What are the benefits of listening to instrumental music for patients with anxiety, depression, or cognitive impairment, including those with dementia or Alzheimer's disease?

Benefits of Listening to Instrumental Music

Music therapy and music-based interventions, including listening to instrumental music, should be recommended for managing anxiety, with large effect sizes demonstrated across multiple systematic reviews, and may also provide benefits for depression and behavioral symptoms in patients with dementia. 1

Evidence for Anxiety Reduction

Cancer Patients

• Music interventions produce large effect sizes for anxiety reduction in cancer patients, with standardized mean differences of -7.71 points on the STAI-S scale and -0.76 for other anxiety measures across 26 trials involving over 2,200 participants. 1

• Both music therapy delivered by trained therapists and listening to pre-recorded music demonstrate significant benefits, though music therapy sessions with trained therapists produce more consistent results than self-directed listening. 1

• Individual RCTs show even larger effects, with one study demonstrating an effect size of -1.87 for music therapy during chemotherapy. 1

Dementia and Alzheimer's Disease

• Music interventions significantly reduce anxiety in dementia patients (SMD = -0.67, p < 0.001), with particularly strong effects in Alzheimer's disease and mixed-type dementia. 2

• A controlled RCT in Alzheimer's patients showed significant improvements in anxiety (p < 0.01) starting at week 4, with effects sustained for up to 8 weeks after discontinuation of sessions. 3

• Music listening and caregiver singing decrease agitation and improve well-being in people with dementia through effects on mood and social connections. 4

Evidence for Depression

• Music therapy demonstrates significant reductions in depression in both cancer patients and those with dementia, according to the Society for Integrative Oncology-ASCO guidelines. 1

• In Alzheimer's patients, depression scores improved significantly (p < 0.01) with weekly music therapy sessions, with benefits lasting 8 weeks post-treatment. 3

• The Alzheimer's and Dementia guidelines report evidence for reductions in depression and behavioral problems, though effects on cognition are minimal. 5

Cognitive Function Considerations

• The "Mozart effect" claims of enhanced spatial-temporal reasoning are modest, short-term, and do not generalize to broader cognitive abilities or meaningful health outcomes, according to Psychological Science in the Public Interest guidelines. 5

• Music therapy may have value as part of a broader approach to managing dementia, but expectations should be modest regarding cognitive outcomes. 5

• Music engages extensive brain networks for auditory, cognitive, motor, and emotional processing, and these effects are often well-preserved in aging and dementia. 6

Additional Benefits

Behavioral and Neuropsychiatric Symptoms

• Music interventions significantly improve agitation (p = 0.021) and reduce other neuropsychiatric symptoms in dementia patients. 2

• Group singing supports cognitive health and well-being in older adults and those with mental health problems through effects on cognitive functions, mood, and social connections. 4

Social and Emotional Benefits

• Shared music listening (concerts, radio programs) enhances social connections and mood in older adults and hospital patients. 4

• Music activities support psychological well-being and social cohesion across diverse populations and settings. 7, 4

Clinical Implementation

Practical Approach

• Start with patient-selected music to maximize engagement and cultural relevance, as demonstrated in studies comparing different musical styles including religious music. 1

• Consider referral to trained music therapists for more consistent results, particularly for patients with severe symptoms or complex needs. 1

• Self-directed listening to pre-recorded instrumental music remains a viable, accessible option with demonstrated benefits, though effects may be less consistent than therapist-led interventions. 1

Duration and Frequency

• Weekly sessions show sustained benefits, with effects lasting up to 8 weeks after discontinuation in Alzheimer's patients. 3

• Benefits typically emerge by week 4 of regular music intervention. 3

Important Caveats

• Methodologic quality ratings are typically low for music intervention studies because participants cannot be blinded to the intervention and anxiety is measured by self-report, but this does not necessarily indicate poor study design. 1

• Traditional five-element Chinese music interventions showed no evidence of effect on anxiety, suggesting that music selection and cultural appropriateness matter. 1

• One RCT found no significant difference for patient-selected music during radiotherapy, indicating that context and timing of intervention may influence outcomes. 1

• Music therapy should be viewed as an adjunctive intervention rather than a replacement for evidence-based treatments like cognitive behavioral therapy or SSRIs for moderate to severe anxiety and depression. 8