A cross-cultural randomized pilot trial of western-based and five elements music therapy for psychological well-being

Music therapy and culture are interconnected. It is unclear whether the therapeutic effects of music can be exerted in diverse cultural contexts. Both Western-based and Chinese Five elements music therapy (FEMT) have shown effectiveness in improving the perception of stress, anxiety and depression in their respective cultures. FEMT is a commonly used traditional Chinese Medicine approach; however, it has not been investigated with non-Chinese participants. To investigate the impact of FEMT and of Western-based music therapy on stress and related outcomes and explore cross-cultural comparisons in participants from Chinese and Canadian contexts. This pre-post randomized controlled study was conducted with 35 participants, 23 from Canada and 12 from China. Participants from the two cultural groups were randomly divided into two groups: a FEMT group (n = 20), a western art music therapy (WAMT) group (n = 15). The main outcome was self-rated stress, evaluated by a 10-point numeric rating question. Secondary outcomes included anxiety/depression (Hospital Anxiety and Depression Scale (HADS), pulse rate and qualitative comments. Cross-sectional, pre-post and longitudinal comparisons were pursued. We observed comparable effects of FEMT and WAMT in both the Chinese and Canadian samples. There was a statistically significant decrease in self-rated stress over time, especially after the conclusion of the four-week music therapy intervention (p = 0.001), regardless of type of music therapy, and in both cultural contexts. We observed a statistically significant decrease in anxiety and depression scores in the FEMT group only (p<0.001), but no effect on pulse rate. This is the first study to report evidence of feasibility, acceptability and effectiveness of FEMT in non-Chinese participants. Further investigation of the observed differences is warranted.