Psychoneuroendocrinological effects of music therapy versus mindfulness in palliative care: results from the \u2018Song of Life\u2019 randomized controlled trial

Friederike Koehler,Beate Ditzen,Martin Stoffel,Hubert J Bardenheuer,Martin Weber,Marco Warth,Jens Kessler

doi:10.1007/s00520-021-06435-y

Abstract

PurposeAlthough research on psychosocial interventions in palliative care provided evidence for their effectiveness regarding patient-reported outcomes, few studies have examined their psychobiological effects yet. Therefore, the purpose of the present work as part of an overarching study was to investigate differential effects of music therapy versus mindfulness on subjective distress and both neuroendocrine and autonomic stress biomarkers.MethodsA total of 104 patients from two palliative care units were randomly assigned to three sessions of either music therapy or mindfulness. Before and after the second session (completed by 89 patients), participants rated their momentary distress and provided three saliva samples for cortisol and α-amylase analysis. Furthermore, photoplethysmography recordings were continuously assessed to calculate mean heart rate and heart rate variability. Data were analyzed using multilevel modeling of all available data and sensitivity analysis with multiply imputed data.ResultsBetween 67 and 75% of the maximally available data points were included in the primary analyses of psychobiological outcomes. Results showed a significant time*treatment effect on distress (b = − 0.83, p = .02) indicating a greater reduction in the music therapy group. No interaction effects were found in psychobiological outcomes (all p > .05), but multilevel models revealed a significant reduction in cortisol (b = − 0.06, p = .01) and mean heart rate (b = − 7.89, p = .05) over time following either intervention.ConclusionFindings suggest a beneficial effect music therapy on distress while no differential psychobiological treatment effects were found. Future studies should continue to investigate optimal stress biomarkers for psychosocial palliative care research.Trial RegistrationGerman Clinical Trials Register (DRKS)—DRKS00015308 (date of registration: September 7, 2018)

Highlights

Palliative and supportive care aims at the relief of suffering in patients facing a life-threatening disease addressing their needs holistically on a physical, psychological, social, and spiritual level
Due to the paucity of research linking psychological with biological effects of psychosocial interventions in palliative care, we aimed to explore stress biomarker trajectories in response to both interventions during the second session, in which a biographically meaningful song was played live to the patient
With regard to all psychobiological outcomes, we found no statistically significant time*treatment interaction in the available data (AAD) set

Summary

Introduction

Palliative and supportive care aims at the relief of suffering in patients facing a life-threatening disease addressing their needs holistically on a physical, psychological, social, and spiritual level. Psychosocial interventions from various disciplines have been developed with a therapeutic focus on emotional, spiritual, or interpersonal consequences of a terminal disease and its symptoms, or more broadly, on the relief of stress. The diagnosis and treatment of the illness itself may be highly strenuous, which can further increase stress-related symptoms [2]. In this context, psychosocial interventions were hypothesized to reduce stress [3] and to impact clinical outcomes via pathways on a biological, psychological, and social level [4, 5]

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Conclusion