Creative Music Therapy with Premature Infants and Their Parents: A Mixed-Method Pilot Study on Parents’ Anxiety, Stress and Depressive Symptoms and Parent–Infant Attachment

Abstract

Premature birth is stressful for infants and parents and can adversely affect the parent–infant dyad. This mixed-methods pilot study evaluates whether creative music therapy (CMT) can alleviate anxiety, stress, and depressive symptoms in parents and support the bonding process with their infant. Sixteen parent couples were included. Ten couples were randomly allocated to the music therapy group (MTG) and six to the control group (CG). All couples completed psychological questionnaires measuring anxiety and depressive symptoms as well as an implicit measure of parent–infant attachment at two weeks postpartum (T1), at approximate neonatal intensive care unit (NICU) hospitalization halftime (T2), and two weeks after the infant had been discharged (T3). At T1 and T2, the parents additionally completed a questionnaire assessing the degree of stress they experienced at the NICU. Qualitative data were collected through a semi-structured, problem-centered interview with MTG parents at T3. The results of the quantitative analyses revealed reductions in anxiety levels from T1 to T2 (p = 0.002) as well as decreases in depressive symptoms from T2 to T3 (p = 0.022). No such changes were apparent in the CG. In fact, parental stress increased from T1 to T2 (p = 0.016). Significant increases in attachment across time were also observed within the MTG, but not in the CG. The qualitative inquiry confirmed that CMT can support the parent–infant relationship. Being in musical interaction evoked feelings of joy and relaxation in the parents and encouraged them to interact more profoundly with their infant. The results call for a more extensive powered follow-up study to further investigate CMT’s potential for parental well-being and parent–infant bonding.

Maternal Anxiety, Infant Stress, and the Role of Live-Performed Music Therapy during NICU Stay in The Netherlands

“…In our study, an important reduction in maternal state anxiety was seen after LMPT, compared with the waitlist period. Our results correspond with those of Kehl et al, who found a reduction in anxiety levels in mothers whose preterm infants received creative music therapy [ 23 ]. Creative music therapy in their study consisted of humming or singing by a music therapist, preferably in the presence of the parents who had skin-to-skin contact with their child, and was accompanied by vibroacoustic stimulation by an instrument manufactured for therapeutic purposes.…”

“…We therefore advocate starting music therapy early, to accelerate maternal anxiety reduction during NICU stay. Indeed, Kehl and colleagues reported a significant reduction in state anxiety levels after only six music therapy sessions, which started after the first week of the infants’ life [ 23 ]. Interestingly, several studies argue that there may even be a role for music therapy during pregnancy, evidenced by the reduction of maternal anxiety following such interventions [ 40 , 41 ].…”

“…The strength of our study was that it confirms the presumed influence of neonatal stress, regardless of gestational age, on the mothers’ wellbeing. Second, we demonstrated that not only creative music therapy [ 23 ], but also LPMT based on the ‘rhythm, breath, and lullaby’ method is effective at reducing maternal anxiety in very preterm infants. Third, we used the NISS score to quantify the amount of infant stress, which made it possible to measure cumulative stress exposure.…”

“…More recently, there is growing interest in the potential stress-reducing effect of music-based interventions on parents in the NICU, and its possible value in enhancing the developing relationship between parents and their infants [ 22 ]. The limited evidence indicates that music interventions decrease parental stress perception and reduce maternal anxiety symptoms in parents of preterm infants [ 17 , 23 ].…”

Creative Music Therapy and Neurodevelopmental Outcomes in Pre-term Infants at 2 Years: A Randomized Controlled Pilot Trial

“…A relative strength of this study is that CMT is noninvasive, low-cost, and family-integrating approach and we used standardized routine long-term clinically relevant measures of neurodevelopment to evaluate the intervention. Future trials could investigate parental psychological adjustment and bonding as preliminary evidence suggests that CMT contributes to parental empowerment and activates "communicative musicality" (64) thereby benefiting parent-infant-attachment (21,65,66). Interventions that support parent-infant attachment in early life may enhance infant socioemotional development, mental health and future relationships (67,68).…”