This article addresses using music for relaxation and to help relieve stress and anxiety. We begin with an overview of the impact of anxiety and stress in the world’s population. We then review what the research tells us about the ability of music to help alleviate stress. And finally based on this research, we offer some suggestions and recommendations on how you can begin to use music to reduce the anxiety in your life, including guidance for augmenting your music-based relaxation with mindfulness.
STRESS & ANXIETY IN THE MODERN WORLD
We all face stressful situations throughout our lives, ranging from minor annoyances like long lines and traffic delays to more serious worries, such as a loved one's grave illness. No matter what the cause, stress floods your body with hormones. Your heart pounds, your breathing speeds up, and your muscles tense. This so-called "stress response" is a normal reaction to threatening situations, honed in our prehistory to help us survive threats like an animal attack or a flood. Today, we rarely face these physical dangers, but challenging situations in daily life can set off the stress response. We can't avoid all sources of stress in our lives, nor would we want to. But we can develop healthier ways of responding to them. 
Anxiety disorders are the most prevalent mental illnesses worldwide. Anxiety affects up to 28.8% of the population in Western countries, and its incidence appears to be increasing.  When it comes to lowering anxiety, the stakes couldn't be higher. Stress either exacerbates or increases the risk of health issues like heart disease, obesity, depression, gastrointestinal problems, asthma, chronic pain, anxiety disorders, depression, burnout, addictions, and more. More troubling still, a recent paper out of Harvard and Stanford found health issues from job stress alone cause more deaths than diabetes, Alzheimer's, or influenza.  High levels of stress are costly in monetary terms, too. Researchers found that stress-related health problems could be responsible for between 5 to 8 percent of annual healthcare costs in the U.S. at amounts to about $180 billion each year in healthcare expenses. 
There is a growing body of evidence that music interventions yield positive effects on stress reduction. Considering the demands of today’s society, there is an increasing need for stress reduction interventions. Millions of people around the world use tranquilizing medications, such as antidepressants and benzodiazepines, to cope with life stressors or anxiety. Not only do these types of medication have considerable negative side effects, including substance dependence and abuse, research also indicates that the effects of pharmacological treatment on stress-related problems are not much larger than the effects of music interventions. In addition, a common argument for starting pharmacological treatment instead of psychological treatment for stress reduction is that its effects occur immediately. However, research shows that most of the time on a single occasion, music has a direct effect in reduction of stress and anxiety.  Music has been shown to beneficially affect stress-related physiological, as well as cognitive, and emotional processes. Thus, the use of listening to music as an economic, non-invasive, and highly accepted intervention tool has received special interest recently in the management of stress and stress-related health issues. 
MUSIC CAN REDUCE STRESS AND ANXIETY? PROVE IT TO ME!
In every era of human history and in every society around the globe, music has allowed people to express their feelings and communicate with others. More than simply expressing emotions, music can alter them; as British dramatist William Congreve put it in 1697, "Music has charms to soothe a savage beast."  And, modern scientific research has been taking a look at this. According to a report from Stanford University, "We may be sitting on one of the most widely available and cost-effective therapeutic modalities that ever existed. Systematically, this could be like taking a pill. Listening to music seems to be able to change brain functioning to the same extent as medication, in many circumstances."  What’s the scientific research that backs this up? Below are some findings reported by Harvard Medical School.
Few things are more stressful than illness and surgery. Can music reduce stress in these difficult circumstances? Several trials show it can. A recent study examined how music affects surgical patients. Forty cataract patients with an average age of 74 volunteered for the trial. Half were randomly assigned to receive ordinary care; the others got the same care but also listened to music of their choice through headphones before, during, and immediately after the operations. Before surgery, the patients in both groups had similar blood pressures. Just before surgery, the average blood pressure in both groups rose substantially, and in both groups, the average heart rate jumped by 17 beats per minute. But the patients surrounded by silence remained hypertensive throughout the operation, while the pressures of those who listened to music came down rapidly and stayed down into the recovery room. The listeners also reported that they felt calmer and better during the operation. Research has also revealed that surgeons show fewer signs of stress and demonstrate improved performance while listening to self-selected music. 
Another study of 80 patients undergoing urologic surgery under spinal anesthesia found that music can decrease the need for supplementary intravenous sedation. In this trial, patients were able to control the amount of sedative they received during their operation. Patients who were randomly assigned to listen to music needed less calming medication than those assigned to listen to white noise or to the chatter and clatter of the operating room itself. 
In the cataract and urologic surgery studies, the patients were awake during their operations. But a study of 10 critically ill postoperative patients reported that music can reduce the stress response even when patients are not conscious. All the patients were receiving the powerful intravenous sedative propofol, so they could be maintained on breathing machines in the intensive care unit (ICU). Half the patients were randomly assigned to wear headphones that played slow movements from Mozart piano sonatas, while the other half wore headphones that did not play music. Nurses who didn't know which patients were hearing music reported that those who heard music required significantly less propofol to maintain deep sedation than those patients wearing silent headphones. The music recipients also had lower blood pressures and heart rates as well as lower blood levels of the stress hormone adrenaline and the inflammation-promoting cytokine interleukin-6. 
How is music able to reduce stress and anxiety? Listening to music triggers the release of hormones cortisol and dopamine, brain chemicals that makes people feel engaged and motivated. Sound processing begins in the brainstem, which also controls the rate of your heartbeat and respiration. This connection explains why relaxing music can lower heart rate, breathing rate, and blood pressure, and reduce stress and anxiety.  Music can also promote relaxation of tense muscles, enabling you to easily release some of the tension you carry from a stressful day (or week). When you relax your muscles and loosen your body, your mind also relaxes, which can help you to reduce plenty of tension and stress that you may not have realized you were carrying.  A review of the neurological effects of music on emotional processes indicated that music listening can deactivate the amygdala, which may decrease the intensity of stress-related emotional states and psychophysiological arousal. This in turn has been shown to evoke feelings of pleasure and happiness. 
In addition, there are a number of other ways in which music listening can enhance relaxation. One use is listening to music as a masking agent to cover over unwanted environmental stimuli, such as background sounds in a hospital, that might induce stress or prevent relaxation. Another use is to provide distraction from other foci of awareness such as existing stress or physical pain. 
According to the article “Stress Management” published by Mayo Clinic, the benefits of relaxation techniques, such as listening to music, are quite substantial. According to this report “When faced with numerous responsibilities and tasks or the demands of an illness, relaxation techniques may not be a priority in your life. But that means you might miss out on the health benefits of relaxation. Practicing relaxation techniques can have many benefits including the following.”
What does the latest research say about the best-practices, recommendations and suggestions regarding the use of music for relaxation and reduction of stress and anxiety? We now turn our attention to address these very topics.
USING MUSIC FOR RELAXATION AND ANTI-STRESS: SUGGESTIONS AND RECOMMENDATIONS
A study from Harvard suggests that patient-selected music shows more beneficial effects than music chosen by someone else. According to the American Music Therapy Association, music "provokes responses due to the familiarity, predictability, and feelings of security associated with it." In a cardiac stress study done at a Texas university, both classical and rock music were studied. Improvements were greater when classical aficionados listened to classical music than when they listened to rock, and vice versa. Someone who loves opera might find a soaring aria immensely calming. "But quite frankly, if you don't care for opera, it could have the opposite effect!" 
In general, it has been observed that music that is preferred by the listener may have the most beneficial effects on the relaxation and stress reduction responses of that listener. Thus, the preference for the music may be an important factor in choosing what music to listen to as part of a relaxation experience or regimen. This aspect of individual listener preference is especially important to consider, because music which is perceived to be soothing or relaxing to one person may not be so for another .
Characteristics of Relaxing Music
There are some common elements of what is considered by many to be relaxing or sedative music which may be helpful to keep in mind when selecting music for listening. These musical elements which are perceived by many listeners to be relaxing include a slow and stable tempo (pace or speed), low volume level and soft dynamics, consistent texture (combination of sounds and instruments), absence of percussive and accented rhythms, gentle timbre (sound or tone color), legato (connected) melodies, and simple harmonic or chord progressions. These elements are often found in music composed for relaxation, as well as music classified as new age and classical, which may be why selections representing these music styles have been used in commercial recordings marketed for relaxation.  It is not surprising that music tempo is considered as one of the most important moderators of music-related relaxation. Music with a slow tempo (60–80 bpm) has often been associated with reductions in heart rate, resulting in greater relaxation. It should be noted that, while classical music is often used for relaxation, it is a very broad style and descriptor, and can also include music that is very arousing in one or more of the above musical elements.  Other genres that tend to promote relaxation include soft pop and certain types of world music. The complexity of the music and – surprisingly – familiarity with the piece, are not so important. In fact, knowing a piece too well was found in some cases to be counterproductive.  The length of the recording is also important to consider. Many recordings produced specifically for relaxation purposes are 20–30 min long, which may be a good target length for a relaxation experience. Recordings of shorter pieces may also be used, but the transitions from one recording or track to another may not be smooth, and the relaxation process may be interrupted because of this. 
If the Music Has Lyrics, Choose Carefully
Another consideration is whether or not to select recordings with narration (or music compositions with words) as opposed to selecting instrumental-only compositions. Commercially produced relaxation recordings often have narrations which lead the listener through breathing and muscle relaxation exercises followed by pleasant imagery to help facilitate relaxation. This can be beneficial for the listener, and it has been shown that combining techniques such as progressive muscle relaxation, body-awareness techniques, and cognitive cues such as those involved with imagery may beneficially enhance the relaxation experience. However, if the imagery is distracting to the listener, then the relaxation experience may actually be inhibited. Music compositions such as songs or classical vocal works such as art songs, operas, or choral pieces may also be used, but the lyrics or words may again be distracting. The use of instrumental music, instead of music with lyrics, would often lead to greater effects of music interventions on stress reduction. Several studies reported that music containing lyrics may be more distracting and activating instead of calming. In addition, processing of the meanings of the lyrics or word texts may actually arouse cortical responses and stimulate emotional responses, which again may be counterproductive considering the goal of relaxation and inhibition of the sympathetic nervous system response. 
However, a 2011 study reported that the use of music with lyrics may reinforce the positive effects of music interventions on stress reduction through the possible comforting effects of the lyrics.  The way you see the world and the type of self-talk you habitually use can also have a profound effect on your stress level, which is why positive affirmations that create more positive self-talk are so helpful. Music that has affirming lyrics can bring the double benefit of music and positive affirmations, helping you to surround yourself with positive energy and more often look on the bright side, letting stressful events more easily roll off your back. 
Not Only Slow Music – Upbeat Tunes Can Help, Too
Music, especially upbeat tunes, can take your mind off what stresses you, and help you feel more optimistic and positive. This helps release stress and can even help you keep from getting as stressed over life’s little frustrations in the future. An uplifting song can also bring the benefits of positive affect, which can empower you to notice more opportunities and seize them when you can, which can also help with stress relief. (And while we're on the topic of uplifting music, some happy songs practically force you to dance to them, and this type of exercise can be great for stress management, too! 
Have a Variety of Music to Choose From
In addition to these overall elements, having control over selecting the specific music recording to use for a relaxation experience at any particular time is also important. Consumers may wish to have a selection of recordings from which to choose so that one selection or piece does not become too repetitive and tedious with repeated listening. They may also wish to have selections of varying tempos and activity levels ranging from faster and more active to slower and less stimulating. It is often helpful to initially match a recording to existing levels of activity and stress in terms of the tempo of the piece and its musical complexity. These aspects of the music may then gradually change to slower and less active or arousing. 
Make It A Routine
Being able to design a personalized music listening and relaxation routine that can be used when, where, and how the consumer desires can empower and allow them to actively take part in their own wellness initiatives. This routine may be enhanced when the consumer combines the music listening experience with a preferred and relaxing listening environment. This might consist of a quiet room with an absence of intrusions from other people, phones, cell phones, or pagers. If living with others, the consumer might want to put a note or sign on the room door to let others know not to disturb them. A comfortable chair or recliner, soft lighting, or scented candles might also contribute to this environment. If taking a break at work or on the go, the consumer might want to use a personal music device such as an MP3 (e.g., iPod) or portable CD player. An MP3 player also allows the listener to customize play-lists, which could include various sequences of music for relaxation from which to select at any given time. Over the ear (as opposed to in-ear) headphones may help keep out unwanted environmental noises. Noise-cancelling headphones offer the additional advantage of reducing ambient environmental noises. An eye mask such as those used on airplanes may help to create a personalized environment and block out visually distracting stimuli. 
Sample Music for Relaxation and Reduction of Stress & Anxiety
In one recent research study at Mindlab International, participants listened to different songs while researchers measured brain activity as well as physiological states that included heart rate, blood pressure, and rate of breathing. According to the research, one song produced a greater state of relaxation than any other music tested to date. In fact, listening to that one song -- "Weightless" -- resulted in a striking 65 percent reduction in participants' overall anxiety, and a 35 percent reduction in their usual physiological resting rates. That is remarkable! Equally remarkable is the fact the song was actually constructed to do so! The group that created "Weightless", Marconi Union, did so in collaboration with sound therapists. Its carefully arranged harmonies, rhythms, and bass lines help slow a listener's heart rate, reduce blood pressure and lower levels of the stress hormone cortisol. 
Here are links to three different versions/lengths of the song “Weightless”:
More Music for Relaxation suggested by this same research study: 
Here is some additional music for relaxation suggested by a respected music therapist: 
Continuous, Commercial-Free Relaxation Music
Art Blevins, one of the members of the “Magic of Music” Team at Boquete Health & Hospice has experimented for the last few months with relaxation music. He reports a consistently elevated manner of well-being from the soothing sounds. His routine consists of playing “live” streams from YouTube on the tv in the living room of his home, from the time he gets up in the morning until the time he goes to bed, every day, all day. Of utmost importance for his daily routine is the fact that the YouTube relaxation music “live” streams are continuous 24/7 without any pauses or commercial interruptions.
Here are Art’s favorite non-stop, commercial-free relaxation music streams on YouTube:
How to Enhance Your Music-Based Relaxation: Adding Mindfulness to Music Listening
Mindfulness is a wellness practice that can add additional potency to your experience of listening to music for relaxation and reduction of stress and anxiety. As described in the Harvard report “Six Relaxation techniques to Reduce Stress,” the practice of mindfulness involves sitting comfortably, focusing on your breathing, and bringing your mind's attention to the present moment without drifting into concerns about the past or the future. This form of meditation has enjoyed increasing popularity in recent years. Research suggests it can be helpful for people with anxiety, depression, and pain. 
Mindfulness—the practice of being in the present moment—can be practiced at any time and anywhere. However, if you find mindfulness challenging (or haven’t tried it!), the addition of music can help you stay focused, while simultaneously helping you to connect with music as a source of strength and creative energy. Listening to music can be a powerful way to stay focused on the present moment.  In addition, research has shown that mindfulness combined with listening to music increases one’s music listening sensitivity and music listening enjoyment 
What Does Research Say About Combining Mindfulness and Music Listening?
A report in the Journal of Creativity in Mental Health found the combination of mindfulness and music listening to be effective in treating depression, one of the most common mental health issues.  Another research study published in “Annals of the New York Academy of Sciences - Special Issue: The Neurosciences and Music VI” indicated that combining both music listening and mindfulness can have beneficial effects on mood and cognition in patients recovering from strokes. Fifty‐six stroke survivors were randomized to receive an 8‐week intervention of mindful music listening, music listening, or audiobook listening. Among the three different groups, mindful music listening was most strongly associated with relaxation and concentration, improved attentional control, and emotion regulation, as well as enjoyment. 
How do I try Mindful Music Listening for Myself?
When you are listening to music for relaxation and stress reduction, slow down and focus on the present moment. The following steps will guide you through this mindful music listening experience:
1. Choose a piece of music to listen to. Instrumental pieces are recommended, as lyrics can more easily lead to distraction. It can either be a familiar or unfamiliar piece (it’s interesting to repeat this exercise with the opposite of what you choose this time, just to notice if anything feels different).
2. Take a moment to breathe and ground yourself—no matter where you are, or what’s going on around you. Inhale gently through your nose, and exhale deeply through your open lips. Notice your body, and tune into how it feels, whether you’re standing, sitting, walking, or laying down. Just notice any physical structures your body is touching (the floor, the chair, or your shoes) as well as any physical sensations (tightness, tension) in your body.
3. Just listen. Use headphones or earbuds if that helps you focus or shut out external noise. Give yourself permission to only listen to the music, without simultaneously checking your email or refreshing your Facebook feed. If it helps, close your eyes (if that’s challenging, it’s likely because you really need the break!).
4. Notice. Let yourself be aware of anything you notice, without judgment or self-criticism. Notice the pace of the music, the sounds of the different instruments, or the shifts in volume. Notice if you’re more aware of a certain part of your body as you listen (i.e., “I often feel vibrations of cello music in my chest”). Notice any thoughts or feelings that come up—perhaps the music is connected to a memory, or perhaps an anxious thought is trying to pop through. Let any thoughts just pass through your awareness, and then gently bring yourself back to the sounds of the music.
5. Reflect. Take a moment to breathe and check in with your body, breath, and mind (see step 2). Does anything feel different? Do you notice any shifts after listening to the piece of music? Do you feel calmer? If the piece you chose didn’t feel like a good fit, what might you look for in another piece (i.e., slower, fewer instruments, louder)?
This short mindfulness experience can be useful to practice daily. You might experiment with different types of music as a way to notice different responses. You may also find that repeating the same piece of music is a sort of touchstone, a way to continually reconnect to that place inside where gentle pausing and noticing can happen with ease. 
We Welcome Your Feedback
What is your experience with music and relaxation? Let us know! Email us at Music@boquetehospice.org
16. “Participants’ Experiences of Music, Mindful Music, and Audiobook Listening Interventions for People Recovering from Stroke” - Annals of the New York Academy of Sciences - Special Issue: The Neurosciences and Music VI
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