A Music Imagery Intervention for Adults with Acute Leukemia in Protective Environments.
Authors: Burns Debra S. , Azzouz Faouzi , Hincher Katie , Rutledge Cheryl , Monahan Patrick , Cripe Larry D. 
Published: April 2020

Abstract
Patients with acute leukemia who receive intensive chemotherapy often require a prolonged hospitalization in a protective environment. The required isolation may increase the psychological distress related to the diagnosis and intensive chemotherapy treatment. The combination of music and imagery offers an innovative approach to reduce distress. To assess the feasibility and the potential efficacy of a music imagery intervention, we randomly assigned adults to standard care or standard care plus music imagery. The initial music imagery session with a board certified music therapist occurred within two days of admission and then twice weekly for 8 sessions. Each 45-minute session consisted of a relaxation exercise and patient created imagery while listening to music. Patients were encouraged to independently use the music imagery daily. Patients completed the State Anxiety Inventory (SAI), the FACIT-Fatigue, and the Positive Affect Negative Affect Schedule (PANAS) at baseline, then every 7 days until discharge, and at a follow-up outpatient clinic visit. Of the 78 patients approached for participation, 29 refused. The 3 most common reasons cited were: overwhelmed by treatment (9), not interested (8), and too sick (6). Forty-nine individuals were randomized to the intervention (25) or control (24) group. There were 19 men and 30 women and a majority of participants were married (65%). Average age for participants was 52 (SD 15.36) for intervention and 55 (SD 15.87) for control. The median length of stay was 28 and 26 days, respectively. For the intervention group, 8 (32%) individuals received 8 sessions, 5 (20%) received 5–7 sessions, 9 (36%) received 2–4, and 6 (24%) received 0–1 sessions. After adjusting for baseline scores, there was a main time effect in predicting Fatigue, PANAS-PA, PANAS-NA, and Anxiety (all p&lt;.001), and no interaction effects between time and group, indicating that both groups improved over time. There were no significant main effects between control and intervention group on the four outcomes. However, when we analyzed patients by level of baseline distress, patients with low negative affect at baseline who received music imagery had lower anxiety at the time of discharge compared to standard care (mean of 48 vs. 23 p=.02). The values correspond to the 80th and 20th percentile, respectively, for the general population. Thus the reduction appears to be clinically significant. In conclusion, music imagery is feasible for adults with acute leukemia in protected environments. Some patients experience significant benefit in terms of reduced anxiety at discharge. We postulate that the intervention was not powerful enough to overcome elevated levels of distress. Future trials will explore titrating the dose of the intervention based upon levels of distress at the time of hospital admission. In addition, a wider range of questionnaires will be used along with formal interviews to better understand the impact of the music imagery intervention.