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OUTCOME MEASUREREFERENCE LinkKeywordsBrief summary MeasuresSampleDesignResultsProgram Description
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Heart rate and circulatory system
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Vickhoff, B., Malmgren, H., Åström, R., Nyberg, G., Engvall, M., Snygg, J., ... & Jörnsten, R. (2013). Music structure determines heart rate variability of singers. Frontiers in psychology, 4, 334.Linkchoral singing, heart rate variability, respiratory sinus arrhythmia, frequency analysis, autonomic nervous systemIn this study, we investigate how singing, which is a form of guided breathing, affects heart rate variability (HRV) and Respiratory sinus arrhythmia (RSA). The subjects are asked to; (1) hum a single tone and breathe whenever they need to; (2) sing a hymn with free, unguided breathing; and (3) sing a slow mantra and breathe solely between phrases. Heart rate (HR) is measured continuously during the study. Implications concerning the effect on wellbeing and health are discussed as well as the question how this inner entrainment may affect perception and behavior.HR activity recorded using ear clips for optical reading (emWave technique developed by HeartMath, n=110–5 min: subjects silently read an emotionally neutral text (baseline).
5–10 min: subjects hum (keep a collective tone). The humming implies holding a tone (no text) and breathing whenever needing to.
11–16 min: subjects sing Fairest Lord Jesus (Figure ​(Figure1A).1A). This song was chosen because it is well known and is a representative hymn in terms of tempo and structure. The singers, who have access to the lyrics but not to the score, are accompanied by a pianist. 17–22 min: subjects sing a 10 s phrase mantra Just Relax (Figure ​(Figure1B).1B). The mantra, composed for the occasion, contains song phrases of 10 s duration, producing respiration cycles of 0.1 Hz (including inspiration). Subjects are strictly instructed to inspire only between phrases. The singers are accompanied by a pianist.
23–28 min: subjects silently read an emotionally neutral text (baseline).		While humming does not produce a significant increase in HRV as measured by RMSSD, we can conclude that humming does lead to a significantly more regular HRV. HRV as measured by RMSSD is significantly increased during hymn singing compared to both baseline and humming, Interestingly, despite the less obvious regularity of the HRV during hymn singing, coherence analysis shows that HR fluctuations occur at common, shared frequencies for subjects. Finally, the mantra produces a significantly higher RMSSD compared to all other conditions as well as significantly more regular HRV compared with baseline and humming (but not hymn singing).N/A
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Bernardi, N. F.; Snow, S.; Peretz, I.; Orozco Perez, H. D.; Sabet-Kassouf, N.; Lehmann, A. (2017): Cardiorespiratory optimization during improvised singing and toning. Scientific reports, 7(1), S. 8113. Link
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Bernardi, N. F., Codrons, E., Di Leo, R., Vandoni, M., Cavallaro, F., Vita, G., et al. (2017). Increase in synchronization of autonomic rhythms between individuals when listening to music. Front. Physiol. 8:785. doi: 10.3389/fphys.2017.00785Link
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Müller, V., Lindenberger, U. (2011): Cardiac and respiratory patterns synchronize between persons during choir singing. PloS one, 6(9), e24893.Link
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de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. J. (2020). Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses. Health psychology review, 14(2), 294-324.Link
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Ruiz-Blais, S., Orini, M., & Chew, E. (2020). Heart rate variability synchronizes when non-experts vocalize together. Frontiers in Psychology, 11, doi:10.3389/fphys.2020.00762.Link
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McCrory, C., Finucane, C., O’Hare, C., Frewen, J., Nolan, H., Layte, R., ... & Kenny, R. A. (2016). Social disadvantage and social isolation are associated with a higher resting heart rate: evidence from the Irish longitudinal study on ageing. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(3), 463-473.Link
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HRV Somayaji, K., Frenkel, M., Tabaza, L., Visotcky, A., Ruck, T. K., Ofori, E. K., ... & Kulinski, J. (2022). Acute effects of singing on cardiovascular biomarkers. Frontiers in Cardiovascular Medicine, 9, 869104.LinkThere was a reduction in HRV during singing (compared to baseline) (RMSSD: 42.0 ± 5 to 32.6 ± 4, p = 0.004 and SDNN: 54 ± 4 to 33.5 ± 3, p = 0.009). HRV measures trended back toward baseline after singing.
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Immune system
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Beck, R. J., Cesario, T. C., Yousefi, A., & Enamoto, H. (2000). Choral singing, performance perception, and immune system changes in salivary immunoglobulin A and cortisol. Music perception, 18(1), 87-106.Link
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SIgA, CortisolBeck, R. J., Gottfried, T. L., Hall, D. J., Cisler, C. A., Bozeman, K.W. (2006) Supporting the Health of College Solo Singers: The Relationship of Positive Emotions and Stress to Changes in Salivary IgA and Cortisol during Singing. Journal for Learning through the Arts, 2(1). Linkquantitative study was to determine whether effects on immune and stress responses obtained with choral singers (Beck et al., 2000) would also occur in solo singers.n=8, college students
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Fancourt, D., Williamon, A., Carvalho, L. A., Steptoe, A., Dow, R., & Lewis, I. (2016). Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. Ecancermedicalscience, 10.Link
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Kreutz, Gunter; Bongard, Stephan; Rohrmann, Sonja; Hodapp, Volker; Grebe, Dorothee (2004): Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of behavioral medicine, 27(6), S. 623–635.Link
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Brain function
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Besson, M., Faita, F., Peretz, I., Bonnel, A. M., & Requin, J. (1998). Singing in the brain: Independence of lyrics and tunes. Psychological Science, 9(6), 494-498.Link
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Callan, Daniel E.; Tsytsarev, Vassiliy; Hanakawa, Takashi; Callan, Akiko M.; Katsuhara, Maya; Fukuyama, Hidenao; Turner, Robert (2006): Song and speech: brain regions involved with perception and covert production. NeuroImage, 31(3), S. 1327–1342. Link
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Peretz, I., Gagnon, L., HÉÉBERT, S., & MACOIR, J. (2004). Singing in the brain: Insights from cognitive neuropsychology. Music Perception, 21(3), 373-390.Link
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Cortisol
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 Beck, R. J., Cesario, T. C., Yousefi, A., & Enamoto, H. (2000). Choral singing, performance perception, and immune system changes in salivary immunoglobulin A and cortisol. Music perception, 18(1), 87-106.Link
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Fancourt, D., Williamon, A., Carvalho, L. A., Steptoe, A., Dow, R., & Lewis, I. (2016). Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. Ecancermedicalscience, 10.Link
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Fancourt, D., & Perkins, R. (2018). The effects of mother–infant singing on emotional closeness, affect, anxiety, and stress hormones. Music & Science, 1, 2059204317745746.Link
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de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. J. (2019). Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses. Health psychology review, 14(2), 294-324.Link
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Oxytocin
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Well-being of amateur singers compared to professional signers after completing singing lessonGrape, C., Sandgren, M., Hansson, L. O., Ericson, M., & Theorell, T. (2002). Does singing promote well-being?: An empirical study of professional and amateur singers during a singing lesson. Integrative Physiological & Behavioral Science, 38(1), 65-74.LinkN/AParticipants (amateur or professional singers) underwent a 45-minute singing lesson. Participants' heart rates, cortisol and prolactin levels, TNF-alpha levels and oxytocin levels were measured. Participants completed 5 VAS tests that measured their emotions and post-lesson interviews. Researchers hypothesized that singing lessons would have cardiovascular and hormonal effects on participants & anticipated that the effects would positively impact amateur singers more than professionals. Blood sampling: sample taken before lesson and after. Cortisol and prolactin were measured using time resolved immunofluorometric assays. THF-alpha was measured using enzyme-linked immunoassay. Oxytocin was measured using competative enzyme-linked immunoassay. 5 visual analogue scales (VAS) that measured emotional extremes (sad-joyful, anxious calm, worried-elated, listless-energetic, tense-relaxed): participants completed one VAS test prior to the lesson and one after. Semi-structured interviews after the lesson. ECG, heart rate variability was measured. They measured total power, high frequency power, low frequency power, and the low frequency power/high frequency power ratio.n=16, Half were amateur singers and the other half were professional singers.Oxytocin levels increased for both groups after the lessons. Amateurs experienced more joy and elatedness after the lesson, professionals did not. Post-lesson interviews revealed professionals prioritized singing technique, vocal apparatus and body throughout the lesson, while amateurs experienced self-actualization and a relief of negative emotions through self-expression.Amateurs and professionals gave blood samples and completed the VAS tests. Participants underwent singing lessons (45 mins) and completed the VAS test right after the lessons finished. Demographic information was recorded and semi-sturcture interviewa were conducted. Then, participants gave their second blood sample. The whole process took roughly 2 hours per subject. Lessons took place between 9am-7pm. However, 4 amateur singers did their lessons at 7pm.
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Impact of group singing on social flow, ACTH and oxytocin levelsKeeler, J. R., Roth, E. A., Neuser, B. L., Spitsbergen, J. M., Waters, D. J. M., & Vianney, J. M. (2015). The neurochemistry and social flow of singing: bonding and oxytocin. Frontiers in human neuroscience, 9, 518.LinkSinging, oxytocin, social flow, ACTH, improvisation, music, bonding, trustParticipants underwent two consecutive singing conditions: standard performance condition and imporvised performance condition. Blood samples were collected before and after each condition, and FSS-2 was completed after each condition to assess flow levels. Researchers hypothesized that group singing would decrease stress (ACTH) and increase social bonding (oxytocin).Blood sampling: plasma oxytocin and ACTH measured before and after each signing condition, used to analyze levels of social affiliation, engagement, and arousal. Social flow measured using Flow-State Scale-2 (FSS-2: 36 questions that analyze participant's percieved level of social flow in a given situation).n=4 jazz vocalists at American universitySocial flow was experienced during both conditions, however, it was slightly higher in the standard performance condition. Significant decrease in ACTH levels after standard singing performance. Minor decrease in ACTH levels after improvised singing performance. Mean concentrations of oxytocin increased during improvised performance, however, they decreased in standard performance condition. Results should be interpreted with caution due to small sample size. Results indicate group singing reduces stress and arousal in participants and produces social flow.All participants (n=4) formed a vocal quartet (within-participant design). Blood samples were taken before and after both conditions. In the first condition, participants were instructed to sing a piece without any improvisations or embellishments (called the Standard Performance). After the performance concluded, participants completed the FSS-2. Participants took a 30 minute break for ACTH and oxytocin levels to return to baseline. In the second condition, participants were instructed to sing a piece that encouraged improvisation and lots of embellishments (labelled the Improvised Performance). After the performance, the FSS-2 was completed.
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Impact of singing on oxytocin levels and coritson/DHEA ratio.Kreutz, G. (2014). Does singing facilitate social bonding. Music Med, 6(2), 51-60.LinkAmateur singing, Psychological wellbeing, Oxytocin, Cortisol, DehydroepiandrosteronThis naturalistic study examied how group singing impacts perceived psychological wellbeing, oxytocin levels and cortisol/DHEA ratio. Ad hoc questionnaires of psychological wellbeing and saliva samles were collected before and after the singing condition and chatting condition. Researchers hypothesized that group singing would lead to increased perceived wellbeing scores and oxytocin levels and decreased negative affect and cortisol/DHEA ratio.Ad hoc questionnaire of subjective feelings, saliva samples (measuring oxytocin, cortisol, DHEA)n=21, novice and experienced singersPositive feelings significantly increased after both singing and chatting. Negative feelings significantly decreased after singing, but not after chatting. Mean oxytocin levels increased significantly after singing, but not after chatting. No changes to the cortisol/DHEA ratio.Within-subjects design. 2 Conditions: singing condition and chatting condition. In both conditions, saliva samples were collected and questionnaires were filled out before the task (baseline) and after 30 minutes of engaging in the task. In the singing condition, participants underwent 10 minutes of warm-ups and 20 minutes of choir singing. In the chatting condition, participants spoke with neighbours (switching pairs after each 10 minute period) about recent positive life events.
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*Schladt, T. M., Nordmann, G. C., Emilius, R., Kudielka, B. M., de Jong, T. R., & Neumann, I. D. (2017). Choir versus solo singing: effects on mood, and salivary oxytocin and cortisol concentrations. Frontiers in human neuroscience, 11, 430.Linkchoir singing, mood, oxytocin, cortisol, salivan=38
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Pain threshold
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Dunbar, R. I., Kaskatis, K., MacDonald, I., & Barra, V. (2012). Performance of music elevates pain threshold and positive affect: implications for the evolutionary function of music. Evolutionary psychology, 10(4), 147470491201000403.Link
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Pearce, E., Launay, J., & Dunbar, R. I. (2015). The ice-breaker effect: singing mediates fast social bonding. Royal Society Open Science, 2(10), 150221.Link
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Tarr, B., Launay, J., & Dunbar, R. I. (2014). Music and social bonding:“self-other” merging and neurohormonal mechanisms. Frontiers in psychology, 5, 1096.Link
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Weinstein, D., Launay, J., Pearce, E., Dunbar, R. I., & Stewart, L. (2016). Group music performance causes elevated pain thresholds and social bonding in small and large groups of singers. Evolution and human behavior, 37(2), 152.Link
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Werner, L. M., Skouras, S., Bechtold, L., Pallesen, S., & Koelsch, S. (2023). Sensorimotor synchronization to music reduces pain. Plos one, 18(7), e0289302.Link
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Mood
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Boyd, M., von Ranson, K. M., Whidden, C., & Frampton, N. (2020). Short-term effects of group singing versus listening on mood and state self-esteem. Psychomusicology: Music, Mind, and Brain, 30(4), 178.Link
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Good, A., & Russo, F. A. (2021). Changes in mood, oxytocin, and cortisol following group and individual singing: A pilot study. Psychology of Music, 03057356211042668.Link
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Kreutz, G., Bongard, S., Rohrmann, S., Hodapp, V., & Grebe, D. (2004). Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of behavioral medicine, 27(6), 623-635.Link
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Unwin, Margaret M.; Kenny, Dianna T.; Davis, Pamela J. (2016): The Effects of Group Singing on Mood. Psychology of Music, 30(2), S. 175–185. Link
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Quality of life
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Abell, R. V., Baird, A. D., & Chalmers, K. A. (2017). Group singing and health-related quality of life in Parkinson’s disease. Health Psychology, 36(1), 55.Link
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Bonilha, A. G., Onofre, F., Vieira, M. L., Prado, M. Y. A., & Martinez, J. A. B. (2009). Effects of singing classes on pulmonary function and quality of life of COPD patients. International journal of chronic obstructive pulmonary disease, 4, 1.Link
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Boster, J. B., Spitzley, A. M., Castle, T. W., Jewell, A. R., Corso, C. L., & McCarthy, J. W. (2021). Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review. Journal of Music Therapy, 58(1), 12–42. https://doi.org/10.1093/JMT/THAA015Link
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Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G., & Stewart, D. (2010). Choral singing and psychological wellbeing: Quantitative and qualitative findings from English choirs in a cross-national survey. Journal of Applied Arts & Health, 1(1), 19-34.Link
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Coulton, S., Clift, S., Skingley, A., & Rodriguez, J. (2015). Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial. The British Journal of Psychiatry, 207(3), 250-255.
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Grape, C., Sandoren, M., Hansson, L. O., Ericson, M., & Theorell, T. (2003). Does Singing Promote Well-Being?: An Empirical Study of Professional and Amateur Singers during a Singing Lesson. Integrative Physiological and Behavioral Science, 38(2), 65–74. https://doi.org/10.1007/BF02734261/METRICSLink
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Ready, R. E., & Ott, B. R. (2003). Quality of life measures for dementia. Health and quality of life outcomes, 1, 1-9.Link
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Reagon, C., Gale, N., Enright, S., Mann, M., & Van Deursen, R. (2016). A mixed-method systematic review to investigate the effect of group singing on health related quality of life. Complementary Therapies in Medicine, 27, 1-11.Link
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Social connectedness and belonging
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Adderley, C., Kennedy, M. & Berz, W. (2003). “A home away from home”: The world of the high school music program. Journal of Research in Music Education, 51(3), 190-205. Link
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Boster, J. B., Spitzley, A. M., Castle, T. W., Jewell, A. R., Corso, C. L., & McCarthy, J. W. (2020). Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review. Journal of Music TherapyLink
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Launay, J., Tarr, B., & Dunbar, R. I. (2016). Synchrony as an adaptive mechanism for large scale human social bonding. Ethology, 122(10), 779-789.Link
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Parker, E. C. (2016). The experience of creating community: An intrinsic case study of four midwestern public school choral teachers. Journal of Research in Music Education, 64(2), 220-237. Link
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Parker, E. C. (2010). Exploring student experiences of belonging within an urban high school choral ensemble: an action research study. Music Education Research, 12(4), 339-352. Link
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Pearce, E., Launay, J., & Dunbar, R. I. (2015). The ice-breaker effect: singing mediates fast social bonding. Royal Society Open Science, 2(10), 150221.Link
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Wulff, V., Hepp, P., Wolf, O. T., Balan, P., Hagenbeck, C., Fehm, T., & Schaal, N. K. (2021). The effects of a music and singing intervention during pregnancy on maternal well-being and mother-infant bonding: a randomised, controlled study. Archives of gynecology and obstetrics, 303(1), 69–83.Link
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Prosocial behaviours and cooperation
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Good, A., & Russo, F. A. (2016). Singing promotes cooperation in a diverse group of children. Social Psychology. 47(6)Link
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Kirschner, S., & Tomasello, M. (2010). Joint music making promotes prosocial behavior in 4-year-old children. Evolution and Human Behavior, 31(5), 354-364.Link
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Welch, Graham F.; Preti, Costanza (2019): Singing as Inter- and Intra-personal Communication. In: Graham F. Welch, David M. Howard, John Nix und Costanza Preti (Hg.): The Oxford Handbook of Singing: Oxford University Press, S. 368–392.Link
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Wiltermuth, S. S., & Heath, C. (2009). Synchrony and cooperation. Psychological Science, 20(1), 1–5. Link
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Community building
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Bailey, B. A. & Davidson, J. W. (2005). Effects of group singing and performance for marginalized and middle-class singers. Psychology of Music, 33(3), 269-303. Link
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Gosine, J., & Travasso, R. (2018). Building community through song: The therapeutic hospice choir. British Journal of Music Therapy, 32(1), 18-26. Link
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Merrick, I., & Maguire, A. (2017). From let it be to it must be love: the development of a choir for patients and staff at a high secure hospital. Arts & Health, 9(1), 73-80.Link
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Rio, R. (2005). Adults in recovery: A year with members of the Choirhouse. Nordic Journal of Music Therapy, 14(2), 107-119. Link
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* counter evidenceLink
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Counter Evidence?
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Valentine, E. & Evans, C. (2001) The effects of solo singing, choral singing and swimming on mood and physiological indices. British Journal of Medical Psychology, 74, 115-120.LinkSwimming compared to group and choral singing, swimming produced best improvement.
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The Impact of Group Singing on Mood, Coping, and Perceived Pain in Chronic Pain Patients Attending a Multidisciplinary Pain ClinicLinkThis study explored the impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic.
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Singing, health and well-being: A health psychologist’s review.Link
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