The Effect of Therapeutic Music Playlists on Symptoms of Anxiety: A Clinical Trial

Mental health diagnoses affect a significant portion of the population, with 50% of all Americans receiving at least one mental illness diagnosis in their lifetime (American Psychological Association, 2018). The percentage of people who will receive a mental illness diagnosis in their lifetime is higher than the 39.66% who will receive a diagnosis of cancer (American Cancer Association, 2018), and the 47.7% who will be diagnosed with coronary disease (American Heart Association, 2017). Additionally, 45% percent of adults with a mental health diagnosis also meet the criteria for at least one other disorder (American Psychological Association, 2018). The prevalence of Americans diagnosed with specific conditions that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) lists emotion dysregulation as a key component of are as follows: anxiety disorders at 31.1%, other mood disorders at 21.4%, attention deficit hyperactivity disorder (ADHD) at 8.7%, posttraumatic stress disorder (PTSD) at 6.8%, bipolar disorder at 4.4%, eating disorders at 2.7%, obsessive compulsive disorder (OCD) at 2.3%, and borderline personality disorder (BPD) at 1.4%. (American Psychiatric Association, 2013; National Institute of Mental Health, 2017). In a survey by Bautch (2019), 84% of participants reported using music for the purposes of regulating emotions. As is noted in a study performed by McFerran et al. (2010), people do not always select music for themselves that will improve their emotional state. In their research they found that it is not uncommon for people who are struggling with mood to select music which can actually intensify rumination and which can have a detrimental effect on their emotions. However, music has the ability to assist in mood elevation. The effectiveness of music listening as a means of improving scores on the state section of the STAI was demonstrated in a study by De La Torre-Luque et al. (2017) where within group differences were found in the experimental group (p In her 2013 systematic review, Sena Moore explained these results by examining the neural correlates between the structures involved in emotion regulation and the impact of music experiences on those neural structures. Neural structures and activity that are related to emotion regulation include activation of the anterior cingulate cortex (ACC), the orbitofrontal cortex (OFC), and the lateral prefrontal cortex (PFC), the latter of which has a mediating effect on the amygdala. Multiple studies have used neural imaging as well as other measures to demonstrate the effect of music listening experiences on an increase of activation of the OFC, the ACC, and a decrease of activation in the amygdala (Blood & Zatorre, 2001; Brown et al., 2004, Mitterschiffthaler et al., 2007; Berns & Moore, 2012; Berns et al., 2010, Flores-Gutierrez et al., 2007; Koelsch et al., 2006; Levitin, 2013; Alluri et al, 2015; Hou et al., 2017). Activity in the limbic system is also altered by music listening, engaging the limbic and the paralimbic systems and improving functional connectivity of the limbic regions (Brown et al., 2004; Alluri et al., 2015). This indicates that music may facilitate neurological functioning that supports optimal emotion regulation. Both music listening as well as music therapy has long been utilized as a means of effectively addressing goals of emotion regulation. Beginning in the 1940’s, music therapy was used as a means of addressing symptoms of what eventually became known as PTSD, though it was then called shell shock. Interventions currently used in addressing symptoms of anxiety include music assisted relaxation, guided imagery and music, improvisation, and therapeutic playlists (Wurjatmiko, 2019; Karadag et al., 2019; Ribeiro et al., 2018; Millet & Gooding, 2017; Pavlov et al., 2017; Hwang et al., 2013; Alam et al., 2016; Hammer, 1996; Bradt & Teague, 2018; Zarate, 2016; Hense et al., 2018). Many of these interventions are done in the presence of a music therapist and are not self-administered. Notable exceptions are therapeutic playlists, and music assisted relaxation, which are interventions that can be taught and used in the home environment. A therapeutic playlist is a sequence of songs that are targeted to reach a goal. They are frequently used as a means of addressing dysregulation of emotions, most commonly symptoms of anxiety and/or depression. The present study will address the use of one-directional mood vectoring playlists and musical contour regulation playlists in the treatment of symptoms of anxiety. For the purposes of this study, Shatin’s (1970) definition of mood vectoring will be used, which is “The directed alteration of mood through music- an alteration from one affective pole to it’s opposite or it’s contrast” (pg. 81). Musical contour regulation, on the other hand, alternate between high- and low-arousal music experiences in order to support healthy management of high- and low-arousal situations which may induce symptoms of anxiety (Sena Moore, 2018). This study will utilize two different kinds of playlists which will be designed to address a range of emotions and assist listeners in shifting from dysregulated to regulated mood states. Music will be participant selected from their own collection of recorded music and organized in collaboration with a board-certified music therapist. Playlists will be designed to facilitate a reduction of anxiety symptoms. In addition, it is important to also examine the feasibility of both interventions, as well as barriers to faithful adherence to the protocol that participants experienced. This will assist practitioners in the identification of persons who would benefit, as well as those for whom the interventions may not provide optimal results. The results of this study may also provide information as to whether there are changes that could be made to improve accessibility and increase fidelity in the protocol in order to facilitate improved outcomes for patients