Research and References

*Below is a research paper and list of references used during our pilot research study as well as development of our business. Heart Beat Music Therapy (HBMT) is the term used to describe using the moms heartbeat and voice to sooth newborns, the exact technique we use at Heartbeat Tranquility.* 

Physiological Response to Music Stimuli: the Beneficial Effects of Lullabies on Infants and Potential Implementation of Heart Beat Music Therapy.

Since the late 19th century, physiological responses to musical stimuli has been researched, supporting the idea that music influences physiological processes. However, the direction of the response pattern has been inconsistent. Similar types of musical stimuli have produced increases, decreases, and occasionally no changes in autonomic function (Davis and Thaut, 1989). Another discrepancy contributing to physiological response to musical stimuli is the belief that intersubjective responses to musical and other sensory stimuli are similar, predictable, and generalizable (Thaut, 1989). However, previous studies have shown that individuals comprehend similar autonomic effects differently due to their cognitive perception of the stimulus situation. Harrer and Harrer (1977) have identified three factors as possible contributions accountable for determining response patterns to music. The first factor is physiological response, which can be affected by the individual’s autonomic regulatory system influenced by fundamental principles such as age, sex, and physical fitness, state of health, lifestyle, and temporary conditions (fatigue/hunger). Second, is emotional reactivity; how the individual psychologically interprets a set of circumstances. The third factor identifies the individual’s attitudes toward the stimulus, influenced by extramusical associations, preference, as well as how the testing situation influences physiological responses. Taking these factors into consideration reinforce the idea that each individual may have a unique biological system that reacts to a given stimulus with an idiosyncratic but consistent physiological response and perceived psychological experience (Davis and Thaut, 1989). These three factors become present at the earliest stages of brain development. During pregnancy, researchers verified that the mother’s biological and psychological conditions influence the physical and emotional well-being and development of the unborn child (Nöcker-Ribaupierre, 2013). As the child and mother are biologically connected during this period, research on physiological response in infants in correlation to the mother’s music preference may have merit in the development of HMBT.

Research has shown that neural responses to auditory stimulation have been measured from the 24th week of gestation and on; including frequency resolution, temporal resolution, and auditory thresholds. The first heart-rate changes in response to sound occur roughly two weeks later, and the auditory system is fully developed by the end of the fourth month of pregnancy (Lehmann, and Sloboda, 2007). With the advancement in developed experimental methods, research has shown that musical learning and sensitivity is established before birth. Lehmann and Sloboda, (2007) explain that newborn babies respond with greater attention to music that was repeatedly played by their mother before birth compared to novel melodies, suggesting that babies have already stored information about the music surrounding them before birth. A recent study Prenatal Music Exposure Induces Long-Term Neural Effects (2013) examined 24 women during their final trimester of pregnancy. Half of the women played Twinkle Twinkle Little Star five days a week during the final stages of pregnancy. The results indicated that the brains of the babies who heard the melody in utero reacted more strongly to the familiar melody both immediately and four months after birth compared to the control group, suggesting that fetuses can recognize and remember sounds from the outside world (Hoffmann, T. 2013). Although there is little research on the effect of lullabies on infants, the research outcomes previously discussed is encouraging enough to merit further research. 

Lisa Bonnár, Research Fellow at the Norwegian Academy of Music in Oslo, claims “Lullabying is a heartfelt bonding experience for parents and children alike, and can be important in establishing a child’s physical and psychological well-being” (Eggen, A. 2014). Bonnár believes there are three beneficial effects of lullabying: 1.) lullabying creates unique musical connections that nourish the parent-child relationship, promoting exploration and reaffirmation of bonding. 2.) Nightly rituals of singing at bedtime establishes bedtime routines over time, as predictable lullabies can be reassuring and generate positive shared expectations of going to bed. 3.) Lullabying is an effective mean of soothing the baby, and creating a calm night-time atmosphere. (Eggen, A. 2014). Other research suggests the benefits of lullabies on infants include; a mean of providing for a healthier period of growing up, decrease in blood pressure, active stimulation to the related perception centers in the brain promoting increased comprehension, and the feeling of a safe environment via the mothers voice when singing (GÜNEŞ. 2012).

Current research in NICU settings may support the potential use of HBMT. A premature infant who is between 23 and 40 weeks’ GA in the NICU follows the same developmental sequences as a fetus in the womb, including infants with extreme prematurity (23–24 weeks’ GA), sensory systems are capable of processing and reacting to various stimuli (Nöcker-Ribaupierre, 2013). Recent research has suggested that the environmental noise of the NICU may be related to the high number of speech and language problems found in children born prematurely. Doheny and Hurwitz (et al 2012) found that the loud transient noise also has short-term, aversive effects on the respiratory and cardiovascular systems of premature infants. Most music therapy methods in NICU settings are receptive music therapy techniques including; 1. Individually provided sustained music, 2. Music and multimodal stimulation, 3. Music-reinforced nonnutritive sucking, 4. Breathing entrainment, 5. Singing as entrainment, 6. Environmental music therapy (EMT), and 7. Contingent singing (Nöcker-Ribaupierre, 2013).  

As these methods promote the neurological development and well-being in pre-mature infants, the individually provided sustained music and EMT methods in particular promote the potential implementation of HBMT. The individually provided sustained music method primary goals are to help the infant to calm down, provide a soothing environment, and reduce his stress-related behavior. The EMT method addresses the noise of the unit and provides for a quieter, more aesthetically pleasing, and safer environment (Nöcker-Ribaupierre, 2013) with the use of live music (particularly lullabies or song of kin). HBMT could be used with such methods as the heart beat lullaby recording can insure consistency in sound (using the same equipment/settings to play the recording fit to the infant’s current needs). This could eliminate possible variables of sound (such as timbre or tempo) that may arise with live performances in the NICU. As well as the EMT method, HBMT may provide a soothing environment on a more consistent basis. As the heart beat lullaby with the mother singing is recorded, it can be played regularly by the infants care team if the music therapist is unavailable. Additionally, having the recording played during specific times each day may promote the sense of a safe environment. 

Gerhardt & Abrams (2004) found the background sounds of the uterus (produced by maternal blood flow, respiration, digestion, and movement) are the backdrop above which maternal vocalisations and externally generated sounds emerge. This results in a reduction of sound levels in the different frequency ranges. The high-pass filter function of the tissues and fluids of pregnancy shapes any external stimuli before they reach the fetal auditory system and thus protects the fetus from being overwhelmed by noise. The maternal womb reduces frequency ranges above 500 Hz by 40 to 50 dB and below 500 Hz by 10 to 20 dB before they reach the inner ear of the fetus (Nöcker-Ribaupierre, 2013). With the discovery of such results along with current recording and editing technology, HBMT recordings can match the frequency range of the recording to the specifications of the womb as listed above. Having the lullaby recording fit to these frequency specifications may prove to have greater beneficial outcomes compared to a typical recording that does not take such consideration. 

Although there is research on music therapy in NICU settings, very little research is available on how music therapy can be implemented with lullabies for healthy infants. However, previous studies on physiological response to music stimuli can potentially be generalized to such settings. The strong response and association of the mother’s voice during pregnancy merits the need to research infant responses to the mother’s heartbeat. As lullabies have shown to reduce stress and blood pressure, perhaps hearing the mothers heart-rate (at a relaxed rate: 60-80 bpm) can reduce physiological states as well. With the use of new technology, heart beat microphones can be used to record the mother’s heart-rate and incorporate it into a lullaby recording. This new microphone enables new development for possible music therapy interventions. Recording the mothers heart-rate, and making a track of the mother singing a lullaby with the heartbeat layered in the recording might enable faster responses in the infant compared to random lullaby recordings. Especially in cases where the mother might be absent, the recording might give the infant the sense of a safe environment that has been established and associated with the mother’s voice. HBMT may also have potential with additional populations such as at risk youth who are pregnant, single mothers, mothers with PTSD, and expecting mothers with mood disorders such as depression. Music therapy lullaby songwriting interventions might also provide a way to promote healthy feelings towards preparation of giving birth, as well promoting the mother’s/parents expressions of wishes, desires, love, and general well-being to affect the child’s subconscious positively when listening to the recording. 

References That Support Our Method:

Lehmann, A., & Sloboda, J. (2007). Psychology for musicians: Understanding and acquiring the skills. Oxford: Oxford University Press. 

Davis, W., & Thaut, M. (1989). The Influence of Preferred Relaxing Music on Measures of State Anxiety, Relaxation, and Physiological Responses. Journal Of Music Therapy, 26(4), 168-187. doi:10.1093/jmt/26.4.168 

Bales, D. (2014) "The Role of Music (C 1053-06)." Building Baby's Brain Series: The Role of Music. Web.

Hoffmann, T. (2013) "Babies Learn Lullabies in Mother's Womb." Sciencenordic.com. Web. 21 Apr. 2016. 

Eggen, A. (2014) "Absent-minded Lullabying Does Not Put Your Baby to Sleep." Sciencenordic.com. Web. 21 Apr. 2016. 

GÜNEŞ, Hasan, and Nadide GÜNEŞ. (2012) "The Effects of Lullabies on Children." International Journal of Business and Social Science 3.7 (2012). Web. 

Nöcker-Ribaupierre, M. (2013). Premature Infants. Guidelines for Music Theray Practice in Pediatric Care, Edition: 1, Chapter: 3, 48.

Gerhardt, K. J., & Abrams, R. M. (2004). Fetal hearing: Implications for the neonate. In M. Nöcker-Ribaupierre (Ed.), Music therapy for premature and newborn infants (pp. 21–32). Gilsum, NH: Barcelona Publishers.

Doheny, L., Hurwitz, S., Insoft, R., Ringer, S., & Lahav, A. (2012). Exposure to biological maternal sounds improves cardiorespiratory regulation in extremely preterm infants. Journal of Maternal-Fetal and Neonatal Medicine.

Iwanaga, M., & Moroki, Y. (1999). Subjective and Physiological Responses to Music Stimuli Controlled Over Activity and Preference. Journal Of Music Therapy, 36(1), 26-38. doi:10.1093/jmt/36.1.26 

Ferrer, A. (2007). The Effect of Live Music on Decreasing Anxiety in Patients Undergoing Chemotherapy Treatment. Journal Of Music Therapy, 44(3), 242-255. doi:10.1093/jmt/44.3.242

Korhan, E., Khorshid, L., & Uyar, M. (2011). The effect of music therapy on physiological signs of anxiety in patients receiving mechanical ventilatory support. Journal of Clinical Nursing, 20, 1026-1034. doi:10.1111/j.1365-2702.2010.03434.x 

Wang, S., Kulkarni, L., Dolev, J., & Kain, Z. (2002). Music and Preoperative Anxiety: A Randomized, Controlled Study. Anesthesia & Analgesia, 94, 1489-1494. 

Rider, M., Floyd, J., & Kirkpatrick, J. (1985). The Effect of Music, Imagery, and Relaxation on Adrenal Corticosteroids and the Re-entrainment of Circadian Rhythms. Journal Of Music Therapy, 46-58. 

Iwanaga, M., Ikeda, M., & Iwaki, T. (1996). The Effects of Repetitive Exposure to Music on Subjective and Physiological Responses. Journal Of Music Therapy, 33(3), 219-230. doi:10.1093/jmt/33.3.219 

Knight, W., & Rickard, N. (2001). Relaxing Music Prevents Stress-Induced Increases in Subjective Anxiety, Systolic Blood Pressure, and Heart Rate in Healthy Males and Females. Journal Of Music Therapy, 254-272. 

Urakawa, K., & Yokoyama, K. (2005). Music Can Enhance Exercise-Induced Sympathetic Dominancy Assessed by Heart Rate Variability. Tohoku J. Exp. Med. The Tohoku Journal of Experimental Medicine, 206(3), 213-218.