Efficacy of Music Therapy In patients with Hypertension/Ischemic heart disease with co-existing Anxiety Neurosis

 

Hypothesis

Therapeutic music brings a definite improvement in the level of anxiety in patients with hypertension/ischemic heart disease

 

Objectives

To study the impact of music on individuals with hypertension/ischemic heart disease with co-existing anxiety neurosis.

 

Instruments

Pre-recorded vina music for the duration of half-an-hour.

• Semi structured interview schedule
• Spielberger’s  State and Trait Anxiety Inventory(1)
• Quetelet’s index for Body-Mass ratio(2)
• Self-report

 

Inclusion criteria

• Patients with hypertension/ischemic heart disease who were certified as having anxiety neurosis by the psychologist
• Male and female patients in the age group ranging between 26-72 years

 

Procedure

Patients were gathered through advertisements in newspapers. After getting the informed consent of the patients the study was commenced. Therapy Music was prepared before the commencement of the study. Two ragas –Todi and Subhapantuvarali were selected and they were played on the Vina by Dr. P. Bharathi – one raga on each side of the cassette. Patients were asked to select the raga of their choice after listening to both the sides of the tape for an hour. The duration of the therapy was for 14 days. The first session was done in the clinic. Before starting the session the following data was collected:

• Height & weight of the subjects
• Blood pressure
• Pulse rate
• Semi-structured interview to obtain information about socio-demographic details, subject’s eating, sleeping habits and emotional disturbances etc.
• Psychological assessment-State and trait anxiety score as reflected by the Spielberger’s Anxiety Inventory

The subjects were asked to adopt a reclined posture ‘savasana’(dead-man’s pose) and relax completely with breath awareness and keeping eyes closed. Then they were asked to shift their awareness alternatively on the following four centers –1) Hara (3 finger-widths below the navel), 2) heart center, 3) throat center and 4) eyebrow center, in order to facilitate the circulation of life-energy or ’prana’ along these important centers. The subjects were instructed to shift their awareness along with the breath and the music to all these 4 centers while listening. After listening to the music for an hour they were asked to give an introspective report on how the experience of listening to music was, and were asked to select the raga with which they felt most comfortable.

Then the subjects were given pre recorded therapeutic music cassettes and were asked to listen to them at home daily for half-an-hour in the night, at a fixed time, adopting the ‘savasana’ position, for the rest of the 14 days of study. Follow-up was done on these subjects after a week, and the blood pressure and weight changes were recorded. They were asked to come to the therapy center on the fifteenth day. The same parameters were measured again and the findings were documented. Statistical analysis was performed using paired ‘t’ test and student ‘t’ test.

Discussion

Analysis of the results shows that among those with heart ailments like ischemic heart disease, 55.6% were males, while 44.4% were females. Among those with hypertension, 87.5% were males, while 12.5% were females.

The mean age of heart patients was 61.22 years (S.D-11.4) while the mean age of hypertensive patients was 53.81 (S.D-13.57).

Comparison was done between the effect of the two ragas, Todi and Shubapantuvarali on the heart and hypertensive patients. It was found that Rag Shubapantuvarali was effective in 88.9%, of the patients with heart ailments and these patients preferred to listen to the raga repeatedly. Only 11.1% of the patients with heart problems preferred to listen to Rag Todi. 87.5% of the patients with hypertension benefited from Rag Todi, and preferred to listen to it repeatedly, while 12.5% of the patients with hypertension preferred to listen to Rag Subhapantuvarali and benefited from it.

Comparison of state and trait anxiety scores between heart and hypertensive patients revealed the following:

The mean pre-test state anxiety score was 33.22 for heart patients with a standard deviation (S.D.) of 13.92. The mean post-test state anxiety score was 22.56 for heart patients with a S.D of 7. The mean pre-test trait anxiety score was 39.78 for patients with heart ailments, with a S.D. of 11.8. The mean post-test trait anxiety score was 30.56 for heart patients, with an S.D. of 7.91. The results were analyzed by means of paired t-test. The state anxiety score showed a significant decline {p <0.05} after 14 days of music therapy (post-test) in the case of heart patients. The trait anxiety score showed a significant decline {p<0.01} in these patients. The body-mass index (mean 24.65, S.D. – 2.83) during pre-test, showed a significant decrease during post-test sessions (mean 24.33, S.D. 2.62, p <0.05) in patients with heart ailments.

In hypertensive patients the mean pre-test state anxiety score was 36.88, (S.D-12.64), and declined to 33.63 (S.D-10.35) during post-test sessions. The decrease was highly significant (p<0.01). The pre-test trait anxiety score showed a tremendous decline from a mean value of 43.06 (S.D. -11.24) to a mean value of 36.75, ( S.D.-10.5) during post-test sessions. The p value was highly significant (p < 0.001). The body-mass index in hypertensives showed a trend towards decline in the post-test sessions, though the decrease was not statistically significant.

The changes in state and trait anxiety scores were compared between heart and hypertensive patients, using student t-test. Though the trend showed a decline when compared between heart and hypertensive patients, the decline was not statistically significant, and needed a larger sample size for showing a significant decrease. Hence we intend extending the study on a larger sample population to show the significance in decline.

The above results indicate:

1.  The majority of hypertensives responded to Raga Todi successfully and showed a significant decline in state and trait anxiety scores, after 14 days of daily listening to the raga.
2.  The majority of heart patients responded to raga Shubapantuvarali successfully and showed a significant decline in state and trait anxiety scores, after 14 days of daily listening to the raga.

Shubhapantuvarali heals heart ailments. Shubhapantuvarali is a raga full of emotions, and helps to release the suppressed emotions in patients with heart ailments. Type a personalities, who are mostly businessmen are prone for is chemic heart disease. This may be because they do not vent out their emotions, mostly neglect their family life and concentrate on business activities. According to Yogic scriptures, the heart center is located close to the emotional center. When the life energy is blocked due to suppression of emotions, it also affects the heart. Hence, Rag Shubapantuvarali, which has an emotive quality, might aid in releasing the sorrow and other negative emotions, thereby clearing the energy flow in the subtle energy pathways.

 

Raga Todi can relieve blood pressure

Rag Todi is characteristic because of its content of komal svaras. Hypertensive patients are usually high-string, and a melody filled with komal notes might smoothen the emotions. Further the Rag is full of gamakas, and each note always goes to the next higher one, and comes back. Again this wavy pattern might smoothen the disturbances in the subtle energy flows. Further, the downward flow of komal swaras brings about a cascading effect, which synchronizes well with the normal circulations physiology.

“Sa” is a peaceful and tranquil note, and the komal ‘ri’ which is a slight disturbance, always comes back to ‘Sa’ in the case of Rag Todi, because of its wavy nature in rendering the gamaka.

Distribution of sex by type of patients

Sex	Patients with ischemic heart diseaseNo.               %		Patients with hypertension  No.               %		Total No.               %
Male	5	55.6	14	87.5	19	76
Female	4	44.4	2	12.5	6	24
Total	9	100.0	16	100	25

 

 

Distribution of mean age by type of patients

Group	Mean	S.D
Heart	61.22	11.40
B.P.	53.81	13.57

 

 

Distribution of type of patients according to preference of ragas

	Patients with ischemic heart diseaseNo.            %		Patients with hypertensionNo.                 %		TotalNo.                 %
Todi	1	11.1	14	87.5	15	60
Subhapantuvarali	8	88.9	2	12.5	10	40
Total	9	100	16	100	25

 

 

Comparison of state and trait anxiety scores for heart and BP patients

Groups	Pre-test		Post-test		Changes		Pairedt-value
	Mean	S.D	Mean	S.D	Mean	S.D
HeartState	33.22	13.92	25.56	7.00	7.67	10.79	2.15 *
Trait	39.78	11.80	30.56	7.91	9.22	9.01	3.07  **
BMI	24.65	2.83	24.33	2.62	0.31	0.42	2.23 *
B P   State	36.88	12.64	33.63	10.35	3.25	4.27	3.05  *
Trait	43.06	11.24	36.75	10.50	6.31	5.93	4.20  ***
BMI	23.28	3.10	23.14	3.10	0.14	0.28	1.94 (N.S)

*- P<0.05,           ** – P<0.01,  *** – P <0.001

 

Comparison of changes in the mean value of state and trait scores between heart and BP patients

	Changes in Patients with ischemic heart disease		Changes in Patients with hypertension		Total value
	Mean	S.D.	Mean	S.D.
State Anxiety score	7.67	10.79	3.25	4.27	1.18 (P=0.27) (N.S)
Trait Anxiety score	9.22	9.01	6.31	5.93	0.87 (P=0.40) (N.S)
Body-Mass Index	0.31	0.42	0.14	0.28	1.12 (P=0.29) (N.S)