Music: More than just a melody.

Anxiety is one of the most persistent psychological findings in persons with chronic obstructive pulmonary disease (COPD). Anxiety is an emotional state characterized by subjective, consciously perceived feelings of tension and apprehension as well as heightened autonomic nervous system activity that may vary in intensity and fluctuate over time. As dyspnea is the most frequent symptom seen in patients with pulmonary disease, the development of concomitant anxiety is common. Dyspnea is anxiety provoking due to the suffocating sensations and other physiological factors that generate real fear. At the same time, dyspnea, a psychophysiologic phenomenon, may be triggered by non-ventilatory factors such as anxiety. More than 60 years ago, Altshuler theorized that music altered moods unconsciously through the stimulation of an autonomic response at the thalamic level. Brody believed that music influenced the right-hand side brain activity, causing the pituitary gland to release endorphins and generate a calming effect. The positive impact of music on anxiety has been described in multiple populations and settings including ambulatory surgery patients, myocardial infarction (MI) patients and mechanical ventilation. Music has been shown to reduce perceptions of dyspnea during exercise. In the current issue of Chronic Respiratory Disease, Vijay Singh and colleagues report the findings of their pilot study comparing the effectiveness of music versus progressive muscle relaxation (PMR) in hospitalized COPD patients experiencing an acute exacerbation. This randomized trial exposed participants to either music or PMR during two sessions within the same day. The authors report that both groups had significant reductions following both the first and second sessions for perceived dyspnea as measured by the Borg score and systolic blood pressure, heart and respiratory rates and anxiety as measured by the Spielberger State-Trait Anxiety Inventory State. These reductions were seen to increase following the second session. When the two groups were compared, the music group was shown to have significantly greater reductions for all outcomes compared to the PMR group ( p < .001). As dyspnea increases and activity tolerance declines in patients with COPD, anxiety commonly ensues. Often, patients with COPD develop anxiety with dyspnea when they believe the dyspnea episode is beyond their control. Because of the close interaction of dyspnea and anxiety, relief of one symptom often results in the relief of the other symptom. Desensitization, distraction and relaxation have been shown to be effective in reducing dyspnea and anxiety. The affective dimension of dyspnea has been well reported, with distraction shown to reduce the negative affective perception of dyspnea. Pulmonary rehabilitation (PR) has been shown to reduce anxiety in multiple studies using serial interviews and questionnaires related to psychological symptoms before and after PR. More than 20 years ago, Renfroe and colleagues described anxiety reduction over 4 weeks of PR sessions in 20 persons with COPD. In 40 moderate-to-severe COPD patients, Dekhuijzen and colleagues reported significant reductions in anxiety and depression components of the Symptoms Checklist (SCL-90) in persons assigned to PR exercise training. Gayle and colleagues noted reduction in anxiety scores as measured by the State-Trait Anxiety Inventory in 15 COPD patients enrolled in a 28-week outpatient PR program. The combination of behavioral therapy and PR has been shown to reduce anxiety.