Ecological Momentary Music Intervention for the Reduction of Stress
Condition: Stress, Psychological; Stress, Physiological; Discrimination, Racial
MeSH terms: Stress, Psychological
Study type: Interventional

Summary: 
      Ethnic discrimination is a prevalent problem in the European Union and other regions. In view
      of the significant negative impacts of discrimination on mental and physical health, it is of
      high relevance to counteract these negative effects and provide appropriate interventions.
      This study aims to investigate the feasibility and the effectiveness of a mobile-based
      intervention, delivering self-selected relaxing music to buffer biological (salivary
      cortisol, salivary alpha-amylase) and psychological (perceived stress, perceived ethnic
      discrimination) stress reactions in moments of acute stress and perceived ethnic
      discrimination in the everyday life of Turkish immigrant women (N=20, age range 18-65 years).
      An intra-individually randomized design will be used, i.e., participants will be instructed
      on a random basis to either listen to music (intervention event) or not (control event). The
      whole study period consists of 35 days with a baseline period (week 1), intervention period
      (week 2-4), and post period (week 5). To investigate the feasibility of the intervention,
      post-monitoring interviews will be conducted after the end of the whole study period.
    

Detailed description: 
      The experience of unfair treatment because of one's own ethnicity, i.e., ethnic
      discrimination, constitutes a complex stressor which triggers both physical and psychological
      stress reactions. In this regard, women may constitute a particularly vulnerable group, as
      they may be confronted with intersectional stigmata, i.e., both ethnicity-related and
      gender-related stigmata. Considering the resulting health impairments many people with
      migration background are confronted with, it is of great importance to provide interventions
      with the potential to minimize those negative consequences. Recognizing this necessity, an
      ecological momentary music intervention was developed in order to reduce psychological and
      biological (cortisol, alpha-amylase) stress levels due to perceived ethnic discrimination in
      everyday life. The primary aim of this study is to investigate the feasibility and the
      effectiveness of this mobile-based intervention.

      It is hypothesized that listening to music after an event of acute stress and/or ethnic
      discrimination will result in stronger decreases in psychological (perceived stress,
      perceived ethnic discrimination), and biological (cortisol, alpha-amylase) stress levels
      compared to no music listening in everyday life (immediate effect). Further, it is expected
      that a decrease in diurnal psychological and biological stress levels will be observed
      throughout the study period (intermediate effect) and that participants will start to consume
      or increase their deliberate consumption of music after an event of acute stress and/or
      ethnic discrimination in their everyday life after the intervention (behavior change). In
      addition, it is hypothesized that the feasibility of the intervention will be confirmed by
      participants' self-reports of high usefulness of and satisfaction with the intervention as
      well as by a high usage rate.

      The study design is as follows: Baseline period (week 1), intervention period (week 2 to 4),
      post period (week 5).

      During the baseline and post period, psychological and biological stress fluctuations and
      perceived ethnic discrimination in daily life will be assessed. To this end, participants
      will be signaled three times a day (9:00 am, 2:00 pm, 7:00 pm) in order to answer questions
      on their momentary levels of stress, perceived discrimination, positive and negative affect,
      and their music-listening activities (time-contingent data entries). Additionally, whenever a
      stressful or discriminatory event occurs, participants are instructed to initiate a data
      entry by themselves in order to report their momentary levels of stress, perceived
      discrimination, positive and negative affect, and to answer questions on the current
      situation. To investigate activities after such self-initiated, event-contingent data
      entries, the app will signal the participants 20 (post 1) and 35 minutes (post 2) later for
      an additional data entry. As part of every time-contingent and event-contingent report,
      participants will provide a saliva sample in order to examine biological stress markers:
      salivary cortisol levels as index of hypothalamic-pituitary-adrenal axis (HPA axis) activity,
      salivary alpha-amylase as index of autonomic nervous system (ANS) activity.

      A daily diary assessment will be conducted every evening at the same time. In this diary,
      participants will be asked about their current perceived stress, perceived discrimination,
      positive and negative affect, fatigue, coping strategies. Additionally, they will be asked
      whether discriminatory events had happened over the course of the day and if so, to describe
      the event(s). For this data entry, no saliva sample will be collected.

      During the Intervention period (week 2 to 4), the sampling protocol will be the same as in
      baseline and post period (i.e., time-contingent data entries, daily diary assessment,
      self-initiated event-contingent data entries, post 1, post 2). Additionally, after every
      self-initiated event-contingent report, participants will be randomly assigned (50:50) to
      either the intervention event (listening to music for 20 minutes) or the control event (no
      music listening, continue the activity before the data entry). This approach constitutes an
      intra-individually randomized design.

      To investigate the feasibility of the intervention, qualitative data from post-monitoring
      interviews will be gathered at the end of the study period.
    

Intervention name(s): self-selected relaxing music
Intervention type(s): Behavioral
Intervention description(s): 20 minutes music listening
Intervention model: Single Group Assignment
Intervention model description: Intra-individually randomized design: Random assignment (50:50) to either the intervention condition or the control condition
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Ecological Momentary Intervention; Music; Stress reduction; Discrimination; Cortisol; Alpha-Amylase