This study that aimed to evaluate the effect of music on anxiety during bronchoscopy, showed a decrease of anxiety level using the VAS, in patient listening to music, when compared to the control group. This result was not found when using the S-STAI.
The effect of music on anxiety has been the subject of several studies in various fields including psychiatry(21), oncology (22), cardiology(23) and surgery(24) and procedures such as endoscopy(25). In fact, the use of music during surgery under local anesthetic has been shown to reduce patient’s stress levels by masking unpleasant sounds.(26)
In a previous study, it has been demonstrated that the use of music can reduce pre-operative anxiety during short waiting periods .(27)
Bronchoscopy is a procedure that frequently elicits feelings of anxiety and stress among patients(28), potentially resulting in diminished satisfaction and compliance.(6) Previous studies using music has failed to reduce anxiety levels among patients undergoing bronchoscopy(16,29). In the other hand a previous study reported a positive effect of music on STAI level(9). A systematic review showed that music during bronchoscopy reduced patients' blood pressure and heart rate, but no conclusive results were obtained on the effect of music on anxiety levels(30) .
Several different scales, therefore, were used to evaluate the anxiety outcome. In our study we opted to assess anxiety using two types of indicators: psychological, subjectively measured using the STAI and VAS, and physiological, objectively measured using the HR, SatO2 and BP. The STAI is a very widely known and reliable self-report scale that has been used extensively to assess anxiety. (31). the State portion of this questionnaire including 20 questions may be more complex for our participants who mainly have a low education level when compared to the VAS.
Furthermore, it seems that in some situations, subjects are likely to underestimate their current state in response to self-protection strategies. These defensive attitudes allow subjects not to recognize their emotions and therefore their weaknesses. In fact, for some patients, it is more appropriate to express discomfort than fear.(32)
To overcome this anxiety during bronchoscopy, different types of music have been studied like binaural beat audio(9) ,piano improvisation(16), soft music (30)or even self-selected music(15) .Music therapy uses various musical elements, including melody, timbre, rhythm, harmony and pitch, to enhance physical and psychological well-being (33).In fact, music acts as a distractor, diverting the patient's attention from negative stimuli to something pleasant and encouraging, thereby improving anxiety.(34). The underlying theory behind the use of music as an anti-anxiety intervention method is its ability to trigger relaxation by stimulating the autonomic nervous system.(27). it has been shown that in addition to the intrinsic perception of music, the feeling of well-being is linked to symbolic, iconic and behavioral meanings.(35)
For these reasons, we have opted in our study, for Tunisian classical music, which is characterized by its authentic dimension, manifested in its respect for formal structure, poetic texts, rhythms, melodic modes and Tunisian musical intonation, resulting from technical elements characteristic of the traditional musical language of each region. This heritage reflects an aspect of Tunisian culture rooted in the depths of history. This music is part of the "oriental" music movement and is a synthesis of the Tunisian own cultural heritage and external contributions, mainly from the Andalusian and Oriental traditions. In other words, Tunisian music is music that lives, it's full of feeling and Its music that supports people in their daily lives.
Strength and limitations
To the best of our knowledge, it’s the first study that involves music therapist in the choice of the music, thus meeting the exact definition of music therapy, as distinct from music medicine, used in the majority of previous studies. Furthermore, double blinding to the investigator and the bronchoscopist is one of the strong points of our study. Moreover, anxiety was assessed using two different subjective scales (STAI and VAS) and objective measurement like oxygen saturation and blood pressure.
However, some limitations of the study should be mentioned. The time given to the patient to listen to the music (10 minutes) before bronchoscopy maybe insufficient to relax the patient. Although the STAI is still the most widely used for assessing anxiety, it may not be suitable for our population, as this questionnaire can be confusing for illiterate patients, who make up the majority of our population. the use of pre-selected music can reduce the expected positive effect of music. In addition, we didn’t use subjective direct measurement to assess anxiety like blood cortisol.
Implication for practice and research
Future studies can address these limitations. The positive effect of the music can be enhanced by giving the choice to the patients to select the preferred music and increasing the amount of time the music is played. In addition, the use of subjective measurement like blood cortisol or salivary indices may be an interesting prospect for future research.