Beyond lifelong physical conditions, cancer survivorship can bring about long-term mental health concerns, such as anxiety, depression and isolation.

In hopes of supporting cancer survivors, researchers from Drexel University are exploring music therapy as a way to better understand what they’re going through and help them to manage these post-treatment challenges.

One study, called the Music Therapy Versus Cognitive Behavioural Therapy for Cancer-related Anxiety (MELODY) trial, a collaboration between researchers from Memorial Sloan Kettering Cancer Centre and Joke Bradt, PhD, a professor in Drexel’s College of Nursing and Health Professions, examined the effectiveness of music therapy compared to cognitive behavioural therapy, which is currently considered the gold standard for anxiety management in cancer care.

Building on the MELODY research, Sarah Biedka, a PhD candidate in Bradt’s Music, Creativity and Wellness Lab in the College, led a study analysing 26 songs, written during the music therapy sessions, to better understand the needs and challenges of the cancer survivors who created the songs.

The study was recently published in the Journal of Cancer Survivorship.

“We identified needs and challenges that extended far beyond cancer-related anxiety, including prioritising self-care, redefining identity, navigating relationships and finding deeper meaning,” said Biedka.

The MELODY trial involved 300 cancer survivors experiencing anxiety, who participated in one of two evidence-based treatment approaches for managing anxiety: telehealth cognitive behavioural therapy, a goal focused type of talk therapy, or telehealth music therapy, a therapy in which credentialed music therapists engage participants in music experiences to help them progress toward personalised health and well-being goals.

As part of the music therapy sessions, participants wrote songs with the support of a board-certified music therapist.

In Biedka’s qualitative study, the researchers then analysed 26 of the songs that focused on the needs and challenges of the participants who created them.

The MELODY trial showed that music therapy — in this case, the process of writing songs with a music therapist — helped cancer survivors reduce their anxiety.

Through their analysis, Biedka and the research team were able to better understand the needs and challenges participants expressed and identify nuanced stressors beyond cancer-related anxiety.

“Several songs described how coping with one challenge often created new challenges in other areas of life, especially relationships,” said Biedka.

“Essentially, participants described feeling like they had to choose between acting on their needs and preserving the status quo in their relationships. Until MELODY, these participants had been mostly choosing their relationships over their needs, leading to feelings of isolation and resentment.”

Researchers explained that songwriting helped participants explore, process and communicate complex and often uncomfortable needs and challenges that they might not have otherwise discussed.

Many cancer survivors avoid talking about difficult thoughts and feelings because they don't want to burden others or worry about being misunderstood or rejected.

An additional related study, led by Bradt and recently published in the European Journal of Integrative Medicine, found that participating in music therapy during the MELODY study may have helped participants reduce anxiety, not only by helping them manage anxious moments, but also by helping them engage with the deeper personal, relational and societal experiences that shape anxiety during survivorship.

Biedka explained that songwriting was integral to the music therapy sessions because it helped participants identify and process fears, worries and painful emotions and shared that one participant described feeling uniquely “seen” and “heard” through collaborative songwriting.

During interviews, participants also highlighted the value of learning music-based strategies that were easily transferable to daily life and applicable across contexts, as well as feeling a renewed appreciation for music and creativity as accessible resources for self-care and wellness.

For the song analysis, the research team identified themes and categories across the lyrics of songs written by 26 participants in the MELODY trial.

The songs were specifically chosen because they focused on the needs and challenges of the participants who wrote them.

Because songs can include multiple meanings and communicate through both words and music, the research team also consulted song recordings, brainstorming notes from the songwriting sessions and notes from individual meetings with the study’s music therapists to better understand the participants’ contexts and support their interpretations of the lyrics.

During interviews, participants shared that after finishing their song, they felt a sense of accomplishment, pride and satisfaction from achieving a goal and personally creating a song that was aesthetically pleasing, valued by the music therapist and loved ones and gave them a sense of ownership and identity.

Music therapy enabled the participants to creatively access, examine, communicate and release their thoughts and emotions –– sometimes emotions they did not know they were feeling.

Songwriting also has built-in tools to help cancer survivors better understand and communicate their needs, according to the researchers.

For example, writing original songs increases the therapeutic potency of metaphors, because they become specifically pertinent to a cancer survivor’s life and how they are feeling.

Also, the musical and lyrical structures used to organise a song can help participants organise their thoughts.

Survivors can group similar ideas in one verse and then express a contrasting idea in the chorus.

These groupings can help validate, and subsequently communicate, two seemingly incompatible yet true experiences.

Cancer survivors can also use the elements of music (melody, rhythm, harmony, form and texture) to support or question the meaning of their song.

In the end, using all these tools helped the participants gain insights into patterns and an overall picture of their survivorship experience.

Sharing their songs with others also allowed the participants to communicate difficult topics, which can feel much more comfortable and effective than using words alone.

Biedka shared that some of the MELODY participants shared their songs for that purpose.

“Avoiding difficult conversations is a significant concern for cancer survivors, so this could be a key benefit of songwriting for them,” said Biedka.

Together, the researchers explained, the results of the MELODY trial and the two qualitative studies suggest that helping cancer survivors effectively address their anxiety may involve more than just reducing episodic anxiety symptoms.

The research findings showed that cancer survivors can experience interconnected social, emotional and existential challenges that can shape their experiences of anxiety throughout survivorship.

“In light of the MELODY trial results, the findings of this qualitative study, as well as findings from interviews we conducted with 30 of the music therapy participants, suggest that music therapy may offer a creative way to explore and address some of the underlying issues that contribute to anxiety while also supporting longer-term coping,” said Bradt.

“Ultimately, all of the MELODY findings highlight the potential value of music therapy as a part of comprehensive cancer survivorship care.”

Bradt and Biedka hope these studies encourage healthcare providers and decision-makers to consider music therapy as a legitimate component of comprehensive cancer care.

Further research will need to examine the economic benefits and any potential implementation challenges and solutions, because currently CBT is the first-line treatment for anxiety management.

“As music therapists, we sometimes take for granted that songwriting is such a powerful therapeutic medium, and with the help of a music therapist, songwriting is so much more accessible than people realise,” said Biedka.

Source: Drexel University