The effect of music and progressive muscle relaxation on anxiety, fatigue, and quality of life in family caregivers of hospice patients

family visiting hospice

By: Amy Dunlap, MT-BC

Caregiver stress, burnout, compassion fatigue; We have all heard those words before, but have we really listened? Or taken the time to consider whether we are at risk? And if so, what are we going to do about it? If you are a healthcare professional or have ever cared for a loved one who was ill, you have likely felt any or all of these things at some point, but were simply too busy helping others to help yourself. You might have thought, “I’m not the one who is ill. How can I justify taking the time to care for myself when my spouse/parent/child/patient needs me? I’ll be okay.”

If you can relate, you are certainly not alone. Over two million individuals die in the United States each year and between five and nine million individuals serve as caregivers. Terminal illnesses are a major source of stress that affect nearly all areas of life for both the patient and the primary caregiver including job security, finances, emotional and physical health, and personal relationships. Naturally, this stress leads to an increased risk for anxiety, depression, sleep disturbance, fatigue and a myriad of other health problems, from which caregivers are not excluded.

We might think, “I can handle a little fatigue and anxiety. It’s nothing compared to what my loved one is going through.” However, you may not realize that as a primary caregiver, your health state (physical and emotional) is an important factor in overall patient care. Hospice philosophy even emphasizes the importance of providing support for family caregivers. Research shows the correlation between caregiver and patient stress, which means that the caregiver’s health (or lack thereof) impacts the patient’s condition!

So what does this mean? It means that self care is very important. Not just for your own sake, but for the sake of your loved one and/or patients. While many productive self care techniques exist, this post will discuss the usefulness of music therapy on hospice caregiver health.

In 2010, Choi examined the effectiveness of music and progressive muscle relaxation (PMR) on anxiety, fatigue, and quality of life in family caregivers of hospice patients. The study involved 32 family caregivers (20 spouses and 12 adult children) who had been caregiving in hospice for more than two weeks. Participants received one of four conditions (silence, just music, just PMR, and music with PMR) for 30 minutes, twice weekly, for two weeks. The researcher conducted pre- and post-tests for anxiety and fatigue before and after each individual session; quality of life was measured before the two-week treatment began and again after it concluded.

The research showed a significant decrease in anxiety and fatigue across all four conditions after two weeks. This means that even sitting in silence for 30 minutes two times each week can improve a caregiver’s overall quality of life, and in turn, improve the patient’s care. And all you need is a quiet room with no distractions, a comfy chair, and 30 minutes!

However, the study also found that those participants who received music, with or without PMR, exhibited a greater decrease in anxiety and fatigue and a larger increase in quality of life than those who did not receive music. In the study, the music therapist used a CD player to play the song “Awakening” by Steven Halpern on repeat. When PMR was included, the music therapist read a script with directions for the participant to tense and release different body parts for greater relaxation. The study did not provide the exact script, but these are widely available online. While we all have certain music that we enjoy, research has identified specific musical elements that support physiological relaxation, such as a slow tempo, low pitches, regular rhythmic patterns, no extreme dynamic changes, primarily string orchestration, and music without lyrics. This is where a music therapist’s skills come in handy. Our unique musical training enables us to easily identify a number of pieces that fit the criteria and implement the treatment in a conscientious and sensitive way that considers volume, environment, and emotional responses to music.

All in all, caregiving is a difficult and taxing task and imbalances in the caregiver’s well being should be taken seriously. Luckily, music therapists are working tirelessly to make our services more accessible and to educate colleagues, patients and families about music-assisted self-care. For more information about music therapy, please visit

Choi, Yoon Kyung (2010). The effect of music and progressive muscle relaxation on anxiety, fatigue, and quality of life in family caregivers of hospice patients. Journal of Music Therapy, 47(1), 53-69.