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MUSIC THERAPY AND WOMEN’S HEALTH:
EFFECTS OF MUSIC-ASSISTED RELAXATION ON WOMEN GRADUATE
STUDENTS’ STRESS AND ANXIETY LEVELS
By

Chan g-Chi Musetta F u

A THESIS
Submitted to
Michigan State University

in partial fulfillment of the requirements
for the degree

MASTER OF MUSIC
Music Therapy

2008

ABSTRACT
MUSIC THERAPY AND WOMEN’S HEALTH:
EFFECTS OF MUSIC-ASSISTED RELAXATION ON WOMEN GRADUATE
STUDENTS’ STRESS AND ANXIETY LEVELS
By

Chang-Chi Musetta Fu

The purpose of this study was to examine the effects of music-assisted relaxation
(MAR) on women graduate students’ stress/anxiety levels. It was predicted that MAR
would: (1) help reduce women graduate students’ stress and anxiety and (2) modulate this
population’s moods in a positive way. Thirty-two women graduate students enrolled in
graduate programs of a large research-intensive university in the Midwest served as
subjects in this study. STAI Y-l and POMS short form, blood pressure, and heart-rate
were used to evaluate the subjects’ stress/anxiety levels and stress-related mood and
physiological states. There were significant differences found in STAI and two factors
(tension-anxiety and vigor) of POMS, suggesting that MAR can facilitate stress/anxiety

management for women graduate students and increase their vigor.

ACKNOWLEDGEMENT

I would like to thank all people who have helped and inspired me during my master
study.

I especially want to thank my advisor, Dr. Frederick Tims, PhD MT-BC, for his guidance
during my research and study at Michigan State University. Dr. Tims was always
accessible and willing to help his students with their research. As a result, research life
became smooth and rewarding for me.

Dr. Cynthia Taggart and Prof. Roger Smeltekop deserve special thanks as my thesis
committee members and advisors. I would like to thank Dr. Taggart for guiding me on
the statistical analysis and willingness to devote her time for me. Prof. Smeltekop has
always been warm and supportive. I thank him for being a wonderful listener and guide.

I would like to bring my gratitude to all who were willing to share their time and
participate in my study. Thank you for giving me wonderful and rewarding experiences
as being a music therapist.

My deepest gratitude goes to my family for their unflagging love and support throughout
my life; this thesis is simply impossible without them. I cannot ask for more from my
mother, Yi-Wei Sung, as she is simply perfect. I have no suitable word that can fully
describe her everlasting love to me. I love you, mom! I am indebted to my father, Hsin-
Ping IFu, for his understanding and warmth. I also want to thank my brother, Wei-Chun
Fu, for always being a role model in my life and bringing a kind sister-in law, Hsia-Jing
Chung, and two precious nieces, Ro-Ro and Shiang-Shiang to me. Finally, I would like to
bring my deepest love to Bryan Huang and many dear friends. Thank you all for always
being there, loving me and supporting me. Without you, I would not have enough
strength to accomplish this.

iii

TABLE OF CONTENTS

LIST OF TABLES .............................................................................. vii
LIST OF FIGURES ............................................................................. viii
CHAPTER 1
INTRODUCTION .............................................................................. 1
Physiological Factors of Stress ............................................................... 2
Chronic Stress and Health ...................................................................... 2
Stress and Risks of Breast Cancer ............................................................ 3
Stress and Depression ........................................................................... 4
Anxiety and Women ............................................................................ 4
Common Modalities of Stress Management .................................................. 6
Music Therapy .................................................................................... 6
Purpose of Study ................................................................................. 8
CHAPTER 2
THE REVIEW OF LITERATURE
Music Interventions and Human Biological Functions .................................... 10
Music Interventions for Stress and Anxiety Reductions ................................... 11
Music Therapy and Female Population ....................................................... 12
CHAPTER 3
MEHTOD
Subjects ........................................................................................... 17
Design and Procedure .......................................................................... 17
Materials .......................................................................................... 18
Measurement ...................................................................................... 19
Statistical Analysis .............................................................................. 20
CHAPTER 4
RESULTS ............................................................................................ 22
Demographic Information ...................................................................... 22
Sate Trait Anxiety Inventory (STAI) Y-l Form .......................................................... 22
Profile of Mood States Short Form (POMS) .................................................. 26
Blood Pressure and Heart-rate ................................................................. 30
CHAPTER 5
DISCUSSION ...................................................................................... 32
Findings and Previous Studies ................................................................... 32
Interpretation and Implications of Results ................................................... 34

iv

STAI Y-l ..................................................................................... 34

POMS ....................................................................................... 34

Blood Pressure and Heart-rate ........................................................... 35
Conclusion ....................................................................................... 35
Suggestions for Future Studies ................................................................ 36
APPENDICES ....................................................................................... 38
REFFERENCES ................................................................................... 46

LIST OF TABLES

Table 1. Pretest and Posttest Means of Music-Assisted Relaxation and ........... 23
Non-Music Treatment on STAI

Table 2. The STAI Gained Scores of Music-Assisted Relaxation and . ...24
Non-Music Treatments

Table 3. Paired t-Test for the Differences Between Music-Assisted .......... 24
Relaxation and Non-music Treatment on STAI

Table 4. Pretest and Posttest of POMS with Music-Assisted . ...26
Relaxation

Table 5. Pretest and Posttest of Non-Music Treatment on POMS . ...27

Table 6. Mean Differences Between Music-Assisted Relaxation and . ...28

Non-Music Treatments on POMS

Table 7. Paired t-Test for the Changes Between Music-Assisted . ...29
Relaxation and Non-Music Interventions (POMS)

Table 8. Pretest and Posttest on Blood Pressure and Heart-rate . ...30

Table 9. Pretest and Posttest on Blood Pressure and Heart-rate with . ...31

Non-Music Treatment

Table 10. t-Test for the Changes of Blood Pressure and Heart-rate in . ...31
Music-Assisted Relaxation and Non-Music Treatments

vi

Figure 1.

Figure 2.

Figure 3.

LIST OF FIGURES

Pretest and Posttest of Music-Assisted Relaxation and Non-
Music Treatment on STAI

Differences of STAI Changes with Music-Assisted
Relaxation and Non-Music Treatment

Differences of Changes in POMS Between Music-Assisted
Relaxation and Non-Music Treatment

vii

...23

...25

...29

Chapter One
Introduction
Since feminism began to grow in 18th century, women have started standing up for

their own rights and interests (Humphrey, 1992). In the 19605 and 19703, the
contemporary women’s movement, also known as the second wave of feminism, further
accelerated the changing concept of gender roles in society (Biaggio, 2000). Women
began joining the male-dominated world, and their self-expectations heightened. A large
and increasing number of women now pursue higher education and their need of
satisfaction from careers (Betz, 2006). Because of the competition with men, the pursuit
of professional accomplishments, and balancing the multiple roles of colleague, student,
wife, and mother, today’s women may experience more stress and pressure than women .
of the past. Since excessive stress and anxiety can be often associated with negative
health conditions, exploring effective methods for stress/anxiety management may help
women maintain their wellness.

Currently, career women and women pursuing higher educations, find their lives rife
with stressors due to the multiple roles inflicted upon them. Women who have
professional careers often confront work-family conflicts, sexual-role stereotyping, and
differential gender treatment in occupation and wages (Yang, 1998). Moreover, Vander
Zanden, Crandell, and Crandell (2007) argue that women have higher expectations for
their performance than do men. Therefore, besides balancing their relationships with
family and work, women also realize they need to work harder in order to compete with
male colleagues for equal earnings and treatment in their careers. In the article, “The

Gender Pay Gap,” Compton (2007) argues that statistical gaps in salaries exist between

women and men who both work full-time at similar position levels. The US. Bureau of
Labor (2007) released a statistical report of median weekly earnings, showing that
women’s earnings were about 12% less than men’s in 2006. Moreover, women enter the
advanced academic arena to pursue self-fulfillment, increase professional and personal
credibility; however, they may also anticipate a stressful life because they often need to
balance school, work, and family (Younes & Asay, 1998).
Physiological Factors of Stress

Stress is defined as “the process by which we appraise and cope with environmental
threats and challenges” (Myers, 2004, p. 532). It affects the endocrine system, which
releases stress hormones. At the onset of stress, the hypothalamus, which is located in the
middle of base of the brain, releases a hormone that excites the pituitary gland to secrete
adrenocorticotrophic hormone (ACTH). Then, ACTH stimulates the adrenal glands that
are located in the kidneys to release stress hormones, glucocorticoids, which include
cortisol and cortisone. These stress hormones turn on the body’s fight—and-flight function,
resulting in increasing heart rate, respiration, muscle tension, and sweaty, cold skin.
These natural physiological arousals have evolved to help cope with an undesired
stimulus or danger (Myer, 2004; Nevid, Rathus, & Greene, 2005).
Chronic Stress and Health

Some short-term and appropriate stress has the positive effects of stimulating and
motivating people to overcome problems. With the removal of the danger or unpleasant
stimuli, the body decreases the production of stress hormones and returns to its normal

physiological states.

However, excessive and prolonged stress can be harmful to one’s health (Myer,
2004). Chronic stress can cause an imbalance of the endocrine system, causing it to
continue pumping out stress hormones that have damaging effects throughout the body,
such as restraining the ability of the immune system to defend infections and diseases and
contributing to cardiovascular diseases (Nevid, Rathus, & Greene, 2005). These
physiological imbalances emphasize the risks of gastrointestinal disorders, cardiovascular
diseases, and even cancers (Dotevall, 1985; Goldstein, 1995). Additionally for women,
excessive stress may induce the disturbance of menstruation (Smith & Shimp, 2000).
Stress and the Risks of Breast Cancer A

Every year, 180,000 women in the United States are diagnosed with breast cancer.
The Center of Disease Control (CDC) reports that the occurrence of breast cancer has
increased fifty-two percent from 1950 to 1990 (Mitchell & Cordon, 2001). Although the
cause of breast cancer is suspected to be associated with genetic factors, there have been
a number of researchers investigating the relationship between stress and breast cancer.
Jacob and Bovasso (2003) found that maternal death and chronic stress and depression
that occurred at least 20 years prior to the breast cancer hospitalization could have
facilitated breast cancer development. In addition, Dettenbom, James, Berge-Landry,
Valdimarsdotti, Montgomery, and Bovjerg (2005) studied 215 healthy women who
worked in medical centers in New York and evaluated their levels of cortisol, the main
hormone that responds to stress, in daily life settings outside the laboratory. They divided
the subjects into two groups based on whether they had a family history of breast cancer.
The findings suggest that women with at least one first-degree relative with breast cancer

tended to have higher cortisol levels during work (the most stressful period of a day) than

those without a first-degree relative with breast cancer. This supports the relationship
between high cortisol (stress) response and risk of breast cancer. Since prolonged stress
has an effect on women’s health, exploring methodologies of stress reduction could be
useful in helping women maintain of healthy lives.
Stress and Depression

As well as increasing physiological risks, experiencing needless stress is associated
with many psychological disorders and increases the rate of depression and suicide
(Nevid, Rathus, & Greene, 2005; Smith & Simp, 2000; Taylor, 1997). Wallenstein (2003)
argues the cause-and-effect of stress and emotions through the following medical
vieWpoints. First, people with Cushing’s syndrome, which causes a vast over-secretion of
corticol, a stress hormone, often become clinically stressed and depressed. Second,
people who are receiving glucocorticoids (steroid/stress hormones) as treatment for
certain diseases, such as asthma or multiple sclerosis, have high risk of becoming
clinically depressed. Thus, Wallenstein concludes that stress and negative emotions may
have cause-and-effect relations. In addition to the high association between stress and
depression, Vander Zanden, Crandell, and Crandell (2007) argue that women, who
experience higher stress, pressure, and responsibility, such as a single mother, a career
woman, and a woman in an advanced academic field, also have higher rates of
depression. The statistics of the National Mental Health Association (2003) suggests that
depression affects nearly 19 million people in the United States, and the rate of women
who experience depression is much higher than the rate of men. Hence, developing a
healthy way to cope with stress may help control and prevent depression.

Anxiety and Women

Experiencing stress usually results in anxiety. “Anxiety is a generalized state of
apprehension or foreboding” (Nevid, Rathus, & Greene, 2005, p. 159). In daily life, there
is much to be worried about, such as our health, social and family relationships,
examinations, careers, childcare, and environmental conditions. Anxiety is the most
common among all psychiatric disorders, and many studies Show that women have higher
rates of anxiety disorders than men (Silverman & Carter, 2006), and because women tend
to demonstrate higher heritability of anxiety symptoms than men. Additionally, some
studies suggest that female hormones (estrogen and progesterone) may have a regulatory
impact on neurotransmitter systems to heighten the internalizing symptoms, such as
anxiety and reaction to stress (Smith & Shimp, 2000; Silverman & Carter, 2006).
Furthermore, Silverman and Carter (2006) argue that women have a tendency to be more
sensitive about anxiety than do men. From the vieWpoints of social science, women
continuously report experiencing greater psychological distress than men (Mohr, Armeli,
& et al, 2003). In the study, Mohr, Armeli, and et al. (2003) have researched how
negative daily interpersonal experiences impact personal emotions in men and women.
More than the male subjects, the women subjects reported that they received more
distress due to the negative daily interpersonal experiences and also prolonged negative
moods. Thus, women biologically and psychologically tend to perceive anxiety more
than men.

Although anxiety is a natural reaction to fear and worry, maladaptive anxiety can
affect the psychological health and impair daily functions (N evid, Rahtus, & Greene,
2005). Smith and Shimp (2000) also suggest that clinical depression commonly coexists

with anxiety disorders, and as high as seven percent of people with one or more

diagnoses will ultimately commit suicide. Hence, good management of anxiety is
essential to maintain healthy physical and psychological health.
Common Modalities of Stress Management

Although chronic stress and anxiety negatively influence women’s psychological and
physiological health (Smith & Shimp, 2000; Silverman & Carter, 2006; Nevid, Rahtus, &
Greene, 2005), many have written about various methodologies of stress and anxiety
reduction. These methodologies include self-management techniques (Hypnosis and Self-
Hypnosis, Autogenic, Imagery, Meditation, Progressive Muscle Relaxation Training, and
Behavior Therapies), Biofeedback (Galvanic Skin Response Biofeedback, Thermal
Biofeedback, Electroencephalographic Biofeedback, and Electromyography), and body
movements such as, Yoga and Tai-chi (Scartelli, 1989). Besides those methods of stress
and anxiety reduction, an increasing number of studies in the fields of music psychology
and music therapy suggest that specific music interventions can positively affect human
emotional states and physiological reactions (Matthews, 1941; Peters, 2000; Radocy &
Boyle, 2003; Reed, 2000; Taylor, 1997).
Music Therapy

Music is powerful and meaningful for human beings. Throughout history, people
have believed in music’s healing, soothing, and persuasive effects (Radocy & Boyle,
2003; Peters, 2000). For instance, in ancient times, African and American Indian People
used particular songs and rhythms to drive away diseases. Ancient Hebrews recognized
that music had calming effects on people. Egypt and Babylonia not only used hymns to
cure sickness and suffering but also composed songs for particular tasks. Ancient Asian

cultures believed that music improved the human mind and spirit. Greek and Roman

people believed that music affected an individual’s will, character, and conduct (Peters,
2000). Gaston (1968) suggested that music is an essential part of human behavior. In
every comer of the world, music exists where people are.

Moreover, to human beings, music is functional because: (1) music affects human’s
physical, emotional, and cognitive responses, and also expresses human’s feelings; (2) it
connects people; and (3) it offers human aesthetic experiences and gratifications (Radocy
& Boyle, 2003; Peters, 2000; Reed, 2000). Music affects human emotions. People used
different types of music to create certain environmental ambiences, such as in movies, in
the market place, in restaurants, and in gyms. Iwanaga and Moroki (1999) suggest that
energetic music arouses feelings of vigor and tension, while sedative music releases
tension. Therefore, music therapists prefer soothing music as a treatment for stress
reduction.

Music therapy is a structured, systemized, and objective procedure of providing
therapeutic outcomes through musical experiences (Peters, 2000; Radocy & Boyle,
2003). Reed (2000) suggests that music is a master key to assessing our inner being;
music therapy has explored how to use the key, and a music therapist is a person who
administers the process. The agenda of music therapy is to provide music experiences in:
(1) attaining a person’s attention and offering order and structure, (2) supplying self-
knowledge, self-expression, and self-gratification, and (3) promoting positive
relationships with others. American Music Therapy Association also states that music
interventions can be designed to: promote wellness, manage stress, alleviate pain, express
feelings, enhance memory, improve communication, and promote physical rehabilitation

(American Music Therapy Association, 2004). Promoting wellness and managing stress

are two of the main categories of music therapy goals. Therefore, music therapy may
provide effective therapeutic services for people with physical or psychological
impairments as well as contribute to stress management and improvement of wellness in
the general population.
Purpose of Study

Prevention helps people maintain their health and decreases risk of diseases. The
holistic theoretical concept emphasizes the individuals’ responsibilities for their own
health, prevention of illnesses, and maintaining optimum wellness (Peters, 2000).
Therefore, this study aims at health maintenance and illness prevention and focuses on
music interventions for general female graduate students who may have a highly stressful
life. The following review of literature in the next chapter will reveal music interventions
for women are effective in reducing their stress and anxiety. However, most of these
studies’ participants were either women who have been abused or women who already
have mental disorders. As stated previously, chronic stress and anxiety heightens the risk
of diseases and impacts a woman’s physiological and psychological health. Although
therapies may help improve symptoms or reduce anxiety for those women who are
diagnosed with physiological illnesses or psychological disorders, it is also important to
acknowledge these diseases prior to their appearance. According to what has been stated
earlier, women have more tendencies to feel stressed and anxious than do men, and that
has negative effects resulting in various disorders and diseases. It is important for women
to develop and discover new methods of stress management.

In this study, the subjects were female graduate students who were generally

healthy and did not take medication for chronic physical disease or psychological

disorders. Besides encountering the stresses of college life, female graduate students may
also need to juggle the multiple roles of a colleague, a wife, a daughter, and even a
mother (Younes & Asay, 1998). In addition, research studies suggest that women tend to
perceive more stress and anxiety in biological and psychological aspects. Hence, this
population tends to have a higher risk of experiencing stress and anxiety. Music-assisted
imagery with specific chosen music and written script for relaxation and music paired
with progressive muscle relaxation have been Shown to be effective in reducing stress
and anxiety. Consequently, the intervention in this study combined these two methods
and particularly added the progressive muscle relaxation script into the relaxation stage.
Based on the need for stress management and few studies found for music interventions
for women in general good health, the purpose of this research was to investigate whether
music therapy improves the health of women. In addition, this study examined the
following research problems: (a) the effect of music-assisted relaxation on the reduction
of female graduate students’ stress, and (b) the effect of music-assisted relaxation in

modulating female graduate students’ mood states in a positive manner.

Chapter Two
The Review of Literature
Music Interventions and Human Biological Functions
An increasing amount of research has investigated the therapeutic effect of music
interventions on human biological and physiological functions (Dileo, 1997; Maranto,
1989; Taylor, 1997). Taylor (1997) advocates that the universal domain of music therapy
should be the brain, which governs the whole body, and the neurophysiologic responses
to music stimuli explain the concept of “music as medicine”. He argues that irregular
nerve impulses which involve feelings of anxiety spread when GABA, a neurotransmitter
associated with calming or sedative responses, receptivity is low. “Musical activity may
be used to synchronize neuronal discharge patterns in such a way that any abnormal
spread of nerve impulses will be incorporated into the musical task.” (Taylor, 2007,
p.104). Taylor also suggests that “music can decrease activity in the brain, resulting in
decreased [sic] the stress hormonal production and associated recovery of normal white
blood cell activity.” (p. 108). As mentioned earlier, prolonging in excessive stress
hormones may affect health; several researchers have studied the change of stress
hormones through engaging in musical experiences. Barlett, Kaufman, and Smeltekop
(1993) have studied the effects of music listening and perceived sensory experiences on
the immune system with measuring Interleukin-l (an immune systematic protein that
enhances the immune function) and cortisol on thirty-six subjects. The findings suggest
that engaging in music listening to provoke positive emotional behaviors helps decrease
cortisol levels and increase Interleukin-1. Moreover, Miluk-Kolasa and Matejek (1996)

compared the blood glucose and cortisol levels of pre-surgical patients with music

10

intervention and those without music intervention. The result showed that the group with
music intervention tended to have lower blood glucose and cortisol levels. These studies
have supported the idea that music is effective in changing human physiological
functions.
Music Interventions for Stress and Anxiety Reduction

Several researchers have investigated music interventions that help reduce stress and
anxiety. The Bonny Method of Guided Imagery and Music (BMGIM) is one of the most
well-known interventions in music therapy. BMGIM uses classical music as a medium to
stimulate one’s imagery in order to achieve altered states of consciousness. The
procedure of BMGIM consists of four stages: prelude, relaxation/induction,
music/imagery, and postlude. When BMGIM is properly presented, it may lead the
listener from states of relaxation to deeper emotional states (Bonny & Savery, 1973;
Scartelli, 1989; Summer, 1988). In Hammer’s study (1996), participants reported
significantly less stress and anxiety levels after 10 sessions of guided imagery
accompanied by music. However, Summer (1988) argues that BMGIM technique is not
only useful for relaxation. She argues that BMGIM uses classical music because its
continuity and unpredictability pushes the psyche forward, creating psychological,
physiological and physical tensions that are perfect for goal-oriented therapy, but are
counterproductive to the sedative goal of relaxation. Nevertheless, She further points out
that the specific selection of music and the verbal guided script components of BMGIM
can achieve the purpose of relaxation.

Another music intervention for stress reduction is Music Assisted Progressive Muscle

Relaxation (MPR). In the technique of progressive muscle relaxation training, a therapist

ll

gives a person verbal prompts to relax major muscle groups in the body in a sequenced
manner until the person reaches a deeply relaxed state (Scartelli, 1989). Music assisted
progressive muscle relaxation is a combination of music listening and progressive muscle
relaxation. In Robb’s (2000) study, she compared four relaxation techniques: music
assisted progressive muscle relaxation, progressive muscle relaxation, music listening,
and silence. The results indicate that each treatment condition was equally effective in
producing Si gnificant changes in stress and anxiety level from the pre-test to the post-test.
However, among these techniques, music assisted progressive muscle relaxation
condition tended to produce the highest mean changes. This implies that music might
enhance progressive muscle relaxation.

Since guided imagery and music assisted progressive muscle relaxation training
reduced stress and anxiety, researchers have further adapted these two interventions as a
treatment in their study. Robb, Nichols, Rutan, Bishop, and Parker (1995) used music
assisted relaxation (MAR) intervention that included music listening, deep diaphragmatic
breathing, progressive muscle relaxation, and imagery as a pre-operative treatment. The
subjects were pediatric burn patients, ranging in ages from eight to twenty. They were
randomly divided into two groups. One group received MAR interventions in conjunction
with the regular pre-operation interventions while the other group only received the pre-
operation interventions. The researchers used the state portion of the State-Trait Anxiety
Index for Children (STAIC) to evaluate the subjects’ anxiety levels. The experimental
group showed a significant decrease in anxiety while the control group did not. The
finding again suggests the positive effect of relaxation techniques combined with music.

Music Therapy and the Female Population

12

Several researchers have investigated music interventions for women. In a Taiwanese
study, Lai (1999) selected 30 female psychiatric inpatients that were diagnosed with
depression disorder. She randomly divided the subjects into two groups. One of the two
groups received music listening as the treatment, and the other one received no music
listening. The music selections were based on inpatients’ choices. Lai (1999) measured
the participants’ heart rates, respiratory rates, and blood pressure, along with asking
subjects to complete a questionnaire to report their mood states. There were significant
differences on post-tests between the two groups on the physiological and emotional
states. The results support the use of music listening as a healing modality for women
with depression. In Lai’s (1999) study, she suggests that music may help participants
reveal or disclose their feelings, and music listening was effective in stimulating changes
among women with depression and in modulating their emotional states in a more
positive direction.

Although studies have supported that music listening is helpful for reducing negative
psychological disorders, music listening can further be structured as a specific therapeutic
system. For instance, Shiraishi (1997) investigated a home-based music therapy program
for multi-risk mothers who lived in a Midwest the inner-city and received social service
due to unstable living situations. The home-based music therapy program was structured
with a music listening protocol, which included a serial of different types of music. The
first program of the music listening protocol was a music workout. Participants were
asked to do gentle exercise to vocal or instrumental music as a way to identify and ease
muscle tension. The second program was music massage, in which participants’ received

gentle facial massage with soothing, pleasant vocal or instrumental music, in order to

ease the tension in the face and neck. The third program was building a bond with music.
In this stage, participants received progressive muscle relaxation accompanied with slow,
melodic, and pleasant instrumental music for entire body. The fourth was a program of
lullaby and goodnight music. Following programs one to three, participants achieved a
relaxed state. The fourth stage consisted of deeper relaxation in order to help the
participants reach the state of sleep. The fifth and final program was a music boost, which
had more vigorous exercise with more energetic music. The researchers used the Beck
Depression Inventory (BDI), Brief Symptom Inventory (BSI), State Trait Anxiety
Inventory (STAI Y From), Profile of Mood States (POMS), and Rosenberg Self-Esteem
(RSE) to evaluate the subjects’ mood states, self-esteem, and anxiety levels. The results
of all measures have showed positive changes. Among them, the scores of STAI and RSE
had the most positive changes (18% and 17%), the scores of POMS and BDI indicated
moderate improvement (11% and l 1%). The subjects who received the music listening
protocol showed obvious decreases in depression and increases in self-esteem levels. This
indicated that the serial of home-based music therapy program helped women with high—
risk living conditions improve their self-esteem and anxiety.

Whipple and Lindsey (1999) focused on the outcome of a sequential music
therapeutic procedure for a group of battered women, ranging in age from 20 to 50. They
argued that women who have suffered abuse not only have physical harm but also high
levels of anxiety, depression, and fear. They designed an eight-week long program with
the objectives of increasing self-esteem, enhancing communication skills, heightening
self-awareness, increasing reality orientation, improving coping skills, and elevating

mood. In this eight-week program, besides song-writing, song-discussion, singing, and

14

instrument-playing, participants also received music with imagery and progressive
muscle relaxation treatment for their ease Of stress and anxiety. Like Shiraishi’s study
(1997), Whipple & Lindsey (1999) also selected music with guided imagery and
progressive muscle relaxation techniques for reducing participants’ anxiety and tension.
Most of participants reported a higher level of relaxation, better self-esteem, and more
positive feelings about their situations at the end of the program. Whipple and Lindsey
used a five-point Likert scale to obtain self-evaluation on relaxation levels afier every
session. The mean relaxation level is 4.33 on the five-point scale, implying that the
participants received relaxation after music interventions. This further underlines the
effectiveness of the combination of music and relaxation in stress management and
anxiety reduction. However, the music interventions for relaxation in those two studies
combined other elements, such as music assisted imagery and progressive muscle
relaxation. For instance, Shiraishi (1997) added facial-neck massage in her music
protocol. In Whipple & Lindsey’s eight-week program, song-singing, song-discussion,
and instrument-playing were listed, as well as the techniques of music assisted imagery
and progressive relaxation.

Hemandez-Ruiz (2005) designed a method of music listening paired with progressive
muscle relaxation as the music intervention for abused women in Shelters. Decreasing
abused women’s anxiety and sleep disturbance was the purpose of Hemandez-Ruiz’s
study. She argued that the high presence of anxiety in abused women often increased the
risk of Post-traumatic stress disorder (PTSD), which is categorized in anxiety disorders,
and that sleep disturbance is one of the serious symptoms of PTSD. The design was a

pretest-posttest with control and experimental groups for all measures. Hernandez-Ruiz

15

used the Pittsburgh Sleep Quality Index (PSQI) to evaluate quality of subjects’ sleep and
the STAI for adults to evaluate the changes of anxiety levels of the subjects. Before the
treatments, the research evaluated the subjects’ overall sleeping quality and divided them
into “G” and “B” groups (“G”- good sleep quality and “B”- bad sleep quality). The
subjects in these two categories also received number codes. The subjects with odd
numbers were assigned to control groups while those with even numbers were assigned
to experimental groups (G-odd and B-odd were control groups; G-even and B-even were
experimental groups). Every subject met with the researcher for five continuous Music-
paired Muscle Progressive Relaxation sessions. STAI was used to pre- and post-test the
subjects’ anxiety levels in the third and fourth sessions. Sleep quality was measured only
on the first day (pretest) and the last day (posttest day). On the first day of STAI measure,
both the control group and experimental group reported lower anxiety after the
intervention. However, there was a Significant difference in the two groups on the second
day of treatment: the control group decreased .5 degrees while experimental group
decreased 8.14 degrees on STAI scores. The result explicitly indicated that the music
intervention (music paired with relaxation technique) can positively reduce anxiety

levels.

16

Chapter Three
Method

Subjects

Thirty-two female graduate students (age range 23-42) who were in residence and
enrolled in masters or doctoral programs at Michigan State University served as subjects
for the study. All subjects were mentally healthy and did not take medications for
psychiatric disorders. The method of recruiting subjects was through posters and flyers
on the Michigan State University campus (see Appendix C).
Design and Procedure

The design of this study was a randomized control group design with pretest and
posttest measurement. The researcher divided subjects randomly into two groups. The
experimental procedure included two sessions. Including the instruction, the 20-minute
intervention and the time for filling out self-evaluation questionnaires, each session
consisted of approximately 40 minutes. In the first session, Group A received music
intervention as a treatment, while Group B received non-music intervention (subjects
were prompted to relax themselves). In the second session, the researcher switched
treatments for each group. Group B received music intervention while Group A received
non-music intervention. In order to minimize the effect from the last session, there was at
least one week between the first and second sessions. Because the researcher wanted the
subjects to be as relaxed as possible, they could choose to have the treatment either in the
Michigan State University Music Psychology Laboratory or in their own homes.

The procedure of each session consisted of pretest, treatment, and posttest. First, the

subjects in both groups completed the S-Anxiety scale of STAI Y-l and POMS forms

17

before the intervention. Also, the researcher measured every subject’s heart rate and
blood pressure with the blood pressure monitor (OMRON HEM-780) before and after
treatments. After the pretest for the group that received the music therapy intervention,
the subjects were asked to Sit or lie down and get into a most comfortable position. The
researcher asked the subjects to take several deep breaths and close their eyes. The
researcher also played the selected music and gave live verbal instruction reading the
script of imagery and muscle relaxation for the subject (see Appendix D). The whole
music-assisted relaxation lasted approximately 20 minutes. Likewise, the group with the
non-music intervention had the same procedure for the session; however, instead of
receiving music-assisted relaxation, they were asked sit or lie down into the most
comfortable positions and lie in Silence for 20 minutes. The researcher gave the verbal
prompt, “Please try to relax yourself during this 20-minute time” to subjects in control
group. Robb (2000) pointed out that individuals may have their own strategies for
relaxation; therefore, the treatment of silence was included in contrast to the music
condition. Lastly, while finishing the 20-minute treatment, the researcher immediately
requested every subject to fill out the S-Anxiety Scale of STAI Y and POMS forms as
well as had their heart rate and blood pressure measured again.
Materials

As previously stated, the intervention was a music—assisted relaxation procedure;
therefore, the researcher used a SONY ZS-SZiP CD player as the music medium.
Iwanaga & Moroki (1999) suggested that sedative music, which was categorized as slow
and melodic music, created a relaxing ambience, whereas stimulating music created vigor

and energetic moods. Their study for 60 undergraduate students compared the

18

physiological reaction and anxiety reports to different styles Of music. The results
suggested that students who listened to classical music or music they believed was
relaxing reported more relaxed states after listening. For the music stimulus, in the
current study, the researcher used the pieces “Cello Blue” and “Moming” from the album
Cello Blue by David Darling (2001). The music pieces were selected by the researcher, a
Board-Certified Music Therapist. The reasons for choosing the music selections were as
follows: (1) the pieces fit into the sedative category as described in previous studies, and
(2) they were selected to be complementary with the relaxation instruction. The verbal
instruction for the imagery and muscle relaxation followed a script that was adapted from
Goodwin’s (2004) guided imagery script and Scartelli’s (1989) suggestion for muscle
relaxation techniques (see Appendix D). An OMRON HEM-780 Automatic Blood
Pressure Monitor featuring ComF it Cuff was the device of measuring heart rate and
blood pressure.
Measurement

Because the main purpose of this study was to determine whether music interventions
can reduce female graduate students’ stress and anxiety levels and modify their mood
states, the State-Trait Anxiety Inventory Form Y (STAI) (Spielberger, Gorsuch, Lushene,
Vagg, &Jacob, 1983) and the Profile Of Mood States Short Form (POMS) (McNair &
Lorr, 1964) were used to assess the anxiety levels and mood states. The STAI Form Y is
the newer version of the original STAI Form X. It includes two main parts: the S-Anxiety
Scale and the T-Anxiety Scale. The S-Anxiety Scale comprises 20 statements that
evaluate how subjects feel “right now, at this moment”, and the T-Anxiety Scale consists

of 20 statements that assess how the subjects “generally” feel. According to the need of

19

measuring immediate feelings for this study, subjects only completed the S-Anxiety Scale
part for pretest and posttest. The STAI is a published and standardized scale that has been
extensively used for assessing the level of anxiety in scientific studies. Shiraishi (1997),
Burns et al. (2002), and Hemandez-Ruiz (2005) all used STAI to evaluate the
participants’ anxiety levels. Hence, considering its validity and reliability, it is an
appropriate measure for anxiety levels in this study.

Besides STAI Y form, Profile of Mood States (POMS) Short Form was another self-
report measurement in this study. The POMS Short Form is a 30-item Likert scale with a
5-response option (0-not at all; l-a little; 2-moderately; 3-quite a bit; 4-extremely). The
scale measures are composed of the six following factors: tension-anxiety, depression—
dejection, anger-hostility, vigor-activity, fatigue—inertia, and confusion-bewilderment.
Each factor consists of five items. The reliability of POMS consists of stability
coefficients from 0.43-0.74 and internal consistency (alpha coeffiéients) ranging between
0.87-0.95 (McNair & Lorr, l964). Also, Wipple and Lindsey (1999) and Lai (1999)
evaluated subjects’ mood states with POMS in their study. Thus, this study used POMS
as an instrument to measure the subjects’ emotions.

In additions to the self-reported scale discussed above, the researcher measured
subjects’ heart-rate. Iwanaga and Moroki (1999) suggested that physiological responses
(heart-rate, respiration, and blood pressure) change due to listening to different types of
music. The results of their study indicate that sedative music induced or relaxed feelings
and lowered physiological activities. Furthermore, as stated previously, stress reaction is
associated with physiological arousals. Burns et al. (2002) also suggest that Slow music is

usually correlated with lower physiological responses. Consequently, heart-rate and

20

blood pressure were categories of measurement for stress, and the pretest and posttest
were recorded on the physiological state sheets.
Statistical Analysis

The researcher collected STAI scores, POMS scores, blood pressure and heart-rate on
pretest and posttest as the data. A paired-samples T-Test was used to compare the
differences between scores and heart—rate of each group’s pretest and posttest. The
analysis was conducted with SPSS 15.0.1 computer software for Microsoft. The
significance level was set at pg .05.

Both STAI and POMS consist of positive questions (i.e. STAI: I feel happy; POMS:
content) and negative questions (i.e. STAI: I feel strained; POMS: Muddled); therefore,
the final scores of each test used the sum of positive question scores to subtract the sum
of negative question scores. The more the final score indicated the better anxiety
reduction and the better mood modification.

As stated, this study consisted of two sessions: (1) Group A with MAR and Group B
with non-music treatment; and (2) Group A with non-music and Group B with MAR. The
researcher combined the two sub-MAR sessions (Group A/ MAR and Group B/MAR) to
form an entire MAR experimental group, as well as, combining the two sub-sessions of
non—music sessions to form a control group in the analysis. The rationale of combining
these two parts were: (1) the order was controlled for this study, and it was not an
independent variable in the design, (2) the subjects were randomly selected, knowing
they would receive music therapy in one of two sessions, (3) the two sessions were at
least one-week apart to minimize the effect from the last session, and (4) the interest of

this study focused on how music therapy effected the stress/anxiety reduction.

21

Chapter Four
Results

The data were analyzed with paired-sample t-tests to compare the differences
between music-assisted relaxation and non-music treatment for women graduate students
using two dependent variables: (1) stress/anxiety levels and (2) mood modulation.
Demographic Information

Of the 32 women who participated in this study (mean age: 28), two subjects who
finished the MAR session and did not return for the non—music treatment. Forty percent
of the subjects were enrolled in masters programs while sixty percent of them were in
doctoral programs. F orty-four percent of the subjects were in music-related professions
(i.e. music therapy, music performance, and music composition). Fifty percent of subjects
were in non-music professions. Four different ethnic backgrounds were represented:
12.5% were White/Caucasian, 3.1% were African-American, 9.4% were Hispanic/Latin,
and 75% were Asian/Pacific Islander. The marital status of the subjects was as follows:
12.5% were manied and 87.5% were single. Only three percent indicated that they have
children. F orty-seven percent of the subjects had a either full-time or part-time job
besides school, while fifty-three percent were full-time students.
State Trait of Anxiety Inventory (ST AI) Y -1 Form

A paired-samples t-test was conducted to test the differences between pre-tests and
post-tests of both MAR and non-music treatments. Both mean scores of MAR and non-
music sessions numerically increased after the treatments (see Figure l). The pretest and

posttest are displayed in Table 1.

22

Table l.

Pretest and Posttest Means of Music-Assisted Relaxation and Non-Music Treatment on
S TAI

 

Mean N SD Std. Error Mean
MAR Pretest 10.00 32 13.61 2.41
Posttest 21.06 32 7.99 1.41
NON Pretest 8.37 30 11.13 2.03
Posttest 12.90 30 10.14 1.85

Note. MAR= music-assisted relaxation. NON= non-music treatment

Figure 1.

Pretests and Posttests of MAR and Non-Music Interventions on S T AI

 

30
I
20"- l
11 ,
10—‘ i

-10-

 

 

ti
_—_1
fig

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-20 -i

 

~30"

 

 

 

 

I l I I
PRE_MAR POST_MAR PRE_Non-Musrc POST_Non-Music

23

The differences between the results of the MAR and Non-Music sessions were
compared to see if the two treatments resulted in different STAI scores. There was
Si gnificant differences between the music-assisted relaxation and non-music treatment

(see Table 2, Table 3, and Figure 2).

Table 2.

The STAI Gain Scores of MAR and Non-Music Treatment

 

Std.

Error

Mean N SD Mean
STAI_Diff_MAR 1 1.67 30 10.35 1.89
STAI_Diff_NON 4.53 30 6.73 1.23

Note. MAR: music-assisted relaxation. NON= non-music treatment.

Table 3.

Paired T - T est for the Differences Between MAR and Non-Music Treatment on S T AI
=

Paired Differences

 

 

 

95% Confidence
Std. lngegal of the
Error ' erence Sig.
Mean SD Mean Lower Upper t df (2-tailed)
STAI_Diff_MAR - ,
STAI_Diff_NON 7.13 10.49 1.92 3.21 11.05 3.72 29 .001

Note. MAR: music-assisted relaxation. NON= non-music treatment. 'p< .05

24

Figure 2.

Differences of S T AI Changes with MAR and Non-Music Interventions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50—i
8
O
40—
30-4
8
20-< O
10— L
o— i
— 1 0 -d
F I
STAI_Drfi_MAR STAI_DIH_Non-mu5icl

25

Profile of Mood States Short Form

There are six factors in POMS: tension-anxiety, anger-hostility, depression-dejection,
vigor, fatigue, and confusion. The differences of pretest and posttest scores in two
treatments were compared with a paired-samples t-test.

Music-assisted relaxation treatment

The pretest and posttest means of the six factors on POMS with MAR treatments all

presented in Table 4. In tension-anxiety

Table 4.

Pretest and Posttest of POMS with Music-Assisted Relaxation Treatment

 

Std. Error
Mean N SD Mean

TA Pretest -3.75 32 3.39 .60
Posttest -.81 32 1.18 .21

AH Pretest -2.25 32 3.24 .57
Posttest -.53 32 1 .02 .18

DD Pretest -4.63 32 5.19 .92
Posttest -1 .59 32 1.90 .34

V Pretest 5.72 32 4.03 .71
Posttest 7.88 32 5.01 .89

F Pretest -5.59 32 4.39 .78
Posttest -1 .22 32 1 .48 .26

C Pretest -3.75 32 3.67 .65
Posttest -1 .72 32 2.13 .38

Note. TA: Tension-Anxiety. AH: Anxiety-Hostility. DD= Depression-Dejection. V= vigor. F: Fatigue. C=
Confusion.

26

Non-music treatment
The pretest and posttest scores of six factors on POMS with non-music treatments are

presented in Table 5.

Table 5.

Pretest and Posttest Scores of Non-Music Treatment on POMS.

 

 

Std. Error
Mean M SD Mean
TA Pretest -4.10 30 3.70 .68
Posttest -2.43 30 2.57 .47
AH Pretest -2.70 30 4.32 .79
Posttest -.97 30 1.65 .30
DD Pretest -4.53 30 4.69 .86
Posttest -2.60 30 2.75 .50
V Pretest 6.43 30 3.95 .72
Posttest 5.57 30 3.68 .67
F Pretest -5.67 30 4.04 .74
Posttest -1.67 30 1.92 .35
C Pretest -3.67 30 3.40 .62
Posttest ~2.07 30 2.07 .38

w
Note, TA= tension-anxiety. AH= anger-hostility. DD= depression-dejection. V= vigor. F= fatigue. C= confusion

27

Difference between MAR and non—music treatment

The means of gain scores on POMS of the MAR and non-music treatments are shown
in Table 6. In tension-anxiety factor, the mean score increased 3.07 with MAR while the
mean score only increased 1.67 with the Non-Music treatment. In vigor factor, the mean
score increased 2.47 with MAR whereas the mean score decreased .87 with Non-Music

treatment.

Table 6.

Mean Differences Between MAR and Non-Music Treatment on POMS

 

Std. Error
Mean N SD Mean
TA Diff_MAR 3.07 30 3.23 .59
Diff_NON 1 .67 30 2.50 .46
AH Diff_MAR 1.83 30 2.91 .53
Diff_NON 1.73 30 3.31 .60
DD Diff_MAR 3.13 30 4.33 .79
Diff_NON 1 .93 30 2.92 .53
V Diff_MAR 2.47 30 3.62 .66
Diff_NON -.87 30 3.28 .60
F Diff_MAR 4.60 30 3.91 .71
Diff_NON 4.00 30 3.70 .67
C Diff_MAR 2.10 30 3.01 .55
Diff_NON 1.60 30 2.95 .54

Note. TA= Tension-Anxiety. AH: Anxiety-Hostility. DD= Depression-Dejection. V= Vigor. F: Fatigue. C=
Confusion.

The differences between MAR and non-music treatments were compared using
paired-samples t-test. Significant differences between MAR and non-music treatment

were only found for the tension-anxiety and vigor factors (see Table 7 and Figure 3).

28

Table 7.

Paired T -T est for the Changes Between MAR and Non-Music Treatment (POMS)

Paired Differences

 

 

 

95%
Confidence
Std. Inga/a! of the
Error ' erence Sig.
Mean SD Mean Lower Upper t df (2-tailed)
MAR V's' Tens'on'Anx'et’ 1.40 3.30 .60 .17 2.63 2.33 29 * .027
NON
Anger—Hostility .10 2.84 .52 -.96 1.16 .19 29 .849
Defreis'on‘ 1.20 3.97 .72 -.28 2.68 1.66 29 .108
Dejection
Vigor 3.33 4.64 .85 1.60 5.07 3.93 29 * .OOC
Fatigue .60 4.02 .73 -.90 2.10 .82 29 .421
Confusion .50 3.35 .61 -.75 1.75 .82 29 .420

Note. MAR: music-assisted relaxation. NON= non-music treatment. *p < .05

Figure 3.

Dijferences of Changes in POMS Between MAR and Non-Music Treatment

 

 

 

 

20-1
1 6 1
8 * O
1 5-n O 1
*-
1 O * 8 1 I O 8
O32 1 6 * 1 7
I o 22
5—I B {I 01 g I .
0— é
-5 —II
-1 O —
l I I I I I I ‘ F I r I
TA_ TA_ AH_ AH_ DD DD_ V_ V__Non F_ F_Non C_ C_Non
MAR Non MAR Non MAR Non MAR MAR M R

Note. TA= Tension-Anxiety; AH: Anger-Hostility; DD= Depressron- Dejcction; V: Vigor: F= Fatigue; C= Confusion;
MAR= Music-Assisted Relaxation; NON= non-music treatment.

29

Blood Pressure and Heart Rate

Music-assisted relaxation treatment

The pretest and posttest scores systolic blood pressure (BP), diastolic BP, and heart
rate (HR) with MAR treatments are shown in Table 8. Systolic BP decreased by 4%,
diastolic BP decreased by 3%, and HR decreased by 10%, but none of these changes

were significant.

Table 8.

Pretest and Posttest on BP and HR with MAR

 

Mea h SD Std. Error Mean

Systolic Pretest 102.31 32 1 1.39 2.01
3'” Posttest 98.38 32 12.73 2.25
Diastolic Pretest 66.72 32 8.74 1.55
3P Posttest 64.66 32 9.41 1.66
HR Pretest 76.50 32 9.37 1 .66
Posttest 71 .34 32 9.43 1 .67

Note. MAR: music-assisted relaxation. BP= Blood Pressure. HR= Heart Rate

Non-music treatment
The pretest and posttest scores of systolic BP, diastolic BP, and HR with the non-
music treatment are shown in Table 9. Systolic BP decreased by 2%, diastolic BP

decreased by 0.3%, and HR decreased by 3.7%.

30

Table 9.

Pretest and Posttest on BP and HR with Non-Music Treatment

 

Mear N SBtd. Error Mean
Systolic Pretest 103.03 30 12.61 2.30
3" Posttest 101.03 30 12.20 2.23
Diastolic Pretest 67.23 30 9.62 1.76
BP Posttest 67.03 30 8.90 1 .62
Heart Pretest 74.87 30 8.95 1 .63
Rate Posttest 72.13 30 9.09 1 .66

Note. BP= Blood Pressure. HR= Heart Rate

Differences between MAR and non-music treatments

The differences of the changes of the three physiological states between the two

treatments were compared by a paired-samples t-test. There were no significant

differences found between the two treatments (see Table 10).

Table 10

T - T est for the Changes of BP and HR in MAR and Non-Music Treatments

Paired Differences

 

 

95%
Confidence
nterval of the
Difference
Std. Std. ErrorLowe Sig.
Mean Deviation Mean r Upper t df (2-tailed)
Pair 1 Systolic_Change_Ml
Systolic_Change_NC -1.63 10.05 1.83-5.38 2.12 -.89 29 .381
Pair 2 Diastolic_Change_M.
Diastolic_Change_Nt -2.03 9.48 1.73-5.57 1.51 -1.17 29 .250
Pa'r3HR-Change-MAR"-2.33 8.45 1.54-5.49 .82 -1.51 29 .141

Change_NON

Note. The means = mean MAR change — mean Non-Music change. P* < .05

31

Chapter Five
Discussion

This purpose of this study was to compare the effects of music-assisted relaxation and
non-music interventions on female graduate students’ stress and anxiety levels. Self-
report measures for stress/anxiety and mood, and physiological changes (blood pressure
and heart rate) were evaluated before and after every session. Previous studies examined
whether music therapy helped decrease stress/anxiety levels for either women with
clinical psychological disorders, abused women in shelters, or high-risk inner-city
women. However, this study aimed at the population of women graduate students with
generally good health in order to learn whether music therapy can facilitate stress/anxiety
management in their stressful lives.
Findings and Previous Studies

STAI and POMS results are in line with previous studies. According to the STAI Y
scores, although both the MAR and non-music sessions showed numerically higher mean
scores after the interventions, the MAR treatment significantly reduced the subjects’
stress/anxiety levels more than the non-music treatment (see Table 3 on the page 25). The
mean scores of the six factors on POMS all numerically increased after the MAR sessions
(Table 4 and Table 6 on page 25 and 27). The significant differences were found in
tension-anxiety and vigor factors between MAR and non-music treatments (Table 7). All
physiological arousals decreased more in MAR treatments than non-music treatments,
although there was no significant difference (Table 10 on page 30). For the factor of
reducing stress/anxiety levels with music therapy treatments, the findings of this study

matched Hammer (1996) as well as Robb, Nicoles, Rutan, Bisho, and Parter( 1995).

32

Hammer reported significant reduction of stress/anxiety levels after ten Bonny Method
Guided Imagery and Music sessions. This study incorporated Music-Assisted Relaxation
techniques including imagery into the treatment; this supports the effectiveness of music
and imagery for stress/anxiety reduction. Robb, Nicoles, Rutan, Bisho, and Parker (1995)
used music therapy to help alleviate stress for pre-operative patients. In their study, the
music interventions were comprised of music listening, deep diaphragmatic breathing,
progressive muscle relaxation, and imagery. The findings of this study suggested that a
music therapy intervention that integrated music, imagery, and progressive muscle
relaxation was helpful for reducing stress/anxiety levels. Therefore, the results of the
current study were consistent with their finding that music-assisted relaxation
intervention significantly decreased the subjects’ anxiety levels.

Shiraishi (1997) developed a six-stage, home-based music therapy program, which
also integrated imagery and progressive muscle relaxation, for multi-risk mothers who
lived in a Midwestern inner-city. The subjects reported better mood states and
stress/anxiety reduction after the music therapy program. Wipple and Lindsey (1999)
suggest that music therapy (incorporating music, imagery, and progressive muscle
relaxation) was effective in managing battered women’s stress and reduce their anxiety
levels. Hemandez-Ruiz (2005) studied music-assisted progressive muscle relaxation for
abused women in shelters, and her findings also support that music therapy improves
sleep quality as well as reduces anxiety levels. All the three studies concluded that music
therapy was effective in reducing anxiety levels in women. Hence, this study further
supports earlier findings that music therapy, which integrates music, imagery, and

progressive muscle relaxation, can help reduce stress/anxiety, as well as positively

33

modulate mood states in women. However, the previous studies have examined the
effectiveness of music therapy for stress/anxiety and emotional modulation for women
who had psychological disorders or for high-risk women with unstable living conditions.
This study focused on female graduate students’ with generally good psychological and
physical health. Since this study has shown positive improvement for stress/anxiety
reduction and mood modification after music-assisted relaxation treatments, the findings
may indicate that music therapy also facilitates female graduate students’ stress
management and anxiety reduction.
Interpretations and Implications of the Results

STAI Y form

MAR treatment reduced significantly more than the non—music streatment. The
subjects showed substantial receptivity to the MAR treatment and were able to become
engaged in the intervention to enhance their stress/anxiety reduction. It was observed that
most of the women had already developed their own strategies to manage their stress and
anxiety. As previously stated, female graduate students’ stressfiil lives can be filled with
school, work, and family. It is not uncommon to hear from women graduate students in
general, things such as, “My class starts at 6:00pm; that is just a half hour after I get out
of my work!” or “I need to pick up my daughter from school and drop her at the dance
class right before the group meeting. Sorry, I probably will be late.” With a “non-stop”
life like this, female graduate students tend to have limited time for themselves.

POMS short form

On POMS, with MAR treatment, there were significant differences found in tension-

anxiety and fatigue factors (see Table 4 on page 26 and Table 6 on page 28). With non-

34

music treatment, the gain scores Of tension-anxiety, depression-dejection, fatigue, and
confusion factors numerically increased as well, although the mean score of vigor factor
decreased (see Table 5 on page 27 and Table 6 on page 28). To compare the effectiveness
of the two treatments, the MAR treatments resulted in significant differences in tension-
anxiety and vigor subsections. Although the differences in the depression-dejection
subsection were not significant, the mean scores of MAR treatments was greater than the
non-music treatment when compared to the other factors (see Table 7 on page 29). MAR
treatments had greater effectiveness in modulating the subjects’ mood factors of tension-
anxiety & vigor than the non-music treatment. The significant difference between the two
treatments in tension-anxiety also duplicated the results on STAI that the MAR
treatments had better outcomes for stress/anxiety reduction. The significant difference
found in the vigor factor indicated that the MAR treatments helped female graduate
students’ increased their vigor while resting on their own did not.

Blood pressure and heart-rate

As stated previously, a person who experiences stress/anxiety may have physiological
arousals, such as higher blood pressure, faster hear-rate, cold skin, and higher stress
hormonal levels (Myer, 2004; Nevid, Rathus, & Greene, 2005). In this study, the systolic
BP, diastolic BP, and heart-rate were measured to examine whether the music therapy
treatments helped reduce short-term physiological arousals. There were no significant
differences found in the reductions of blood pressure and heart—rate between the two
treatments. However, with the MAR treatments, the mean of heart-rate numerically
decreased greater than it did with the non-music treatment, whereas systolic BP and

diastolic BP only had no differences (see Table 10 on page 30). This study only evaluated

35

the outcomes of a one-time treatment, and normally physiological states are associated
with long-term life styles, especially blood pressure. Also, as a general rule, change will
Show up on psychological tests sooner than it will on physiological measures.
Conclusion
The findings of this study suggest that music-assisted relaxation composed of music

listening, imagery, and progressive muscle relaxation may facilitate female graduate
students’ stress/anxiety reductions. The findings also suggest that the music therapy
intervention may modulate female graduate students’ mood states in a positive way,
particularly in decreasing tension-anxiety and increasing vigor and energy. Therefore,
this may suggest education institutes that providing music therapy service for women
graduate students may be beneficial to promoting their health and quality of life while
pursuing advanced educations.
Suggestions for Future Studies

Since this study only evaluated the outcomes after one treatment, it might be difficult
to determine how this music intervention would affect long-term psychological and
physical health for this population. Another factor which could have affected the outcome
of this study was that 75% of the subjects were Asian/Pacific Islanders, and most of them
speak English as a second language. Since the implementation and measurement of this
study was in English and involved the subjects’ understanding of the verbal instruction
and self-evaluation questionnaires, this might affect the outcomes of this study.
Therefore, using versions of relaxation scripts and questionnaires in the subjects’ native
languages might produce a different outcome. Blood pressure and stress/anxiety levels

might vary at different times, due to various events (i.e. midtenns, papers, presentations,

36

or finals); various outcomes may be obtained because of this issue. In future studies it

may be wise to use stressful life events as a covariate when using physiological measures.

37

APPENDICES

38

MICHIGAN STATE

UNIVERSITY

December 7, 2007

To: Frederick TIMS
School of Music
201 Music Practice Building

APPENDIX A

Initial IRB
Application
Approval

Re: IRB# 07-1021 Category: EXPEDITED 4, 7

Approval Date: December 7, 2007
Expiration Date: December 6, 2008

Title: Music and Women's health: The effect of music-assisted relaxation on women graduate students'

stress and anxiety levels

The Institutional Review Board has completed their review of your project. I am pleased to advise you that your

project has been approved.

The committee has found that your research project is appropriate in design, protects the rights and welfare of
human subjects, and meets the requirements of MSU's Federal Wlde Assurance and the Federal Guidelines (45.
CFR 46 and 21 CFR Part 50). The protection of human subjects in research is a partnership between the IRB
and the investigators. We look forward to working with you as we both fulfill our reSponsibllities.

Renewals: IRB approval is valid until the expiration date listed above. If you are continuing your project, you
must submit an Application for Renewal application at least one month before expiration. If the project is
completed, please submit an Application for Permanent Closure.

Revisions: The IRB must review any changes In the project, prior to initiation of the change. Please submit an
Application for Revision to have your changes reviewed. It changes are made at the time of renewal, please
include an Application for Revision with the renewal application.

Problems: lf issues should arise during the conduct of the research, such as unanticipated problems, adverse
events, or any problem that may increase the risk to the human subjects, notify the IRB office promptly. Forms

are available to report these issues.

Please use the IRB number listed above on any forms submitted which relate to this project, or on any

correspondence with the IRB office.

Good luck in your research. If we can be of further assistance, please contact us at 517-355-2180 or via email
at IRB@msu.edu. Thank you for your cooperation.

Sincerely,

7%,;

Peter Vasilenko, Ph.D.
SIRB Chair

c: CHANG-CHI MUSETTA FU
1643 Spartan Village

39

APPENDIX B

Participant Consent Form
“Music-assisted Relaxation and Women 's Health "

PURPOSE OF RESEARCH:

You are being asked to participate in a research project in the College of Music, Michigan State
University. You have been selected as a possible participant in this study because you are an
enrolled graduate student at Michigan State University. From this study, the researcher hopes to
learn whether music-assisted relaxation can help reduce women graduate students’ stress and
anxiety levels. 30 people are being asked to participate in this study. Your participation in this
study will take about one hour. If you are under 18, you cannot be in this study without parental

permission.
WHAT YOU WILL DO:

' You will need to schedule two one-hour appointments with the researcher and arrive for the
appointments on time. The procedure will take place in either the College of Music Psychology
Laboratory or your place, according to your decision. You will be asked to fill out two evaluation
forms before and after the music-assisted relaxation procedure; as well, your heart rate and blood
pressure will also be taken before and after the procedure in each session (total 4 times).

POTENTIAL BENEFITS:

Your participation in this study may contribute to the understanding of stress management in
music therapy.

POTENTIAL RISKS:

The study includes music-assisted imagery. Since individuals have different perceptions of
music, occasionally some unpleasant emotions and feelings may be induced during the
procedure. However, the researcher is a Board-Certified Music Therapist with special training on
how to deal with this situation.

PRIVACY AND CONFIDENTIALITY:

All information for this project will be kept confidential Although you will be asked to provide
demographic information on the questionnaire forms, all the documents including those with the
personal information and responses to the questionnaires will be coded with numbers to protect
your privacy. Your name will not be on any questionnaire or form. The only parties that can
access the information are the researcher and research staff and the institutional review board in
order to secure the confidentiality of personal information. The data will be maintained, without
any personal identifiers, for 3 years after completion of the study. Your confidentiality will be
protected to the maximum extent allowable by law.

This consent form was approved by the Social Science/BehaviorallEdueation Institutional Review Board (SIRE) at Michigm State
University. Approved 1217/07 - valid Waugh 12!6i08. This version supersedes all previous versions. lRB if 07-1076.

40

YOUR RIGHTS TO PARTICIPATE, SAY NO, OR VVITHDRAW

Participation in this research project is completely voluntary. You have the right to say no. You
may change your mind at any time and withdraw. There will be no negative consequences of
withdrawal or incomplete participation. You may choose not to answer specific questions or to
stop participating at any time. Choosing not to participate or withdrawing from this study will
not make any difference in the quality of any services you may receive and benefits to which you
are otherwise entitled. Whether you choose to participate or not will have no affect on your grade
or evaluation in any course you may be taking. You will be told of any significant findings if you
request the experimenter to provide such findings to you.

COST AND COMPENSATION FOR BEING IN THE STUDY

Procedures being performed for research purposes only will be provided fiee of charge by the
researchers. You will receive a free audio CD composed of music therapy interventions for stress

management at the end of your participation.
CONTACT INFORMATION FOR QUESTIONS AND CONCERNS

If you have any questions about this study, such as scientific issues, how to do any part of it, or
to report an injury, please contact one of the following:

Dr. Frederick Tims, PhD, MT-BC Chang-Chi Musetta Fu, MT-BC
Professor and Chair of Music Therapy Area Music Therapy Graduate Student
Michigan State University Michigan State University

201 Music Practice Building 1643 Spartan Village, Apt .1

East Lansing, MI 488241] East Lansing, MI 48823

Phone: 517-353-98560 Phone: 734-330-8003

Email: tims@gu.edu Email: fccmuse@msu.edu

 

If you have any quesn'ons about your role and rights as a research participant, or would like to
register a complaint about this study, you may contact, anonymously if you wish, the Director of
MSU Human Research Protection Programs, Dr. Peter Vasilenko, at 517-355-2180, FAX 517-
432-4503, or email irb@msu.edt_r, or regular mail at: 202 Olds Hall, MSU, East Lansing, MI
48824.

DOCUMENTATION OF INFORMED CONSENT:

Your signature below means that you voluntarily agree to participate in this research study.

 

 

Signature Date

You will be given a copy of this form to keep.

This consent form was approved by the Social SclencelBehavioraVEduealion institutional Review Board (SIRE) at Michigan State
University. Approved 12i7l07 - valid through 12l6/08. This version supersedes all previous versions. iRB it 07-1076.

41

APPENDIX C

SIIIIIr lite Stressful?

Do you want to learn a technique to manage your STRESS??

 

Here is an OPPORTUNITY to learn how ml- SIC help you
maintain your wellnessll

If you are. ..
o A woman graduate student
0 Interested in learning and receiving stress management in a
musical way

Please feel free to contact ...... éfil
‘Wl
if my l
r): Chang-Chi Musetta Fu, MT-BC

Music Therapy Graduate Student
The College of Music
Michigan State University

42

APPENDIX D
Relaxation Script

Begin by taking in a deep breath... Now, as you exhale, let your eyes close... Feel that
this time is just for you.

Take three deep breaths. Feel as if you are releasing all the thoughts and tension of the
day when you breathe out. .. Allow your abdomen to expand when you breathe in and
contract when you breathe out. Let go of tension and tightness as you exhale.

Breathe in... and breathe out. .. Expend your stomach... and contract your stomach...
Breathe in... and breathe out. ..

To enter into a deeper state of relaxation, you will soon tense the entire muscular system
until your whole body is tense. Then you will exhale and relax all at once.

Shift your attention to your feet... Curl your toes and feel tension spread into your legs.
Press your knees together and feel the tightness in your thighs. Squeeze your buttocks
and tighten your pelvic area. Make two fists and feel the tension spread into your arms.
Raise your shoulders and create tension in your stomach and chest. Tense your jaw and
gently squeeze your eyes shut. Experience tension all over your body.

Now exhale and let your body relax all at once... Let go and unwind... Feel the warmth
and heaviness of deep relaxation penetrate your muscles. Feel your muscles releasing...
letting go... unwinding. ..

Relax the comers of your mouth... Allow your jaw to drop... allow your neck to be so
relaxed that a gentle breeze blowing through the room would rock your head from side to

side.

Lower your shoulders... relax your hands, turning your palms up... Relax your forearms
and upper arms.

Allow your chest to sink down deep into the floor or chair... Let your stomach be so soft
that it gently expands when you breathe in and contracts when you breathe out, receiving

each breath freely. Allow your hips and buttock muscles to let go and unwind.

As you sink down deeper into relaxation, let go of your thighs and legs... Let your knees
separate Relax your feet and toes... Relax your whole body. . ..

Keep breathing smoothly and slowly ......... Allow your self to be surrounded by the

music.

Now you are about to take a journey. ..

43

Imagine that you are walking through a meadow... a meadow with deep, washed-out
colors. Notice the path underfoot... feel what it is like... hear the sounds as your take
each step, one by one... Looking around, you see a field to one side... and a wide creek
on the other.

As you continue walking, become aware of the sun shining on you... feel its radiance...
its warmth... the heat is gentle... and welcoming. You feel safe being here.

As you look to one side, you begin to pay attention to the water in the creek... Hear the
sounds of the water... See the water... Feel yourself walking over to it... step by step...
feeling the ground beneath your feet.

Standing beside the creek, you kick off your shoes and step into the water and feel its
coolness against your skin... The water surrounds your feet. Sink your feet and toes into
the sandy creek bottom.

Feel the water’s wetness and its coolness. Feel your connection to the earth through your
feet... Wiggle your toes... Feel the earth’s power... the energy Now feel the water
line... Feel the energy and power beneath your feet.

Now let the feeling of the earth’s energy come up from your feet to your legs. . to your
knees... then spread to your hips and torso... from your hips and torso past your heart
and all the way to your shoulders... Now it moves down your arms to your fingertips...
and back up your arms to your shoulders... neck, face, and head.

Feel the energy going back down your body... slowly and easily... Feel the energy
flowing all around.

Once again, let the energy come from the earth and up through your body... like a
fountain... sprinkling the energy through the top of your head and showering you all
over. . .sprinkling on you all over...

Now look at the water... See the sparkles... the reflections... Watch the water as it
passes by... Feel and see the movement... Hear it.

Look up the creek and watch the water flow past you... realize where the water has been
and where it is going as it circles the entire earth and be part of it.

Looking up, you see the trees and the leaves blowing in the breeze... Now pick out one
tree and gaze upon it... Notice its Size. .. its age... See its branches and leaves... Look up

overhead and see the sky... its magnificent color... its beautiful clouds.

Now feel the energy from the sky traveling down from the heavens, through the top of
your head... through your heart and down to your feet... across the earth and up to your

44

 

tree... back from your tree across the earth... through your
feet. . .legs. . .torso. . .heart. . .head and back up to the sky... Feel the flow of energy.

Feeling your connection with the heavens... take it all in... soak it up (enjoy it)...
Pause for 1 minute

Draw your attention back to standing in the creek... step by step, walk out of the water...
put your shoes on... and now walk back down the path... and through the meadow.

Notice how refreshed and grounded you are.

Take a full deep breath... all the way in... slow and easy... and all the way out... Each
time you breathe, you feel more and more alive... more and more alert...

Pa use

When you are ready... begin to stretch and move... and open your eyes.

45

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