Lessons From the Implementation of Music Therapy Services in Inpatient Hospital Settings

Music therapy is an integrative service that uses music interventions within a therapeutic relationship with a board-certified music therapist to address nonmusical goals (cognitive, social, emotional, and physical). Patients of all ages can benefit from music therapy, and do not need a prior musical background. Music therapists use evidence-based interventions and have knowledge in neurology, psychology, development, and music.

Examples of Music Therapy in Medical Settings

*Music entrained to breathing rate or heart rate at bedside (matched and then adjusted in tempo), reducing stress levels even when patient can’t actively participate in session.
*Using musical instruments and games to help patients, family, and staff improve nonverbal communication.
*Rhythmic Auditory Stimulation improving motor function in people with Parkinson’s disease or in stroke recovery.
*Use of singing to regain speech and improve prosody after a traumatic brain injury.
*Musical playlists and life review to maintain memory and reconnect families of patients with memory loss and reduce the agitation levels of patients with dementia.
*Heartbeat recordings and songwriting legacy projects in palliative care settings.
*Adaptive teaching of wind instruments and singing to reduce asthma episodes and increase lung capacity in patients with lung disease.
*Improve sleep patterns and increase weight gain in premature infants

These examples of therapeutic music are noteworthy, but are not clinical music therapy:

  *   A person with Alzheimer’s listening to an iPod with headphones of his/her favorite songs
  *   Groups such as Bedside Musicians, Musicians on Call, Music Practitioners, Sound Healers, and Music Thanatologists
  *   Celebrities performing at hospitals and/or schools
  *   A piano player in the lobby of a hospital
  *   Nurses playing background music for patients
  *   Artists in residence
  *   Arts educators
  *   A high school student playing guitar in a nursing home
  *   A choir singing on the pediatric floor of a hospital


Brief History of Music Therapy at Maine Medical Center:

2013: Music Therapist, Occupational Therapist, and Recreation Therapist facilitated movement and discussion to music performed by Portland Symphony musicians at New England Rehabilitation Hospital.
2014: Grant-funded music therapy sessions begin on Barbara Bush Children’s Hospital
2015: Family Medicine residents engage in music meditation, group drumming, and songwriting for self-care led by MT-BC and integrative medicine physician
2016: Music therapy expands into Neonatal ICU via the Lullaby Program, supporting families with psychosocial challenges through songwriting and infant-family vocal connections
2017: Music therapy program expands on BBI and Maine Children’s Cancer Program
2019: Patients in neuro rehab setting (R6) are seen by music therapist for stroke recovery and pain management
2020: Music therapy requested for emergency department with longer term psychiatry patients
2022: Geriatric psychiatry department (P6) develops a 12 week pilot study for group music therapy to reduce PRN meds for agitation
2023: Emergency Department requests music therapy pilot for the ER waiting room
2023: Pilot study in development on adult medical oncology floor (CFT7) to study music therapy in reduction of PRN meds for pain and agitation


Challenges and Lessons On Service Implementation and Study Design:

  • Knowledge of availability and purpose of music therapy by medical staff is helpful for appropriate referrals

  • Medical billing could explore insurance coverage options for music therapy services as MT-BCs have NPIs and are trained in use of codes appropriate to their services

  • Both groups and individual, bedside sessions are effective depending on the setting

  • Since MT-BCs are often part time or contracted, pilot studies should have an additional PI

  • RNs, CNAs, or others who will be involved in data collection for the study need to complete the CITI training and engage in the IRB process- floors should decide how to fund this extra time before beginning a pilot study

  • Floors should be sure to collect data using pre and post tests, surveys, or chart review to

  • Philanthropy team should explore short-term funding opportunities for pilot programs

  • MT-BCs should have access to patient chart for more impactful multidisciplinary co-treating, which improves patient care. In turn, other staff members’ access to MT-BC’s chart notes provide greater clarity around the role of music therapy and its goals and objectives.

    References and Prior Studies:

  • Allen K, Golden LH, Izzo JL, Jr., et al. Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Psychosom Med. May-Jun 2001;63(3):487-492.

  • Atkinson TM, Liou KT, Borten MA, et al. Association Between Music Therapy Techniques and Patient-Reported Moderate to Severe Fatigue in Hospitalized Adults With Cancer. JCO Oncol Pract. 2020 Dec;16(12):e1553-e1557.

  • Barrera ME, Rykov MH, Doyle SL. The effects of interactive music therapy on hospitalized children with cancer: a pilot study. Psychooncology. Sep-Oct 2002;11(5):379-388.

  • Bates D, Bolwell B, Majhail NS, et al. Music Therapy for Symptom Management After Autologous Stem Cell Transplantation: Results From a Randomized Study. Biol Blood Marrow Transplant. Sep 2017;23(9):1567-1572.

  • Belfi AM, Karlan B, Tranel D. Music evokes vivid autobiographical memories. Memory. Aug 2016;24(7):979-989.

  • Belland L, Rivera-Reyes L, Hwang U. Using music to reduce anxiety among older adults in the emergency department: a randomized pilot study. J Integr Med. Nov 2017;15(6):450-455.

  • Bieleninik L, Geretsegger M, Mossler K, et al. Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. JAMA. Aug 8 2017;318(6):525-535.

  • Bittman BB, Berk LS, Felten DL, et al. Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Altern Ther Health Med. Jan 2001;7(1):38-47.

  • Bradt J, Dileo C, Grocke D, et al. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev. Aug 10 2011(8):Cd006911.

  • Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev. Jun 6 2013(6):Cd006908.

  • Bro ML, Johansen C, Vuust P, et al. Effects of live music during chemotherapy in lymphoma patients: a randomized, controlled, multi-center trial. J Support Care Cancer. 2019 Oct;27(10):3887-3896

  • Brotons M, Marti P. Music therapy with Alzheimer’s patients and their family caregivers: a pilot project. J Music Ther. Summer 2003;40(2):138-150.

  • Bulfone T, Quattrin R, Zanotti R, et al. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holist Nurs Pract. Jul-Aug 2009;23(4):238-242.

  • Burns DS, Perkins SM, Tong Y, et al. Music Therapy is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care. J Pain Symptom Manage. Aug 2015;50(2):225-231.

  • Cadwalader A, Orellano S, Tanguay C, et al. The Effects of a Single Session of Music Therapy on the Agitated Behaviors of Patients Receiving Hospice Care. J Palliat Med. Aug 2016;19(8):870-873.

  • Canga B, Azoulay R, Raskin J, et al. AIR: Advances in Respiration - Music therapy in the treatment of chronic pulmonary disease. Respir Med. Dec 2015;109(12):1532-1539.

  • Carlson LE, Ismaila N, Addington EL, et al. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol. 2023 Aug 15:JCO2300857. 

  • Cassileth BR, Vickers AJ, Magill LA. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial. Cancer. Dec 15 2003;98(12):2723-2729.

  • Cepeda MS, Carr DB, Lau J, et al. Music for pain relief. Cochrane Database Syst Rev. Apr 19 2006(2):Cd004843.

  • Chan YM, Lee PW, Ng TY, et al. The use of music to reduce anxiety for patients undergoing colposcopy: a randomized trial. Gynecol Oncol. Oct 2003;91(1):213-217.

  • Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA. Jun 12 2013;309(22):2335-2344.

  • Chu H, Yang CY, Lin Y, et al. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs. Apr 2014;16(2):209-217.

  • Clark IN, Baker FA, Taylor NF. Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. J Music Ther. Winter 2016;53(4):364-397.

  • Contreras-Molina, M., Rueda-Núñez, A., Pérez-Collado, M. L., & García-Maestro, A. (2021). Effect of music therapy on anxiety and pain in the critical polytraumatised patient. Enfermería Intensiva (English ed.), 32(2), 79-87.

  • Crawford MJ, Gold C, Odell-Miller H, et al. International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study. Health Technol Assess. Oct 2017;21(59):1-40.

  • Dain AS, Bradley EH, Hurzeler R, et al. Massage, Music, and Art Therapy in Hospice: Results of a National Survey. J Pain Symptom Manage. Jun 2015;49(6):1035-1041.

  • Deng C, Xie Y, Liu Y, et al. Aromatherapy Plus Music Therapy Improve Pain Intensity and Anxiety Scores in Patients With Breast Cancer During Perioperative Periods: A Randomized Controlled Trial. Clin Breast Cancer. Feb 2022;22(2):115-120.

  • Emard N, Lynch KA, Liou KT, et al. Virtual Mind-Body Programming for Patients With Cancer During the COVID-19 Pandemic: Qualitative Study. JMIR Cancer. Jun 8 2021;7(2):e27384.

  • Fallek, R., Corey, K., Qamar, A., Vernisie, S. N., Hoberman, A., Selwyn, P. A., ... & Lounsbury, D. W. (2020). Soothing the heart with music: A feasibility study of a bedside music therapy intervention for critically ill patients in an urban hospital setting. Palliative & Supportive Care, 18(1), 47-54.

  • Fu VX, Oomens P, Klimek M, et al. The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay: A Meta-analysis. Ann Surg. Dec 2020;272(6):961-972.

  • Galaal K, Bryant A, Deane KH, et al. Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database Syst Rev. Dec 7 2011(12):Cd006013.

  • Gallagher LM, Gardner V, Bates D, et al. Impact of Music Therapy on Hospitalized Patients Post-Elective Orthopaedic Surgery: A Randomized Controlled Trial. Orthop Nurs. Mar/Apr 2018;37(2):124-133.

  • Garcia Gonzalez J, Ventura Miranda MI, Requena Mullor M, et al. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. J Matern Fetal Neonatal Med. Apr 2018;31(8):1058-1065.

  • Ghetti C, Chen XJ, Brenner AK, et al. Music therapy for people with substance use disorders (https://pubmed.ncbi.nlm.nih.gov/35532044/). Cochrane Database Syst Rev. 2022;5(5):CD012576.

  • Goldenberg RB. Singing Lessons for Respiratory Health: A Literature Review. J Voice. Jan 2018;32(1):85-94.

  • Good M, Anderson GC, Stanton-Hicks M, et al. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs. Jun 2002;3(2):61-70.

  • Gotell E, Brown S, Ekman SL. Influence of caregiver singing and background music on posture, movement, and sensory awareness in dementia care. Int Psychogeriatr. Dec 2003;15(4):411-430.

  • Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. May 6 2017;67(3):194-232.

  • Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. Summer 2003;40(2):113-137.

  • Hutchinson JC, Karageorghis CI, Black JD. The Diabeates Project: Perceptual, Affective and Psychophysiological Effects of Music and Music-Video in a Clinical Exercise Setting. Can J Diabetes. Feb 2017;41(1):90-96.

  • Jia R, Liang D, Yu J, et al. The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis. Psychiatry Res. 2020 Sep 19;293:113464.

  • Jia T, Ogawa Y, Miura M, et al. Music Attenuated a Decrease in Parasympathetic Nervous System Activity after Exercise. PLoS One. 2016;11(2):e0148648.

  • Kacem, I., Kahloul, M., El Arem, S., Ayachi, S., Hafsia, M., Maoua, M., Ben Othmane, M., El Maalel, O., Hmida, W., Bouallague, O., Ben Abdessalem, K., Naija, W., & Mrizek, N. (2020). Effects of music therapy on occupational stress and burn-out risk of operating room staff. Libyan Journal of Medicine, 15(1), 1–2.

  • Karageorghis CI, Priest DL. Music in the exercise domain: a review and synthesis (Part I). Int Rev Sport Exerc Psychol. Mar 2012;5(1):44-66.

  • Killingback C, Tsofliou F, Clark C. Older people’s adherence to community-based group exercise programmes: a multiple-case study. BMC Public Health. Jan 25 2017;17(1):115.

  • Knoerl R, Mazzola E, Woods H, et al. Exploring the Feasibility of a Mindfulness-Music Therapy Intervention to Improve Anxiety and Stress in Adolescents and Young Adults with Cancer. J Pain Symptom Manage. Apr 2022;63(4):e357-e363.

  • Knoerl R, Phillips CS, Berfield J, et al. Lessons learned from the delivery of virtual integrative oncology interventions in clinical practice and research during the COVID-19 pandemic. Support Care Cancer. Aug 2021;29(8):4191-4194.

  • Lam HL, Li WTV, Laher I, Wong RY. Effects of Music Therapy on Patients with Dementia-A Systematic Review. Geriatrics (Basel). 2020 Sep 25;5(4):E62.

  • Lee AL, Dolmage TE, Rhim M, et al. The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD. Chest. May 2018;153(5):1134-1141.

  • Li XM, Yan H, Zhou KN, et al. Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast Cancer Res Treat. Jul 2011;128(2):411-419.

  • Li, G., Yu, L., Yang, Y., Deng, J., Shao, L., & Zeng, C. (2023). Effects of Perioperative Music Therapy on Patients with Postoperative Pain and Anxiety: A Systematic Review and Meta-Analysis. Journal of Integrative and Complementary Medicine.

  • Lichtl A, Casaw C, Edwards J, et al. Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study. J Pain Symptom Manage. 2022 Nov;64(5):478-485.

  • Lin MF, Hsieh YJ, Hsu YY, et al. A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. J Clin Nurs. Apr 2011;20(7-8):988-999.

  • Liou KT, Lynch KA, Nwodim O, et al. Comparison of Depressive Symptom Outcomes in Hospitalized Adult Cancer Patients Receiving Music Therapy or Massage Therapy. J Pain Symptom Manage. 2022 Feb;63(2):e155-e159.

  • Liu Q, Li W, Yin Y, et al. The effect of music therapy on language recovery in patients with aphasia after stroke: a systematic review and meta-analysis (https://pubmed.ncbi.nlm.nih.gov/34816318/). Neurol Sci. 2022;43(2):863-872.

  • Low MY, Lacson C, Zhang F, Kesslick A, Bradt J. Vocal Music Therapy for Chronic Pain: A Mixed Methods Feasibility Study. J Altern Complement Med. 2020 Feb;26(2):113-122.

  • Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. Sep 1 2018;36(25):2647-2655.

  • Lynch KA, Emard N, Liou KT, et al. Patient Perspectives on Active vs. Passive Music Therapy for Cancer in the Inpatient Setting: A Qualitative Analysis. J Pain Symptom Manage. Jul 2021;62(1):58-65.

  • Machado Sotomayor MJ, Arufe-Giráldez V, Ruíz-Rico G, Navarro-Patón R. Music Therapy and Parkinson's Disease: A Systematic Review from 2015-2020 (https://pubmed.ncbi.nlm.nih.gov/34770129/). Int J Environ Res Public Health. 2021;18(21):11618.

  • Mandel, S. E., Davis, B. A., & Secic, M. (2019). Patient satisfaction and benefits of music therapy services to manage stress and pain in the hospital emergency department. Journal of Music Therapy, 56(2), 149-173.

  • Maratos A, Crawford MJ, Procter S. Music therapy for depression: it seems to work, but how? Br J Psychiatry. Aug 2011;199(2):92-93.

  • Menon V, Levitin DJ. The rewards of music listening: response and physiological connectivity of the mesolimbic system. Neuroimage. Oct 15 2005;28(1):175-184.

  • Merrett DL, Peretz I, Wilson SJ. Neurobiological, cognitive, and emotional mechanisms in melodic intonation therapy. Front Hum Neurosci. 2014;8:401.

  • Miladinia M, Voss JG, Molavynejad S, et al. Slow-Stroke Back Massage Compared With Music Therapy for Leukemia-Related Pain and Fatigue: A Randomized Controlled Trial. JCO Oncol Pract. Nov 2021;17(11):e1614-e1621.

  • Millett CR, Gooding LF. Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers. J Music Ther. Jan 13 2018;54(4):460-478.

  • Nguyen TN, Nilsson S, Hellstrom AL, et al. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. J Pediatr Oncol Nurs. May-Jun 2010;27(3):146-155.

  • Quoniam N, Ergis AM, Fossati P, et al. Implicit and explicit emotional memory for melodies in Alzheimer’s disease and depression. Ann N Y Acad Sci. Nov 2003;999:381-384.

  • Ramirez R, Planas J, Escude N, et al. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients. Front Psychol. 2018;9:254.

  • Ratcliff CG, Prinsloo S, Richardson M, et al. Music therapy for patients who have undergone hematopoietic stem cell transplant. Evid Based Complement Alternat Med. 2014;2014:742941.

  • Robb SL, Burns DS, Stegenga KA, et al. Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: a report from the Children’s Oncology Group. Cancer. Mar 15 2014;120(6):909-917.

  • Rocha PA, Slade SC, McClelland J, et al. Dance is more than therapy: Qualitative analysis on therapeutic dancing classes for Parkinson’s. Complement Ther Med. Oct 2017;34:1-9.

  • Rossetti A, Chadha M, Torres BN, et al. The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy. Int J Radiat Oncol Biol Phys. Sep 1 2017;99(1):103-110.

  • Rossetti, A. (2020). Environmental Music Therapy (EMT): Music’s contribution to changing hospital atmospheres and perceptions of environments. Music Med, 12(2), 130-141.

  • Salamon E, Bernstein SR, Kim SA, et al. The effects of auditory perception and musical preference on anxiety in naive human subjects. Med Sci Monit. Sep 2003;9(9):Cr396-399.

  • Schauer M, Mauritz KH. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement. Clin Rehabil. Nov 2003;17(7):713-722.

  • Shabandokht-Zarmi H, Bagheri-Nesami M, Shorofi SA, et al. The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients. Complement Ther Clin Pract. Nov 2017;29:53-57.

  • Shimizu N, Umemura T, Matsunaga M, et al. Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial. Aging Ment Health. Sep 22 2017:1-13.

  • Singhal G, Jaehne EJ, Corrigan F, et al. Cellular and molecular mechanisms of immunomodulation in the brain through environmental enrichment. Front Cell Neurosci. 2014;8:97.

  • Sliwka A, Nowobilski R, Polczyk R, et al. Mild asthmatics benefit from music therapy. J Asthma. May 2012;49(4):401-408.

  • Smith M, Casey L, Johnson D, et al. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncol Nurs Forum. Jun 2001;28(5):855-862.

  • Suzuki M, Kanamori M, Watanabe M, et al. Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia. Nurs Health Sci. Mar 2004;6(1):11-18.

  • Tang H, Chen L, Wang Y, et al. The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy. Support Care Cancer. Dec 2021;29(12):7299-7306.

  • Tang Q, Huang Z, Zhou H, et al. Effects of music therapy on depression: A meta-analysis of randomized controlled trials. PLoS One. 2020;15(11):e0240862.

  • Torres E, Pedersen IN, Perez-Fernandez JI. Randomized Trial of a Group Music and Imagery Method (GrpMI) for Women with Fibromyalgia. J Music Ther. Jun 7 2018;55(2):186-220.

  • Trevino KM, Raghunathan N, Latte-Naor S, et al. Rapid deployment of virtual mind-body interventions during the COVID-19 outbreak: feasibility, acceptability, and implications for future care. Support Care Cancer. Feb 2021;29(2):543-546.

  • Tuinmann G, Preissler P, Bohmer H, et al. The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study. Psychooncology. Mar 2017;26(3):377-384.

  • van der Heijden MJ, Oliai Araghi S, van Dijk M, et al. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One. 2015;10(8):e0133608.

  • van der Heijden MJE, Mevius H, van der Heijde N, et al. Children Listening to Music or Watching Cartoons During ER Procedures: A RCT.  J Pediatr Psychol. 2019 Nov 1;44(10):1151-1162.

  • Warth M, Koehler F, Brehmen M, et al. “Song of Life”: Results of a multicenter randomized trial on the effects of biographical music therapy in palliative care. Palliat Med. Jun 2021;35(6):1126-1136.

  • Young HJ, Mehta TS, Herman C, et al. The Effects of Movement-to-Music (M2M) and Adapted Yoga on Physical and Psychosocial Outcomes in People with Multiple Sclerosis. Arch Phys Med Rehabil 2019 Mar;100(3):391-400.

  • Yun H, Sun L, Mao JJ. Growth of Integrative Medicine at Leading Cancer Centers Between 2009 and 2016: A Systematic Analysis of NCI-Designated Comprehensive Cancer Center Websites. J Natl Cancer Inst Monogr. Nov 1 2017;2017(52).