Edith Cowan University Research Online Theses: Doctorates and Masters Theses 2018 Comparing live to recorded music and stories using multiple psychoneuroendocrine and psychological measures Ronniet Orlando Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Music Commons, and the Psychology Commons Recommended Citation Orlando, R. (2018). Comparing live to recorded music and stories using multiple psychoneuroendocrine and psychological measures. https://ro.ecu.edu.au/theses/2136 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/2136 Edith Cowan University      Copyright Warning            You may print or download ONE copy of this document for the purpose  of your own research or study.    The University does not authorize you to copy, communicate or  otherwise make available electronically to any other person any  copyright material contained on this site.    You are reminded of the following:     Copyright owners are entitled to take legal action against persons  who infringe their copyright.     A reproduction of material that is protected by copyright may be a  copyright infringement. Where the reproduction of such material is  done without attribution of authorship, with false attribution of  authorship or the authorship is treated in a derogatory manner,  this may be a breach of the author’s moral rights contained in Part  IX of the Copyright Act 1968 (Cth).     Courts have the power to impose a wide range of civil and criminal  sanctions for infringement of copyright, infringement of moral  rights and other offences under the Copyright Act 1968 (Cth).  Higher penalties may apply, and higher damages may be awarded,  for offences and infringements involving the conversion of material  into digital or electronic form. Comparing live to recorded music and stories using multiple psychoneuroendocrine and psychological measures This thesis is presented for the degree of Doctor of Philosophy Ronniet Orlando Edith Cowan University School of Arts and Humanities 2018 Declaration I certify that this thesis does not, to the best of my knowledge and belief: i. incorporate without acknowledgment any material previously submitted for a degree or diploma in any institution of higher education; ii. contain any material previously published or written by another person except where due reference is made in the text of this thesis; or iii. contain any defamatory material Ronniet ORLANDO Ronniet Orlando PhD Thesis i Abstract Listening to music brings health benefits, according to an expanding opus of empirical research. Studies to date cover a wide range of music interventions and outcome measures. Music has been applied to healthy participants, as well as clinical populations to target anxiety and pain. But little is known about whether live music is more effective than recorded music as an intervention for these common symptoms. This exploratory study sought answers with the emerging science of saliva analysis, which focuses on biomarkers that indicate stress and immune function. In this case salivary cortisol, alpha-amylase, immunoglobulin-A, interleukin- 1beta, and pH levels were measured. Saliva samples from 50 university students and 23 palliative care and surgical patients were compared before and after each participant listened to a live (ML), audiovisual (MAV) or audio recorded (MA) standardised program of classical music played on a solo violin, viola or cello. Live (SL) or audio (SA) story readings were added as interventions to control for psychosocial variables. Saliva’s non-invasive, repeatable, objective psychoneuroendocrine (PNE) snapshots were supplemented with subjective visual analogue scales for anxiety (VASA) and pain (VASP), and self-report affect scales to rate liking, perceived and felt emotion, and absorption. Participants were also asked for a one-word summary of their listening experience. It was anticipated that ML would reduce anxiety and pain, as well as boost the immune markers, more than MAV and MA, and that music overall would demonstrate stronger benefits than the story readings. No single outcome measure provided sufficient data to draw conclusions, but trends in the melange of both objective and subjective instruments revealed that overall more positive health indicators arose from live music than recorded music, particularly in the clinical settings. Stories were also shown to have some Ronniet Orlando PhD Thesis ii moderating effects on pain and anxiety. This study demonstrated the therapeutic values of music as well as story readings, and the superior benefits of live music and stories compared to audio recordings of the same presentations. The PNE methodology had some limitations, particularly with the clinical population, resulting in gaps in the patients’ biomarker data. Some differential results highlighted the value of using a kaleidoscope of both objective and subjective outcome measures to gain a fuller understanding of the complex cognitive, emotional, neural, hormonal, and biopsychosocial processes involved in music’s beneficial effects. Ronniet Orlando PhD Thesis iii Acknowledgements It may take a village to raise a child, but it takes a world — and coffee — to create a PhD! Ronniet Orlando To all those who have supported me along the way: my supervisors, fellow students and staff at Edith Cowan University; willing mentors I have called on for guidance; staff and patients at Bethesda Hospital, Perth; and all participants and presenters, for their enthusiasm and cooperation in facilitating this ambitious project. To my family and friends: for advice and practical help, for keeping me grounded, feeding me, listening to me, jamming with me, travelling with me, and loving me. To my lifelong companion music: you have helped me find my voice and navigated me through rough waters; nourished my soul and intellect and made my heart dance; fed and clothed me; given me wings to fly to distant lands; laid paths and highways to friends and mentors; and accompanied rich relationships with fellow travellers through life, sharing joyful dances to sultry songs, and sweet lullabies to sorrowful laments. Thank you all! Ronniet Orlando PhD Thesis iv TABLE OF CONTENTS Declaration ................................................................................................................................. i Abstract ...................................................................................................................................... ii Acknowledgements ............................................................................................................... iv TABLE OF CONTENTS ........................................................................................................... v List of Tables .................................................................................................................. xi List of Figures ................................................................................................................ xi Abbreviations ......................................................................................................................... xv Dedication ............................................................................................................................ xviii Prelude .....................................................................................................................................xix Overture ..................................................................................................................................... 1 Chapter 1: THEMATIC EXPOSITION - A Review of the Literature ...................... 4 Music and the arts as therapeutic tools ..................................................................... 5 Music in history .............................................................................................................. 5 Arts and science ............................................................................................................. 6 Engagement with the creative arts......................................................................... 6 Music therapy and music in medicine ................................................................... 8 What is music? ................................................................................................................. 10 A Westernised perspective ..................................................................................... 10 A more functional perspective .............................................................................. 11 Multimodal complexities ......................................................................................... 11 Meaningful, structured and patterned sound ................................................. 12 Characteristics of music ............................................................................................... 13 Musical structure ........................................................................................................ 13 Rhythm and tempo .................................................................................................... 14 Ronniet Orlando PhD Thesis v Dynamics and the sounds of silence ................................................................... 15 Timbre, pitch and harmony .................................................................................... 16 Musical genre and musical preferences ............................................................ 18 Song, lyrics, and the meaning of music .............................................................. 21 Aesthetics, music and noise ................................................................................... 23 Modes of presentation: live versus recorded music ..................................... 26 Clinical applications of music ..................................................................................... 31 Music as a low-risk intervention .......................................................................... 31 Music for the control of pain .................................................................................. 32 Pain in the palliative care setting ......................................................................... 37 Pain and surgery ......................................................................................................... 40 Assessment of pain .................................................................................................... 41 Anxiolytic effects of music ...................................................................................... 43 Anxiety and palliative care ..................................................................................... 45 Anxiety in surgical patients .................................................................................... 46 Measuring anxiety ...................................................................................................... 48 Are pain and anxiety really measurable as separate constructs? ........... 51 Music and the immune system.............................................................................. 53 Music in non-clinical settings ..................................................................................... 56 Music and wellbeing .................................................................................................. 56 Students and stress ................................................................................................... 57 Chapter 2: BRIDGE - Purpose and Conceptual Framework ................................ 59 Biomedical model ........................................................................................................... 60 Music and the physiology of stress ...................................................................... 61 The biomedical model of pain ............................................................................... 66 Music and neurology ................................................................................................. 68 Neurology, music, pain and anxiety .................................................................... 69 Ronniet Orlando PhD Thesis vi Cognitive – emotional model ...................................................................................... 72 Emotions and cognition: an intermeshed relationship ............................... 72 How does music evoke emotions? ....................................................................... 75 Summary of cognitive-emotional framework of music ............................... 83 Biopsychosocial model ................................................................................................. 85 Music, pain and the biopsychosocial model ..................................................... 85 Psychosocial implications of cancer ................................................................... 86 Music as a social facilitator ..................................................................................... 86 Illness identity ............................................................................................................. 88 Music versus noise ..................................................................................................... 89 Ecological approach .................................................................................................. 90 Psychoneuroendocrine approach ............................................................................. 92 Natural and acquired immune responses......................................................... 92 The immune system, stress, and the brain-gut connection ....................... 93 Music and the immune system.............................................................................. 94 Saliva and biomarkers .............................................................................................. 96 Summary ..........................................................................................................................103 What is known so far ..............................................................................................103 What are the gaps ....................................................................................................103 Why do this study? How will it contribute? ...................................................104 Aims of this study .....................................................................................................106 Chapter 3: DEVELOPMENT - Methodology..............................................................107 Some limitations of previous research methodologies ..................................107 Confounds and bias .................................................................................................107 Study designs .............................................................................................................108 Participants and settings .......................................................................................110 Recruitment of participants .................................................................................113 Ronniet Orlando PhD Thesis vii