Complementary Therapies in Medicine 40 (2018) 171–178

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Complementary Therapies in Medicine

journal homepage: www.elsevier.com/locate/ctim

Feeling the sound – short-term effect of a vibroacoustic music intervention T

on well-being and subjectively assessed warmth distribution in cancer
patients—A randomized controlled trial
⁎
Sarah Bieligmeyera, E. Helmerta, Martin Hautzingerb, Jan Vagedesa,c,
a
ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
b
Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Germany
c
Department of Neonatology, University Children’s Hospital, University of Tuebingen, Germany

A R T I C LE I N FO A B S T R A C T

Keywords: Objectives: So far, the effects of vibroacoustic music therapy in cancer patients are unknown. However, used in
Music therapy anthroposophic medicine, it could be an approach to enhance well-being.
Cancer The goal of this study was to evaluate the immediate effects of a sound-bed music intervention with respect to
Palliative care the subjective well-being as well as body warmth and pain.
Quality of life
Patients and methods: We treated 48 cancer patients with 10 min of sound-bed intervention in a cross-over de-
Well-being
sign. Primary outcome was the total sum of the Basler Mood Questionnaire (BMQ), secondary outcomes were
Anthroposophic medicine
subscales of the BMQ and questions addressing body warmth and pain. The EORTC-QLQ C30 was used as
baseline assessment for quality of life (QOL).
Results: Patients had lower QOL values than the EORTC reference samples (p < .001, d = 0.90). The primary
outcome increased after music (p < .001, d = 0.47), no changes were seen in the control condition (p = .73,
d = 0.04), the time by condition interaction was significant (p < .05). Secondary outcomes: Increase after
music for the BMQ subscales inner balance (p < .001, d = 0.73), vitality (p < .001, d = 0.51) and vigilance
(p < .001, d = 0.37) as well as for the additional questions satisfaction (p < .001, d = 0.43), current mood
(p < .001, d = 0.43), body warmth (p < .05, d = 0.44) and warmth distribution (p < .01, d = 0.49). No
significant changes were seen in pain levels and social extroversion.
Conclusion: Sound-bed intervention improved momentary well-being and caused self-perceived physiological
changes associated with relaxation beyond the benefits of simple resting time (control condition). Thus, it might
be a promising approach to improve well-being in cancer patients.

1. Introduction
In the oncology setting, quantity of life and quality of life (QOL) are
interdependent and yet often have to be weighed up against each other
when making hard therapy decisions.1 Symptoms most affecting QOL in
cancer patients are fatigue, anxiety, pain, stress, nausea, vomiting2 and
altered taste perception.
Different definitions of the term QOL make it difficult to compare
research studies.3 For example, with respect to the functional perfor-
mance, QOL can describe the ability to walk one block or climb stairs as
well as having sufficient social support.4 The World Health Organisa-
tion (WHO QOL group) defined QOL as an individuaĺs physical health,
level of independence, psychological status and social relationships as
well as the relationship to salient features of their environment.5
Music or music therapy as one of the art therapies is a powerful and
effective medium to reduce fatigue, depression, anxiety, pain and
stress6–8 and enhance positive emotions. The specific use of music
therapy to positively influence behaviour and mental status represents a
field of growing interest in music research. “Music therapy is an es-
tablished healthcare profession that uses music to address physical,
emotional, cognitive and social needs of individuals of all ages”.9 Ad-
ditionally, music therapy promotes resilience, control, comfort and
peace for people affected by life-threatening illnesses.10–12 In cancer
patients, the main goal is to stimulate physical, emotional and cognitive
processes to influence the patient’s stress physiology, alter individual
coping behaviours and evoke positive emotions13 to engage the in-
dividual’s full coping capacity.
Today, music therapy often consists of listening to or making music

⁎
Corresponding author at: ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Im Haberschlai 7, 70794, Filderstadt, Germany.
E-mail address: j.vagedes@arcim-institute.de (J. Vagedes).

https://doi.org/10.1016/j.ctim.2018.03.002
Received 1 December 2017; Received in revised form 2 March 2018; Accepted 2 March 2018
Available online 03 March 2018
0965-2299/ © 2018 Published by Elsevier Ltd.
S. Bieligmeyer et al.
Fig. 1. Exemplary scene. The therapist plays the sound-bed with the fingers while sitting beside the instrument ©Edwin Wall, studios delĺarte.
with different kinds of instruments. This kind of music therapy mostly
acts via the auditory experience. In contrast, the potential of vi-
broacoustic or tactile effects of music has hardly been studied system-
atically. The idea is that the beneficial effects of musical as well as
emotional experiences could be amplified if a person not only listens to
music, but actually senses the tactile vibration.14
In clinics with an integrative approach, sound-beds are frequently
used for vibroacoustic music therapy, striving to enhance well-being
and improve the body awareness of patients. Mainly used in an an-
throposophical setting, these are made with a set of 48 strings strung
horizontally across the underside of the bed frame which is constructed
as a wooden resonance body (Fig. 1). The strings are tuned in a special
fifth tuning called TAO (tones D, E, A, B) over four octaves. During
treatment, the patient lies on the sound-bed while the therapist sits
beside the instrument and strokes evenly across the strings with the
fingers of both hands, producing a sound carpet. The patient hears the
sound and perceives the vibration of the strings through the full body
contact with the wooden bed.
In the last decades monochords are also increasingly used for vi-
broacoustic music therapy, especially in German speaking countries,
and have been the subject of a limited set of studies. The monochord is
a sound-bed version with approximately 30 strings tuned to one base
tone while nevertheless producing a variety of overtones. It has mainly
been explored by a research group of the Heidelberg School of
Therapeutic Sciences. In the last years, they focused on the therapeutic
effects of the monochord with respect to psychological and physiolo-
gical benefits.14–18 Sandler et al.19 examined for example whether the
spontaneous EEG activity during a relaxation state induced by mono-
chord vibroacoustic stimulation differs from a state of relaxation in-
duced by listening to audio CD relaxation music. The authors found that
vibroacoustic stimulation with a monochord appears to induce states of
relaxation which are experienced as pleasant by a subset of patients and
is associated with focused attention and a simultaneous release of
control.19
So far, the TAO-tuned sound-bed has often been used as a ther-
apeutic instrument in the clinical context but to the best of our
knowledge the effects of this approach have not been systematically
studied yet. We therefore did a randomized controlled trial to evaluate
the immediate effects on the general well-being of oncology patients
after 10 min of TAO-tuned sound-bed intervention.
2. Objectives
We hypothesized that oncological patients who receive the TAO-
tuned sound-bed intervention show a significantly greater short-term
improvement in self-reported parameters of well-being (as assessed by
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Complementary Therapies in Medicine 40 (2018) 171–178
the BMQ total sum and subscales inner balance, vitality, vigilance, so-
cial extroversion), body warmth, current mood and pain when com-
pared to a control group.
2.1. Patients and methods
2.1.1. Design
We did a randomized controlled clinical trial with a two-group
cross-over design to compare the effect of a sound-bed intervention on
current well-being of patients with advanced cancer to a control con-
dition (lying on the sound-bed without music). The study was con-
ducted from November 2013 to May 2014. Based on a priori-G*power
calculations for optimal sample size with a 20% drop-out rate included
(significance α = 0.05. 1-β = 0.80; estimated effect size of the primary
outcome d = 0.45 was based on an uncontrolled pilot study we had
conducted in advance with 16 cancer patients using the same music
intervention and questionnaires [unpublished]), a minimum of 48
participants was required. The primary outcome was the sum score of
the Basler Mood-Questionnaire (BMQ)20 indicating mental well-being.
The study protocol was reviewed and approved by the ethics committee
of the University of Tuebingen and was recorded at the German Clinical
Trials Register (DRKS00005411). Fig. 2 presents the flow diagram for
participant identification, temporal evolvement and compliance
throughout the trial.
2.1.2. Patients
Study participants were recruited from the Filderklinik oncology
inpatient department by the author (S.B., psychologist), regardless of
the oncological diagnosis. Patients had to be aged between 25 and 65
years and able to read, write and speak German. Exclusion criteria were
extreme immobility, severe pain symptoms or previous experience with
the sound-bed. Eligible patients who agreed to participate gave written
informed consent prior to completing the baseline assessment forms
(demographic data and case history, EORTC-QLQ C30). Using opaque
envelopes for the randomization procedure, participants were ran-
domly assigned to either music intervention followed by control in-
tervention or control intervention followed by music intervention. For
every block of four participants, two envelopes were allocated to each
arm of the trial to ensure groups of approximately the same size. Block
size was unknown to the participants so that the schedule was not
predictable. The participants opened the envelopes immediately before
the first intervention so that at this moment the author was informed
about the actual sequence for the respective participant. Randomization
was carried out by the author.
S. Bieligmeyer et al.
Fig. 2. Flow of study participants over the study period.
2.1.3. Intervention
Each patient received one music and one control intervention carried
out individually according to the random order assignment at intervals of
24 h. The sound-bed is located in a separate room of the Filderklinik. On
the trial day, the author met the patients in their hospital rooms. They
completed the BMQ and five additional questions addressing currently
perceived body warmth, pain level and general mental state before the
intervention (t1) and were then escorted to the sound-bed room. During
an introduction and preparation phase (4 min) the patients occupied a
supine position on the sound-bed and were covered with a blanket if
desired. They were asked to remain awake during the intervention time
and listen to the music without doing anything else. This was followed by
a five-minute silence period. Then the actual intervention began, con-
sisting of 10 min of music or control condition. Another five-minute si-
lence period followed, after which the patients left the sound-bed and
were escorted back to their rooms where they completed the ques-
tionnaires (BMQ and additional questions) again (t2). The sound-bed was
played by the author, who had been trained by a music therapist with
many years of sound-bed experience in palliative and end-of-life care
prior to the study. The 48 strings of the sound-bed are tuned in a TAO
tuning as a precursor of pentatonics (tones D, E, A, B) over four octaves.
The sound-bed was constructed by the manufacturer of musical instru-
ments Robert Benedek (https://www.benedeks.net); a sound sample is
available at https://www.benedeks.net/tao-leier-tao-klangliege-tao-
klangkabine/die-tao-klangliege/klangbeispiele-tao-klangliege/.
In the control condition, participants underwent the same process
but without any music. Participants were included in the final analysis
if they completed both sessions.
2.1.4. Outcome measures
The BMQ is a self-rating polarity profile to assess the current state of
mood, resulting in total sum and the subscales inner balance, vitality,
vigilance, social extroversion. It consists of 16 items with a total sum
score of 112 (range 16–112). Answers are given on seven-category bi-
polar scales. High scores indicate greater values corresponding with
better well-being. (Cronbach’s α for the subscales between α = 0.63
and α = 0.77, total sum: α = 0.76). The BMQ is suitable to assess the
immediate effects of an intervention with respect to a healthy or ill
person’s situational subjective well-being.21,22 It has been used in
cancer patients and has proven to be a feasible and significant tool.23
The additional questions we devised were based on the long-term
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Complementary Therapies in Medicine 40 (2018) 171–178
experience of sound-bed therapists and were measured on seven-cate-
gory bipolar rating scales (questions 1, 2, 4, 5) or on a visual analogue
scale (VAS; question 3, pain intensity). They were as follows: 1. What is
your current perception of your body warmth (bipolar response op-
tions: warm/cold)? 2. How do you perceive your body warmth dis-
tribution (even/uneven)? 3. How severe is your pain at the moment (no
pain/worst pain imaginable)? 4. What is your current mood (good/
bad)? 5. How satisfied are you with your general state of health at the
moment (satisfied/dissatisfied)? It took an average of 10 min for par-
ticipants to complete the questionnaires at each time point.
The EORTC-QLQ C30, designed by the EORTC (European
Organization for Research and Treatment of Cancer), was used in this
study in order to address the quality of life of cancer patients
(Cronbach’s α: 0.65 (nausea and vomiting) to 0.89 (global health/
quality of life)). The QLQ C30 (Quality of Life Questionnaire) consists of
30 items rated on a nominal scale from 1 (not correct at all) to 4 (I
strongly agree). The items include ratings of overall QOL, functional
dimension (cognitive, social, physical, emotional and role functioning)
and symptom dimension (fatigue, nausea and vomiting, pain). Six
single items (dyspnoea, constipation, diarrhoea, appetite loss, in-
somnia, financial difficulties) frequently encountered by advanced
cancer patients are also assessed.
2.1.5. Data analysis
Statistical analyses were performed using the Statistical Package for
Social Sciences, version 22 (IBM SPSS Statistics). Missing values were
replaced by the mean imputation method.
Baseline comparisons between the two groups with respect to de-
mography were calculated with Χ2− tests or independent t-tests as re-
quired. To exclude interaction of treatment and carryover effects we
used Mann-Whitney U tests for each participant corresponding to sta-
tistician recommendations.24 If no carryover effects exist, both condi-
tions can be included in the analysis. For baseline comparisons of both
conditions t-tests were calculated. To test changes in the primary out-
come parameter (total sum of BMQ) we did a 2 × 2 factor ANOVA with
time point (pre vs. post) as the dependent variable and condition (music
vs. control) as the between factor and analysed time × condition in-
teractions. To avoid problems attributable to multiple testing, post-hoc
tests were alpha-adjusted for the primary outcome with the Bonferroni-
Holm method. Supplementary evaluations of changes in BMQ subscales
involved comparisons of average change from the different time points
S. Bieligmeyer et al. Complementary Therapies in Medicine 40 (2018) 171–178

Table 1
Baseline characteristics of study participants by group.
Total Group 1 Group 2
Music-Control Control-Music
n = 44 n = 21 n = 23

Age t(42) = 0.94, p = .35

Mean ± SD 54.35 (7.67) 55.49 (5.84) 53.30 (9.03)
Range (years) 29–65 41–64 29–65
Sex χ2(1) = 0.28, p = .74
female 31 (70.5%) 14 (66.7%) 17 (73.9%)
male 13 (29.5%) 7 (33.3%) 6 (26.1%)
Disease stage (at initial diagnosis) χ2(4) = 1.25, p = .87
unknown 9 (20.4%) 3 (14.3%) 6 (26.1%)
I 4 (9.1%) 2 (9.5%) 2 (8.7%)
II 4 (9.1%) 2 (9.5%) 2 (8.7%)
III 16 (36.4%) 9 (42.9%) 7 (30.4%)
IV 11 (25.0%) 5 (23.8%) 6 (26.1%)
Chemotherapy χ2(1) = 0.38, p = .54
Yes 23 (52.3%) 12 (57.1%) 11 (47.8%)
No 21 (47.7%) 9 (42.9%) 12 (52.2%)
Education (n = 43) χ2(2) = 3.88, p = .14
≤secondary school 19 (43.2%) 12 (57.1%) 7 (30.4%)
Abitur 7 (15.9%) 1 (4.8%) 5 (21.8%)
University degree 17 (38.6%) 6 (28.6%) 11 (47.8%)
Employment status (n = 43) χ2(1) = 0.003, p = .95
Yes 26 (59.1%) 12 (57.1%) 14 (60.9%)
No 17 (38.6%) 8 (38.1%) 9 (39.1%)
Practicing relaxation techniques χ2(1) = 0.28, p = .60
Yes 13 (29.5%) 7 (33.3%) 6 (26.1%)
No 31 (70.5%) 14 (66.7%) 17 (73.9%)

across groups via t-tests. The additional questions were treated as ex- Table 3
ploratory testing. EORTC QLQ C-30 results were compared with the Distribution of tumour diagnosis of participants.
reference samples of the questionnaire (a general population sample25 primary diagnosis number of patients %
and an oncology reference sample [EORTC Manual, p. 15 ff., “All
cancer patients: all stages”26]) calculating t-tests. Effect sizes were Mamma CA 12 27.3
calculated for each parameter using Cohen’s d. The statistical sig- Colorectal CA 6 13.6
Bronchial CA 4 9.1
nificance was set at p < .05; all reported p values are two-tailed.
Lymphoma 4 9.1
Others 18 40.9
3. Results

3.1. Demographic data
Baseline characteristics were balanced across treatment arms. There
were no statistically significant differences between the groups in the
baseline demographic and medical parameters (Tables 1 and 2). Data
were obtained from 31 female and 13 male patients (aged 29.3–65.6
yrs, mean age: 54.4 yrs, SD = 7.7). Twelve patients (27%) had breast
cancer, the others had different cancer diagnoses (Table 3). Almost 30%
(29.5%) reported previous experience with relaxation techniques and
34% often listen consciously to music. During the study, twenty-three
patients (52%) underwent chemotherapy, four of these with
Carboplatin, three with Doxorubicin, three were treated according to
the Folfox scheme. The remaining patients received other chemother-
apeutics such as Bortezomib, Capecitabin and the PCV and PEB
schemes. Antibiotics were administered to 18% of all patients (n = 8),
Cortisone to 23% (n = 10). Eight patients underwent full-body hy-
perthermia, five had local applications and two received full-body as
well as local hyperthermia. Bisphosphonates were administered to three
patients. Almost two thirds (n = 28) of all patients received mistletoe
therapy with Abnoba viscum fraxini (68% of all mistletoe treatments),
Iscador Q (11%), Helixor M (7%), Iscador M (7%), Iscador U or Helixor
P (7%).

3.2. BMQ outcomes and additional questions

Table 2
Baseline calculations comparing t1 music vs. t1 control. For the primary outcome (total sum of BMQ), there was a significant
time effect (F(1,86) = 6.96, p < .01) and a significant interaction of
music control
time × condition (F(1,86) = 9.74, p < .01). Post-hoc tests indicate
t1 t1 t(42) greater gain in well-being in the music-condition (d = .47) than in the
control-condition (d = 0.04). The values of the subscales inner balance
Total sum 71.80 (19.67) 73.52 (20.62) -0.74, p = .46 (p < .001, d = .73), vitality (p < .001, d = .51) and vigilance
Inner balance 19.70 (5.18) 20.50 (5.28) −1.1, p = .28
(p < .05, d = .37) of the BMQ increased only after the music inter-
Vitality 16.50 (6.31) 16.41 (6.17) 0.03, p = .97
Vigilance 18.52 (5.39) 18.95 (.84) −0.65, p = .52 vention (Table 4). We found no change in social extroversion in either of
Social extroversion 17.07 (5.58) 17.66 (5.55) −0.75, p = .46 the two groups (Fig. 5).
Satisfaction 4.53 (1.93) 4.45 (2.12) 0.22, p = .83 Among the additional questions, significant improvements in the
Current mood 5.02 (1.73) 5.27 (1.56) −1.03, p = .31 perception of body warmth (p < .05, d = 0.44), warmth distribution
Pain intensity (VAS) 12.88 (19.59) 12.75 (18.62) 0.18, p = .86
Body warmth 5.14 (1.46) 4.68 (1.60) 1.46, p = .15
(p < .01, d = 0.49), present mood (p < .001, d = 0.43) and overall
Warmth distribution 4.80 (1.94) 4.57 (1.86) 0.65, p = .52 satisfaction (p < .001, d = 0.43) were observed (Fig. 6 and Table 4)
only for the music intervention group. Pain intensity increased

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S. Bieligmeyer et al. Complementary Therapies in Medicine 40 (2018) 171–178

Table 4
Descriptive statistics (M (SD)) of behavioural parameters at t1 and t2 for music and control condition.
music control

t1 t2 t1 vs. t2 t1 t2 t1 vs. t2

BMQ
Total sum 71.80 (19.67) 81.00 (16.26) t(43) = −3.98. p < .001 73.52 (20.62) 72.75 (20.63) t(43) = 0.35. p = .73
Inner balance 19.70 (5.18) 23.47 (4.40) t(43) = −5.72. p < .001 20.50 (5.28) 20.84 (5.39) t(43) = −0.49. p = .63
Vitality 16.50 (6.31) 19.75 (5.33) t(43) = −4.12. p < .001 16.41 (6.17) 16.73 (5.85) t(43) = −0.54. p = .59
Vigilance 18.52 (5.39) 20.50 (4.95) t(43) = −2.60. p = .01 18.95 (.84) 18.55 (5.56) t(43)=0.58. p = .57
Social extroversion 17.07 (5.58) 17.27 (4.95) t(43) = −0.25. p = .81 17.66 (5.55) 16.64 (5.86) t(43) = 1.74. p = .09

Additional questions
Satisfaction 4.53 (1.93) 5.36 (1.78) t(43) = −3.83. p < .001 4.45 (2.12) 4.61 (1.94) t(43) = −0.62. p = .54
Current mood 5.02 (1.73) 5.36 (1.78) t(43) = −5.69. p < .001 5.27 (1.56) 5.18 (1.54) t(43) = 0.45. p = .66
Pain intensity 12.88 (19.59) 10.00 (16.3) t(43) = 1.28. p = .21 12.75 (18.62) 15.36 (21.56) t(43) = −1.86. p = .07
Body warmth 5.14 (1.46) 5.77 (1.38) t(43) = −2.50. p = .02 4.68 (1.60) 4.70 (1.79) t(43) = −0.104. p = .92
Warmth distribution 4.80 (1.94) 5.75 (1.30) t(43) = −2.84. p = .007 4.57 (1.86) 4.86 (1.75) t(43) = −1.29. p = .2

marginally significantly in the control group (Table 4). No other ad-
verse effects were reported.
3.3. Quality of life (EORTC QLQ C-30)
At baseline, we found a significantly lower QOL global score for our
participants compared to a general population reference sample [25](t
(3062) = −6.37, p < .001, d = −0.90). With respect to the subscales,
all values of the functional dimension were significantly lower (Fig. 3),
whereas symptom dimension values (Fig. 4) were higher than those of
the reference sample, indicating lower quality of life. For pain, the
difference between our study population and the general population
sample was only a trend (t(3062) = 1.91, p ≤ .10 (*)) which can be
explained by the fact that our patients received pain medication if re-
quired.
4. Discussion
To the best of our knowledge, this is the first randomized controlled
study to compare the immediate effects of a TAO-tuned sound-bed in-
tervention on cancer patients with a control condition. We determined
overall well-being measured by the Basler Mood Questionnaire as our
primary outcome (BMQ total sum). Compared to the control condition,
the total sum of the BMQ scored higher after the sound-bed intervention
indicating greater well-being. The BMQ subscales (secondary outcomes)
inner balance, vitality and vigilance enhanced only in the music inter-
vention group. Furthermore, significant improvements in body warmth,
warmth distribution, present mood and overall satisfaction were observed
in the music intervention group (additional questions, secondary out-
comes). However, no changes were found with respect to social ex-
troversion which is in line with the results of Baumann and Schüle who
used the BMQ to evaluate effects of physical activity in cancer pa-
tients.23 A marginally significant increase in pain intensity (additional
questions) was reported in the control group. During the interventions,
patients had to lie on the wooden sound-bed for 20 min with only a
woollen blanket as padding underneath. If no music was played this
might have been more consciously experienced as slightly un-
comfortable which might have resulted in a stronger perception of pain.
Compared to the reference samplesof EORTC QLQ C-30, our study
population reported lower QOL values.
Focusing on the vibroacoustic stimulation during sound-bed inter-
vention, a research group of the Department of Psychosomatic Medicine
at the Charité in Berlin/Germany recently examined the spontaneous
EEG activity during vibroacoustic stimulation compared to the relaxa-
tion state induced by listening to audio CD relaxation music in patients
with a psychosomatic disorder. The authors found changes in EEG

Fig. 3. EORTC QLQ-C30 functional scales of study participants compared with a general population25 and an oncology reference sample of the EORTC manual
(means and standard deviation with ***p ≤ .001).

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S. Bieligmeyer et al.
Fig. 4. EORTC QLQ-C30 symptom scales of study participants compared with a general population25 and an oncology reference sample of the EORTC manual (means
and standard deviation with ***p ≤ .001).
24
(***)
22
inner balance
20 (*)
vitality
(***)
18 vigilance
16
14
Fig. 5. Mean ( ± SE) changes in the subscale scores of the Basler Mood
Questionnaire over each condition. Each item scored from 1 to 7; higher
numbers indicate greater values for inner balance, vitality, social extroversion
and vigilance.
activity which can be interpreted as flow experience or release of
control. Furthermore, the authors did another study on altered states of
consciousness that can occur during various relaxation states.19 The
subjective ratings of their participants with respect to both conditions
showed that vibroacoustic stimulation (body monochord) led to greater
release of control than CD music exposure. The body monochord tended
to be experienced as more transcendental and the CD music as sadder.27
Additionally, the authors found reduced skin conductance levels during
both relaxation conditions and a slight increase in salivary cortisol after
exposure to the first treatment independent of the condition.28 Sum-
marizing the results, they found improvements in psychological and
physiological parameters during relaxation conditions supporting the
hypothesis of the positive effects of music interventions. In contrast to
the Charité research group, we focused on patients with an oncological
disease rather than psychosomatic disorders. Investigating the use of a
monochord for music intervention, the research group of the
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Complementary Therapies in Medicine 40 (2018) 171–178
Heidelberg School of Therapeutic Sciences compared the effects of live
played monochord music combined with a vocal improvisation to a
verbal relaxation program played through headphones. In two studies
the authors mainly focused on EEG and heart rate variability (HRV)
changes.15,16 At a later time, they evaluated HRV changes, self-ratings
of relaxation, well-being and acute pain using visual analogue scales
and health-related quality of life questionnaires.29 The research group
found an increase of well-being and relaxation during music interven-
tion as well as changes in physiological parameters corresponding to
altered relaxation states.
The same research group did a feasibility study to examine the ef-
fects of a monochord singing chair combined with a vocal improvisa-
tion for palliative-care patients. The authors included self-ratings of
pain, relaxation and well-being before and after each session as well as
recordings of HRV as a measure of autonomic function. Due to high
artifact rates in the HRV recordings, the criterion of feasibility was not
met in this study.14
Recently, the group published another study that compared re-
ceptive live monochord music with a pre-recorded verbal relaxation
exercise in healthy adults. However, the differences between groups
with respect to subjective relaxation and HRV changes were only
marginal.30 In all of their studies, the authors used a monochord. Our
results confirm the increase of subjective well-being. However, due to
the fact that we applied a TAO-tuned sound-bed, comparability remains
limited. The same applies to some other studies exploring music
therapy in palliative care focusing e.g. on quality of life in which other
instruments are used such as the guitar or the voice.31,32
The present study has some limitations: Only immediate effects of
the sound-bed intervention and no physiological parameters were
evaluated. Consequently, no conclusions can be drawn about possible
long-term effects of sound-bed music intervention or about physiolo-
gical changes caused by the sound-bed. With respect to the special
features of the TAO-tuned sound-bed, we did not examine the differ-
ences between listening to sound-bed music alone and the presumable
additional effects of the vibroacoustic stimulation.
Our results might be biased by social desirability – patients could
assume that the investigator expected a higher impact of the music
intervention – and by the fact that neither the patients nor the study
team were blinded and the assessed endpoints were subjective.
S. Bieligmeyer et al.
6.0
(***)
5.5 (*)
(**)
(***)
5.0
4.5
Fig. 6. Mean ( ± SE) changes in the additional questions over each condition. Each item scored from 1 to 7; higher numbers indicate greater values for body warmth,
warmth distribution, actual mood and overall satisfaction.
Chemotherapy might in some patients have caused peripheral neuro-
pathy which could result in an impaired sensitivity for the vibroacoustic
stimulation whose possible impact could not be quantified and thus
might be another source of bias. Moreover, only few of the oncological
in-patients were in shape to participate in the study and of these several
declined due to a subjective lack of energy and motivation. Thus, the
patients who consented to participate might represent a selective
sample.
However, we can now provide a set of data raised from oncology
patients during their inpatient treatment including both sexes, different
ages and various oncology diagnoses.
Future research should investigate the data from multiple sessions
for each patient to determine if the benefit of sound-bed intervention
increases over time. Particular emphasis should be placed on the col-
lection of physiological data. Evaluations of study populations differ-
entiated by cancer type might shed light on the question if the response
to music intervention varies in different forms of cancer. Finally, the
differences between a TAO-tuned sound-bed and a monochord for
music intervention should be addressed in the future.
5. Conclusion
In conclusion, we found positive emotional experiences induced by
the vibroacoustic TAO-tuned sound-bed in oncology patients. The re-
sults showed greater subjective well-being following the vibroacoustic
music intervention compared to the non-music control condition.
However, to estimate the overall effects of a vibroacoustic sound-bed
music intervention, especially the role of the bodily vibrations of the
instrument, more objective outcome measures are needed such as
physiological parameters that can reinforce the argument of the ther-
apeutic effect of the sound-bed.
Authors’ disclosures of potential conflicts of interest
The authors indicate no potential conflicts of interest.
Acknowledgements
We would like to express particular thanks to Dr Stefan Hiller and
Dr Sebastian Schlott of the department of oncology, Filderklinik, for
supervision and general support, to Doris Dorfmeister (music therapist
at the Filderklinik, Filderstadt, Germany) for teaching how to play the
sound-bed. We also thank the Filderklinik, Germany, especially the
oncology team for their support by providing their sound-bed. Thanks
177
Complementary Therapies in Medicine 40 (2018) 171–178
body warmth
actual mood
to Dr Katrin Vagedes, Tido von Schön-Angerer and Prof David Martin
for help with the translation. The study was financed by the ARCIM
Institute.
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