb, S. (2003). Music therapy in pediatric healthcare. Silver Spring, MD: American Music Therapy Association.
Robb, K. A., Williams, J. E., Duvivier, V., & Newham, D. J. (2006). A pain management program for chronic cancer-treatment-related pain: A
preliminary study. The Journal of Pain, 7(2), 82–90.
Roskam, K. S. (1993). Feeling the sound: The influence of music on behavior. San Francisco: San Francisco Press.
Sagar, S. M. (2006). Integrative oncology in North America. Journal of the Society for Integrative Oncology, 4(1), 27–39.
Sarafino, E. P. (2005). Health psychology: Biopsychosocial interactions (5th ed.). New York: John Wiley.
Scartelli, J. P. (1987). Music and self-management methods—A physiological model. St. Louis: MMB Music.
Scartelli, J. (1991). A rationale for subcortical involvement in human response to music. In C. D. Maranto (Ed.), Applications of music in medicine
(pp. 30–40). Washington, DC: National Association for Music Therapy.
Scartelli, J. (1992). Music therapy and psychoneuroimmunology. In R. Spingte, & R. Droh (Eds.), MusicMedicine (pp. 137–141). St. Louis: MMB
Music.
Scheufele, P. M. (2000). Effects of progressive relaxation and classical music on measurements of attention, relaxation, and stress responses. Journal
of Behavioral Medicine, 23(2), 207–228.
Scheve, A. M. (2004). Music therapy, wellness, and stress reduction. Advances in Experimental Medicine and Biology, 546, 253–263.
Schneck, D. J., & Berger, D. S. (2006). The music effect: Music physiology and clinical applications. London: Jessica Kingsley Publishers.
Schwoebel, J., Coslett, H. B., Bradt, J., Friedman, R., & Dileo, C. (2002). Pain and the body schema: Effects of pain severity on mental representation
of movement. Neurology, 59(5), 775–777.
Sharon, C. W., & Donahue, T. (2006). Consumer-driven health care: Lessons from the first five years. Benefits Quarterly, 22(2), 15–16, 18–22.
Smith, J. C., & Joyce, C. A. (2004). Mozart versus new age music: Relaxation states, stress, and ABC relaxation theory. Journal of Music Therapy,
41(3), 215–224.
Smith, S. J., & Llloyd, R. J. (2006). Promoting vitality in health and physical education. Qualitative Health Research, 16(2), 249–267.
Society for Neuroscience. (1991). Stress and the brain. Washington, DC: Society for Neuroscience.
Spintge, R. (1999). MusicMedicine: Applications, standards, and definitions. In R. R. Pratt, & D. E. Grocke (Eds.), MusicMedicine3: MusicMedicine
and music therapy: Expanding horizons (pp. 3–11). Parkville, Victoria, AU: The University of Melbourne.
Standley, J. M. (2000). Music research in medical treatment. In American Music Therapy Association (Ed.), Effectiveness of music therapy
procedures: Documentation of research and clinical practice (3rd ed., pp. 1–64). Silver Spring, MD: American Music Therapy Association.
Standley, J. M., Gregory, D., Whipple, J., Walworth, D., Nguyen, J., Jarred, J., et al. (2005). Medical music therapy: A model program for clinical
practice, education, training, and research. Silver Spring, MD: American Music Therapy Association.
Staum, S. J., & Brotons, M. (2000). The effect of music amplitude on the relaxation response. Journal of Music Therapy, 37(1), 22–39.
Taylor, D. B. (1997). Biomedical foundations of music as therapy. St. Louis: MMB Music.
Taylor, D. B. (2004). Biomedical music therapy. In A. A. Darrow (Ed.), Introduction to approaches in music therapy (pp. 159–174). Silver Spring,
MD: American Music Therapy Association.
Wago, H., & Kasahara, S. (2004). Music therapy, a future alternative intervention against diseases. Advances in Experimental Medicine and Biology,
546, 265–278.
Watkins, G. R. (1997). Music therapy: Proposed physiological mechanisms and clinical implications. Clinical Nurse Specialist, 11(2), 43–50.
White, J. M. (1992). Music therapy: An intervention to reduce anxiety in the myocardial infarction patient. Clinical Nurse Specialist, 6(1), 58–63.
Wigram, T., Pederson, I. N., & Bonde, L. O. (2002). A comprehensive guide to music therapy. London: Jessica Kingsley.

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