Music Therapy for Fear in Palliative Care

Viola Heckel, Doris Dorfmeister

Last update: 05.04.2019

Music therapy is suitable for countering and alleviating fears in palliative care (1). Fear is associated with changes in the person’s breathing and heart rate and thus finds immediate expression in their rhythmic system. Fears can be alleviated and addressed where they mainly arise, namely in the soul. Music takes its starting point from this. It opens inner spaces of experience through sounds, rhythms and melodies, and has a regulating effect right into physical processes via the soul, especially the rhythmic physiological processes of respiration and pulse (2).

Stringed instruments have proven their worth, especially the lyre, which is characterized by a clear, floating and free quality of sound, and so have the slowly fading tones of gongs, hand bells, cymbals and voices. When we meet a fear-filled person with music which is individually tailored to him—either improvised together (3) or working with existing music that stimulates musical breathing—we can observe how a perceptible space that is free of fear develops in the patient.  His breathing becomes deeper and calmer, warmth flows through him to the periphery. What touches the person the most is what lives between the tones. Music comes to life in rhythmic alternation between sounding and fading away, comparable to a gesture of binding and loosening, like a kind of superordinate breathing process. A spiritual listening space opens up, which can convey a feeling of being connected to this space.

At the beginning it is good to involve the patient’s own activity in the musical process, as far as possible. Later, in advanced stages of the illness, the focus is on receptive music therapy, which is active listening to music played or sung live by the therapist. This has a strengthening and straightening effect through the simplicity of a song, a chorale, a melody—played on a lyre or sung by the therapist. This listening activity enables forces to arise that orientate towards the eternal, indestructible, spiritual nature of the human being.

Therapeutic recommendations

Anxiety with tension

  • Two instruments that have proven their worth are the lyre and the tenor chrotta.
    Both instruments convey a sense of envelopment and warmth.
  • Among the metal instruments, copper or bronze gongs are suitable, or hand bells,
    best played from the surrounding area, also in combination with singing.
  •  The sounds of a pentatonic-tuned kantele or TAO lyre,
    played around the patient’s bed, also have a relaxing effect on the soul.

Warmth can also be stimulated from the outside via perceptions of vibrations, e.g., when

  • a kantele or tenor chrotta is played at the patient’s feet,
  • or on their back using an instrument that they can lie on.

Anxiety with depression

The patient’s depressive-anxious mood is met with a lyrical prelude and gradually lightened up, enlivened and led into the patient’s own activity. We stimulate breathing processes in the soul in musical dialogue with

  • easy-to-play instruments that have optimal sound quality, like a bordun (drone) lyre.
    When the finger strokes the strings, the tones combine to form a harmonious sound. Major keys have a liberating effect on the soul, favoring exhalation. Minor keys have an impulsive effect on inhalation. On the level of soul they lead inward.
  • The patient’s breathing is deepened by subsequently playing cymbals
    with a widening arm movement during the long ensuing reverberations. Their bright, clear tone brightens the mood.

Fear of “losing one’s center”

Singing is particularly suitable for stimulating a sense of being able to rely on one’s own innate capacities. It is therapeutic to create a protective sheath and active silence, e.g., by

  • listening to what comes before and after a piece of music, an interval, or processes of sounding—fading away—pausing.

Anxiety with shortness of breath

  • The therapist plays “breathing” melodies with figure-eight structures, as well as intervals of thirds and fifths—preferably on an alto lyre.

This can relieve anxiety and shortness of breath. Changes in harmony help to support the patient’s breathing and the soul’s ability to resonate. This also stimulates hearing and has a positive effect on physiological respiration. This happens most directly when singing, which involves the whole patient through their breathing.

Anxiety with mental unrest

We use stabilizing elements to meet fear and inner agitation, such as

  • compositions that have clear structures and an orientation to the tonic note, as well as elements of repetition.
  • The tenor chrotta, a low-stringed instrument, has also proven valuable.
    Rhythmic bowing of its open strings stimulates structuring forces and imparts a sense of inner support.


  1. Heckel V, Krüerke D, Weiss S, Simões-Wüst AP, Metzner S. Veränderungen von Atmung und Herzrhythmus bei live-gespielter Musik. Eine empirische Pilotstudie in einem spezifisch musiktherapeutischen Setting mit gesunden Probanden. MA Thesis. Magdeburg-Stendal University of Applied Sciences; 2015.
  2. Bissegger M. Musiktherapie in der Onkologie. Der Merkurstab 2009;62(4):382–387.
  3. Boelger E. Improvisation und Übung in der Musiktherapie. Versuch einer Zusammenfassung. Der Merkurstab 2005;58(1):24–27.

Research news

Mistletoe therapy in addition to standard immunotherapy in patients with non-small-cell lung cancer indicates improved survival rates 
Immunotherapy with PD-1/PD-L1 inhibitors has significantly improved the survival rates of patients with metastatic non-small-cell lung cancer (NSCLC). Results of a real-world data study (RWD) investigating the addition of Viscum album L. (VA) to chemotherapy have shown an association with improved survival in patients with NSCLC - regardless of age, degree of metastasis, performance status, lifestyle or oncological treatment. The mechanisms may include synergistic modulations of the immune response by PD-1/PD-L1 inhibitors and VA. However, the results should be taken with caution due to the observational and non-randomised study design. The study has been published open access in Cancers

Further information on Anthroposophic Medicine