Music Listening for Self-Management of Anxiety : A Qualitative Survey

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ Music Listening for Self-Management of Anxiety : A Qualitative Survey © The Author(s) 2024 Published version Taipale, Marianne; Peltola, Henna-Riikka; Saarikallio, Suvi; Minkkinen, Gulnara; Randall, William M.; Carlson, Emily Taipale, M., Peltola, H.-R., Saarikallio, S., Minkkinen, G., Randall, W. M., & Carlson, E. (2024). Music Listening for Self-Management of Anxiety : A Qualitative Survey. Music and Science, 7. https://doi.org/10.1177/20592043241264424 2024 Music Listening for Self-Management of Anxiety: A Qualitative Survey Marianne Taipale , Henna-Riikka Peltola , Suvi Saarikallio , Gulnara Minkkinen , William M. Randall and Emily Carlson Abstract Anxiety is among the most commonly experienced affective states—prominent in both everyday emotions, and a range of mood disorders. Music seems to be an effective tool for managing negative mood states, but recent research indicates that anxiety may be a particularly challenging state to self-regulate, even for those without diagnosed anxiety disorders. In this study, the use of music for anxiety self-management in everyday life is explored. Data consist of free descriptions by adult participants (N=36), collected through an online survey and analyzed with data-led thematic analysis. Findings indicate that music listening is often considered helpful with milder states of anxiety—particularly when an individual has control over the choice of music—and that different regulatory strategies are required to deal with different forms of anxiety. These strategies can provide help in a number of ways, such as recognizing or validating emotions, or positive refocusing. In future research, the possibility of unrecognized maladaptive strategies in music listening should be addressed, as well as the mechanisms behind avoidance of music related to high levels of anxiety. Keywords Emotion regulation strategies, everyday life, music listening, nonclinical anxiety, self-regulation Submission date: 24 October 2023; Acceptance date: 3 June 2024 Introduction One of the most common reasons for listening to music is to regulate our affective states (Baltazar & Saarikallio, 2019; Saarikallio, 2008; van Goethem & Sloboda, 2011). The affective state of anxiety—commonly experienced both through mood disorders and as an everyday emotion— increased in the general population during the global coronavirus pandemic (Calling et al., 2017; Salari et al., 2020). A number of studies have shown that to music can be used successfully to decrease anxiety, particularly in the context of music therapy for people with clinical anxiety disorders (Elliott et al., 2011; Guetin et al., 2009; Knight & Rickard, 2001) or coping with chronic illness or surgery (Bradt, Dileo, & Potvin, 2013a; Bradt, Dileo, & Shim, 2013b; Harney et al., 2023). A systematic review and meta-analysis by Harney et al. (2023) showed that music listening can decrease anxiety in various settings but stated that many previous studies focus on music listening interventions for experimentally manipulated anxiety. When it comes to music listening as an everyday strategy to manage naturally occurring anxiety, the evidence is less clear. In a recent experience-sampling study, Randall et al. (2023) found that listeners in an anxious state were less successful in reaching their self-regulation goals, when compared with all other negatively valenced states. Along similar lines, Carlson et al. (2021) noted that some participants surveyed about their music use during the first coronavirus lockdown reported negative emotional responses to music, which in many cases was related to severe levels of anxiety. One reason for this may be that anxiety is understood to be multidimensional and includes somatic and cognitive elements Centre of Excellence in Music, Mind, Body and Brain; Department of Music, Art and Culture Studies, University of Jyväskylä, Jyväskylä, Finland Corresponding author: Marianne Taipale, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyväskylä, Seminaarinkatu 15, Finland. Email: marianne.h.taipale@jyu.fi Data Availability Statement included at the end of the article Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Research Article l Music & Science Volume 7: 1–18 © The Author(s) 2024 DOI: 10.1177/20592043241264424 journals.sagepub.com/home/mns (Bishop, 2007; Endler et al., 1991; Sharp et al., 2015), and may thus represent a more complex regulatory problem than, for example, using music to elevate low mood or energy. Research into music listening for regulation of negative affect has primarily explored how music listening may relate to depression or risk for depression (e.g., Garrido & Schubert, 2015; Stewart et al., 2019), with comparatively little focus on anxiety, particularly everyday (nonclinical) anxiety. To address this, this study explores how listeners use music for managing naturally occurring anxiety, to better understand how musical engagement relates to this everyday experience. Anxiety as a Condition The American Psychological Association (APA, 2018) defines anxiety as “an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune.”Compared with acute fear, which is a reaction to immediate danger, anxiety is a longer-lasting and more future-oriented emotion, often built on negative future expectations (Barlow, 2004). Anxiety is a multidimensional state, which can vary from feeling debilitated to experiencing hyperactivity or obsessive behavior (Barlow, 2004); thus, both low and high arousal can be characteristic of anxious states. Anxiety is a natural human experience that serves an evolutionary purpose in keeping us safe and cautious in certain situations where danger may arise from the environment but becomes problematic if the feeling of anxiety becomes chronic or greater than the situation would require (Storch & McKay, 2013). If the anxiety is long-lasting, intense, or interferes with daily life, there is a possibility of an anxiety disorder (Barlow, 2004). The Diagnostic and Statistical Manual of Mental Disorders (APA, 2013) recognizes 11 different types of anxiety disorder, of which the most common are generalized anxiety disorder, panic disorder, and phobias. Anxiety is currently among the most commonly diagnosed mental disorders in the adult population (Storch & McKay, 2013) and the most common mental illness in adolescents and young adults (Teunisse et al., 2022). According to the World Health Organization, 301 million people, worldwide, were living with anxiety disorders in 2019 (WHO, 2022). The experience of anxiety can also be a common part of everyday life for people recruited to studies from nonclinical settings (Carstensen et al., 2000; Zelenski & Larsen, 2000), although it remains unclear how many people experience anxiety at subclinical levels. A number of paradigms distinguish between state anxiety—which is focused on a specific situation or place—and trait anxiety, which is related to personality traits, and closely connected to a person’s overall thinking or worldview (Julian, 2011). Trait anxiety tends to correlate with neuroticism, a personality trait related to a tendency to experience negative affect (Eid et al., 2022). Knowles and Olatunji (2020) have argued that trait anxiety might not be meaningfully distinct from neuroticism. For the purpose of this study, we focus on anxiety as an everyday emotion, which some individuals may experience more often than others, rather than as a clinical disorder. The main treatment methods for anxiety disorders are psychotherapy and medication (APA, 2022). Studies on anxiety self-management are often related to hospital environments, medical procedures, and subsequent recovery periods (Chlan, 2009; Eyles et al., 2015; Hill et al., 2013). Such studies have shown breathing exercises to be a common and effective self-management strategy for postoperative anxiety (Chandler et al., 2019; Fredericks et al., 2012). Music and relaxation therapy are recommended to postoperative patients for managing anxiety (Fredericks et al., 2012), as they are evidently effective techniques in anxiety management. In contrast to research within medical environments, anxiety self-management across the contexts of everyday life has received less attention in the literature. Adaptive cognitive emotion regulation strategies, which an individual may use independently or develop in therapy, include acceptance, positive refocusing, refocusing on planning, putting into perspective, and positive reappraisal, while maladaptive strategies include rumination, selfblame, catastrophizing, and other-blame (Garnefski et al., 2002). In the case of arousal anxiety—which involves physiological hyperarousal, tension, panic, phobias, and somatic reactivity—there is no strong correlation with frequent use of any specific cognitive emotion regulation strategy. In contrast, apprehension anxiety—which can appear as worrisome thoughts and reduced attentional control—is related to more frequent use of rumination (Domaradzka & Fajkowska, 2018; Fajkowska et al., 2018). Music in Anxiety Management In music therapy settings, the effects of music in managing anxiety have been widely studied in relation to other mental health issues, and across various healthcare settings. For example, music has been found to be an effective tool in reducing anxiety related to medical procedures (Mackintosh et al., 2018; Thoma et al., 2015; Vachiramon et al., 2013), critical illness (Chlan, 2009), postoperative pain (Kuhlmann et al., 2018), childbirth (McCaffrey et al., 2020), and psychiatric care (Yang et al., 2012). In each of these cases, music was used to relieve anxiety caused by a very specific situation, and the music was provided as an intervention guided by another person. In studies addressing music in the treatment of anxiety, the music used is often classical (Pelletier, 2004), and the majority of the interest appears to be related to musicians’ performance anxiety. Labbé et al. (2007) conducted an experiment with 56 college students and found that listening to relaxing music and the ability to influence the selection of music seemed to reduce perceived and physiologically measured 2Music & Science anxiety, anger, and stress levels, while heavy metal music seemed to slightly support relaxation but increase anxiety levels. A meta-analysis of music listening for alleviating anxiety in a healthy adult population suggests that the beneficial effects are related more to underlying individual processes, rather than the type or mode of the music (Panteleeva et al., 2018). Previous research has shown that engagement with music (e.g., listening, playing, or dancing to music) is often used in the self-management of mood and emotion (Saarikallio, 2011), a process that involves a choice of both specific music and cognitive strategies. While listening to music appears to be a successful strategy overall for emotion management, some patterns in music engagement have been associated with more negative outcomes for mental wellbeing (Carlson et al., 2015; Saarikallio et al., 2015). For example, young people with symptoms of depression use music frequently for mood regulation but are often attracted to music that intensifies rather than alleviates their symptoms, and they may not be aware of the impact of their music listening on their wellbeing (Stewart et al., 2019). While maladaptive regulation strategies such as these have been extensively studied in relation to depression, the corresponding literature on anxiety is relatively lacking, despite the prevalence of anxiety as an everyday emotion. Previous anxiety research has largely been focused on the use of classical music, treatment of situational anxiety, and music interventions provided by professionals, while the role of nonclassical genres, everyday anxiety management strategies, and the nuances of anxiety self-regulation remain unexplored. Studies in laboratory and clinical settings suggest that music can be an effective intervention for reducing anxiety (Elliott et al., 2011; Harney et al., 2023), but information about the music choices and cognitive strategies used by average listeners in everyday anxiety management, and which factors affect whether anxiety is effectively managed, is lacking in the literature. In a recent experience-sampling study examining selfregulation goals through listening to music (Randall et al., 2023), it was found that listening to music appears to work particularly well for adults and adolescents for regulating negatively valenced mood states, as compared with positive states. Among the affective states that participants most frequently aimed to change through their listening, anxiousness was the least successfully regulated negative state for adolescents, and the least successfully regulated of all states for adults. This finding suggests that, compared with other negative mood states, anxiety may be more difficult to self-regulate by listening to music. Relatedly, in an investigation of the role of music in everyday life during the coronavirus pandemic (Carlson et al., 2021), it was found that highly anxious people reported having negative responses to music. These findings seem contradictory with a meta-analysis of listening to music for anxiety reduction, in which music was seen to decrease self-reported anxiety levels (Panteleeva et al., 2018). Thus, this topic warrants further investigation. Aims of the Study Former research has been focused on clinical levels of anxiety and the alleviation of anxiety in various healthcare settings. While music has been used to help alleviate anxiety in various situations, some results suggest that anxiety might be an especially challenging affective state in terms of independent emotion regulation. The aim in this study is to explore the use of music in anxiety management in participants’everyday lives. By examining the role of listening to music in the management of nonclinical levels of anxiety, we can better understand the underlying mechanisms and strategies in successful and unsuccessful self-regulation with music. This study offers novel insights to participants’own descriptions of their everyday music use for different levels of naturally occurring anxiety. The aim of the study was to answer the following research question: What are the characteristics of successful and unsuccessful attempts at using music to self-manage anxiety? Methods Data Collection and Participants The data were collected in English using an online survey, which was open between the end of January and the end of March 2023. A total of 36 participants, ranging in age from 20 to 70 (M=46.71; SD =15.57; 11 identified as “male”, 24 as “female”, and 1 as “other,”when replying to a forced-choice question), were recruited using social media and mailing lists. Approximately half of the participants were from Finland (47%), while the rest came from elsewhere (including Asia, Europe, North America, and South America). On accessing the survey, participants were provided with information about the topic of the survey and the survey duration. The information page clearly stated the age requirement (at least 18 years), that participation was voluntary, and that consent to participate could be withdrawn at any time by closing the survey before completion. The information page also included a full privacy notice regarding protection of participants’data. The participants were asked to describe situations in which music engagement had been successful for them as a means of managing anxiety, as well as situations when music engagement had been unsuccessful for managing anxiety. In these open-ended questions, participants were asked to describe each situation in detail, and provide, for example, types of music or situational details that influenced anxiety management. Participants used a Likert scale to report how various types of musical engagement (listening, playing, singing, dancing, composing, or imagining music) in different social contexts (alone or with others) Taipale et al. 3 related to their anxiety management with music. Additionally, they filled out the 21-item Depression Anxiety and Stress Scale (DASS-21; Lovibond & Lovibond, 1995) and provided general demographic information. On the anxiety subscale of the DASS-21, most participants’scores were quite low overall: as defined by the DASS-21, 15 participants registered scores that reflect normal levels of anxiety (0–7); 7, mild (8–9); 7, moderate (10–14); 4, severe (15–19); and 3, extremely severe (20+) (M=8.94; SD =6.74). Thus, most of the results can be considered representative of a population without clinical symptoms. Finally, participants were asked to provide the name and artist of at least one song that might help them in managing anxiety. Analysis Qualitative data were analyzed using data-led thematic analysis (e.g., Braun & Clarke, 2006), to identify common themes within the experiences of using music to manage anxiety. Coding took place in three stages. In the first stage, the first author coded the data using the data-led approach and developed a preliminary set of codes. The second and third authors completed the second round of analysis by coding the data using the same codes as the first author. They also made additions to the set of codes when necessary. During this second stage, the codes were discussed and negotiated together by the three coders, the codes were thematically grouped, and, as a result, the main themes were formed. Finally, the analysis and interpretations were discussed with all the authors. Basic statistical analysis was applied to Likert-scale and DASS-21 answers to provide additional information about the participants’backgrounds and styles of music engagement. Background information, such as gender (F =female; M =male; N =nonbinary), age, level of musicianship (nonmusician, amateur musician, or professional musician), and DASS-21 anxiety score (mild, normal, moderate, severe, or extremely severe anxiety) of the respondent are provided with each data extract in the results section. Results The overview of demographics (Figure 1) shows that the survey reached people from all age groups, with the majority being working age adults. A majority of the participants were female. Participants from different educational backgrounds and occupations were represented; however, the data did not include, for example, any unemployed persons. All participants estimated their proficiency in the English language to be at least intermediate, and there was a fairly even distribution in terms of musical background. A clear majority of the participants engaged with music or other audio (or audiovisual) content (such as podcasts or videos) while feeling anxious (Table 1). “Imagining music” was slightly more common way to engage with music than “singing or playing an instrument”; this is a surprising finding. According to Mitani et al. (2019), simply imagining music that is self-selected and easy to imagine may have similar relaxing effects to listening to music for relaxation. Voluntary musical imagery (i.e., imagining music) has also been studied specifically with relation to anxiety management, and it was suggested to lead to decreased anxiety and increased positive mood (Ulor, 2020). The songs mentioned by participants as helpful in anxiety management spanned a wide range of musical genres and styles (Appendix A). This resonates well with the multidimensionality of anxiety (Barlow, 2004), where the desired outcome can be at very different extremes for different individuals, or even within the same individual across different situations. However, a further analysis of the music examples was not within the scope of this study. In the analysis, we identified two broad main themes: successful strategies for using music for anxiety—consisting of three subthemes—and unsuccessful strategies—consisting of two subthemes. It is important to acknowledge that the data describe only participants’experiences and perceptions of managing anxiety in retrospect, and not necessarily actual strategies per se. As there may be a common bias toward the belief that music always has a positive effect, we must keep in mind that certain music listening episodes might have been regarded as successful by the participants, but that the actual behavior might have been maladaptive and resulted in feeling worse over time. Strategies of Successful Music Use The situations in which participants reported that music works for anxiety management can be grouped into three subthemes: (a) changing the current state, (b) strengthening the current state, and (c) distraction. Changing the Current State. For many participants, feelings of anxiety, pressure, and stress were managed by trying to calm down with music. For this purpose, the strategy was often to use calm, slow, and peaceful music, which resulted in calming down, reducing stress, and slowing down heart rate. Easy jazz type of music or my favorite songs typically help reduce stress and calm my pulse down. (F, 49, amateur musician, normal anxiety) Sometimes I might need very relaxing songs to help me calm down. (F, 28, nonmusician, severe anxiety) However, for some people, heavy metal music had a similar calming effect: When I’m really troubled by something, metal music helps me to detach myself from unpleasant feelings. (F, 43, nonmusician, normal anxiety) 4Music & Science If I listen to music as a tool to manage anxiety, usually heavy metal or peaceful (yes, opposite) music works best. I can feel more calm after I have played or listened to music. (F, 29, professional musician, severe anxiety) These strategies are in agreement with previous findings concerning the role of certain music genres for affect regulation. Soothing and relaxing music can decrease the activation of the parasympathetic nervous system, and thus support positive emotional and cognitive states (Labbé et al., 2007). However, as Panteleeva et al. (2018) state, among healthy adults, underlying individual factors are likely to play a more significant role than the style of music in anxiety alleviation. For instance, musical preference and individual traits might explain why heavy metal music can provide psychological and emotional benefits to its fans (Olsen et al., 2023), similar to the experiences of the participants of our study. In addition to calming down, some people turned to energizing and exciting music to cheer themselves up instead. Actively aiming to change their emotional state to a more positive and energized one with the help of music was a way to achieve a more relaxed and focused state, which for some, was needed for problem solving. I choose something groovy to release myself from the stiffness caused by anxiety. (F, 38, professional musician, extremely severe anxiety) I will play some exciting classical music to cheer me up. I will feel relaxed and can be more focused to solve the problem. (F, 26, professional musician, moderate anxiety) Figure 1. Demographics: participants’age, gender, education, occupation, English language proficiency, and level of musicianship. Table 1. “How do you usually engage with music to manage anxiety?” Never: % Rarely: % Sometimes: % Often: % Always: % Average Median Music listening 0.0 3.4 34.5 41.4 20.7 3.8 4.0 Singing or playing an instrument 6.9 24.2 24.1 37.9 6.9 3.1 3.0 Dancing 41.4 34.5 13.8 10.3 0.0 1.9 2.0 Composing or writing my own music 44.8 20.7 20.7 10.3 3.5 2.1 2.0 Imagining music in my head 10.4 13.8 34.5 31.0 10.3 3.2 3.0 Taipale et al. 5 Based on previous research, the effect of an energizing activity (e.g., sports, exercise) in anxiety alleviation is comparable to relaxation (Bandelow et al., 2017). Energizing exercises can be used to alleviate depressive tendencies of anxiety, in which case getting out of the mood state can require additional energy. Conversely, in the case of panic-related anxiety, the goal of energizing activity can be related to learning to tolerate physiological feelings of arousal (e.g., rapid pulse) in a more controlled, safe situation (Smits & Otto, 2009). Some strategies were cognitively insightful, with different music choices leading to a restorative state, back to a nonanxious mindset, or slowing down an anxious train of thought. Music was also considered to offer empowerment, peer support, and a means for perspective-taking, when participants were alone with their anxious thoughts. When anxious, familiar music helps to remind me of how far I’ve journeyed so far in life. (M, 43, amateur musician, severe anxiety) It helps calm my nerves and restore a bit of a “regular”mind. (M, 46, amateur musician, mild anxiety) The benefit of taking a break from stress, however short, is that it helps me gain a little perspective. This reduction in stress can be quite long-term. (M, 70, nonmusician, normal anxiety) These accounts illustrate intentional cognitive strategies for self-regulation, which have been found to be more beneficial for wellbeing than is the use of music to avoid or suppress emotions (Chin & Rickard, 2014). Listening to music was also used to decrease arousal, especially when going to sleep. Familiar music (as well as meditative, classical, and instrumental music) was considered helpful for trying to relax, slowing down the train of thought, and finding comfort. There are specific pieces by Bach and Beethoven, specific movements I use to try to calm down before sleep. (F, 42, professional musician, mild anxiety) I sometimes try to breathe calmly and slowly, but more than often, playing some meditative music helps the most. I also play meditative music every night when I’m in bed, as I read and start winding down. It really helps me to get rid of any stressors from the day. (F, 56, professional musician, mild anxiety) Situational hyperactivity and mind wandering were also dealt with by listening to calming music. I choose something peaceful, usually classical music to calm myself down if anxiety has led to hyperactivity. (F, 38, professional musician, extremely severe anxiety) I use music to help me sleep when my mind is wandering at night with thoughts of anxiety about the days to come. I usually turn to very familiar music. (F, 24, amateur musician, normal anxiety) These descriptions highlight the calming effects of music on a bodily level. Listening to relaxing music has been shown to have measurable effects on the body, including reduced cortisol levels and lowered heart rate and mean arterial pressure, thus decreasing perceived stress levels (Burrai et al., 2016). Previous research with pregnant women found that calm and comforting music is effective in improving sleep quality and reducing anxiety and stress levels (Liu et al., 2016). Strengthening the Current State. Some participants used music to strengthen their current emotions. This was done by listening to calm music when feeling down, or metal music when feeling angry, for instance. This strategy can be considered as having two separate goals: on the one hand, the music matches the listener’s emotions and validates them, so the listener does not need to let go of a current emotion to tune into the emotion represented by the music. On the other hand, music can strengthen the current emotion, in which case experiencing the emotion with more intensity makes it easier to process it and move on. Sometimes I like to listen to very sad music, sad pop songs usually, to really feel the feelings and move on. (F, 28, nonmusician, severe anxiety) When choosing music to listen to while feeling anxious, the music tends to be rather emotionally introspective. (M, 37, professional musician, moderate anxiety) Strengthening negative emotions in order to have a more intense experience was considered helpful by several participants. In a few responses, musical engagement was even described as something that could lead to cathartic and purifying states. I want to increase the anxiety by a certain type of music so that the feeling reaches the “intensity cutpoint”and then passes. (F, 47, amateur musician, normal anxiety) In previous literature, this type of discharge of a negative emotion has been identified as a common affect regulation strategy when it comes to coping with negative mood states (Saarikallio, 2008). Similar findings have been made in the context of sad music: music-induced catharsis can be an effective self-regulation strategy; although reliving painful emotions while listening to music can be exhausting, feelings of relief often follow (Peltola & Eerola, 2016; Van den Tol & Edwards, 2013). Discharging the emotion can thus lead to solace, which is another efficient affect regulation strategy (Saarikallio, 2008). However, seeking to experience strong emotions can sometimes lead to outcomes that 6Music & Science are not necessarily beneficial for the listener’s wellbeing. The intense emotional process of alleviating anxiety with music was also described as feeling quite addictive. It was almost as if I craved the bad feelings to get the same drug of comfort again. (M, 42, amateur musician, normal anxiety) Previous findings indicate that rumination, i.e., repetitive thought processes related to negative content, is common among depressed individuals and can relate to the development of anxiety (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema & Morrow, 1991). Rumination has also been linked to self-reported symptoms of generalized anxiety, post-traumatic stress, and social anxiety (Fresco et al., 2002; Mellings & Alden, 2000; Nolen-Hoeksema & Morrow, 1991), and it seems to work as a predictor of anxiety and depressive symptoms (Nolen-Hoeksema, 2000). Ruminative uses of music can lead to maladaptive listening strategies that feed into a listener’s negative emotional state, and even to self-destructive thoughts and behavior (Carlson et al., 2015; Garrido & Schubert, 2013; Peltola, 2018). Distraction. In anxiety management with music, distraction emerged as a common strategy. Music helped to avoid thinking about anxiety and offered something else to focus on instead of troubles and anxious thoughts. Distraction was achieved with various types of music: some preferred calm, simple, beautiful, and familiar music, while others turned to upbeat or complicated music to not think about their anxiety. Contemporary music is hard to understand and to think about music is a good way to not think about my anxiety. (F, 44, amateur musician, mild anxiety) What is important is that music is loud and fast enough that my brain will only focus on the music and not on my feelings. (F, 20, nonmusician, moderate anxiety) Music gives me something to focus on besides my internal feelings of nervousness. (F, 28, amateur musician, mild anxiety) Distraction from anxiety with music can be related to positive refocusing, which is categorized as an adaptive emotion regulation strategy. However, distraction can sometimes be seen as maladaptive behavior, if it relates to avoiding the current emotions, and distracts from acceptance of the negative state. (Garnefski et al., 2002.) Some participants reported having developed selfregulation strategies for selecting certain types of music in situations which require concentrating on some task or blocking other distracting sounds. When working or studying, I have used calm, instrumental music that is not too interesting to follow and “analyze”, but still gives some content for the mind to focus on a little. Mind wanders less! (F, 29, professional musician, severe anxiety) I use various genres of music (rock, indie, alternative, classical) and headphones to mask some of the things that increase my anxiety (the sound of toxic coworkers talking in my office, repetitive beeping from the hallway). So music can be preventative for me. (F, 42, professional musician, mild anxiety) Music is also a great way to block surrounding sounds when I’m feeling sensory overload. (F, 20, nonmusician, moderate anxiety) In some cases, even imaginary music could provide a virtual space to escape from the surrounding reality. If I don’t have the possibility of actually listening to music, I play through familiar songs in my head. (F, 28, amateur musician, mild anxiety) Vytal et al. (2012) found that while anxiety can impair cognition and make concentrating on low level tasks difficult, handling a higher cognitive load can actually decrease anxiety. While trying to concentrate on a task, music can add to the cognitive load and mask anxious thoughts. In addition to the music itself, headphones used for music listening can also be a crucial element in anxiety alleviation by blocking the surrounding sounds and providing a personal space. Creating these kinds of auditory bubble seems to be a common strategy for many people, when they want to isolate themselves from their environment, create personal space in public, avoid aversive music and annoying soundscapes, and thus enhance their sense of agency (e.g., Heye & Lamont, 2010; Peltola & Vuoskoski, 2022; Saarikallio et al., 2020). However, sometimes music itself was considered too distracting if the situation required attention and concentration. There are cases, usually demanding immediate attention, where any music would be an annoying distraction. I have learned when I can go to music for relief. (M, 70, nonmusician, normal anxiety) This finding is not too surprising, since previous research has found that background music can have a negative effect on cognitive performance, although some of the results are still inconclusive (e.g., Dalton & Behm, 2007; Furnham & Strbac, 2002; Vasilev et al., 2023). The second part of analysis will focus on these negative outcomes of music engagement in more detail. When Music Does Not Help with Anxiety The majority of the descriptions of the situations when music did not help to manage anxiety were not so much about failed music use attempts, but about situations Taipale et al. 7 where some factor made music unfavorable for the purpose of alleviating anxiety. These factors can be divided into two main themes: internal factors, such as (a) unwanted memories and triggers or (b) problematic initial states, and external factors, such as (c) lack of control when it comes to selecting music or (d) how appropriate the music is. While describing the situations in which music did not help manage anxiety, participants also described some alternative solutions to the problems they had faced, such as using noise-cancelling headphones, not listening to music at all when they knew silence would be more helpful, and making playlists with helpful songs beforehand so that they would not need to search for the music when feeling anxious. Internal Factors: Memories and Triggers Evoked by Music. The emotional content of the music was one explanation for music not helping with anxiety. When music expressed an emotion that was too strong to handle, it could make some participants feel more anxious. Music that sounded too negative was considered unhelpful, as well as music that reminded of bad experiences in the past, brought back painful memories, or triggered unwanted emotions. [It does not work] when the subject matter or certain songs relate too closely to my trauma. (F, 42, professional musician, mild anxiety) There are some specific songs I tend to stay away from, because they bring back some aspects or situations from my past life that I don’t want to be faced with anymore. (M, 46, amateur musician, normal anxiety) Lyrics or other associations with music that have to do with the possible source of my anxiety. (M, no age given, amateur musician, normal anxiety) Avoiding (sad-sounding) music that reminds listeners of their past is one strategy to cope with personal loss or painful memories (Peltola, 2018; Peltola & Eerola, 2016). These descriptions also emphasize the possibility that people with nonclinical anxiety might recognize that rumination and excessive focus on negative emotions with music is not a healthy solution for their anxious state, thereby preventing them from facing harmful levels of anxiety. Internal Factors: Problematic Initial State. In some cases, the anxiety felt by participants was too high for music to serve as an effective distraction. Several participants reported that when their anxiety level rises too high, they do not engage with music at all. Usually music does not sound too good to me when anxiety is hitting hard, and I feel like it is maybe not enough in itself to distract me from anxious thoughts. (M, no age given, amateur musician, normal anxiety) If the music does not help, my experience is that the anxiety is too strong. (M, 29, amateur musician, extremely severe anxiety) Only rarely, when I’m feeling really anxious, music will not make me feel better. In these situations my anxiety is too bad and I am not able to focus only on the music. (F, 20, nonmusician, moderate anxiety) Although strengthening the current emotional state can feel cathartic in some situations (see the previous main theme), in the case of problematic negative states and high levels of anxiety, engaging with music does not seem to have the desired outcome. As my anxiety manifests as racing thoughts, or physical sensations (tight chest, lightheadedness), some music can have the effect of overshooting the mark. (M, 43, amateur musician, severe anxiety) I was already in a bad mood and Spotify on shuffle played only emotional, mostly acoustic sad songs. It was difficult to get out of the bad mood after breaking down. (F, 28, nonmusician, severe anxiety) In severe cases of anxiety, the person often needs help from other people, and even medication to start recovering (see, e.g., Bandelow et al., 2015). When anxiety levels reach this point, it can affect one’s ability to turn to self-regulatory tools. If the initial state was panic, or even psychosis, music was not considered helpful. I do not use music to manage my anxiety when I’m having a severe attack. (M, 67, nonmusician, normal anxiety) It can’t help when anxiety becomes stronger or even clinical. It does not soothe panic attacks, for instance. (M, 46, amateur musician, mild anxiety) I’ve suffered a couple of occasions of psychosis and during those episodes music with a notable amount of violence in it certainly hasn’t helped. (M, 37, professional musician, moderate anxiety) Feelings of disintegration and timelessness are typical for individuals with psychosis. Music therapy studies have shown that patients with psychosis typically express themselves musically in a repetitive and fragmented way (De Backer, 2008). Listening to music in itself can be difficult or unenjoyable when the perception of time is altered, and it is challenging to understand entities. 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Artist or composer Song Year Genre Mustan Kuun Lapset Morfiinisiivet 2007 Black metal Enochian Crescent Väkisinkastettu 2000 Black metal Tiziano Manca Sui moti apparenti 2010–2014 Classical Beach House Space Song or any song from the albums Depression Cherry, Thank Your Lucky Stars,orTeen Dream 2010–2015 Indie pop Bon Iver Flume or any song from the albums For Emma, Forever Ago, and Bon Iver 2007–2011 Indie folk J. S. Bach Erbarme dich from St. Matthew Passion (Andreas Scholl) 1727 Classical J. S. Bach Air (Thomas Enhco & Vassilena Serafimova) 1731 Classical Norah Jones Don’t Know Why 2002 Pop, jazz J. Karjalainen Sinulle, Sofia 2015 Rock, blues L. van Beethoven Piano concerto (unspecified) —Classical S. Rachmaninoff Elegie for piano (unspecified) —Classical Queen Don’t Try So Hard 1991 Rock Kirk Franklin My Life Is in Your Hands 1997 Religious hip hop, soul Ida Paul & Kalle Lindroth Hiekkalaatikolla 2020 Pop —Various saved music combinations on the Relax Meditation app —— Ola Gjeilo Playlist of songs: The Rose, The Ground 2012–2017 Classical Ludivico Einaudi Nuvole Bianche 2003 Classical Sara Bareilles Breathe Again 2010 Pop Radiohead Exit Music (For a Film), Street Spirit 1995–1997 Alternative rock Samuli Putro Jokainen tarvitsee 2021 Pop Gregory Porter Hey Laura 2013 Jazz, blues Pekka Ruuska Rafaelin enkeli 1990 Pop Egotrippi Matkustaja 2004 Pop Beach House Lazuli 2012 Indie pop Red Hot Chili Peppers By the Way 2002 Alternative rock Sonata Arctica Wolf & Raven 2001 Power metal Amorphis Death of a King 2015 Heavy metal —Hymns —— Antti Tuisku Blaablaa 2015 Pop The 1975 Give Yourself a Try 2018 Alternative, indie pop P!nk Raise Your Glass 2010 Pop Becky Hill Remember 2021 Dance, electronic Sigala & Rita Ora You for Me 2023 Dance, electronic Tiësto Ritual 2019 Pop Ola Gjeilo The Rose 2017 Classical Keane Watch How You Go 2012 Alternative rock Stam1na Kadonneet kolme sanaa 2005 Thrash metal Arvo Pärt Spiegel im Spiegel 1978 Classical Amorphis The Moon 2022 Heavy metal P. I. Tschaikovsky Classical pieces —Classical G. Mahler Symphonies, especially second and fourth movements —Classical D. Shostakovich ——Classical J. Suk ——Classical Queen ——Rock Stevie Wonder ——Soul Tina Turner ——Rock —— —Jazz, rock all over the world T. Albinoni (arr. R. Giazotto) Adagio in G minor 1958 Classical J. Sibelius Finlandia 1899 Classical L. van Beethoven Piano concerto no. 5 1809 Classical J. S. Bach Violin concerto in E major, BWV 1042, second movement 1717–1723 Classical Voces8 Luxæterna 2015 A cappella, classical (continued) Taipale et al. 17 (continued) Artist or composer Song Year Genre Arvo Pärt Spiegel im Spiegel 1978 Classical Forgotten Tomb Todestrieb 2003 Black metal Radiohead The Bends 1995 Alternative rock Ella Fitzgerald & Louis Armstrong Cheek to Cheek 1956 Jazz —— —Instrumental jazz Five Finger Death Punch IOU, War Is the Answer 2009–2022 Heavy metal —— —Favorite music Captain Beefheart Frownland 2004 Rock, blues Counting Crowns Sullivan Street 1993 Rock Theodore Shapiro Main titles, Severance (Season 1) 2022 Film music, classical The Doobie Brothers Long Train Runnin’1973 Rock P. I. Tschaikovsky Swan Lake 1875–1876 Classical Erykah Badu Green Eyes, Bag Lady 2000 R&B, soul Maná No Ha Parado de Llover 1995 Pop Ani DiFranco Out of Range 1994 Alternative rock L. van Beethoven Symphony 9, fourth movement; late quartets 1822–1824; 1825–1826 Classical J. S. Bach Cello suites, BWV 1007–1012; really anything 1685–1750 Classical Howard Shore Lord of the Rings soundtrack 2001 Film music, orchestral Miles Davis Fran-Dance 1991 Jazz Behm Päästä varpaisiin 2020 Pop Led Zeppelin Immigrant Song 1970 Hard rock Fool’s Garden Lemon Tree 1995 Pop, rock Sara Gazarek And So It Goes 2007 Jazz Sarah McLachlan Answer 2003 Pop Jane Siberry & K .D. Lang Calling All Angels 1991 Pop W. A. Mozart Chamber pieces, e.g., Eine kleine Nachtmusik e.g., 1787 Classical The Wailin’Jennys Arlington 2004 Folk 18 Music & Science