How Music Reduces Stress and Improves Mental Health

Music lowers stress, and the size of that effect has been measured. A 2020 review in Health Psychology Review pooled 104 randomized controlled trials covering 9,617 participants and found significant reductions in both physiological stress and reported psychological stress.

The effect sizes were d = 0.380 for physiological markers such as heart rate, blood pressure and hormone levels, and d = 0.545 for psychological stress such as restlessness, anxiety and nervousness. In plain language that is a small-to-moderate effect: real, repeatable across a large body of trials, and not a cure. The strongest of the physiological measures was heart rate, at d = 0.456. You can read the review at de Witte and colleagues, 2020.

Harmony & Healing has been bringing professional musicians to patients in hospitals, hospices and memory care since January 2019, and this evidence lines up closely with what we watch happen in a room. It also contradicts several claims that circulate widely, and those are taken apart in the sections below.

How does music reduce stress?

Music reduces stress through two systems working at the same time. The autonomic nervous system shifts toward a parasympathetic, lower-arousal state, which shows up as a slower heart rate, slower breathing and lower blood pressure. Separately, the endocrine system reduces output of cortisol, the hormone that rises under sustained stress. The 2020 review measured both routes. The largest single effect it found was on heart rate, ahead of both blood pressure and hormone levels, which is a difference between individual markers rather than one system beating the other.

A third route is neurochemical rather than physiological. Chanda and Levitin reviewed the evidence in Trends in Cognitive Sciences in April 2013 and grouped it into four systems: reward and pleasure, stress and arousal, immune response, and social affiliation. Their own summary of the field at the time was that scientific inquiry into music’s neurochemical effects was still in its infancy, which remains a fair description of the mechanism research even now.

The social affiliation route matters more than it usually gets credit for. A musician standing in the room is not only sound. Fancourt and colleagues, publishing in ecancermedicalscience in 2016, studied 193 people across five choirs in South Wales, made up of 72 carers, 66 bereaved carers and 55 cancer patients. A single hour of group singing was associated with reduced cortisol and significantly increased positive affect at p < 0.01. That study was single-arm, with no control group and no listening comparison, so it measures the change after an hour of singing rather than a difference between singing and listening.

Does music lower cortisol?

Yes, but the condition attached to that answer is the whole finding: cortisol drops when you listen in order to relax, and much less reliably when you simply have music on.

The cleanest evidence is Linnemann and colleagues in Psychoneuroendocrinology, October 2015. Fifty-five university students were tracked across ten days, five during an ordinary term week and five during an examination week, rating their music listening and their stress four times a day. Twenty-five of them also gave saliva samples on two consecutive days in each week. Simply listening to music reduced subjective stress at p = 0.010. When participants stated relaxation as their reason for listening, subjective stress fell at p less than or equal to 0.001 and measured cortisol concentrations were lower at the same significance level. You can read it at Linnemann and colleagues, 2015.

That study also caught something the popular summaries miss. Salivary alpha-amylase, a second stress marker, moved in opposite directions depending on the music rather than simply falling: energizing music raised it and relaxing music lowered it, at p = 0.025. Music does not have one physiological direction. It has the direction of the music you chose.

The counterweight is Thoma and colleagues in PLoS ONE in 2013, which put 60 healthy women through a standardized psychosocial stress test after assigning them to relaxing music, the sound of rippling water, or silence. Cortisol response differed significantly across the three conditions at p = 0.025, but in the direction most people would not predict: cortisol was highest in the relaxing-music group and lowest in the rippling-water group. What music did do was speed recovery. Alpha-amylase returned to baseline considerably faster in the music group than in the silent group. The full paper is open access.

Put those two studies together and the defensible claim is narrower and more useful than the headline version. Music listening chosen for relaxation lowers cortisol in daily life. Music played at someone immediately before an acute stressor does not reliably blunt the cortisol spike, but it does help the body come back down afterwards.

How much does music lower heart rate and blood pressure?

Less than the internet claims, and more consistently than skeptics expect. In the 2020 review the effect on heart rate was d = 0.456, on blood pressure d = 0.343, and on hormone levels d = 0.349. Heart rate is the most responsive of the three.

Two Cochrane reviews put numbers on the clinical version of this. Bradt, Dileo and Shim examined preoperative anxiety on 6 June 2013 across 26 trials and 2,051 participants, and found music listening reduced anxiety by an average of 5.72 points on the State-Trait Anxiety Inventory, with a 95% confidence interval of minus 7.27 to minus 4.17. One large trial in that set found music listening more effective than the sedative midazolam at reducing preoperative anxiety, and equally effective at reducing the physiological response. Their 2014 update on mechanically ventilated patients covered 14 trials and 805 participants and found an anxiety reduction of 1.11 standard deviation units, alongside consistent reductions in respiratory rate and systolic blood pressure.

Both reviews carry the same caution, and it deserves repeating rather than burying: most of the included trials were judged at high risk of bias, because you cannot blind a patient to whether music is playing. That limitation does not erase the findings. It does mean the effect is better described as probable and useful than as proven at pharmaceutical standards.

Does music at 60 beats per minute sync your brainwaves?

No. The claim that music near 60 beats per minute entrains your heart rate or brainwaves to the beat is repeated constantly online and it does not survive contact with the literature.

Koelsch and Jancke reviewed the cardiac evidence in the European Heart Journal on 21 November 2015 under the title “Music and the heart,” and stated plainly that they found no studies providing evidence for entrainment of heart rate to musical beats. What the literature does support is simpler and directional: heart rate and respiratory rate run higher with exciting music than with tranquil music, and heart rate appears to fall with unpleasant music relative to pleasant music. Their overall verdict was that effects of music on the heart are small, and that study quality across the field is highly uneven. The review is indexed here.

The practical consequence is that tempo is worth choosing for how the music makes you feel, not because a specific number of beats per minute will lock onto your pulse. Slow, quiet, familiar and pleasant is a better specification than 60 beats per minute.

What type of music reduces stress the most?

The evidence points at your own preference before it points at any genre. Across the trials, the reliable predictors are that the music is perceived as pleasant, that it is not startling or loud, and that it is chosen for the purpose of relaxing. Genre is a weak predictor by comparison.

Three broad categories show up most often in stress-reduction protocols, and they are worth trying in order. Instrumental music removes lyrics as a competing demand on attention, which is why classical, ambient and quiet jazz recordings dominate clinical playlists. Natural soundscapes such as rain or surf work for many people and, in the Thoma study above, actually produced the lowest cortisol response of the three conditions tested. Familiar music from your own life is the third category, and it is the one clinical playlists most often leave out.

Our guide to the most healing music genres goes through the categories in more detail. If your goal is pain rather than stress, the evidence and the song choices diverge, and that is covered separately in our guide to effective music for pain management.

How long do you have to listen before stress drops?

Shorter than most people assume. The intervention lengths in the clinical trials cluster between about 20 and 30 minutes, and the preoperative trials in the 2013 Cochrane review generally used a single session before surgery rather than a course of treatment. In the Fancourt choir study a single hour was enough to shift both mood and cortisol.

Two things do appear to matter more than duration. The first is repetition: the daily-life study found the effect in ordinary listening habits sustained across ten days, not in one heroic session. The second is intent. In that same study, the people who listened without a reason got a smaller effect than the people who sat down specifically to relax. Twenty deliberate minutes beats two distracted hours.

Does music help with anxiety in a hospital?

This is where the evidence is strongest, because hospital settings are where the randomized trials were actually run. Alongside the preoperative and ventilated-patient reviews above, a Cochrane review published on 12 October 2021 examined music interventions in cancer care across 81 trials and 5,576 participants. Within that set it reported an average anxiety reduction of 7.73 points on the Spielberger State Anxiety Inventory in 17 studies covering 1,381 participants, a moderate effect on depression in 12 studies covering 1,021 participants, and a moderate pain-reducing effect at a standardized mean difference of minus 0.67 in 12 studies covering 632 adults.

We see the surgical version of this constantly. Two pieces on this site cover it from the patient side: lessening surgical pain with music and why surgery is so stressful. For post-traumatic stress and for brain injury, the pathways are different enough to deserve their own treatment, and we have written those up as music for patients with PTSD and healing music for brain injury patients.

What does music not do for stress?

Four are worth naming.

It does not reliably reduce agitation in dementia. A Cochrane review published on 7 March 2025 examined 30 randomized trials across 1,720 participants in 15 countries. Compared with usual care, music-based therapeutic interventions probably produced a slight improvement in depressive symptoms at a standardized mean difference of minus 0.23, with moderate-certainty evidence. On agitation or aggression the same review found they likely did not help, at a standardized mean difference of minus 0.05. That review is indexed here, and it is worth reading before anyone promises a family that music will calm a distressed parent. What music does do in memory care is create a moment of recognition and contact, which is a different and still valuable thing, and it is the subject of our page on music for dementia patients.

The same 2025 review found no evidence of effects persisting four or more weeks after treatment ended, at low to very low certainty. That is what one review found for music-based interventions in dementia, and it is absence of evidence in that population rather than proof that nothing lasts anywhere.

It is not a treatment for a psychiatric condition, and none of the trials above tested it as one. Every trial above measured stress, anxiety, mood or pain as symptoms alongside standard care, not instead of it.

And the effect sizes are modest. A d of 0.380 to 0.545 is a genuine finding, not a dramatic one. Music belongs in the same category as a walk outside or a decent night’s sleep: cheap, safe, available immediately, with no adverse effects identified in the 2013 and 2014 Cochrane reviews, and worth doing precisely because the cost of trying it is close to zero.

Is live music different from a recording?

The trial evidence is thinner here. Harmony & Healing sends people rather than playlists, and the evidence behind that specific choice is weaker than the evidence that music helps at all.

The 2021 Cochrane cancer review drew a distinction the popular coverage tends to collapse. It separated music therapy, delivered by a trained therapist using personally tailored music, from music medicine, meaning pre-recorded music offered by medical staff. For quality of life and fatigue, the therapist-delivered interventions produced consistent results across studies and the recorded-music interventions did not. That contrast is about the therapist and the therapeutic process, not about live sound versus a recording. The review never compared a live performance with a recording, so it cannot be read as evidence for either.

A team in the Netherlands is testing that premise. Their July 2021 paper in the Journal of Geriatric Oncology sets out the design of a non-randomized trial of live bedside music on three surgical wards, in which professional musicians play at older patients’ bedsides once a day for six or seven consecutive days, with pain, anxiety, relaxation, heart rate and respiratory rate measured before, 30 minutes after and three hours after. The paper reports no results and says further research must be conducted. Their stated rationale was that live music elicits more meaningful responses than recorded music, and that live music on hospital wards remains rare.

We do roughly 90% of our visits in person and about 10% over Zoom, and the difference between a live visit and a recording is not subtle in the room. The fuller argument is in our guide to how music helps people heal, and the distinction between clinical music therapy and what our musicians do is set out in music therapy versus live music.

How to build a stress-relief playlist that actually works

Five steps, each drawn from the evidence above.

1. Decide the purpose before you press play. Stating relaxation as the reason for listening was the variable that separated a measurable cortisol drop from no cortisol drop in the 2015 daily-life study.
2. Choose music you already like. Perceived pleasantness predicts the response better than genre does, which means an unfamiliar ambient album you find boring will underperform a song you love.
3. Keep it quiet and keep it even. Sudden dynamic jumps and loud passages pull the autonomic response back the other way, which is the same mechanism that makes energizing music raise alpha-amylase.
4. Include music tied to your own history. Familiar songs from a specific period of your life do something that generic relaxation tracks do not, and that is the effect our musicians work with directly. We wrote about it in musical memories and happiness.
5. Give it 20 to 30 minutes, and repeat it. The trials cluster in that range, and the daily-life effect showed up across ten days of ordinary habit rather than in one long session.

If you want somewhere to start, we keep a set of healing songs drawn from what patients ask our musicians for most often.

The evidence at a glance

Every study above, with its date, size and headline result.

Frequently asked questions

Is there scientific proof that music reduces stress?

There is a large and consistent body of randomized trial evidence, which is not quite the same as proof. The strongest single source is the 2020 review of 104 randomized controlled trials and 9,617 participants, which found significant reductions in both physiological and psychological stress. The main weakness across the field is that participants cannot be blinded to whether music is playing, so most individual trials are rated at high risk of bias. The effect is well supported and modest in size.

How quickly does music reduce anxiety?

Within a single session. The preoperative trials in the 2013 Cochrane review used one listening session before surgery and still measured an average 5.72-point drop on the State-Trait Anxiety Inventory. Most protocols run between 20 and 30 minutes.

Is music better than medication for anxiety?

In one specific comparison, for one specific purpose, it performed better. A large trial included in the 2013 Cochrane review on preoperative anxiety found music listening more effective than the sedative midazolam at reducing anxiety before surgery, and equally effective at reducing the physiological response. That is a narrow result about pre-surgical anxiety and it should not be read as advice about any prescribed medication. Talk to your clinician before changing anything.

Does singing reduce stress more than listening?

The evidence usually cited for this cannot answer it. The 2016 choir study of 193 carers, bereaved carers and cancer patients found that one hour of group singing reduced cortisol and raised positive affect at p < 0.01, but it was a single-arm study with no control group and no listening comparison, so it measures what changed after singing rather than whether singing beats listening. Participation and company are plausibly doing part of that work, which is consistent with the social affiliation route in the neurochemistry literature.

What music do hospital patients ask for most?

Their own. Across seven years of visits our musicians are asked for the songs a patient grew up with far more often than for anything designed to be relaxing. That preference is the entire basis of the approach we call Musical Memory Healing, and it is why our roster of about 24 professional musicians covers a deliberately wide range of genres.

Bring live music to your patients

Harmony & Healing is a 501(c)(3) nonprofit founded in January 2019. Our musicians perform at the bedsides of patients in hospitals, hospices, memory care and rehabilitation facilities, in person across the San Francisco Bay Area and by video anywhere. Visits are always free to patients and families, and our artists are paid for their work out of donations.

If you work in a facility, you can request a musical visit or read how we bring Harmony & Healing to your facility. If you would like to keep the musicians playing, you can donate here.

This page is general information, not medical advice. Nothing here is a substitute for care from a qualified clinician.