Traditional Music Shows Promise in Reducing Pre-Surgery Anxiety, Iranian Study Reveals

Could Traditional Music Transform Preoperative Anxiety Management?

The therapeutic potential of traditional music in reducing preoperative anxiety has been demonstrated in a recent clinical trial conducted across two major surgical centers in western Iran. This randomized controlled study explored whether vocal or instrumental traditional music could effectively alleviate anxiety in patients awaiting general surgery, offering insights into non-pharmacological approaches that might complement or replace conventional anxiety medications with their associated side effects. The findings reveal promising evidence for music as an accessible intervention in perioperative care settings.

Preoperative anxiety represents a significant clinical challenge, affecting approximately 20% of surgical patients and potentially leading to negative physiological responses including elevated blood pressure, increased heart rate, sleep disturbances, and impaired concentration. While pharmacological interventions like benzodiazepines and SSRIs are commonly employed, they frequently produce unwanted side effects ranging from restlessness and nausea to more serious complications. This reality has prompted growing interest in complementary approaches such as music therapy, which modulates brain activity in emotional processing centers including the amygdala and limbic system. Music therapy works through multiple mechanisms: suppressing sympathetic nervous system activity, increasing parasympathetic tone, enhancing dopamine secretion, and diverting attention from anxiety-provoking stimuli. Previous research has yielded inconsistent results regarding music's effectiveness and the comparative impact of vocal versus instrumental compositions, creating the rationale for this investigation.

What was the Study’s Methodological Blueprint?

Researchers recruited 102 general surgery candidates from Imam Reza and Taleghani Hospitals in Kermanshah, Iran, randomly assigning them in equal numbers to three groups: instrumental music, vocal music, and a control condition. The instrumental group listened to "Bidar" by renowned Iranian musician Parviz Meshkatian, while the vocal group heard the traditional song "Ey Namat" performed by Maestro Alireza Eftekhari. Control participants wore headphones connected to a silent player to eliminate environmental noise. All interventions lasted 15 minutes and were conducted one hour before scheduled surgeries. Anxiety was measured using the validated Spielberger State-Trait Anxiety Inventory-State Form (STAI-S) immediately before and after the intervention, with scores ranging from 20-80 (higher scores indicating greater anxiety).

The results demonstrated statistically significant anxiety reductions in both music intervention groups. In the instrumental music group, mean anxiety scores decreased from 40.1±10.7 to 34.3±8.97 (p<.001), representing a mean difference of 5.85±4.11 points. Similarly, the vocal music group experienced a reduction from 40.7±11.7 to 35.8±9.83 (p<.001), with a mean difference of 4.82±2.82 points. In contrast, the control group showed no significant change, with anxiety levels actually increasing marginally from 38.5±10.2 to 38.8±10.0 (p=.582). Interestingly, analysis of variance (ANOVA) revealed no statistically significant difference between the effectiveness of vocal versus instrumental music, suggesting both approaches offer comparable benefits for anxiety reduction. The groups were well-matched on demographic variables including age, gender, marital status, education level, surgical history, and type of procedure, strengthening the validity of these comparisons.

How Do the Results Compare with Previous Findings?

This study adds to the growing body of evidence supporting music therapy as a valuable non-pharmacological intervention for perioperative anxiety management. The findings align with several previous investigations demonstrating music's anxiety-reducing effects, though they contrast with others showing no significant impact. These inconsistencies might stem from methodological differences, variations in music selection, individual patient characteristics, or the specific clinical contexts in which interventions were implemented. Unlike some earlier studies that found differential effects between vocal and instrumental music, this trial suggests both formats can be equally effective when using traditional compositions. This provides flexibility for clinicians implementing music interventions based on patient preferences or available resources.

Despite its promising findings, the study had several limitations that warrant consideration. The researchers did not control for comorbidities or concurrent medications that might influence anxiety levels or responses to music therapy. The intervention duration was relatively brief at 15 minutes, potentially limiting the therapeutic effect. Additionally, patient preferences for music type were not factored into the selection of compositions, which might impact engagement and effectiveness. The generalizability of results to non-general surgery populations remains uncertain, and questions persist about whether the control condition truly matched the experimental groups in terms of sound exposure. Future research addressing these limitations could strengthen the evidence base and refine implementation strategies for music therapy in perioperative settings.

The researchers conclude that both instrumental and vocal traditional music represent effective, accessible, and cost-efficient interventions for reducing preoperative anxiety. Given music therapy's non-invasive nature, minimal side effect profile, and ease of implementation, they recommend its incorporation into standard preoperative protocols. Could these findings influence how we approach anxiety management across different surgical specialties? What role might patient-selected music play in enhancing these effects? How might longer duration interventions or repeated exposures modify outcomes? These questions highlight fertile ground for continued investigation into music's therapeutic potential in perioperative care, potentially reducing reliance on pharmacological interventions with their associated risks and side effects.

As healthcare systems increasingly recognize the importance of holistic approaches to patient care, this study offers compelling evidence for a simple intervention that addresses the psychological needs of surgical patients. Reducing preoperative anxiety not only improves patient experience but may also contribute to better physiological outcomes by mitigating the stress response associated with surgical procedures. How might healthcare facilities most effectively implement music therapy programs within existing workflows, and what barriers might need to be overcome to ensure widespread adoption of this evidence-based practice?

The study's design adhered to rigorous methodological standards, with ethical approval obtained from the Ethics Committee of Kermanshah University of Medical Sciences (IR.KUMS.REC.140000.804) and registration in the Iranian Registry of Clinical Trials (IRCT20100913004736N25). Participant consent was carefully documented, with comprehensive explanations provided about study objectives and confidentiality protocols. The recruitment process employed convenience sampling for initial enrollment, followed by randomization using a six-person block method to ensure balanced allocation across the three intervention groups.

How Rigorously Was the Study Conducted?

Eligibility criteria were carefully defined to create a representative yet controlled sample. Participants needed to be at least 18 years old, experiencing anxiety, interested in traditional music, free from drug addiction, thyroid diseases, and active psychiatric disorders, and have adequate hearing ability as verified by the Whisper Test. These criteria helped minimize confounding variables while ensuring the sample reflected typical surgical patients. The most common surgical procedures among participants were related to the gastrointestinal system (56.9%), followed by mass removal and endocrine surgeries. The sample's mean age was 43.4±13.3 years, with a slight male predominance (53.9%), and most participants were married (76.5%) with educational attainment below diploma level (56.9%).

The intervention protocol was meticulously standardized to ensure consistency. Patients completed baseline anxiety assessments 15 minutes before the intervention. During the music sessions, participants were instructed to lie calmly in bed and could adjust volume according to personal preference. Equipment was calibrated before each use to ensure proper functioning and sound quality, with headphones thoroughly disinfected between participants following hygiene standards. This attention to procedural details strengthens the study's internal validity and reproducibility.

What Does the Literature Tell Us About Music Therapy's Impact?

When examining the study's findings in the context of existing literature, it's important to note the diversity of results across previous investigations. A 2020 clinical trial found that silence followed by Western classical music had the greatest anxiety-reducing effect among various music types, while a 2015 study suggested that New Age instrumental music was more effective than vocal compositions. In contrast, this current study found no significant difference between vocal and instrumental traditional music, suggesting that cultural familiarity and music type may interact in complex ways to influence anxiety responses. A 2021 study on children with congenital heart disease demonstrated music's effectiveness in reducing preoperative anxiety, reinforcing the current findings despite differences in population and assessment tools.

The physiological mechanisms underlying music's anxiolytic effects involve multiple pathways. Music appears to modulate activity in the amygdala and limbic system, brain structures central to emotional processing. It suppresses sympathetic nervous system activation while enhancing parasympathetic tone, creating a more balanced autonomic response. The increased dopamine secretion associated with music listening contributes to improved mood states and emotional regulation. Additionally, music serves as an attention diversion technique, redirecting focus away from anxiety-provoking stimuli related to the surgical environment and procedure.

Not all previous research aligns with this study's positive findings. A 2022 trial examining music's effects during lithotripsy found no significant anxiety reduction, while a 2021 study of women undergoing radiation therapy and a 2008 investigation of women having cesarean sections similarly reported no significant benefit. These contradictory findings highlight the complexity of music's effects across different clinical contexts, patient populations, and procedural circumstances. Variables such as musical preference, intervention timing, procedural characteristics, and baseline anxiety levels may all influence outcomes.

What Are the Next Steps for Clinical Practice and Future Research?

For clinical implementation, several practical considerations emerge from this research. The intervention's brevity (15 minutes) and timing (one hour pre-surgery) make it feasible within typical preoperative workflows. The use of headphones provides a private listening experience that doesn't disturb other patients or staff. The finding that both vocal and instrumental traditional music were equally effective offers flexibility in music selection. However, the study's focus on traditional Iranian music raises questions about cultural specificity—would similar effects be observed with traditional music from other cultures, or is cultural familiarity a key component of the therapeutic effect?

Future research directions should address several outstanding questions. Studies incorporating patient music preferences might determine whether personal choice enhances anxiolytic effects. Longer intervention durations or repeated exposures could reveal dose-response relationships. Investigations across diverse surgical specialties would clarify whether effects generalize beyond general surgery. Research controlling for comorbidities and concurrent medications would strengthen causal inferences about music's specific effects. Finally, studies comparing traditional music from various cultures could illuminate whether cultural relevance modifies therapeutic outcomes.

This study contributes valuable evidence supporting music as a simple, cost-effective intervention for preoperative anxiety management. By demonstrating comparable effectiveness between vocal and instrumental traditional music, it expands options for implementing music therapy in clinical settings. As healthcare increasingly emphasizes patient-centered approaches and non-pharmacological interventions, this research offers a promising avenue for improving perioperative care while potentially reducing reliance on anxiety medications and their associated side effects.

Summary

A clinical trial conducted in two Iranian hospitals examined the effects of traditional music on preoperative anxiety among 102 general surgery patients. Participants were divided into three groups: those listening to instrumental music, vocal music, or silence (control). Both music intervention groups showed significant anxiety reduction, with instrumental music decreasing anxiety scores by 5.85 points and vocal music by 4.82 points, while the control group showed no improvement. The study found no significant difference between vocal and instrumental music effectiveness, suggesting both forms can be equally beneficial. The research supports music therapy as a cost-effective, non-pharmacological intervention for managing preoperative anxiety, though further research is needed to address limitations such as intervention duration and patient music preferences.