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Music, Health, and Wellbeing$

Raymond MacDonald, Gunter Kreutz, and Laura Mitchell

Print publication date: 2012

Print ISBN-13: 9780199586974

Published to Oxford Scholarship Online: May 2012

DOI: 10.1093/acprof:oso/9780199586974.001.0001

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Psychoneuroendocrine Research on Music and Health: An Overview

Psychoneuroendocrine Research on Music and Health: An Overview

Chapter 30 Psychoneuroendocrine Research on Music and Health: An Overview
Music, Health, and Wellbeing

Gunter Kreutz

Cynthia Quiroga Murcia

Stephan Bongard

Oxford University Press

Abstract and Keywords

This chapter examines the influences of musical activities such as listening, singing, or dancing on the endocrine system. The underlying assumption is that psychological processes associated with musical experiences lead to changes in the hormonal systems of brain and body. It begins with a brief introduction to general questions of psychoneuroendocrinology as well as to relevant hormonal systems, followed by an overview of empirical studies, which have begun to investigate hormonal responses to musical stimulation and musical activities. The chapter concludes with suggestions for future work that will be derived from initial evidence showing that music can be seen as a psychoactive stimulant inducing physiological effects that are sometime similar to those produced by pharmacological substances.

Keywords:   musical activities, endocrine system, psychological processes, musical experience, hormonal changes, psychoneuroendocrinology

In this chapter, we examine the influences of musical activities such as listening, singing, or dancing on the endocrine system. The underlying assumption is that psychological processes associated with musical experiences lead to changes in the hormonal systems of brain and body. A brief introduction to general questions of psychoneuroendocrinology as well as to relevant hormonal systems is followed by an overview of empirical studies, which have begun to investigate hormonal responses to musical stimulation and musical activities. The chapter concludes with suggestions for future work that will be derived from initial evidence showing that music can be seen as a psychoactive stimulant inducing physiological effects that are sometimes similar to those produced by pharmacological substances.

How does human experience, thought, and action influence individual health and wellbeing? What are the relationships between psychological aspects such as moods, emotions, and social interactions on the one hand, and prevention, treatment, and therapy of mental and physical disorders on the other? Which mechanisms offer the best explanations of these interactions? These questions are traditionally addressed in disciplines including psychology, neurobiology, endocrinology, immunology, neurology and psychiatry. Interrelated interests in these fields have led to the emergence of a new branch of medical sciences called psychoneuroendocrinology (PNE).

PNE is concerned with the interactions between psychological and behavioural processes on the one hand, and neurohumoral and somatic processes in brain and body on the other (e.g. Campeau et al. 1998). Theories of PNE assert that mental or physical stress can induce releases of hormones and modulations of immune functions. PNE research addresses a wide range of topics ranging from psychiatric illness and syndromes that are associated with (severe) stress experiences (e.g. Vingerhoets and Assies 1991) to more positive experiences such as, the neurobiology of love (e.g. Uvnas-Moberg and Carter 1998). While responses to aversive stimuli appear to have dominated to some extent (e.g. Levine and Coe 1999), in recent years, a general increase of interest in more positively stimulating experimental contexts in relation to health and wellbeing can be observed (e.g. Frederickson 2004; Steptoe et al. 2005).

Hormonal stress responses are mainly regulated by three interrelated systems: the hypothalamic–pituitary–adrenocortical axis (HPA), the sympatho-adrenomedullary system, and the endogenous opioid system (Bongard et al. 2011).

The HPA axis involves brain and peripheral structures: the hypothalamus, the pituitary, and the cortical part of the adrenals. A cascade of activation on this axis is initiated by the release of the corticotropin releasing factor (CRF) from the hypothalamus. CRF leads to subsequent release of adrenocorticotropic hormone (ACTH) and beta (β)-endorphin from the pituitary into the circulation. ACTH then stimulates the synthesis and release of cortisol and to a much lesser extent (p.458) testosterone from the adrenal cortex (Breedlove et al. 2007). Though usually not considered as part of the HPA, oxytocin is also released in the hypothalamus and pituitary. Research indicates that is able to buffer stress responses (Heinrichs et al. 2003).

The sympatho-adrenomedullary system is part of the sympathetic nervous system which serves numerous functions including the preparation of the organism in regulating and executing fight or flight responses. When this system is activated by physical or psychological stress, norepinephrine is centrally released by the locus coeruleus. Additionally sympathetic innervations of the medulla of the adrenal glands lead to secretion of catecholamines (epinephrine, norepinephrine, dopamine). Since this system operates by nervous stimulation of the andrenal medulla it responses much faster than the HPA which is regulated by hormonal processes.

The third system related to neuroendocrine stress regulation is the endogenous opioid system. This system seems to be directly related to the HPA axis. Pharmacological blockades of opioidergic inhibitory inputs to the hypothalamic neurons specialized in releasing CRF leads to increased ACTH and cortisol concentrations in the blood (Wand and Schumann 1998).

In sum a variation in physical, mental or emotional challenges produces or prevents a complex orchestra of neurohumoral responses. None of the responses is specific to one kind of challenge and their response delays vary to a great deal.

Music psychology and PNE

The field of music psychology encompasses a wide range of musical behaviours (e.g. Thompson 2009). Listening to music is arguably the most widespread musical activity. It is also present in other musical behaviours such as singing, playing musical instruments, or dancing. There is wide agreement that music listening involves different levels of processing (e.g. Deutsch 1999). From the perspective of auditory perception, there are lawful relations between physical sound properties on the one hand, and perceptual phenomena such as pitch, loudness, and duration (e.g. Fastl 2006) as described in the field of psychophysics. At this level, perception of music supposedly relies on similar mechanisms that are required for processing speech and environmental noise. In fact, whether music processing at this or higher levels of cognitive processing is based on patterns of brain activities that can be clearly associated with or dissociated from those activations that are elicited during processing of non-musical, particularly linguistic sound, is a matter of ongoing debates (e.g. Peretz and Hébert 2000; Koelsch and Siebel 2005; Patel 2008).

To date, musical behaviours, in particular, have not been extensively investigated in the context of PNE research (e.g. Bartlett 1996). Perhaps this is not too surprising due to the increasing availability of neuroendocrinological research methods only over the last two to three decades. However, developmental and evolutionary theories to music, for example, suggest that musical stimulation might be effective in social and emotional self-regulation processes (e.g. Wallin et al. 2000). Therefore, it seems likely that musical behaviours should significantly influence neurohumoral processes in the brain and thus may have profound consequences to individual health and wellbeing (see Chapters 2 and 29, this volume).

In a study on health implications of cultural participation (Cohen 2006), elderly individuals who were assigned to cultural activities including singing (n = 77) were found to have fewer doctor visits and experienced less loneliness over a 12-month-period than individuals in a comparison group (n = 64) without cultural interventions. Cohen (2006) argues that ‘sense of control’ as well as ‘social engagement’ should be seen as likely mechanisms, which are responsible for the positive outcomes of the interventions. In other words, concepts derived from PNE research are not only needed to explain possible health-related outcomes of cultural interventions, but vice versa it appears that those are well-suited to increase the evidence-base of PNE research. Ultimately, (p.459) PNE research should contribute to answering questions including how musical behaviours function as psychological components in processes related to wellbeing and health.

Music as a psychoactive stimulus

Defining music remains a theoretic challenge. In practice, however, there seems less difficulty when effects of musical activity in the context of empirical studies are considered. The important implication is that instead of monolithic uses of the word music, it appears more appropriate to consider psychophysiological responses and behaviours that are under the influence of musically-induced activations within specific experimental contexts. While generalizations appear restricted to those individual experimental contexts, important characteristics of music as a psychoactive stimulus may nevertheless emerge.

Panksepp and Bernatzky (2002) concluded that one key characteristic of musical stimulation of the autonomous nervous system lies in the elicitation of emotions and the modulation of affective states. These authors argue that musically-induced activations involve cortical and subcortical neural networks in the human brain, that are associated with endocrine systems, and homoeostatic changes in these systems. In fact, brain imaging studies have revealed that intensely pleasurable music may activate numerous regions in the midbrain including ventral striatum, amygdalae, and anterior cingulate cortices (Blood and Zatorre 2001). Thus there is emerging indirect evidence that brain circuits of structural and functional relevance to the HPA axis are implicated in emotional processing of music.

Physiological responses to musical activity (predominantly listening) have been reported with respect to a wide range of measures (see Bartlett 1996, for an overview). Since about the mid 1980s of the last century, neurohumoral variables including ACTH, secretory immunoglobulin A (sIgA), cortisol and β-endorphin have been observed in musical tasks. Bartlett (1996) concluded that it was not possible to determine specific effects of music stimulation on neurohumoral responses and that findings need to be interpreted with great caution. For example, patterns of changes that were seen in the context of music showed similarities to other interventions including, for example, relaxation, humour, imagery therapy, meditation, yoga, and mild forms of physical exercise.

Psychophysiological effects of music

Factors influencing the psychophysiological effects of musical activities can be broadly classified as extrinsic and intrinsic. Extrinsic factors entail situation and context of these activities and experiences as well as variables representing individual differences including, for example, personality, preferences, musical expertise, and developmental aspects. Participants in Blood and Zatorre’s (2001) positron emission tomography (PET) study listened to personally meaningful music that was perceived as highly pleasurable. These musically-induced sensations were correlated with neural activations (and deactivations) in the midbrain. The authors interpret their findings as responses of the reward system to music in the limbic system. However, unlike other highly rewarding stimuli including sex or opiates, it was not possible to identify specific structural features in the stimuli which unequivocally elicited pleasurable responses. In fact, the same music that induced so-called chills in one listener was used as a control against other musical pieces inducing chills in a different listener. Therefore, it remains unclear which properties of musical sound might be relevant to induce states of intensely pleasurable emotions.

Some authors assume that intrinsic factors of musical materials can be identified, which modulate psychophysiological responses. Berger and Schneck (2003), for example, suggest that musical (p.460) rhythms may induce physiological adaptation in bodily rhythms and thus may influence oscillatory processes including neuroendocrine activity. Interactions between musical elements (rhythmic structure) and physiological metabolisms could explain sedative effects of music listening which lead to reductions in perceived pain and anxiety. Using a communication model as a starting point, Aldridge (1989) similarly has argued that music may influence neuronal, immunological and endocrine systems. He maintains that because of intrinsic properties music can be effective to modulate homeostasis and vegetative functions.

A comprehensive discussion of intrinsic factors might entail any musical parameters based on pitch, loudness, timing and timbral variations as well as combinations and interactions between these psychophysical properties. However, it appears appropriate to address four aspects here, which appear particularly prominent in the empirical literature, namely musical tempo, consonance, timbre (voice), and loudness. Bernardi and co-workers (1992) assume that musical tempo as measured in beats per minute could systematically influence cardiovascular dynamics. In simplest terms, slow tempi might induce sedation, while fast tempi might induce activation. In light of rather mixes findings concerning cardiovascular responses to music, in general, and to musical tempo, in particular (see Bartlett 1996, for a summary of research), other factors related to the musical structure as well as to the recipient must be accounted for (e.g. Dillman Carpentier and Potter, 2007).

Blood Bermudez and Zatorre (1999) used PET to show that musical excerpts inducing varying degrees of perceived consonance were systematically associated with differential activations in paralimbic and cortical brain areas. Physical characteristics of consonance include sound spectra that are dominated by fusion of partials that are evoked by different parts in a harmonic texture. By contrast, dissonance is characterized by sound spectra in which partials that only approximate integer ratios may give rise to sensations of roughness. However, harmonic spectra and perceived pleasantness ratings of sounds may not necessarily correlate very well. For example, non-linear distortions of musical sounds may be essential, for example, to Rock music and its effects on listeners.

The fetal auditory system is sensitive to sound characteristics of the maternal voice during the last trimester of pregnancy (Parncutt 2009). It is assumed that responsiveness to vocal sound characteristics may become hard-wired within the neural structures that are responsible for auditory processing. Infants are able to extract prosodic cues (pitch patterns) from infant-directed speech, so-called motherese, from the first day after birth (Sambeth 2007). Functional imaging studies in the adult brain further reveal that perception of singing is different from the perception of speech in that the former evokes stronger activations in subcortical regions that are associated with emotional processing (Jeffries et al. 2003). It is not clear yet, however, in what way vocal music may have specific effects on listeners as compared to instrumental music on one hand, and speech on the other.

Physical sound pressure levels and subjective experience of loudness seem both of relevance in relation to psychoneuroendocrinological responses to music in at least two ways. First of all, physical sound energy in and of itself may have significant impact on the human organism. For example, loud music can be equally detrimental to individual wellbeing as is the case for other sound sources with high sound pressure levels—e.g. Zheng and Ariizumi (2007) showed that acute noise bursts led to increases of immune responses, while chronic noise led to suppression of both cellular and humoral immune functions in mice. Second, active control over loudness exposure seems a prerequisite in both clinical and non-clinical studies while measuring psychophysiological responses. In fact, it is not unlikely that in specific contexts, silence may be even more effective than musical sound at all (e.g. Karrer 1999). Finally, Bernardi et al. (2009) observed that increases and decreases of sound volume in musical performances, i.e. crescendi and (p.461) decrescendo, led to specific modulations of cardiovascular activity with increases associated with crescendi and decreases with decrescendi.

Neuroendocrine and immunological markers


Cortisol is a hormone of the HPA axis. Importantly, changes of levels of cortisol concentrations are associated with psychological and physiological stress. Therefore, it has also been used in music-related studies as a psychophysiological marker in various contexts. For example, listening to classical choral (Kreutz et al. 2004), meditative (Möckel et al. 1994), and folk music (Fukui 2003) has been shown to induce significant reductions of cortisol values in healthy adults, whereas significant increases were noted in listeners who were exposed to Techno (Gerra et al. 1998) and upbeat pop and rock music (Brownley et al. 1995). Yamamoto et al. (2007) studied arousal-mediating effects of pre-selected high-tempo (HT) and low-tempo (LT) music in two experiments which involved stress induction. The two experiments differed in that a 10-minute rest was established between stress induction and music conditions. The authors observed decreases of cortisol levels across stress conditions in response to LT music in Experiment 2 only.

Modulations of cortisol levels in response to music listening appear to be subject to individual differences such as musical expertise. VanderArk and Eli (1993), for instance, showed that in a listening experiment music students responded with increases and biology students with decreases of this hormone. Using participants who are less prone to cognitive influences on music processing and potential endocrine responses, Shenfield et al. (2003) investigated the effects of maternal singing on cortisol levels in 6-month-old infants. Results suggested that infants with initially low levels showed increases and other infants with initially higher levels showed decreases of cortisol (Shenfield et al. 2003).

In clinical contexts, exposure to music has been shown to reduce cortisol levels during medical treatment (e.g. Nilsson et al. 2005; Le Roux et al. 2007). Leardi et al. (2007) compared the effects of New Age music to self-selected music and silence during surgeries involving local or peridural anaesthesia. Individuals in those groups who listened to music showed decreases in cortisol levels, while the controls showed increases. Decreases were more pronounced in follow-up measurements after surgeries in the self-selected than in the New Age music group.

Changes of cortisol can be induced also by musical activities such as singing and dancing. Beck et al. (2000) observed decreases of cortisol of 30% on average in members of a professional chorale during a rehearsal and 37% of increases during a performance of the same group. In a subsequent study, Beck and co-workers (2006) showed that solo singers’ satisfaction with performance correlated positively with decreases of cortisol. Grape et al. (2003) were concerned with the effects of singing lessons in small groups of male and female amateur and professional singers. Patterns of changes suggested gender effects as well as effects of musical expertise in these groups. Significant serum cortisol reductions were found in females and increases in males. Re-grouping the data to distinguish professional singers and amateurs showed less pronounced effects albeit decreases in amateurs were still significant. The authors explain their results by differential effects of perceived stress and competitiveness. Music stimulation also had an effect on cortisol levels in the context of tango dancing (Quiroga et al. 2009). These authors observed that the presence of music during dance led to decreases of cortisol levels while a similar effect was not observed in the presence or absence of a dance partner.

In summary, musically induced changes in cortisol were observed across a variety of populations as well as musical activities. While the patterns of changes were mixed, there are initial indications that cortisol concentrations show covariation with psychological measures such as (p.462) perceived arousal and performance satisfaction. Importantly, such effects extend to clinical populations which implies that music could have, for example, sedative effects where reductions of arousal in patients undergoing medical treatment is needed. However, while short-term modulations as evidenced in the majority of studies are important, little is known about the sustainability of these changes over longer periods of time, because measurement intervals as documented in these studies rarely exceed 15–20 minutes.


Oxytocin belongs to a class of peptides that is released in the hypothalamus and the posterior part of the pituitary. This hormone has been found to play a fundamental role in social behaviours by increasing trust and social bonding between mother and infant, sexual partners, as well as within social groups (Uvnas-Moberg 1998). Recent research indicates that the administration of oxytocin is potent to buffer subjective and physiological stress responses (Heinrichs et al. 2003; Ditzen et al. 2008).

Grape et al. (2003) observed significant increases of this hormone in both professional and amateur singers after a singing lesson, suggesting a hormonal mechanism for stress reducing effects of singing. In a clinical context, Nilsson (2009) compared effects of music listening during the first day after coronary surgery in groups of patients with and without music stimulation on oxytocin levels. Increases were observed in the former and decreases were found in the latter group of participants. Here the increase of oxytocin might indicate a facilitating effect of music on need for social support and bonding.


Sex hormones, in general, and testosterone, in particular, appear of particular relevance to music. In many cultures music behaviour like dancing, singing and playing an instrument are part of courting behaviour. Particular dancing seems to facilitate intersexual encounters and might initiate mating and reproductive behaviour. Therefore, Charles Darwin (1871) suggests music as originating from sexual selection. Although the precise implications of this hypothesis are unclear, it appears that sex hormones are ideal targets in order to explore the relevance of physiological mechanisms underlying this assumption. Testosterone is a sex hormone which is found in higher concentrations in males and in lower concentrations in females. It is produced in men’s testes and to a much less extent in the adrenal cortex of both men and women. Empirical work by Fukui and Yamashita (2003) suggested gender differences in testosterone responses after listening to Japanese folk songs showing that testosterone concentrations decreased in males but not in females. No gender effects were noted in relation to cortisol. In a more recent study, Fukui and Toyoshima (2008) suggest that music stimulation may enhance neurogenesis by means of its modulating effect on steroid secretion, because of its crucial role in neurofunction and regeneration of the nervous system (Hammond et al. 2001). However, there is at present no evidence available to support this hypothesis. In a different vein, Quiroga et al. (2009) found that the presence of a dance partner led to significant increases of testosterone levels in both sexes, while music stimulation alone did not have this effect.

In the perhaps most significant long-term study on the effects of testosterone on musical talent that is available to date, Hassler (1992) compared groups of creatively and performatively talented young musicians with non-musician controls. She observed that optimal levels of testosterone in relation to musical creativity differ for the two sexes. Female composers showed above average and male composers below average testosterone levels in comparison to age-matched controls. These findings suggest that physiologically androgynous individuals are more likely to have (p.463) higher levels of creativity than individuals that are more in the centre range of testosterone levels with respect to their sex. However, such an interpretation may be premature as, for example, testosterone:oestrogen ratios were not assessed in these studies.


β-endorphin is a hormone which is primarily released in the pituitary gland. It can be measured as serum concentrations in the peripheral vascular system. Increased levels of this hormone are associated with situative stress (Sheps et al. 1995). Conversely, while alleviating effects of music interventions have been found in pain patients (e.g. Mitchell et al. 2007), β-endorphin appears as a plausible physiological marker of such influences. In fact, McKinney et al. (1997) found that music listening in combination with guided imagery led to significant reductions of β-endorphin, while neither music listening nor guided imagery alone had this effect. Gerra et al. (1998) extended these observations by showing that listening to upbeat techno music led to increases of β-endorphin in groups of healthy adults. In the same study, however, individuals who were high in novelty-seeking did not show this response.

Delivering special relaxation music to coronary patients during rehabilitation led to significant decreases of β-endorphin during physical exercises. In addition, systolic blood pressure, anxiety, and worry were also reduced. Conversely, decreases were not significant in patients which performed the exercises without music (Vollert et al. 2003). Music therapy can also be effective before and during surgeries in operating theatres, again with respect to β-endorphin concentrations, anxiety, and pain (Spintge 2000).

In sum, psychophysiological effects of β-endorphin have been consistently observed in experimental contexts, which involved modulation of psychological stress. In some studies music was used to accompany activities including imagination and physical exercise. Only few studies, however, have contributed to assess individual differences in moderating the observed effects.

Secretory immunoglobulin A

Secretory immunoglobulin A (sIgA) is often interpreted as a marker of the local immune system in the upper respiratory tract and as a first line of defence against bacterial and viral infections. Positive affect may lead to increased levels of sIgA (Pressman and Cohen 2005), while chronic stress may be associated with decreased levels (Hennig 1994).

Significant increases of sIgA concentrations were observed across various contexts and populations, for example, in response to listening to relaxation music (Brauchli 1993), easy-listening ‘muzak music’(Charnetzki et al. 1998), classical (Wago et al. 2002), and various kinds of dance music (Hucklebridge et al. 2000; Enk et al. 2008). McCraty and co-workers (1996) investigated the effects of music listening and positive emotional state on sIgA in healthy adults. Patterns of results indicated that the combination of specially composed relaxation music and self-induced positive affect led to increases of sIgA concentrations, while Rock and New Age music showed no effects. Similar observations were made in clinical populations (Burns et al. 2001) indicating that mood changes appear to be important components in mediating music listening effects on sIgA.

Other musical activities including singing may induce short-term effects on sIgA. Kuhn (2002) investigated these in adults who were assigned to either one group playing drums or singing, or another group watching a live performance without engagement in playing or singing. There were overall more pronounced effects in those participants involved in active participation. Similarly, Kreutz et al. (2004) found that one hour of rehearsing choral music in an amateur choral society led to significant increases of sIgA at group level. However, no such increase over (p.464) time was found when the same singers were only listening to choral music that was Mozart’s ‘Requiem’ in this case. Beck et al. (2000) addressed the influences of rehearsal versus public performance in high-achieving choral singers, again observing significant increases of sIgA following these interventions. Moreover, positive correlations between positive emotions, performance satisfaction and physiological changes of sIgA concentrations emerged. In a follow-up study, Beck et al. (2006) showed that positive emotions and subjective wellbeing predicted increases in sIgA in solo singers who were multiply assessed during rehearsing and performing over a 10-week period.

Other neuroendocrine and immunological markers

Evers and Suhr (2000) investigated short-term effects of musical excerpts which were characterized as ‘pleasant’ (Brahms’ symphony no. 3, op. 90) and ‘unpleasant’ (Penderecki’s ‘Threnos’) on serum concentrations of prolactin, ACTH, and serotonin (5-HT) in healthy adult listeners. The authors observed only significantly reduced concentrations of serotonin under the unpleasant music condition. They interpret this effect as a physiological stress response. Möckel et al. (1994) also used prolactin and, in addition norepinephrine as markers in a similar experimental design which involved listening to contemporary music by Heinz-Werner Henze and meditative music. Prolactin is a hormone that has important regulatory functions during pregnancy. Norepinephrine, by contrast, is a stress hormone which is widely associated with attention, fight-flight responses, and mobilization of physical resources. While prolactin decreased in response to Henze, norepinephrine increased in response to the calmer medidative music.

Hirokawa and Ohira (2003) used a stress induction technique before assessing psychophysiological effects of listening to music which was characterized as ‘high-uplifting’ (Anderson’s ‘The Waltzing Cat’, Kreisler’s ‘Liebesfreud’ and Satie’s ‘Picadilly’) as opposed to ‘low-uplifting’ (Albinoni’s ‘Adagio’, Sibelius’ ‘Swan of Tuonela’ and Satie’s ‘Gnoissiennes’). A number of neuroendocrine and immune markers including natural killer cells, numbers of T lymphocytes, dopamine, norepinephrine and epinephrine were used in pre-post measurements. Although the results were inconclusive, differential trends were observed. These indicated that the low-uplifting music increased a subjective sense of wellbeing that was not reflected in physiological markers, while high-uplifting music led to increases of norepinephrine levels and liveliness, and decreases of depression.

Chromagranin A (CgA) is a marker representing sympathetic-adrenal activity that is also directly, but moderately related to catecholamine secretion and psychosomatic stress (e.g. Omland et al. 2003). Suzuki et al. (2004) investigated the effects of singing and playing musical instruments within a music therapy programme on salivary CgA concentrations in demented patients. The programme delivered over a period of 2 months and involved 16 sessions. The authors observed decreases of salivary CgA concentrations in the music therapy group as compared to controls. Similar findings were reported in a follow-up study (Suzuki et al. 2007) in which the intervention was extended to 3 months.

Conrad et al. (2007) undertook a study, which was designed to assess sedative effects of music stimulation by slow movements of Mozart’s piano sonatas in critically ill patients. Application of music significantly reduced the amount of sedative drugs needed to achieve a degree of sedations that was comparable to controls who received a standard therapy. Moreover, in the music group plasma concentrations of growth hormone increased, whereas those of interleukin-6 and epinephrine decreased. In addition, significantly lower levels of blood pressure and heart rate indicated reductions in systemic stress as a consequence of music listening. Findings were interpreted as showing that (sedative) music activates neurohumoral pathways that are associated with psychophysiological sedation.

(p.465) LeRoux et al. (2007) used a specific psychoimmunological marker called CD4/CD8 ratio to determine physiological influences of music stimulation (J. S. Bach’s ‘Magnificat’) in patients suffering from lung infections. CD4/CD8 indicates the numerical relationship between supporter (CD4) versus suppressor cells (CD8) each of which represent a subpopulation of lymphocytes. During breathing therapy sessions changes of CD4/CD8 rations developed significantly more favourably in the music listening group than in controls. This observation is consistent with the assumption that music stimulation may effectively modulate immune suppression. In a study using a group of healthy adults listening to music, Bartlett et al. (1993) reported that secretion of interleukin-1, which is considered as an important activator of the immune system, was found increased under music stimulation.

In one of the rare studies involving musicians representing different levels of expertise in singing, Grape et al. (2003) used an array of serum concentrations of physiological markers including tumour necrosis factor (TNF-α) as dependent measures to assess responses to singing lesions. TNF-α increases during infections and may also indicate psychophysiological stress. Increases in TNF-α were observed in professional singers, while decreases were found in amateurs.

Bittman and colleagues (2001) studied neuroendocrine and–immune responses to composite drumming based on a music therapy protocol. A total of 60 participants were randomly assigned to a drumming group or to a control group (reading magazines). The authors found, that compared to controls, the percussion session led to increased natural killer cell activity, increased dehydroepiandrosterone-to-cortisol ratio, and increased lymphokine-activated killer cell activity. No changes were observed in plasma cortisol, interleukin 2 or interferon-gamma.

Nuñez et al. (2002) used a standard animal model (male BALB/c mice) to investigate immune responses to cancer development under the influence of sound stress and music stimuli. The rodents were injected with carcinosarcoma cells and sacrificed 8 days after injection. During the experimental phase, mice were allocated randomly to one of four groups who received music, auditory stressor, auditory stressor and music, or nothing (controls) for 5 hours per day. While stress was found to decrease natural killer cell activity and also significantly increase number and percentage of metastatic nodules, a reverse pattern was found in the music group indicating positive immune responses in these rodents to music stimulation. Overall, music appeared to compensate some of the stress responses while showing patterns that were similar to the unstressed group.

Table 30.1 summarizes the above cited research on psychoneuroendocrine responses to musical behaviours. This is one step towards more rigorous evaluations of the available literature.


Empirical approaches over the last two decades have begun to adopt a PNE perspective on the effects of musical stimulation using markers including cortisol, oxytocin, testosterone, endorphin, immunoglobulin A, and others. Although significant effects of musical behaviour on many of these markers have been observed, the development of this research appears compromised by paucity of publications, in general, and methodological issues, in particular. Therefore, empirical evidence, which demonstrates specific influences of musical behaviours at neurohumoral levels, appears limited to date.

In conclusion, patterns of neuroendocrine changes reflecting psychophysiological processes in response to musical interventions are complex, but appear often favourable with respect to health implications. For example, from a psychoneuroendocrinological standpoint, music can be supportive to alleviate physiological effects of stress and unrest and thus can be an effective means as one non-invasive element in psychotherapeutic interventions. However, the available data appear (p.466)

Table 30.1 Summary of empirical studies using neuroendocrine measures as dependent variables in musical intervention studies





Bartlett et al. (1993)

36 healthy students (17 women, 19 men)

Blood samples before and after (1) listening to selected music followed with expression of ‘perceived sensory experience’ vs. (2) reading vs. (3) no treatment

Cortisol decreases were shown immediately and after 24 hrs of the listening condition. Interleukin-1 increases were observed only immediately after the listening condition. No changes were observed in the non music conditions

Brauchli (1993)

16 volunteers (5 women, 11 men) with a mean age of 28 (20–52) years

Saliva samples before and after two conditions: (1) optical-acoustic mind machine vs. (2) relaxing music

Both conditions led to decreased cortisol concentrations and increased sIgA levels

VanderArk et al. (1993)

60 college students, 27–41 years old

Blood samples before and after listening to two musical selections. Comparison between (1) music majors vs. (2) biology majors

Cortisol levels were higher for the music majors than for the biology majors after listening to music

Möckel et al. (1994)

20 healthy students (10 women, 10 men) with a mean age of 25 (20–33) years

Blood samples before and after listening to three different examples of music: (1) waltz by J. Strauss, (2) modern classic by H. W. Henze, and (3) meditative music by R. Shankar

Music by Strauss resulted in an increase of atrial natriuretic peptide. After modern music, prolactin values were lowered. Meditative music led to a decrease of cortisol levels, noradrenaline levels and t-PA antigen levels

Brownley et al. (1995)

16 volunteers (12 women, 4 men), 19–28 years old

Blood samples before and after low, moderate and high intensity exercise under three music conditions (1) no music, (2) sedative, and (3) fast

Following high intensity exercise, higher cortisol levels were associated with fast music as compared to no music and sedative music

McCraty et al. (1996)

10 healthy individuals (6 women, 4 men) with a mean age of 41 (range 27–53) years

Saliva samples before and after listening to three music conditions: (1) rock, (2) new age, and (3) designer music, as well as after two control conditions: (4) self-induced positive emotional state in the absence of music, and (5) silence

Only the designer music and the self-induced state of appreciation produced an increase in sIgA levels. The combination of the designer music and the self-induced appreciation produced a much greater immunoenhancement than either of these two conditions alone

McKinney et al. (1997)

28 health adults (24 women, 4 men), with a mean age of 37 years (SD = 6 years)

Blood samples before, after the 13-week and again at a 6-week follow-up period of a guided imagery and music programme. Participants in a wait-list group served as controls

Cortisol levels decreased after 6 biweekly sessions of the guided imagery and music programme. Pretest to follow-up decrease in cortisol was significantly associated with decrease in mood disturbance

Charnetski et al. (1998)

66 college students (35 women, 31 men) ranging in age from 17 to 40 years.

Saliva samples before and after four conditions: (1) tone/click presentation, (2) silence, (3) Muzak tape referred to as ‘Environmental Music’, and (4) radio broadcast comparable in musical style.

Analysis indicated increases in sIgA for the Muzak music condition, but not for any of the other conditions.

Gerra et al. (1998)

16 healthy subjects (8 women, 8 men), age ranging 18 to 19 years

Blood samples before and after two group conditions: listening to (1) techno music vs. (2) classical music Duration: 30min each

Increases in β-endorphin, ACTH, norepinephrine, growth hormone, and cortisol after listening to techno music

Beck et al. (2000)

41 members of a professional chorale (23 women, 18 men) with a mean age of 46 (range 25–62) years

Saliva samples before and after (1) an early rehearsal, (2) a late rehearsal and (3) a public performance of Beethoven’s Missa Solemnis

sIgA increased during rehearsals and the performance. Cortisol levels decreased during rehearsals and increased during performance. Performance perception and mood were predictive of changes in levels of sIgA during the performance condition, but the results for the rehearsal conditions were not significant

Evers and Suhr (2000)

20 healthy subjects (9 women, 11 men) with a mean age of 28 (SD = 5) years

Blood samples before and after two random ordered blocks of two pieces of music with either pleasant or unpleasant music. Duration: 10min each

Serotonin (5-HT content of platelets) decreased during the perception of unpleasant music as compared to the perception of pleasant music. This decrease was correlated to the subjective attitude towards the music. Prolactin and ACTH did not change for both the pleasant and the unpleasant music

Hucklebridge et al. (2000)

41 students (31 women, 10 men) with a mean age of 20 years

Saliva samples before and after listening to either a (1) happy vs. an (2) unhappy mood induction music tape, both lasting approximately 30min

Mood induction by music resulted in elevations in sIgA levels and secretion rate and responses were not distinguished by mood valence. No changes in cortisol were observed

Bittman et al. (2001)

60 volunteers (29 women, 31 men)

Blood samples before and after (1) composite group-drumming music therapy intervetion vs. (2) control group

Group drumming led to elevated dehydroepiandrosterone-to-cortisol ratios, increased NK cell activity, and increased lymphokine-activated killer cell activity

Burns et al. (2001)

29 cancer patients, aged 21–68 years

Saliva samples before and after (1) listening to music in a relaxed state vs. (2) active involvement of music improvisation (the playing of percussion instruments)

Results showed increased sIgA in the listening experience and a decrease in cortisol levels in both interventions over a 2-day period

Kuhn (2002)

33 students (28 women, 5 men) with a mean age of 20 years

Saliva samples before and after three conditions: (1) active musical activity (instrument playing and singing), (2) passive listening to live music (3) control group

sIgA concentrations of the active music group showed greater increases than those of the passive and control group

Nuñez et al. (2002)

80 male mice aged between 7–12 weeks

Mice were randomly divided into four experimental groups (1) unstimulated controls, (2) music, (3) auditory stressor, (4) auditory stressor and music

Music reduced the suppressive effects of stress on immune parameters (Thymus and spleen cellularity, peripheral T lymphocyte population, and natural killer cells) in mice and decreased the enhancing effects of stress on the development of lung metastases provoked by carcinosarcoma cells

Fukui and Yamashita (2003)

88 healthy college students

(44 males and 44 females) with a mean age of 21 (18–27) years

Saliva samples before and after four conditions: (1) listening to music, (2) listening to music with visual stress (3) visual stress without music, and (4) silence. Duration: 30min each

Music decreased Testosterone in males, whereas it increased Testosterone in females. No gender differences regarding cortisol levels. Cortisol decreased with music and increased under other conditions

Grape et al. (2003)

8 amateur (6 women, 2 men, age 28–53 years) and 8 professional (4 women, 4 men, age 26–49 years) singers

Blood samples before and 30min after a singing lesson. Comparison between (1) amateur vs. (2) professional singers

TNF-alpha increased in professionals after the singing lesson, whereas in amateurs decreased. Levels of prolactin and cortisol increased after the lesson in the group of men and vice versa for women. Oxytocin concentrations increased significantly in both groups after the singing lesson

Hirokawa and Ohira (2003)

24 non-music major college students (15 women, 9 men)

Blood and saliva samples before and after a stressful task, and after a subsequent experimental condition: (1) high-uplifting music, (2) low-uplifting music, and (3) silence. Duration: 20min each

High-uplifting music showed trends of increasing the norepinephrine level. No changes in other variables (sIgA, lymphocyte CD4, CD8. CD16, dompamine) were found

Shenfield et al. (2003)

34 mothers (M = 32 years) and their infants (17 boys, 17 girls; M = 6 months, 3 days)

Saliva samples from infants before their mothers began singing and 20min later

Infants with lower baseline levels exhibited modest

cortisol increases in response to maternal singing; those with higher baseline levels exhibited modest reductions

Vollert et al. (2003)

15 coronary patients (2 women, 13 men) with a mean age of 62 (SD = 8) years

Blood samples before and after listening to an especially composed relaxation music while training patients’ heart-frequency adapted exercises

β-endorphin concentration was found to decrease after listening to music

Kreutz et al. (2004)

31 amateur singers (23 women, 8 men) with a mean age of 57 (29–74) years

Saliva samples before and after two musical conditions: (1) listening vs. (2) singing choral music. Duration: 60min each

Singing led to increases in SIgA. Listening to choral music led to decreases in levels of cortisol

Suzuki et al. (2004)

23 dementia patients (15 women, 8 men) with a mean age of 83 (SD = 6) years

Saliva samples before and after two conditions: (1) music therapy (singing songs and playing percussion Instruments) vs. (2) physical activity. 16 sessions (measures only for sessions 1, 8, 16)

Prior to Music therapy, chromogranin A (CgA) levels before the first session were high compared with those before the 16th session. In addition, after only a week of Music therapy, stress levels were lower, as evidenced by lower CgA levels. Levels of CgA were decreased after each session

Nilsson et al. (2005)

75 patients undergoing open hernia repair surgery

Blood samples during and after surgery. Patients participated in one of three conditions: (1) intraoperative music, (2) postoperative music and (3) silence (control group)

Greater decrease in the level of cortisol in the postoperative music group vs. the control group after 2 hours in the post anaesthesia care unit. There was no difference in sIgA, blood glucose, between the groups

Beck et al. (2006)

10 music majors in a conservatory in an arts college with a mean age of 21 (18–25) years

Saliva samples before and after singers rehearsed and performed repertory in a college conservatory during a 10-week period

Increase in sIgA levels after singing. This effect was mediated by positive emotions of wellbeing and feeling ‘high’. Satisfaction with performance correlated significantly with a decrease of cortisol after singing

Leardi et al. (2007)

60 patients undergoing day surgery (30 men and 30 women) with a mean age 65 (range 25–85) years

Blood samples before, during and after surgery. Patients participated in one of three conditions: (1) listening to new age music (2) listening to a choice of music from one of four styles (3) listening to the normal sounds of the operating theatre (control group)

Cortisol levels decreased during operation in both groups who listened to music, but increased in the control group. Postoperative cortisol levels were higher in group 1 than in group 2. Levels of natural killer cells decreased during surgery in groups 1 and 2, but increased in controls. Intraoperative levels of natural killer cells were significantly lower in group 1 than in group 3

LeRoux et al. (2007)

40 patients with lung infections (9 men and 31 women), 40–75 years old.

Blood samples before and after three days of physiotherapy (1) with music (‘Magnificant’ by J. S. Bach) vs. (2) without music (control group).

Cortisol levels were reduced after the 3rd day of physiotherapy with music, whereas in the control cortisol levels increased. The immunological marker CD4:CD8 ratio increased in the music condition, which impplied less immunological supression.

Suzuki et al. (2007)

16 dementia patients (14 women, 2 men) with a mean age of 85 (SD = 5) years

Saliva samples before and after two group conditions: (1) music therapy vs. (2) control group, at the following three time periods: before the start of the intervention; at the last (25th) session; and 1 month after the end of the intervention

In the music therapy group, the level of salivary CgA after the 25th session was lower than before the intervention, indicating a reduction in stress

Yamamoto et al. (2007)

40 healthy university students (33 women, 7 men) with a mean age of 24 years

Saliva samples before and after four group conditions with vs. without a 10min rest: (1) high-tempo music after a high arousal stressful task, (2) high-tempo music after a low-arousal stressful task, (3) low-tempo music after a high arousal stressful task, (4) low-tempo music after a low-arousal stressful task

Cortisol levels were reduced after task performance including a 10min rest and immediately after low-tempo music exposure, indicating a stress distractive effect under the high arousal stressful task. Other conditions showed no significant differences in cortisol changes

Nilsson et al. (2009)

40 patients (8 women, 32 men) undergoing open-heart surgery, with a mean age of 65 (SD = 9) years

Blood samples at the first postoperative day, before and after 30min and 60min of rest (1) with or (2) without music

In the music group, levels of oxytocin increased significantly in contrast to the control group for which the trend over time was negative, i.e. decreasing values

Quiroga et al. (2009)

22 amateur tango dancers (11 women, 11 men) with a mean age of 43 (30–56) years

Saliva samples before and after four dance conditions: (1) with partner with music, (2) with partner without music, (3) without partner with music, (4) without partner without music

After tango dancing, decreases of cortisol levels were found with the presence of music, whereas increases of testosterone levels were associated with the presence of a partner

(p.467) (p.468) (p.469) (p.470) (p.471) clearly limited with respect to the number of studies, number of participants involved in each study, and a range of methodological aspects. For example, it is not always clear how the musical interventions were constructed. Variables such as familiarity with and liking of the musical materials and activities are rarely systematically assessed, although they are known to have profound psychological influence in many experimental settings which include music stimulation.

These observations of limitations appear even enhanced when subsets such as immunological markers in response to musical activities are considered. Although those represent a particularly important subset of neuroendocrine responses, it is our impression that much more research efforts should be undertaken to ascertain the emerging patterns of changes that were reported in the available literature.

Importantly, sources of musical sound in the environment may have similar effects on the brain such as the same musical sound that is imagined by the listener in the absence of a physical stimulus (e.g. Zatorre and Halpern 2005). The implication is that the sensitivity of the hormonal system to musical activities may well extend to significant influences of even imagined music on hormones and neurotransmitters.

To sum up, psychoneuroendocrine effects of music in the human brain and body are perhaps one of the most fascinating areas of future research. The hormonal system provides direct links between music stimulation, activations in the brain during music processing and emotional responses at both physiological and subjective levels. For example, there is mounting evidence suggesting various roles of music activities in mediating stress responses at hormonal levels. Another promising area can be seen in local immune responses to singing in the upper respiratory pathways.

This initial evidence notwithstanding, basic questions of music emotion research, such as, for instance, the relationship between perceived and felt emotions, need to be examined at hormonal levels. In other words, by understanding how music affects the endocrine system we will increase our knowledge of how music affects emotions. Ultimately, questions of how and why individuals may benefit from music in terms of health and wellbeing must be answered also at that level.


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