The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home
Identifieur interne : 002680 ( Istex/Corpus ); précédent : 002679; suivant : 002681The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home
Auteurs : Sandra Mcbride ; Jane Graydon ; Souraya Sidani ; Leslie HallSource :
- Journal of holistic nursing [ 0898-0101 ] ; 1999-09.
English descriptors
- Teeft :
- Analogue, Aorn journal, Blood pressure, Classical music, Control group, Control groups, Copd, Dyspnea, Heart lung, Heart rate, Holistic, Holistic nursing, Holistic nursing september, Measures design, Music diary, Music effectiveness questionnaire, Music group, Music tape, Music therapy, Nursing practice, Nursing research, Nursing science, Pain perception, Participant, Peak expiratory flow rate, Personal preference, Posttest, Preference questionnaire, Present study, Previous studies, Pulmonary disease, Relaxation, Respiratory rate, Ryerson polytechnic university, Second week, September, Sidani, Significant change, Significant decline, Significant decrease, Significant difference, Significant differences, Significant time effect, Similar findings, Single time period, Spielberger, Stai, Standley, State anxiety, Stratton zalanowski, Systolic blood pressure, Unitary, Vads, Vertical scale, Visual analogue scales, Vital signs.
Abstract
The purposes of this repeated measures study were to examine the feasibility of using music as an intervention for dyspnea and anxiety in patients with chronic obstructive pulminary disease (COPD) who live in their homes and to examine the effect of music on anxiety and dyspnea. Twenty-four participants who experienced dyspnea at least once a week were studied over a 5-week period. Baseline data were collected on Week 1. Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately following the use of music. These measures were repeated on Week 5. There was a significant decrease in dyspnea following the use of music as reported in the music diary (p < .001). There was a significant decline in anxiety (p < .05) and dyspnea (p < .01) following the use of music on Week 2. There was no significant change in anxiety or dyspnea over the 5-week period.
Url:
DOI: 10.1177/089801019901700302
Links to Exploration step
ISTEX:D25CB135CBD4221DB8009CCC3555CDEE4CACE07DLe document en format XML
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Twenty-four participants who experienced dyspnea at least once a week were studied over a 5-week period. Baseline data were collected on Week 1. Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately following the use of music. These measures were repeated on Week 5. There was a significant decrease in dyspnea following the use of music as reported in the music diary (p > .001). There was a significant decline in anxiety (p > .05) and dyspnea (p > .01) following the use of music on Week 2. There was no significant change in anxiety or dyspnea over the 5-week period.</abstract><qualityIndicators><score>8.824</score><pdfWordCount>7315</pdfWordCount><pdfCharCount>41991</pdfCharCount><pdfVersion>1.2</pdfVersion><pdfPageCount>22</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>152</abstractWordCount><abstractCharCount>876</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home</title><pmid><json:string>10690067</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Journal of holistic nursing</title><language><json:string>unknown</json:string></language><issn><json:string>0898-0101</json:string></issn><eissn><json:string>1552-5724</json:string></eissn><publisherId><json:string>JHN</json:string></publisherId><volume>17</volume><issue>3</issue><pages><first>229</first><last>250</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1999</json:string><json:string>1800s</json:string></date><geogName></geogName><orgName><json:string>American Holistic Nurses</json:string><json:string>Further Research There</json:string><json:string>Ryerson Polytechnic University</json:string><json:string>University of Toronto Leslie Hall</json:string><json:string>University of Toronto Souraya Sidani</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Percy Faith</json:string><json:string>Martha Rogers</json:string><json:string>Hilary Stagg</json:string><json:string>Mornhinweg</json:string><json:string>Jane Graydon</json:string><json:string>The</json:string><json:string>Summer Place</json:string><json:string>David Lanz</json:string><json:string>Wayne Gratz</json:string></persName><placeName></placeName><ref_url></ref_url><ref_bibl><json:string>Farnsworth, 1969</json:string><json:string>Carrieri et al., 1984</json:string><json:string>Gift, 1989b</json:string><json:string>Augustin & Hains, 1996</json:string><json:string>Zimmerman et al. (1996)</json:string><json:string>Sidani, 1991</json:string><json:string>Hanser, 1985</json:string><json:string>Phillips, 1992</json:string><json:string>Rogers, 1992, p. 29</json:string><json:string>Kaempf and Amodei (1989)</json:string><json:string>Dossey, Keegan, Guzzella, & Kolkmeier, 1995, p. 138</json:string><json:string>Standley, 1986</json:string><json:string>Gift & Cahill, 1990</json:string><json:string>Gift et al., 1992</json:string><json:string>Lehrer et al. (1994)</json:string><json:string>Gift, 1989a</json:string><json:string>Gift et al., 1986</json:string><json:string>Barnason et al. (1995)</json:string><json:string>Gift and Cahill (1990)</json:string><json:string>McBride et al.</json:string><json:string>Gift, 1989a, b</json:string><json:string>Thornby et al., 1995</json:string><json:string>Barnason, Zimmerman, & Nieveen, 1995</json:string><json:string>Spielberger et al., 1970</json:string><json:string>Thornby, Haas, & Axen, 1995</json:string><json:string>Gift et al. 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(1997)</json:string><json:string>Zimmerman, Nieveen, Barnason, & Schmaderer, 1996</json:string><json:string>White, 1992</json:string><json:string>Taylor, 1973</json:string><json:string>Robb et al., 1995</json:string><json:string>Sidani, 1992</json:string><json:string>Henry, 1995</json:string><json:string>Gift et al.</json:string><json:string>Beck, 1991</json:string><json:string>Stratton & Zalanowski; Taylor, 1973</json:string><json:string>McClellan, 1988</json:string><json:string>Ostrander & Schroeder, 1979</json:string><json:string>Rogers, 1986</json:string><json:string>White (1992)</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/M70-H881K3ZP-4</json:string></ark><categories><wos></wos><scienceMetrix></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Nursing</json:string><json:string>3 - Nursing (miscellaneous)</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1177/089801019901700302</json:string></doi><id>D25CB135CBD4221DB8009CCC3555CDEE4CACE07D</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/D25CB135CBD4221DB8009CCC3555CDEE4CACE07D/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/D25CB135CBD4221DB8009CCC3555CDEE4CACE07D/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/D25CB135CBD4221DB8009CCC3555CDEE4CACE07D/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><availability><licence><p>sage</p></licence></availability><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B"></p><date>1999</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home</title><author xml:id="author-0000"><persName><forename type="first">Sandra</forename><surname>McBride</surname></persName><affiliation>Ryerson Polytechnic University</affiliation><affiliation>Ryerson Polytechnic University</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Jane</forename><surname>Graydon</surname></persName><affiliation>University of Toronto</affiliation><affiliation>University of Toronto</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Souraya</forename><surname>Sidani</surname></persName><affiliation>University of Toronto</affiliation><affiliation>University of Toronto</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Leslie</forename><surname>Hall</surname></persName><affiliation>Ryerson Polytechnic University</affiliation><affiliation>Ryerson Polytechnic University</affiliation></author><idno type="istex">D25CB135CBD4221DB8009CCC3555CDEE4CACE07D</idno><idno type="ark">ark:/67375/M70-H881K3ZP-4</idno><idno type="DOI">10.1177/089801019901700302</idno><idno type="article-id">10.1177_089801019901700302</idno></analytic><monogr><title level="j">Journal of holistic nursing</title><idno type="pISSN">0898-0101</idno><idno type="eISSN">1552-5724</idno><idno type="publisher-id">JHN</idno><idno type="PublisherID-hwp">spjhn</idno><imprint><publisher>Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><date type="published" when="1999-09"></date><biblScope unit="volume">17</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="229">229</biblScope><biblScope unit="page" to="250">250</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The purposes of this repeated measures study were to examine the feasibility of using music as an intervention for dyspnea and anxiety in patients with chronic obstructive pulminary disease (COPD) who live in their homes and to examine the effect of music on anxiety and dyspnea. Twenty-four participants who experienced dyspnea at least once a week were studied over a 5-week period. Baseline data were collected on Week 1. Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately following the use of music. These measures were repeated on Week 5. There was a significant decrease in dyspnea following the use of music as reported in the music diary (p < .001). There was a significant decline in anxiety (p < .05) and dyspnea (p < .01) following the use of music on Week 2. There was no significant change in anxiety or dyspnea over the 5-week period.</p></abstract></profileDesc><revisionDesc><change when="1999-09">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/D25CB135CBD4221DB8009CCC3555CDEE4CACE07D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spjhn</journal-id><journal-id journal-id-type="publisher-id">JHN</journal-id><journal-title>Journal of Holistic Nursing</journal-title><issn pub-type="ppub">0898-0101</issn><publisher><publisher-name>Sage Publications</publisher-name><publisher-loc>Sage CA: Thousand Oaks, CA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/089801019901700302</article-id><article-id pub-id-type="publisher-id">10.1177_089801019901700302</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>McBride</surname><given-names>Sandra</given-names></name><aff>Ryerson Polytechnic University</aff></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Graydon</surname><given-names>Jane</given-names></name><aff>University of Toronto</aff></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sidani</surname><given-names>Souraya</given-names></name><aff>University of Toronto</aff></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hall</surname><given-names>Leslie</given-names></name><aff>Ryerson Polytechnic University</aff></contrib></contrib-group><pub-date pub-type="ppub"><month>09</month><year>1999</year></pub-date><volume>17</volume><issue>3</issue><fpage>229</fpage><lpage>250</lpage><abstract><p><italic>The purposes of this repeated measures study were to examine the feasibility of using music as an intervention for dyspnea and anxiety in patients with chronic obstructive pulminary disease (COPD) who live in their homes and to examine the effect of music on anxiety and dyspnea. Twenty-four participants who experienced dyspnea at least once a week were studied over a 5-week period. Baseline data were collected on Week 1. Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately following the use of music. These measures were repeated on Week 5. There was a significant decrease in dyspnea following the use of music as reported in the music diary (</italic>p <italic>< .001). There was a significant decline in anxiety (</italic>p <italic>< .05) and dyspnea (</italic>p <italic>< .01) following the use of music on Week 2. There was no significant change in anxiety or dyspnea over the 5-week period.</italic></p></abstract><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>
JOURNAL OF HOLISTIC NURSING / September 1999McBride et al. / MUSIC AND DYSPNEA
The Therapeutic Use of Music for
Dyspnea and Anxiety in Patients
With COPD Who Live at Home
Sandra McBride, Ed.D., R.N.
Ryerson Polytechnic University
Jane Graydon, R.N., Ph.D.
University of Toronto
Souraya Sidani, R.N., Ph.D.
University of Toronto
Leslie Hall, Ph.D.
Ryerson Polytechnic University
The purposes of this repeated measures study were to examine the feasibility of using
music as an intervention for dyspnea and anxiety in patients with chronic obstructive
pulminary disease (COPD) who live in their homes and to examine the effect of music
on anxiety and dyspnea. Twenty-four participants who experienced dyspnea at least
once a week were studied over a 5-week period. Baseline data were collected on Week 1.
Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately fol-
lowing the use of music. These measures were repeated on Week 5. There was a signifi-
cant decrease in dyspnea following the use of music as reported in the music diary (p <
.001). There was a significant decline in anxiety (p < .05) and dyspnea (p < .01) fol-
lowing the use of music on Week 2. There was no significant change in anxiety or
dyspnea over the 5-week period.
Chronic obstructive pulmonary disease (COPD) is a debilitating disor-
derthatisfrequentlycharacterizedbydyspnea.Themechanismsunder-
lying the experience of dyspnea are not clearly understood (Carrieri,
229
AUTHORS' NOTE: Funded by the Ontario Respiratory Care Society.
JOURNAL OF HOLISTIC NURSING, Vol. 17 No. 3, September 1999 229-250
1999 American Holistic Nurses' Association
Janson-Bjerklie, & Jacobs, 1984; Gift, Plaut, & Jacobs, 1986). This may
be part of the reason why patients with COPD generally do not obtain
relief from their dyspnea (Gift, Moore, & Soeken, 1992). Because there
are no medications specifically designed for dyspnea relief (Gift et al.,
1992), other methods for patients to reduce dyspnea need to be exam-
ined. Alternate therapies that focus on an holistic approach to practice
may provide some direction.
There have been relatively few studies examining interventions
aimed directly at the relief of dyspnea (Carrieri et al., 1984). There is,
however, evidence of a direct association between dyspnea and anxi-
ety (Gift & Cahill, 1990; Gift et al., 1986), and this provides a potential
area for nursing intervention. Music, as an alternate therapy, is
hypothesized to provide some relief due to its anxiolytic and relaxa-
tion effect. However, most of the studies examining the effect of
music have taken place in a controlled setting. The purpose of this
article is to report on a pilot study that examined the use of music and
its effect on anxiety and dyspnea in patients with COPD who were liv-
ing at home. The present study differs from previous studies examin-
ing the effect of music in several ways. To begin with, the current
study examined the effect of music on anxiety and dyspnea. Previous
clinical studies examined the effect of music on anxiety, pain percep-
tion, vital signs, exercise tolerance, and respiratory discomfort (Bar-
nason, Zimmerman, & Nieveen, 1995; Beck, 1991; Bolwerk, 1990;
Elliot, 1994; Lehrer et al., 1994; Moss, 1988; Sidani, 1991; Standley,
1986; Thornby, Haas, & Axen, 1995; Zimmerman, Nieveen, Barnason,
& Schmaderer, 1996; Zimmerman, Pierson, & Marker, 1988). In addi-
tion, most of the previous studies took place under controlled condi-
tions, often with a one-time testing period. The current study exam-
ined the use of music in the participants' homes, which allowed the
participants more control over the use of music. In addition, the effect
of music was examined over time.
LITERATURE REVIEW
Dyspnea
There is evidence of a direct relationship between dyspnea and
anxiety (Gift & Cahill, 1990; Gift et al., 1986) that suggests that if one
were reduced, the other also might lessen. Gift et al. assessed 20
230 JOURNAL OF HOLISTIC NURSING / September 1999
patients three times: when experiencing high, medium, and low lev-
els of dyspnea as indicated by 20 mm or greater difference on a visual
analogue rating scale. They found no difference in airway obstruction
values at the three levels of dyspnea. They did, however, find that the
individuals' anxiety levels were significantly higher during medium
and high levels of dyspnea, compared to low levels of dyspnea. Gift
and Cahill (1990) obtained similar results. They measured the same
patients at two levels of dyspnea and found that they experienced
more anxiety with severe dyspnea than with a low level of dyspnea.
They also found that during the times of severe dyspnea, the indi-
viduals had higher cortisol levels, higher PCO2 levels, and had
greater use of accessory muscles than during times of little dyspnea.
These studies, showing within-participant variation in levels of anxi-
ety directly related to levels of dyspnea, indicate that interventions
directed toward reducing anxiety may have an impact on patients'
levels of dyspnea.
Music
Music has been used for centuries to promote relaxation and
reduce anxiety and pain. Music first was used as a therapeutic inter-
vention in the 1800s (Henry, 1995). According to Weeks (1991), music
therapy can be very powerful, but there is no clear understanding of
the mechanism of its action. There appears to be two different schools
of thought in regard to the use and effect of music. One perspective is
discussed in the works of Campbell (1991), Gardner (1990), and
Tomatis (cited in Gilmor, Madaule, & Thompson, 1989). Music from
this perspective is viewed as having the potential to open the listener
for a transcendent awareness of self. Music from this view promotes
healing, which is reflected by a balanced state of mind, body, and
spirit (Campbell, 1991). There was no evidence of empirical or clinical
studies to support this perspective.
The use of music to promote relaxation, reduce anxiety, and reduce
pain is more in keeping with clinical interventions with specific
patient populations. However, it is only fairly recently that attempts
have been made to test the effectiveness of music in a clinical setting
(Barnason et al., 1995; Beck, 1991; Bolwerk, 1990; Elliot, 1994; Guzetta,
1989; Kaempf & Amodei, 1989; Lehrer et al., 1994; Schorr, 1993;
Sidani, 1991; Thornby et al., 1995; Zimmerman, L. et al., 1996; Zimmer-
man, L. M. et al., 1988).
McBride et al. / MUSIC AND DYSPNEA 231
Studies examining the use of music to reduce anxiety in cardiac
patients report differing findings. Barnason et al. (1995) compared the
effect of music therapy, music video therapy, and rest on anxiety,
mood, heart rate, and blood pressure. Ninety-six postcoronary artery
bypass graft (CABG) patients were randomly assigned to one of the
three groups and the intervention was administered on two occa-
sions. Analysis of covariance yielded a significant improvement in
mood following the second intervention of music therapy (p = .02),
yet there were no significant changes in anxiety across groups. No sig-
nificant time by group effect in blood pressure or heart rate was
found, yet there was a significant time effect on vital signs regardless
of group.
Anxiety reduction was also examined by Elliot (1994). Fifty-six
participants admitted with a diagnosis of acute myocardial infarction
(AMI) were randomly assigned to music, relaxation, or control group
and received the intervention two to three times during a 24-hour
period. Although there was a significant decline in anxiety in all
groups (control, p = .01; music, p < .001; relaxation, p =.03), there were
no significant differences between groups. A lack of group effect also
was noted for blood pressure and heart rate. Similar findings were
reported by Kaempf and Amodei (1989) in patients awaiting surgery
and by Zimmerman et al. (1988) in a repeated measures design with a
sample of patients with AMI. On the other hand, White (1992) found a
significant decline in anxiety in patients with AMI following the sin-
gle use of music, as opposed to the control rest group (p = .017).
Bolwerk's (1990) findings are similar. She randomly assigned 35
patients with AMI to a music group or a nonmusic control group. The
study ran over a 3-day period with the posttest measure taken follow-
ing the final intervention. Although there was a significant decline in
anxiety in both groups (p = .001), there was a significantly greater
decline in anxiety in the music group (p = .001).
Anxiety reduction also was examined in patients undergoing che-
motherapy (Sabo & Michael, 1996) and in ambulatory preoperative
patients (Augustin & Hains, 1996). Sabo and Michael assigned 100
patients to experimental and control groups, on the basis of physi-
cians' office grouping. In a pretest-posttest design running over the
course of four chemotherapy treatments, there was a significant
decrease in anxiety in the music group (p < .001).
Forty-two preoperative patients were assigned to a music group
and control group in Augustin and Hains's (1996) study. Although
232 JOURNAL OF HOLISTIC NURSING / September 1999
there was a significant reduction in heart rate, respiratory rate, blood
pressure, and anxiety scores in the music group, the control group
also showed a decline in systolic blood pressure and respiratory rate.
The only significant difference between the groups was in heart rate
(p < .05).
Music effect also has been examined in relation to pain (Beck,
1991; Good, 1995; Heiser, Chiles, Fudge, & Gray, 1997; Schorr, 1993;
Zimmerman, L. et al., 1996). Beck examined the effect of music versus
a controlled hum on pain perception and mood in a crossover design
with 15 patients with cancer. There was a significant difference in
pain perception with music and hum compared to baseline and
follow-up (p = .005); however, there was no difference between
groups after music and hum interventions.
Good (1995) randomly assigned 84 surgical patients to relaxation,
music, music and relaxation, or control groups to examine effects on
pain and anxiety postoperatively during ambulation. No significant
differences were found in sensation, distress, anxiety, or narcotic
intake across the groups. Similar findings were reported by Heiser et
al. (1997), who randomly assigned 10 preoperative patients to an
interoperative/postoperative music group and a control group.
There were no significant differences in pain or anxiety in the two
groups.
Schorr's (1993) participants consisted of 30 women with rheuma-
toid arthritis, who listened to music on a single occasion. Testing of
pain perception occurred premusic, during, and following music. She
found a significant increase in pain threshold during and following
the use of music (p < .001). Zimmerman et al. (1996) randomly
assigned 96 post-CABG patients to music, music video, or rest
groups with the intervention administered twice over 2 days. There
was a significant time effect in pain perception in both sessions (Ses-
sion 1, p < .01; Session 2, p < .001), yet there were no group effects at
either time.
The effect of music on vital signs as a measure of relaxation has
been examined in a variety of studies (Guzzetta, 1989; Kaempf &
Amodei, 1989; Sidani, 1991; Thornby et al., 1995; White, 1992; Zim-
merman, L. M. et al., 1988). In Guzetta's study, 80 patients with AMI
were randomly assigned to music, relaxation, or control groups. The
intervention was administered twice daily for three sessions over a
2-day period. There was a significant decrease in apical heart rate in
the music and relaxation group, compared to the control (p < .0001).
McBride et al. / MUSIC AND DYSPNEA 233
Similar findings were evident with peripheral temperatures. No dif-
ference in apical rate was found between relaxation and music, yet
there was a significant increase in temperature in the music group.
There was a significant time effect for apical rate (p = .006), with music
and relaxation being more effective than no intervention. No time
effect was evident for peripheral temperature.
Kaempf and Amodei (1989) found a significant decrease in systolic
blood pressure (p = .055) and respiratory rate (p = .002) following the
use of music. Systolic blood pressure also decreased in the control
group (p = .029). Mean difference between before-and-after scores
yielded a greater reduction in respiratory rate for the music group.
White (1992) also found that music decreased heart rate (p < .001) and
respiratory rate (p < .001) in patients with AMI, following a single
administration of music. Contrary to these findings, Zimmerman
et al. (1988) found no significant difference in heart rate, blood
pressure, or digital skin temperature among participants assigned
to music, white noise, or rest.
Sidani (1991) used a repeated measures design in which 10 patients
with COPD served as their own control. The patients took part in a
6-minute walk, followed by a rest and music condition or a rest-only
condition. The sequence of application of treatment and control con-
ditions was randomized. There was a significant decrease in respira-
tory rate (p = .02) and pulse rate (p = .01) in the music and rest condi-
tion. Thornby et al. (1995) randomly administered classical music,
gray noise, or silence to 36 patients with COPD who were engaged in
an exercise stress test, repeated four times over the course of the day.
Music was found to significantly increase exercise capacity, as evi-
denced by minimal but significant heart rate increase (p < .001),
increased ability to walk longer (22%, p < .001), increased work per-
formance (p < .001), and decreased perceived exertion (p < .001).
An additional study was conducted by Lehrer et al. (1994).
Seventy-two asthmatic patients were randomly assigned to music,
relaxation, or a wait-list control group. Following baseline testing,
interventions took place over eight sessions. Methacholine challenge
tests and pulmonary function tests were administered before and fol-
lowing the training. There was greater perceived relaxation in the
music and relaxation groups than in the control following the last
intervention (p < .02). There was less tension for the relaxation group
compared to the control in Sessions 4 and 8, whereas there was less
tension for music than the control for Session 8 (treatment effect, p <
234 JOURNAL OF HOLISTIC NURSING / September 1999
.02; session by treatment effect, p < .02). There were no differences in
spirometry found between groups after training sessions.
There are obvious discrepancies in the effectiveness of music in
reducing anxiety, promoting relaxation, or controlling pain that have
been reported in the literature. Some of these differences may be
attributed to methodological issues, such as the timing and duration
of the intervention. Generally, the sample sizes were small and were
not supported by power analysis. This might have contributed to
Type II errors. As well, opportunity to select the music and type of
music varied with the studies.
Although these studies contributed to the examination and
description of the therapeutic effects of music on psychological and
physiological outcomes, they were, for the most part, under con-
trolled experimental conditions. Investigations were implemented in
laboratory settings or in patients' rooms. Thus, generalization of find-
ings to community or home settings is not possible. In addition, with
the exception of Lehrer et al. (1994), only the short-term effects of lis-
tening to music were examined.
Several factors have been identified as important to consider when
selecting music as an intervention to promote relaxation, reduce anxi-
ety, or both. These include pitch and tempo (Robb, Nichols, Rutan,
Bishop, & Parker, 1995), type of music (Mornhinweg, 1992), personal
preference (Farnsworth, 1969; Standley, 1986; Stratton & Zalanowski,
1984; Taylor, 1973), and sensitivity to music in general (McClellan,
1988; Taylor, 1973). Music that has a low pitch and a tempo of 60 to 72
beats per minute tends to be perceived as soothing (Robb et al., 1995).
Mornhinweg reports that baroque and classical music tend to be bal-
anced and include a variety of timbres. New age music, sometimes
referred to as meditative music, often uses acoustic instruments, such
as piano or flute, moderate dynamics (soft to medium), moderate
tempos (slow to medium), simple textures (melody with accompani-
ment), flowing rhythms, and little dissonance (Fried, 1990). Baroque,
classical, and new age music contain characteristics that tend to pro-
mote relaxation. However, although music catalogues exist, and defi-
nitions of sedative and stimulative music have been taken into
account, music that is untested may have new subtle elements that
evoke different responses (Hanser, 1985). Personal preference and
musical background also must be considered, because people react
differently to music (Farnsworth, 1969; Standley, 1986; Stratton &
Zalanowski, 1984; Taylor, 1973).
McBride et al. / MUSIC AND DYSPNEA 235
Theoretical Underpinnings
Martha Rogers's science of unitary human beings (Rogers, 1986)
provided the broad underpinnings for the present study. Concepts
from the theory were not tested; rather, the theory served as a means
to understand the effect of music on anxiety and dyspnea. The unitary
human being is viewed as "an indivisible energy field that is integral
with the environmental energy field" (Rogers, 1992, p. 29). The
human-environmental energy field is unique for each individual and
is characterized by patterns. One cannot observe patterns; rather, it is
the manifestations of field patterns that are observable. Patterns are
continuously changing, and this change reflects the open nature of
the field. The nature and direction of change is understood through
Rogers's three principles of homeodynamics, namely helicy, integral-
ity, and resonancy (Rogers, 1986). Helicy describes the nature of the
change as continuous, innovative, unpredictable, and increasingly
diverse. Integrality is the mutual human-environment process by
which change takes place. Resonancy describes the continuous change
from lower- to higher-frequency wave patterns (Phillips, 1992).
Dyspnea, anxiety, or both can be regarded as unitary phenomena
for many patients with COPD. The amount of dyspnea, anxiety, or
both can be viewed as a manifestation of the human energy field pat-
tern. Music can be viewed as part of the environmental energy field in
interaction with the human energy field. Music with characteristics of
slow tempo of 60 to 72 beats per minute (Robb et al., 1995) and self-
selected (Farnsworth, 1969; Hanser, 1985; Standley, 1986; Taylor,
1973) has been reported to create a sense of relaxation in the individ-
ual. In the present study, this type of music has the potential to inter-
rupt the dyspnea-anxiety cycle to promote relaxation and reduced
dyspnea. This interaction between the person and the music reflects
Rogers's (1990) principle of integrality.
Objectives of the Study
The specific objectives addressed in this study are,
1. To examine the feasibility of using music as a therapeutic intervention
for dyspnea and anxiety in patients with COPD who live in their own
homes.
2. To examine the effect of music on the perception of anxiety and dysp-
nea in patients with COPD who live in their own homes.
236 JOURNAL OF HOLISTIC NURSING / September 1999
METHOD
Design
A mixed quantitative and qualitative design was used in this
study. The quantitative aspect of the design consisted of a repeated
measures, single-group design that was used to evaluate the effects of
music on patients' perceived dyspnea and anxiety. The patients were
followed over a period of 5 weeks. Measures of dyspnea and anxiety
were taken (a) at baseline, during the first week (Time 1); (b) during
the second week, before and after the patients listened to the 20-
minute music tape (the scores on dyspnea and anxiety obtained prior
to listening to music were considered as second baseline measures
within the repeated measures design) (Time 2); and (c) on the fifth
week (Time 3). The posttest scores on anxiety and dyspnea from Time
2 and the final individual scores of anxiety and dyspnea on the fifth
week (Time 3) represented the posttest measures of the outcomes.
This design allows for the examination of the effect of music at a single
time period (Time 2) as well as over time. The qualitative aspect of the
design involved the completion of two questionnaires that used an
open-ended format to identify the participants' use and preference of
music as well as their evaluation of the effectiveness of the music dur-
ing the study.
Setting and Sample
Criteria for inclusion in the study consisted of a diagnosis of
chronic bronchitis, emphysema, or both; the ability to read and speak
English; and reported experience of dyspnea at least once a week. Per-
sons attending a community support group held in a large Metropoli-
tan area in southern Ontario were recruited until a convenience sam-
ple of 25 participants was obtained. Only one participant dropped out
of the study following the first week of testing for the reason of lack of
interest in the study topic. Of the remaining 24 participants, the
majority (79%) were born in Canada and 59% had attained some level
of high school education. Fifty-eight percent were female and the
mean age was 69 years (SD = 5.7). Fifty percent of the sample were
married, whereas 58% lived with their families. Fifty-four percent
had a diagnosis of emphysema, with an average of 14.3 years since
McBride et al. / MUSIC AND DYSPNEA 237
diagnosis. The majority (67%) were not using oxygen. All participants
reported use of respiratory drugs, whereas the use of other medica-
tions varied.
Instruments and Measures
Visual Analogue Dyspnea Scale (VADS). This was used to measure
the level of dyspnea being experienced. The VADS consists of a 10
cm vertical visual analogue scale with anchors of shortness of breath as
bad as can be at the top and no shortness of breath at the bottom (Gift,
1989a, b). When tested with asthmatic patients, there was a strong
correlation of .97 between the vertical and horizontal analogue
scales and a correlation of .85 between the score on the vertical scale
and the participant's peak expiratory flow rate, providing evidence
of the concurrent validity of the vertical scale (Gift, 1989a). There is
considerable evidence to support the concurrent and discriminate
validity of visual analogue scales (Gift, 1989b). Test-retest reliability
of visual analogue scales also has been reported (Gift, 1989b). In
addition, the vertical scale was easier for the participants to under-
stand than the horizontal one. The vertical scale was able to discrimi-
nate between participants with COPD who had greater airway
obstruction, as indicated by a peak expiratory flow rate less than 150
lpm (liters per minute) and those who exhibited lesser airway
obstruction, as indicated by a peak expiratory flow rate greater than
150 lpm, thus providing evidence of the construct validity of the
VADS (Gift, 1989a).
The participant is asked to mark a point on the line that indicates
the amount of dyspnea experienced at that time. The VADS is scored
by measuring the distance, in centimeters, from the low end of the
scale to the participant's mark. Scores can range from 0 to 10.
Spielberger State Anxiety Scale (STAI Form X-1). This was used to
measure state anxiety, which is conceptualized as a transitory emo-
tional state that is characterized by subjective, consciously perceived
feelings of tension and apprehension and heightened autonomic
nervous system activity (Spielberger, Gorsuch, & Lushene, 1970). The
scale consists of 20 statements that ask the individuals to indicate how
they feel at a particular point in time. It has been used with patients
with COPD (Gift et al., 1992). Each item on the scale is rated from 1 (not
238 JOURNAL OF HOLISTIC NURSING / September 1999
at all) to 4 (very much). The higher the score on the scales, the greater
the anxiety experienced.
Test-retest correlations have been reported to range from .16 to .54
(Spielberger et al., 1970). The low test-retest correlations were consid-
ered to be consistent with the transitory nature of state anxiety. Inter-
nal consistency reliability of the scale ranged from .83 to .92 (Spiel-
berger et al., 1970). When used with COPD patients, the internal
consistency reliability was reported to be .79 (Gift et al., 1992). With
respect to validity, the scale was found to be sensitive to changes in
experimental situations in which the level of stress was manipulated
(Spielberger et al., 1970).
When repeated measurements of A-States are desired, scales con-
sisting of four to five STAI A-State items may be used to provide valid
measures of A-State (Spielberger et al., 1970). Thus, in this study, all
measures of state anxiety consisted of a random selection of four
items from the STAI Form X-1. Scores thus could range from a possi-
ble low of 4 to a high of 16.
Music Use and Preference Questionnaire. To determine music back-
ground and preference, participants were asked how often they lis-
tened to music, the circumstances under which they listened, type of
music preferred, whether they varied the music on the basis of their
mood, why they listened to music, and whether music had an effect
on them.
Measures to monitor use and effect of music. Two measures were used
to monitor the use and effectiveness of the music--the music diary
and the Music Effectiveness Questionnaire.
Music diary. Participants were instructed to use the music when-
ever they became dyspneic. Each time they used the music, the par-
ticipants were asked to indicate in the diary their level of dyspnea, on
a scale of 0 to 100, immediately prior to and after listening to the
music. They also were asked to indicate the length of time they lis-
tened to the music as well as the use of a puffer or inhaler.
Music Effectiveness Questionnaire. At Time 3, participants were
asked whether they had used the music tapes over the course of the
study and the effects they experienced when using the music.
McBride et al. / MUSIC AND DYSPNEA 239
Intervention
On the basis of the literature (McClellan, 1988; Ostrander & Schroeder,
1979), the music selections chosen were instrumental and with slow
tempo. These studies indicate that music of a duration of 20 to 45 min-
utes with quiet-sounding instruments tends to provide the greatest
relaxation effect. Personal preference has been emphasized as an
important variable in producing the relaxation effect (Standley, 1986;
Stratton & Zalanowski, 1984). Thus, participants were able to select
the type of music they preferred from a master tape containing classi-
cal, easy listening, and new age selections. Sixteen participants chose
easy listening, six chose new age, whereas two selected classical
music (see Table 1 for music selections).
Participants were given the following instructions on the use of
music:
1. Sit in a comfortable chair.
2. Insert selected tape into the Walkman.
3. Put on headphones.
4. Press the "play" button on the Walkman.
5. Place the Walkman in a convenient location.
6. Focus mind on the music, close eyes if desired.
7. Listen to the music for approximately 20 minutes.
8. When finished with the music, turn off Walkman, remove headphones,
and complete the music diary.
Procedure
Patients who expressed interest in participating in the study were
contacted to arrange a convenient time for the first home visit. During
the first visit, the study was explained to the patients and their
informed consents were obtained. A master tape consisting of the
selections of three types of music, together with a Walkman tape
recorder and earphones, were left with the patients so that they could
identify the type of music they preferred: classical, new age, or easy
listening. Measures of dyspnea and anxiety were taken at this time
(Time 1), and demographic data were collected.
At Time 2, patients were given a tape consisting of 20 minutes of
their preferred music (see Table 1). Instructions on the use of the
music were provided at this time. Measures of anxiety and dyspnea
were taken prior to and following the use of music. Participants were
instructed on how to use the music for the remaining study period;
240 JOURNAL OF HOLISTIC NURSING / September 1999
they were encouraged to listen to the music as many times during a
day as they experienced dyspnea, following the procedure described
earlier.
At Time 3, measures of anxiety and dyspnea were taken. The Walk-
man recorder was collected and the music tape was left with each
patient. At all testing times, the measures of anxiety and dyspnea
were administered in random order.
RESULTS
Music Background
To examine the history of the person's use of music, music back-
ground and preference were assessed at Time 1 by the Music Use and
Preference Questionnaire. Thirteen of the 24 participants reported lis-
tening to music in the past on a daily basis, whereas 4 reported fre-
quent or every-other-day patterns. The remaining participants did
not listen to music on a regular basis. Circumstances under which
they listened to music varied from helping to sleep, promoting relaxa-
tion, as a background, when alone, for enjoyment, in the car, and
when there was nothing else to do. Sixteen participants preferred
classical and light classical music, 11 preferred country, folk, and
popular, whereas religious music, jazz, and heavy metal were identi-
fied by a few.
Eleven participants reported that they varied the type of music,
depending on their mood. Most participants indicated that music had
McBride et al. / MUSIC AND DYSPNEA 241
TABLE 1
Music Selection Used in the Study
Classical: Debussy, Prelude to the Afternoon of a Faun
Mozart, Symphony #40 (2nd movement)
Bach, Largo From Concerto for Two Violins
New age: David Lanz, Cristofori's Dream
Wayne Gratz, Reminiscence; Time Out
Hilary Stagg, The Edge of Forever; Timeless Ways
Easy listening: Mantovani's Golden Hits; Greensleeves and Charmaine
Percy Faith; Theme From a Summer Place, Ebb Tide, Sound of
Music
an effect on them. When asked why they listened to music, many indi-
cated that they enjoyed music (n = 14), it helped them to relax (n = 8), it
decreased worry (n = 3), it provided company when alone (n = 3), it
gave them a lift (n = 2), and made them feel good (n = 2).
Use of Music
Music use during the study was assessed in two ways: through the
Music Effectiveness Questionnaire, which was a report at Time 3 of
the use and effect of the music over the course of the study, and the
music diary, which provided an ongoing account of the frequency
and duration of the music use. The findings from the Music Effective-
ness Questionnaire indicated that all participants used the music
tapes. The majority (n = 20) used the tapes whenever dyspneic during
the study, whereas the remaining participants (n = 4) used them spo-
radically, claiming they did not have the time.
The music diary provided an ongoing record of the frequency of
music use, which ranged from 2 to 71 entries (M = 18.37, SD = 17.39)
over the 5-week period, and the duration, which varied from 7 to 120
minutes (M = 25.2, SD = 13.0). Out of the total number of reported use
of music in the diary (n = 340), across all patients over the 5 weeks of
the study, use of the inhaler was reported in only 98 instances. That is,
approximately 71% of the times that music was used, the inhaler was
not used.
To determine whether musical background had any effect on the
frequency of music use, cross tabulations were performed to examine
the relationship between pervious use of music as reported in the
Music Use and Preference Questionnaire and the frequency of music
use reported in the diary. No significant relationship was found.
Music Effect
The effect of music was determined in four ways: the Music Effec-
tiveness Questionnaire, the music diary, a comparison of scores on
the STAI and VADS premusic to postmusic on Time 2, and repeated
mea-sures ANOVA. Findings from the Music Effectiveness Ques-
tionnaire indicated that participants found the music calmed them
and helped them relax (n = 18), they enjoyed the music and it made
them feel good (n = 4), and it helped reduce the shortness of breath (n
= 3). Individual comments of interest include the following:
242 JOURNAL OF HOLISTIC NURSING / September 1999
"decreased my concentration on breathing," "relaxed chest muscles,"
"did not need inhalers as often," "gave me time to gain control,"
"dulled the sound of oxygen," and "uncertain whether the effect was
due to sitting or the music." Several participants commented that the
music tape was too short and, therefore, monotonous.
The music diary provided a means of monitoring episodes of
music use whenever the participant became dyspneic. Participants
were instructed to record their level of dyspnea on a scale of 0 to 100,
immediately prior to and following the use of music. The diary was
analyzed by taking all of the ratings of each participant's pretest and
all of those at posttest to yield number of ratings across the partici-
pants. The comparison of premusic to postmusic scores showed a sig-
nificant decrease in the overall dyspnea reported following the use of
the music t(326) = 13.93, p < .001. The reported mean score of dysp-
nea premusic (M = 31.1) tended to be quite low.
In the diaries, one participant reported anecdotal comments indi-
cating that when she got short of breath while vacuuming, she sat
down, listened to the music, and then was able to finish her vacuum-
ing without further shortness of breath, which she found surprising.
She found that the music made a big difference in her ability to com-
plete work in the house.
Another participant reported using the music while sitting or
when working outside building a deck. He commented,
While sitting, the music was very relaxing after a tiring day. Being re-
laxed, my requirement for oxygen was less, my breathing was
smoother, and I felt more comfortable. The music also helped reduce
the tightness in my chest so that my breathing became more normal.
The music did not reduce strained or forced breathing. While working,
the music was very relaxing and made the work less strenuous
(worked more to a slower rhythm). Consequently, the breathing was
better controlled requiring less stoppages to catch up on my dwindling
oxygen supply.
To test the effect of music on anxiety and dyspnea at a single time
period, a pretest-posttest approach was used to examine levels of
anxiety (STAI) and dyspnea (VADS) following the use of music on the
second week of the study. Significant declines in anxiety and dyspnea
were found (see Table 2).
To determine whether there was a change in anxiety or dyspnea
over time, repeated measures ANOVA was performed. In this design,
the measures of anxiety (STAI) and dyspnea (VADS) taken on the first
McBride et al. / MUSIC AND DYSPNEA 243
week and second week prior to the use of music represented the base-
line measures. Measures of these outcomes following the use of music
in Week 2 and the final individual evaluation in Week 5 constituted
the posttest measures. There was no significant change in anxiety or
dyspnea over time. It is worth noting that the mean scores on the STAI
and VADS taken over the course of the study at Times 1, 2, and 3
tended to be quite low (STAI, 6.4-7.8; VADS, 1.9-2.8).
DISCUSSION
The results of this study suggest that people with COPD will use
music in conjunction with dyspnea, on their own in their own homes,
and that music may help relieve their dyspnea. There was a signifi-
cant decline in dyspnea and anxiety following the use of music at
Time 2 as well as a significant decline in dyspnea reported in the
diary. These findings indicate that music is effective in reducing
dyspnea and anxiety at a single time period. This is consistent with
findings showing that music is effective in relieving anxiety in cardiac
patients (Bolwerk, 1990; Sabo & Michael, 1996; White, 1992), in reliev-
ing pain in patients with rheumatoid arthritis (Schorr, 1993), and in
decreasing vital signs (Augustin & Hains, 1996; Sidani, 1992; White,
1992).
Although music was effective in reducing dyspnea and anxiety at a
single time period, there was no significant change over time in either
anxiety or dyspnea. There may be several explanations for this incon-
sistency. Many of the participants reported that at the time of testing
244 JOURNAL OF HOLISTIC NURSING / September 1999
TABLE 2
Comparison of Scores on STAI and VADS
Following Use of Music, Time 2 (n = 24)
2-Tailed
Variable Mean SD t Value df Significance
STAI pretest 7.75 3.03 2.62 23 p < .05
STAI posttest 6.38 2.32
VADS pretest 2.83 2.01 3.04 32 p < .01
VADS posttest 1.88 1.87
NOTE: STAI = Spielberger State Anxiety Inventory; VADS = Visual Analogue Dyspnea
Scale.
their level of dyspnea was not as high as at other times in the day. It is
possible that the random one-time testing of dyspnea and anxiety at
three consecutive time frames did not capture adequately the dysp-
nea experience. In addition, the participants were asked to rate only
their current level of dyspnea. Different results might have been
obtained if a more thorough assessment of the dyspnea experience
had been carried out. This assessment might have included not only
current level of dyspnea but also worst and average levels of dyspnea
as is frequently done in assessments of pain.
Although 20 of the 24 participants reported in the Music Effective-
ness Questionnaire that they had used the music regularly over the
course of the study, the frequency and duration of reporting in the
diary did not support this. In fact, by the end of the study period there
was a decline in the number of participants reporting the use of music
in the diary. This finding suggests a difficulty in the monitoring of the
use of music in an uncontrolled setting and, thus, a difficulty in exam-
ining effect over time. In addition, there was variability in the extent
to which participants used the music. Because the use of music was
need-based, there was no control over how frequently participants
used it. In addition, no attempt was made to have the participants lis-
ten to the music on a regular schedule, which would have increased
the dosage of the intervention and thus possibly contributed to long-
term effects.
Another reason for the lack of change over time might relate to the
measures used. The consistently low scores on the anxiety and dysp-
nea measures throughout the study raises the question of whether the
instruments were sufficiently sensitive to measure changes in level of
anxiety and dyspnea. However, in previous studies, the instruments
have been shown to be sensitive to change. Gift et al. (1986) were able
to differentiate within-participant variations in levels of dyspnea
using a visual analogue rating scale, and such variations in levels of
anxiety were differentiated with the STAI (Gift et al., 1992). This sug-
gests that these instruments are able to identify changes in levels of
anxiety and dyspnea in individuals with COPD.
Sensitivity to music has been noted to be an important factor in the
person's response to music (Taylor, 1973). People who have a history
of listening to music may have a greater response to music than those
who do not have this background. Seventeen of the 24 participants in
this study stated that they used music frequently in the past. These
people may have had a different response to the music than those
who did not have a history of listening to music. However, there was
McBride et al. / MUSIC AND DYSPNEA 245
no significant relationship between previous use of music and fre-
quency of current use. These findings are limited by the small number
in the two groups.
The results of this study are consistent with some of the elements of
Rogers's (1986) theory of unitary human beings. The uniqueness of
the human-environmental energy field is evidenced by the selection
of music, based on personal preference. The effect of the music on the
experience of anxiety and dyspnea may be viewed as an interaction
between the human and environmental energy fields, which is con-
sistent with Rogers's (1986) principle of integrality. The reduction in
anxiety and dyspnea could be viewed as an outcome of this interac-
tion. The fluctuations in reported anxiety and dyspnea may represent
the continuous, unpredictable nature of change that is characteristic
of Rogers's (1986) principle of helicy.
Rogers's (1986) concepts and principles are consistent with the
concept of holism, which is "concerned with the interrelationship of
body mind spirit in an everchanging environment" (Dossey, Keegan,
Guzzella, & Kolkmeier, 1995, p. 138). Thus, music as an alternate ther-
apy could be viewed as an intervention that focuses on the whole
person.
Limitations
A major limitation of this study was the small sample size, which
may have reduced the opportunity to detect differences in anxiety
and dyspnea over time. As well, the lack of a control group restricts
the interpretation of the findings. No data were collected on the par-
ticipants' lung function to provide an objective indicator of severity of
illness. Although the diary provided some information about use of a
bronchodilator during the 5-week period, there was no consistent
record of use. Although the participants were instructed to use only
the music tape provided, there was no control over the use of other
music during the study. Many participants commented on wanting
more variety of music.
Application to Nursing Practice
The results of this study suggest that listening to music is a poten-
tial intervention for relieving situational dyspnea, anxiety, or both in
patients with COPD. The participants were very positive about the
246 JOURNAL OF HOLISTIC NURSING / September 1999
intervention.Itisimportanttorememberthatpersonalmusicpreference
should be considered (Farnsworth, 1969; Standley, 1986; Stratton &
Zalanowski; Taylor, 1973), as should the pitch and tempo of the music
(Cook, 1981), the type of music (Mornhinweg, 1992), and the person's
music history to determine his or her sensitivity to music (McClellen,
1988; Taylor, 1973).
Implications for Further Research
There is a need to replicate this study with a larger sample and a
control group to determine the impact of music on anxiety and dysp-
nea. Severity and frequency of dyspnea need to be recorded. Alter-
nate ways of measuring anxiety and dyspnea, other than the weekly
assessments performed in this study, need to be considered. Many of
the participants reported that they became bored with the small, short
selection of music; thus, there is a need to provide greater variety and
length of the selected music.
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McBride et al. / MUSIC AND DYSPNEA 249
Sandra McBride, Ed.D., R.N., is an adjunct professor at the School of Nursing,
Ryerson Polytechnic University, Toronto, Ontario, Canada. She and the remaining
authors have an interest in the therapeutic role of music for client populations.
Jane Graydon, R.N., Ph.D., is a professor at the Faculty of Nursing, University of
Toronto, Toronto, Ontario, Canada.
Souraya Sidani, R.N., Ph.D., is an assistant professor at the Faculty of Nursing,
University of Toronto, Toronto, Ontario, Canada.
Leslie Hall, Ph.D., is an assistant professor in the Department of Philosophy and
Music, Ryerson Polytechnic University, Toronto, Ontario, Canada.
250 JOURNAL OF HOLISTIC NURSING / September 1999
</meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Augustin, P.</surname></name>
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