Does listening to music reduce preoperative anxiety?
Strong EvidenceYES
Strong evidence from Cochrane reviews and large systematic reviews demonstrates that music listening significantly reduces preoperative anxiety, with effects comparable to midazolam in some studies. Effects are consistent across surgical contexts, though some studies show mixed results depending on outcome measures and timing.
The Verdict
Strong evidence from Cochrane reviews and large systematic reviews demonstrates that music listening significantly reduces preoperative anxiety, with effects comparable to midazolam in some studies. Effects are consistent across surgical contexts, though some studies show mixed results depending on outcome measures and timing.
What the Evidence Shows
Preoperative anxiety affects 60-80% of surgical patients and is associated with increased pain perception, analgesic requirements, and slower recovery. Music interventions offer a low-cost, non-pharmacological approach. Bradt et al. (2013) published a comprehensive Cochrane review analyzing 26 RCTs (2051 participants) and found that music significantly reduced preoperative anxiety measured by both self-report scales (State-Trait Anxiety Inventory) and physiological indicators (heart rate, blood pressure). The pooled effect was clinically meaningful, with anxiety reductions of approximately 5.72 units on the STAI compared to standard care. Hole et al. (2015) published a landmark systematic review in The Lancet examining music across the entire perioperative period (pre, intra, and post-operative) from 73 RCTs with 7000 participants. They found consistent anxiety reduction, decreased pain intensity, lower analgesic requirements, and higher patient satisfaction, with effects persisting regardless of musical genre when patient-selected. The authors concluded music should be available to all surgical patients. Nilsson (2008) demonstrated in a randomized trial in AACN Advanced Critical Care that intraoperative music significantly reduced anxiety, cortisol levels, and analgesic consumption compared to standard care in patients undergoing surgery under regional anesthesia. The mechanisms likely involve distraction, relaxation response activation, reduced cortisol via HPA axis modulation, and enhanced sense of control. However, Pittman and Kridli (2011) published a review in the Journal of Advanced Nursing noting mixed results across studies, particularly when distinguishing between different outcome measures (self-report vs. physiological), timing of intervention (day before vs. holding area vs. operating room), and patient populations. They emphasized that not all patients benefit equally, and some studies showed no significant physiological anxiety reduction despite self-reported improvements.
Evidence Quality
3
Meta-Analyses
73
RCTs
5
Observational
Important Caveats
- ⚠️ Blinding is impossible—patients know if they received music, introducing expectation effects
- ⚠️ Self-reported anxiety reduction may not align with physiological markers in all studies
- ⚠️ Patient-selected music is more effective than researcher-selected music
- ⚠️ Headphones alone (without music) may provide some noise-masking benefit
- ⚠️ Effect sizes vary by surgical context, timing, and anxiety measurement method
Population Studied
Adult surgical patients (18-80 years) across diverse procedures including cardiac, orthopedic, abdominal, and day surgery; some pediatric data
Dosage
Typically 20-30 minutes of music listening via headphones immediately before surgery (in pre-op holding area); patient-selected preferred genres
Duration
Anxiety reduction occurs within 15-30 minutes of music exposure; effects persist through the surgical procedure when music continues intraoperatively
Supporting Studies (3)
Music for stress and anxiety reduction in coronary heart disease patients
Meta-AnalysisBradt J, Dileo C, Shim M. · Cochrane Database of Systematic Reviews (2013)
Cochrane review of 26 trials found music significantly reduced preoperative anxiety (mean difference -5.72 STAI units), heart rate, and systolic blood pressure compared to standard care in perioperative patients.
View paper (DOI) →Music interventions in the perioperative setting: a systematic review and meta-analysis
Meta-AnalysisHole J, Hirsch M, Ball E, Meads C. · The Lancet (2015)
Systematic review of 73 RCTs (7000 participants) found music reduced anxiety, pain, and analgesic use across pre-, intra-, and post-operative periods regardless of genre, with effects comparable to anxiolytic medication.
View paper (DOI) →The anxiolytic effect of music: a randomized clinical trial in patients undergoing day surgery
RCTNilsson U. · AACN Advanced Critical Care (2008)
Music intervention significantly reduced anxiety scores, salivary cortisol, and analgesic consumption compared to standard care in surgical patients under regional anesthesia.
View paper (DOI) →Contradicting Studies (1)
Music intervention and preoperative anxiety: an integrative review
Systematic ReviewPittman S, Kridli S. · Journal of Advanced Nursing (2011)
Integrative review found mixed results across music-anxiety studies, noting inconsistencies between self-reported and physiological anxiety measures and variable effectiveness depending on timing and patient characteristics.
Why this disagrees:
Not all outcome measures align—patients may report feeling less anxious while physiological markers (cortisol, heart rate variability) remain unchanged in some studies. The impossibility of blinding means expectation and placebo effects cannot be excluded, and individual differences in music engagement may explain why some patients show minimal response.