Effects of Music on CardiovascularReactivity Among SurgeonsKaren Allen, PhD, Jim Blascovich, PhD

Objective.\p=m-\Todetermine the effects of surgeon-selected and experimenter\x=req-\selected music on performance and autonomic responses of surgeons during astandard laboratory psychological stressor.

Design.\p=m-\Within-subjectslaboratory experiment.Setting.\p=m-\Hospitalpsychophysiology laboratory.Participants.\p=m-\Atotal of 50 male surgeons aged 31 to 61 years, who reported

that they typically listen to music during surgery, volunteered for the study.Main Outcome Measurements.\p=m-\Cardiacresponses, hemodynamic mea-

sures, electrodermal autonomic responses, task speed, and accuracy.Results.\p=m-\Autonomicreactivity for all physiological measures was significantly

less in the surgeon-selected music condition than in the experimenter-selected mu-sic condition, which in turn was significantly less than in the no-music control con-dition. Likewise, speed and accuracy of task performance were significantly betterin the surgeon-selected music condition than in the experimenter-selected musiccondition, which was also significantly better than the no-music control condition.

Conclusion.\p=m-\Surgeon-selectedmusic was associated with reduced autonomicreactivity and improved performance of a stressful nonsurgical laboratory task instudy participants.

(JAMA. 1994;272:882-884)

ALTHOUGH no current data exist re¬

garding the prevalence of music in oper¬ating rooms, music is thought to be fairlycommon during surgery. The effects ofmusic on patients during various medicalprocedures including surgery have beeninvestigated from a variety of perspec¬tives. Recent studies have explored theanxiolytic effects ofmusic before, during,and after surgery.14 Other studies havedemonstrated the positive role of musicin pain control during and afterboth medi¬cal and dental procedures.5"9 A third typeof research has produced a wide range offindings regarding the therapeutic ben¬efits of music based on physiological re¬

sponses to music before, during, and af¬ter medical procedures.10-13 It has evenbeen reported that anesthetized patientswho undergo surgery during music re¬

quire less medication for pain.14 Conspicu¬ously absent in the empirical literatureregarding the therapeutic effects of mu¬sic is any mention of the effect that musicmay have on surgeons.

Although we do not know about sur¬

geons specifically, we do know something

From the Department of Psychology and the Centerfor the Study of Biobehavioral and Social Aspects ofHealth, State University of New York at Buffalo.

Address correspondence to Center for the Study ofBiobehavioral and Social Aspects of Health, Park Hall,State University of New York at Buffalo, Amherst, NY14260 (Dr Allen).

about the effects ofmusic on psychophysi-ological responses in general. Peretti15,16measured galvanic skin response and re¬

ported that music had a calming effectduring a stressful task. Stoudenmire17demonstrated the role of music in reduc¬ing state and trait anxiety comparable tomuscle relaxation training. In some cases,certain types of music have been associ¬ated with decreased physiological re¬

sponses during stress,1820 although oth¬ers have failed to demonstrate thisrelationship.2124 Music has also been as¬sociated positively with performance onstressful tasks. Recently, Rauscher et al26reported that subjects' spatial task per¬formance was enhanced when precededby a Mozart sonata compared with silentor relaxation audiotape control conditions.

Ethical and practical concerns limit theuse of a true field experiment to test thehypothesis that music reduces surgeonstress and enhances surgical performance.Consequently, we decided to examine thisassumption by modifying a standard psy-chophysiological laboratory paradigm26"29to include music as an independent vari¬able and surgeons as participants. To de¬termine whether music effects are spe¬cific to subjects' music preferences or sim¬ply the presence of music, we includedthree music conditions. Our specific pre¬dictions were that music would reduceautonomie reactivity (ie, skin conductance,

blood pressure, and pulse rate) and en¬hance performance while physicians ex¬

perienced a standard psychophysiologi-cal stressor (serial subtraction).Methods

Subjects and Setting.—Participantswere 50 male surgeons ranging in agefrom 31 to 61 years (mean, 52 years) whovolunteered for the study because oftheirinterest in learning about physiologicalresponses to music. All were self-reportedmusic enthusiasts who regularly listenedto music during surgery. All were free ofcardioactive medications. The experimentwas performed in a soundproof hospitalresearch laboratory.

Design.—Music was varied in threeconditions within each subject. Each par¬ticipant performed two serial subtrac¬tion tasks in music-free, self-selected,and investigator-selected (ie, Pachelbel'sCanon in D) music conditions. The latteris an orchestral piece often used in com¬

mercially available "stress-reduction"tapes. Order of music conditions wascounterbalanced across subjects.

Stressor.—A serial subtraction taskwas used as the stressor in this study.The task required subjects to performaloud rapid serial subtractions ofa speci¬fied value from a large number. Thistype of mental arithmetic task has beenused in numerous laboratories.26-30"32These studies have demonstrated thattask performance typically induces sub¬stantial increases in autonomie responsesfrom baseline resting values.

Physiological Recording Appara¬tus.—Skin conductance responses wererecorded using laboratory equipment(Grass model 7D polygraph with a skinconductance coupler). Fluctuations inskin conductance exceeding 0.05 mi-cromho during each 20-second periodwere later tallied by experimenters blindto the music condition. Blood pressurewas measured from the index finger ofthe subject's left hand using a blood pres¬sure monitor (Health Check CX-1). Pulserate was measured and recorded usinga photoplethysmographic pulse meter(Panasonic model NKM 017).

Procedures.—Surgeons were sched¬uled individually by telephone to par¬ticipate in this experiment and were re-

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Figure 1.—Physiological responses of participants based on three different music conditions.

quested to mail audiotapes of their pre¬ferred operating room music to the ex¬

perimenter. All complied. On arrival atthe hospital laboratory, surgeons were

greeted by the same experimenter whosubsequently explained the general na¬ture of the experiment and obtained in¬formed consent.

Participants were brought into a sound¬proof room (approximately 3x4 m) andseated in a comfortable upholstered chairprior to attachment ofelectrodes and sen¬sors. After the physiological recordingequipment was calibrated and adjusted,subjects were asked to sit quietly.

Instructions were provided to subjectsthroughout the experiment via audiotape.Immediately after the beginning of theexperiment was announced, the first ex¬

perimental music condition commencedvia headphones. Participants were in¬structed to sit quietly, and a 5-minutebaseline physiological recording periodthen began. This was followed by an in¬struction period during which surgeonslistened to instructions about performingthe upcoming mental arithmetic task.They were instructed to count backwardrapidly out loud by 13s from a five-digitnumber at a start signal. At the end of 2minutes of counting, the surgeons wereinstructed to sit quietly and to continuelistening to the music. After another5-minute baseline rest period duringwhichthe music continued, the participants wereinstructed to repeat the subtraction taskby counting backward by 17s. After thesecond subtraction task, the music, ifany,was turned off, and the sensors wereremoved. Subjects left the room for ap¬proximately 15 minutes duringwhich theywashed theirhands, and the experimenterset up the audio equipment for the secondphase of the experiment.

When surgeons returned, the same

procedures were followed except thatthe music condition was changed, andthe values to be subtracted during themental arithmetic tasks were changedto 23s and 27s. After the second phase,the participants were dismissed whilethe third phase was set up. On the sur¬

geons' return, the procedures were re¬

peated a third time except that the mu¬sic condition changed and the values tobe subtracted changed to 43s and 47s.

ResultsPhysiological Responses.—Four data

analyses were performed using a 3x2x2randomized factorial analysis of variance(ANOVA) design, one for each depen¬dent physiological measure (ie, skin con¬duction response, pulse rate, diastolicblood pressure, and systolic blood pres¬sure). The within-subject factors were mu¬sic condition with three levels (no-musiccontrol, surgeon-selected music, and ex¬

perimenter-selected music control), taskwith two levels (first vs second serial sub¬traction), and period within task with twolevels (rest vs task). Figure 1 depicts thecell means of the physiological responsesaccording to the 3x2x2 design.

The overall ANOVAs (Table) revealedthe same pattern of effects for all physi¬ological measures, including main effectsfor all within-subject variables (music con¬

dition, task, and period) as well as musiccondition by task and task by period in¬teractions. The difference between musicconditions was greater during task per¬formance than at rest for all physiologicalresponses. Further, a posteriori tests re¬vealed reliable differences during bothbaseline and task period, such that allautonomie responses were highest dur¬ing the no-music control condition, next

Analysis of Variance SummaryEffect*

Skin Conductance Response FrequencyMusic condition 641.42 <.0001Task 15.88 <.004Period 1010.34 <.001Task period 9.43 <.004

Pulse RateMusic condition 491.38 <.0001Task 18.26 <.0003Period 3542.06 <,0001Music condition task 7.22 <.002Task period 10.00 <.003

Diastolic Blood PressureMusic condition 152.19 <.0001Task 53.68 <.0001Period 2297.93 <.0001Music condition task 7.99 <.0007

Systolic Blood PressureMusic condition 125.12 <.0001Task 17.64 <.0002Period 1026.48 <.0001Music condition task 4.32 <.02

SpeedMusic condition 17.76 <.0001Task 42.43 <,0001Music condition task_13.92_<.00Q1

AccuracyMusic condition 314.31 <.0001Task 37.81 <.0001Music condition task 20.91 <.0001

"Task refers to first or second serial subtraction; pe¬riod refers to rest or task intervals.

Figure 2.—Speed and accuracy of task perfor¬mance with three music conditions. The values arederived from the following equation: 4-(speed

accuracy), with speed=1 (fast) or 2 (slow), and ac¬curacy^ (accurate) or 2 (inaccurate).

highest during the experimenter-selectedmusic control condition, and lowest dur¬ing the surgeon-selected music condition(P<.02; see Table).

Performance Data.—The surgeons'performance on each task was catego¬rized by speed (fast vs slow) and accu¬racy (accurate vs inaccurate). A labo¬ratory assistant, who was blind to theexperimental conditions, listened to allthe subjects' serial subtractions andrated their task performance.

Separate analyses were performed us¬

ing a 3x2 randomized factorial ANOVAdesign for music condition and minuteswithin each subtraction task. Thesewithin-subject factors were analyzed bylooking at music condition with three lev-

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els (no-music control, surgeon-selectedmusic, and experimenter-selected musiccontrol) and minutes within task byminute 1 and minute 2. The overallANOVAs revealed identical patterns ofeffects for speed and accuracy, includingmain effects for both within-subject vari¬ables (music condition and minutes) anda music condition by task interaction (Fig¬ure 2). Further, a posteriori t tests re¬vealed that both speed and accuracy were

significantly better in the surgeon-se¬lected music condition than the other twomusic conditions (all P<.0001).Comment

This study examined the effects ofmusic on surgeons' psychophysiologicalresponses and performance during astandard psychological Stressor, mentalarithmetic. We believe surgeons havenever been studied in this context. Theresults provide evidence that for thisgroup music can have beneficial effectsboth autonomically and behaviorally.

The beneficial autonomie effects ofmu¬sic demonstrated herein were derivedlargely from the reduced cardiovascularreactivity during task performance. Con¬siderable evidence exists in support ofthe relationship between cardiovascu¬lar reactivity and cardiovascular disease,particularly coronary heart disease andhypertension.3335 The beneficial behav¬ioral effects of music demonstratedherein were derived largely from im¬proved task performance. To the extentthat surgeons' performance and cardio¬vascular responses during a standardlaboratory psychological stress task gen¬eralize to the surgical suite, one wouldexpect beneficial effects of the same mu¬sic on both cardiovascular reactivity andperformance during surgery.

The participants in our study endorsedthis view. They gave many examples ofthe frequent and enduring stress they ex¬

perience during surgery. It is importantto note that all participants believed in thebeneficial effect of music and were eagerto participate in our study. We cannotspeculate whether music would have ben¬eficial effects for surgeons who customar¬ily choose not to listen to it during surgeryor for surgeons who might listen to musicbut are not devoted music enthusiasts.

No specific category ofsurgeon-selectedmusic was associated with favorable physi¬ological responses and improved task per¬formance. Individuals were most posi¬tively affected by the music they chose,regardless of its tempo, timbre, or instru¬mentation. Study participants chose 50different pieces, all instrumental (46 clas¬sical, two jazz, and two Irish folk). Thisexperiment lends credible support to theimportance of individual taste and selec¬tion of music. An example of this is the

more positive influence James Galway andthe Chieftans playing traditional Irish mu¬

sic, complete with drums and tin whistles,had on one surgeon as compared withPachelbel (the control music condition).

These findings raise interesting issuesregarding possible mediators of the re¬

lationship between music and perfor¬mance. We contend that preference andnot just familiarity contributed to thefavorable performance responses and be¬nign physiological responses in the self-selected music condition, since Pachel¬bel was not related to better perfor¬mance and only somewhat to decreasedphysiological reactivity. Accordingly, theself-selected music may have caused thesurgeons to feel better able to performthe experimental stress task because ofthe past association of this specific mu¬sic with positive performance during sur¬

gery. Our position depends, of course,on the assumption that there was noth¬ing particularly distracting or otherwisenegative about the experimenter-se¬lected music, Pachelbel, and that anyother selection from the same genrewould have produced similar results.

In this study, we demonstrated evi¬dence that, for some surgeons, music isrelated to improved autonomie responsesand performance during stressful tasks.Also, support was found for our surgeonsubjects' intuitive beliefs that music isbeneficial during stressful tasks. In 1889Nietzsche wrote, "Without music lifewould be a mistake."36 Over a century lat¬er, our data prompt us to ponder if, with¬out music, surgery would be a mistake.References

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