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Original Article
Gregorian chant: reducing anxiety of mothers with
hospitalized children*
Ana Paula Almeida1, Maria Júlia Paes da Silva2
ABSTRACT
Objective: To determine whether Gregorian chant changes the state of anxiety of mothers with hospitalized children. Methods: This study
was descriptive, exploratory, and correlational with quasi-experimental, quantitative analysis. Data collection was completed during the period
of July 2009 to February 2010. Results: Seventy-one mothers were investigated, with 28 mothers meeting all of the criteria for participation in
this research. The use of Gregorian chant decreased the state of anxiety of mothers of hospitalized children in single room accommodations
within a quaternary care pediatric hospital. Conclusion: It is necessary to investigate the possible effects of Gregorian chant in other hospital
environments and in other forms of patient accommodation.
Keywords: Music, Anxiety, Mothers, Complementary therapies
RESUMO
Objetivo: Vericar a presença de alteração do estado de ansiedade das mães de crianças hospitalizadas com a audição de canto Gregoriano.
Métodos: Pesquisa descritiva, exploratória, correlacional com análise quantitativa, quase experimental. A coleta dos dados foi realizada no pe-
ríodo de julho de 2009 a fevereiro de 2010. A amostra inicial foi de 71 mães e destas 28 concluíram todas as etapas da pesquisa. Resultados: O
uso do canto Gregoriano diminuiu o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária
acomodadas em quartos individuais. Conclusão: É necessário investigar os possíveis efeitos do canto Gregoriano em outros ambientes do
hospital e em outras formas de acomodação do cliente.
Descritores: Música, Ansiedade, Mães, Terapias complementares
RESUMEN
Objetivo: Vericar la presencia de alteración del estado de ansiedad de las madres de niños hospitalizados con la audición del canto Gregoria-
no. Métodos: Investigación descriptiva, exploratoria, correlacional con análisis cuantitativa, cuasi experimental. La recolección de los datos se
realizó en el período de julio del 2009 a febrero del 2010. La muestra inicial fue de 71 madres y de éstas 28 concluyeron todas las etapas de la
investigación. Resultados: El uso del canto Gregoriano disminuyó el estado de ansiedad de las madres de niños hospitalizados en un hospital
pediátrico de atención cuaternaria ubicados en cuartos individuales. Conclusión: Es necesario investigar los posibles efectos del canto Grego-
riano en otros ambientes del hospital y en otras formas de acomodación del cliente.
Descriptores: Música, Ansiedad, Madres, Terapias complementarias
Corresponding Author: Ana Paula Almeida
Rua Marquês de Paranaguá, no 51, apto 501, Consolação
São Paulo (SP), Brasil, CEP 01303050.
e-mail: anaumian@gmail.com
Received article 26/07/2010 and accepted 07/06/2011
Acta Paul Enferm. 2012;25(1):36-42.
* Article prepared from the dissertation submitted to the School of Nursing, University of São Paulo (USP)-São Paulo (SP), Brazil.
1 Graduate (Master’s degree) of the Graduate Program in Nursing in Adult Health, School of Nursing, University of São Paulo (USP)-São Paulo (SP), Brazil.
2Professor, Department of Medical-Surgical Nursing , School of Nursing, University of São Paulo (USP)-São Paulo (SP), Brazil.
Canto Gregoriano: redutor de ansiedade de mães com lhos hospitalizados
El Canto Gregoriano: reductor de la ansiedad de madres con hijos hospitalizados
37
Gregorian chant: reducing anxiety of mothers with hospitalized children
Acta Paul Enferm. 2012;25(1):36-42.
INTRODUCTION
There are historical records of antiquity with different
names, indicating that anxiety is part of human experi-
ence (1). The fact that women present with more anxiety in
relation to men deserves a special look. Faced with the situ-
ation of “being hospitalized” mobilizes a lot of pain and
restlessness in the family ambience, especially for the ac-
companying mother (2). Any change that affects one family
member can affect other members of the nuclear family (3).
Thus, for the nurse to promote actions aimed at reducing
the anxiety for a family member, it is inferred that the ac-
tion will have repercussions among other family members
in question. The woman with a hospitalized child may also
disassociate herself from the roles of woman, wife and
caring for herself, devoting herself (3) entirely to the care
of her child (4). All this tension and burden of concerns
interferes with the manner of a crucial relationship with
the nursing team and the interpersonal communication (5).
Every people or ethnic group has its own music that
carries signs of its history, its culture and even its religios-
ity (6). When listening to music, one can perceive changes
in tone, pitch, volume and intensity that can inuence
the human experience in a psychological manner, and can
produce a calming or exciting effect (7). The value given
to music as a therapeutic means dates back centuries and
is quoted in Greek mythology (8) and in the history of
nursing, when music began to be used with a therapeutic
purpose by Florence Nightingale in 1859 (9).
In this musical context, a study of different profes-
sionals in an emergency service concluded that the use of
the classical music of Johann Sebastian Bach decreased
the state anxiety of professionals to the extent that the
demand for work increased (10). In another Brazilian study
on patients in a coma state, in addition to music, messages
with the voice of a close relative were also used. It was con-
cluded that patients in a coma state had signicant changes
in vital signs and facial expression when compared with
the control group, suggesting a certain perceptiveness to
sounds around them, principally with familiar sounds (11).
The music also gave the perception that time passed faster
in 80% of adult patients undergoing hemodialysis, and an
acceptance of the necessity of these patients to receive this
care (12). We know that music affects humans in the physi-
cal, spiritual and emotional dimensions. We lack research
evidence of its power for restoration or balance.
Music is a strategy of care based on respect for the
rights of the customers, their needs, their desires and ex-
pectations (13). Thus, it is also considered that, music being
an art of the human experience, it could be an ally for
nursing care (14), among other situations, such as reducing
anxiety of mothers of hospitalized children, especially
Gregorian chant that can reduce stress because it uses
natural rhythms of breathing and continuous sounds (15).
OBJECTIVE
Verify the presence of an altered state of anxiety in
mothers of hospitalized children who listen to Grego-
rian chant.
METHOD
We conducted a descriptive, exploratory, correlational
study with quantitative, quasi-experimental analysis (16),
at the Children’s Institute of the Hospital of the Clin-
ics of the University of São Paulo, a pediatric hospital
school providing quaternary pediatric care, in a specialty
inpatient unit.
The signicance level was 5% for statistical analysis.
The initial sample was composed of 71 mothers, 28
of whom completed all the steps of collection. Inclu-
sion criteria for conducting the study were to: want to
participate in the study; be more than 18 years of age;
have the auditory function that preserved hearing and
physical conditions to complete the music session; have
the necessary language function to respond to the State
Trait Anxiety Inventory and the form used for subject
identication and personal information used for the
research; be accompanying a child admitted to that ser-
vice for at least 48 hours; be accommodated in a private
room; accept participation in the research, in writing, with
signature of the Terms of Free and Informed Consent,
as provided by National Health Council, in Resolution
no 196/1996 (17).
Data collection was initiated in July of 2009, after
approval by the Ethics Committee of the School of
Nursing, University of São Paulo (USP) (process no
808/2009) and approved by the Pediatric Council of the
Children’s Institute of the Faculty of Medicine of USP
on July 3, 2009 (opinion no 825/35/2009); data collection
concluded in February 2010, and the statistical analysis
began of the data collected by specialized professionals
at the School of Nursing of USP. For a tool to measure
maternal anxiety, the State-Trait Anxiety Inventory for
Diagnosis (STAID) was used (18). The mother was asked,
personally, to participate in the research and after ac-
ceptance of the invitation, signed the Term of Free and
Informed Consent.
After signing, she completed the State-Trait Anxiety
Inventory for Diagnosis (STAID). This scale was trans-
lated and adapted for Brazil and it is the most widely used
tool for evaluating anxiety. It consists of two scales for
measuring trait anxiety and state anxiety, where these two
concepts are differentiated in the measures of personality
characteristics and the ve cognitive-affective transient
conditions, respectively (18). Two meetings were scheduled
in the patient’s own single room for a private session for
listening to the music of the Gregorian chant. Each subject
38 Almeida AP, Silva MJP
Acta Paul Enferm. 2012;25(1):36-42.
completed the STAID before and after each listening ses-
sion, and completed a form that included subject identica-
tion with data for the research: personal data, data related
to the hospitalized child, and information about the music
they heard, after the individual musical listening session. We
used a portable digital stereo with the aid of headphones
that were cleaned with 70% alcohol for each use.
RESULTS
As already mentioned, the study sample was calculated
to be 71 mothers, but during the course of data collection
it was found that: 15 mothers refused to participate in
the study without justifying their motives, seven moth-
ers who responded only to the characterization of the
research were discharged before starting the musical
intervention, 15 mothers were discharged after rst lis-
tening session, one mother interrupted the rst listening
session stating that this was a type of music that she did
not like to hear, because to her, “it is very still and for
me to listen to it, I’ll be nervous”; two mothers who had
responded to the STAID questionnaire interrupted their
rst listening session, saying that this musical style did
not correspond to their religious beliefs. Although the
purpose of the study was explained to them, they dem-
onstrated discomfort about listening to Gregorian chant.
One mother stopped listening to the second session of
music, because she said he did not like that style of music
despite having completed the rst listening session; two
mothers withdrew from the second listening session; and,
28 mothers completed the second listening session and
met all inclusion criteria of this research.
Among the 28 mothers who completed the research,
there were similar characteristics according to the
socio-demographic variables: regarding age, 11 (39.3%)
mothers were between 32 to 40 years of age; 20 (71.4%)
resided in São Paulo; 9 (32.1%) had completed second-
ary school education, and this statistic was repeated for
the incomplete and complete college. Nineteen mothers
(67.9%) had paid employment; 12 (42.8%) were Catholic;
and, 26 (92.8%) were married.
In regard to the variables related to the hospitalized
children, 21 (75%) children were hospitalized 3-6 days,
20 (71.4%) were hospitalized due to a chronic disease, 25
(89.3%) had a parent participating in care of the child.
The age of the hospitalized children presented in the
following distribution: 10 (25.7%) children were between
29 days to one year and eleven months, 9 (28.6%) were
between 2 to 6 years and eleven months, and 8 (28.6%)
were between 10 to 18 years of age. One (3.6%) child
was between 7-9 years and eleven months old. Nineteen
(67.8%) mothers had help from family members to man-
age their lives while they were with their hospitalized
children. Nineteen (67.8%) mothers had more children.
To characterize the population’s secondary variables
about the universe of musical sound, Brazilian popular
music had the highest preference among the mothers [10
(35.7%)] of these hospitalized children. Among these
mothers, 26 (92.8%) had never studied music; 2 (7.2%)
played an instrument. Seventeen (60.7%) mothers were
in the habit of listening to music, and seventeen (60.7%)
mothers had a close family member with a connection to
music. As shown in Table 1, it was found that after the
rst listening session, 25 (89.2%) women experienced a
reduction in their state anxiety; one (3.6%) woman ex-
perienced no inuence on her state of increased anxiety
after the rst hearing of the Gregorian chant. In the
second listening session of Gregorian chant, 25 (89.2%)
continued to have their state of anxiety decreased and
three (10.8%) had their state of anxiety increased after
listening to Gregorian chant. It is noteworthy that among
the 56 musical sessions held for the 28 women who com-
pleted the study, 23 (41.07%) showed decreased anxiety
with change in the category of anxiety score, i.e., high to
moderate and low. The results obtained were signicant
at a level of 5%, that is, 95% efciency.
DISCUSSION
The contribution of this present study was to verify
that the Gregorian chant changes the state of anxiety in
mothers of hospitalized children. To this end, we assessed
the sociodemographic conditions, the conditions of the
hospitalized child, and characteristics of musical sound
of the mothers. Twenty-eight mothers completed the
research, with 16 (57.1%) reporting that it was a type of
relaxing music when they were asked about why liked the
selection and would listen to it again. Eight mothers had
their state anxiety score decrease following the rst listen-
ing session (E2) and before the second listening session
(E3). One wonders whether this was a residual effect or if it
was related to other conditions experienced by the mother
in the time interval between the rst and second musical lis-
tening sessions. In contrast, mothers with subject numbers
6, 7, 22, 29, 44, 46, 50, 53 and 56 had a state anxiety score
before the second listening session (E3) that was higher
than their scores before the rst listening session (E1). In
these cases, they reported worsening of the clinical status
of their children, expected results of laboratory tests on
the children, or had personal problems in the family, which
probably was a difcult factor impacting concentration
and the ability and willingness of the mother to listen to
music. The mothers with subject numbers 29 and 50 had
increased anxiety scores after the rst listening session.
Despite this, they indicated that they liked listening to the
music and would listen again.
One mother (subject #50) reported that “from time
to time it is good to relax a little and try not to think
39
Gregorian chant: reducing anxiety of mothers with hospitalized children
Acta Paul Enferm. 2012;25(1):36-42.
about the problems.” It was noticed that there was ap-
parent apprehension about the situation of her child,
aged one year and ten months, who was hospitalized
with pneumonia. The experience of hard times by family
members due to the illness of a child carries feelings of
fear, sadness, despair, worry, helplessness and uncertainty.
We believe that these feelings inuence the mothers’ state
of anxiety and that Gregorian chant in this sequence and
frequency, for these mothers, was not enough to reduce
these feelings (19).
At the second listening session, the mothers with
subject numbers 1, 28 and 70 also had increased anxiety
scores. One mother (#1) referred to her concern for
the state of health of her daughter. She had such a rare
chronic disease that, according to the doctor treating
her, beyond her case, there was only one report in the
literature of this disease. Another mother (#28) said she
felt good after listening to the music, but it was noticed
she was in a hurry to nish the session because she would
rest that night in her house and her son, also chronically
ill, would stay with an aunt. This perceived pressure
could justify an increase in anxiety and lack of interest
in hearing the music in that moment. It is the nurse who
determined in what moment she could listen to the music
and also to evaluate its effects on the mothers (20). One
mother (#70), despite having had a signicant decrease
in anxiety score at the rst listening session and pointing
out that the song was “relaxed, took me away from the
problems (...) gave me a little nap,” had no time for a
second listening session, because restless, and impatience
due to the health condition of her daughter was noted.
Two mothers, subject numbers 2 and 23, both studied
music and had family members who were connected to
music. These mothers had decreased anxiety scores in the
two musical listening sessions. One mother (#2) reported
that, “the music is different from what I usually listen
to, but it is quite nice.” She slept during the two musical
listening sessions, so we can infer that people who study
or studied music at some point in their lives can accept
differences in musical styles, even when it is not one
with which they are familiar, as stated by this mother.
Among the contributing factors that inuence a musical
preference for a certain type of music is familiarity with
the music (21). Musicians listen to music differently than
nonmusicians. Musicians tend to analyze the music as
they are listening which can interfere with its effect upon
the listener (22). Thus, one might think that the analysis
would be made in the “musical time” of Gregorian chant,
as the singing accompanies the tempo of human respira-
tion (23), thereby interfering with the respiratory rate, and
decreasing it and as a consequence, diminishing anxiety.
The other mother (#23) said, “it relaxed my mind, my body
and sent me to a world in which I very much wanted to be.” The
inuence of music on the formation of mental images
arises from listening to erudite music (23).
The principal characteristic about the music selection
for this study was that it was sung by male voices. The
Gregorian chant is a monophonic vocal music genre,
monodic (only a melody), unaccompanied, or accom-
panied only by repeating the principal voice with the
organum (one or more voices), in free rhythm and not
measured, used for the Roman Catholic liturgical ritual.
Perhaps the message of the Gregorian chant is that we
should not respond in any way and yes, be content to
Table 1. Distribution of scores of trait and state anxiety of 28
mothers who participated in and completed research in São
Paulo – 2010.
STAID
(Trait)
STAID (State)
First musical
listening session
STAID (State)
Second musical
listening session
n (E1) (E2) (E3) (E4)
1 33eb 47em 41em 41em 43em
2 32eb 33eb 32eb 30eb 32eb
4 45em 43em 36em 41em 33eb
6 51ee 52ee 47em 56ee 54ee
7 60ee 51ee 38em 70ea 56ee
8 58ee 57ee 33eb 41em 35em
12 58ee 49em 46em 45em 44em
14 36em 55ee 42em 40em 30eb
19 41em 58ee 41em 58ee 37em
21 48em 55ee 35em 44em 37em
22 51ee 46em 37em 51ee 45em
23 43em 48em 40em 42em 39em
28 44em 35em 26eb 25eb 28eb
29 40em 33eb 34eb 55ee 35em
35 45em 46em 42em 42em 40em
36 50ee 60ee 47em 46em 41em
38 33eb 48em 40em 40em 32eb
42 48em 48em 39em 44em 37em
44 37em 60ee 46em 64ee 54ee
46 51ee 43em 42em 48em 40em
50 49em 46em 47em 48em 45em
53 47em 35em 26eb 44em 28eb
56 40em 40em 37em 52ee 48em
59 43em 57ee 39em 49em 38em
60 52ee 68ea 65ea 61ee 60ee
62 47em 45em 45em 42em 41em
68 42em 56ee 41em 34eb 33em
70 38em 44em 26eb 34eb 36em
p = 5% signicance
Legend
Low Scoreeb = 20-34
Moderate scoreem = 35-49
Elevated scoreee = 50-64
High scoreea = 65-80
E1 = score of state anxiety before the rst musical listening session
E2 = score of state anxiety after the rst musical listening session
E3 = score of state anxiety before the second musical listening session
E4 = score of state anxiety after the second musical listening session
40 Almeida AP, Silva MJP
Acta Paul Enferm. 2012;25(1):36-42.
relax in a presence that the music awakens, which is serene
and elevated (24).
Three (10.7%) mothers who were interrupted at some
point during the musical listening session returned to it
later. Mothers, subject #12 and #23, despite having been
interrupted, achieved a reduction in anxiety scores with
both musical listening sessions. The mother, subject #29,
had a small increase in anxiety in the rst musical listening
session. The same subject changed the television channel
for her son and seemed impatient with something, which
may have contributed to an increased anxiety score. She
also slept during the second listening session to the Gre-
gorian chant and presented a decrease in anxiety score,
changing her classication from elevated to moderate.
Although the music elicited mental, physical, emotional
and spiritual reactions in human beings, not everyone
reacts to it the same way, just as an individual does not
react the same way twice to the same composition (25).
Twenty (72.4%) mothers had children hospitalized for
chronic diseases. There was evidence of a signicant cor-
relation between the state anxiety scores and the mothers
who had a child hospitalized with chronic disease. Mothers
of children with neurological decits experienced severe
stress due to the illness of the child and their dependence,
the increased likelihood of death, uncertainty about the
child’s development, their daily routine, leisure, occupa-
tional, marital and social life (26). This conictive dynamic
reminds us of how important it is that therapeutic in-
terventions are developed that are sensitive to the needs
of this population, as well as the improvement of health
services to address these families, more specically with
these mothers. So even if we experienced a “bad moment”,
we would extend our hands to sustain her in her fragility,
making humanized care possible (27).
Mothers had high trait anxiety scores, with the high-
est being subjects # 6, 7, 8, 12, 22, 36, 46, and 60. Their
scores on trait anxiety ranged from 50 to 60. They were
between 24 and 39 years of age. There was a reference in
the study of depressive and anxiety symptoms in mothers
of premature infants with and without malformations,
where the median age of these mothers was 24 years. In
this study, the application of the STAID showed that
mothers of children with visible malformations presented
higher trait scale scores in comparison to mothers who
had children of normal appearance (28). Trait anxiety
refers to individual differences, relatively stable person-
ality traits, a tendency to react in an anxious manner in
situations perceived as dangerous or threatening by the
individual (18). One mother’s (#60) speech was consistent
with this observation, because she related that it felt good
listening to music, but that she could not concentrate.
She said she was worried about her other daughter who
was under the care of her father, with the help of family
members. She demonstrated much concern for the dis-
ease of her child of one year and ten months, admitted
with histiocytosis.
The illness of a child may be perceived as a threaten-
ing and impotent situation for a mother, leading her to
react in an anxious way (3), and elevating her trait anxiety
score. Yet for all these mothers, Gregorian chant reduced
the state anxiety scores in both the rst and the second
listening session.
One mother (#59) was 37 years of age, had com-
pleted a university course, had contact with people who
had knowledge of music, was evangelical, came from
another state, and had a child hospitalized for a chronic
disease (neuroblastoma). She stated that while listening
to explanations about the study, she wondered how it
would have a positive result, since the music was very
specic. She also revealed that this style of music would
be the last that she would have chosen. However, she
agreed to participate in the research and prepared for
listening to the music. After the rst intervention she
showed and verbalized surprise at the knowledge that
her state anxiety scores dropped from 57 to 39. In the
second listening session, after responding to the STAID,
she settled on the couch of the room, and asked to have
the lights turned off. Her son was in the playroom with
his father. Again, her state anxiety score decreased. She
seemed to give herself totally to the pleasure of listening
to the sound of Gregorian chant without thinking, and
without much awareness of this act (29).
As noted previously, the autonomy of the mother
was respected at all moments during the research. No
studies were found with mothers accompanying their
hospitalized children using music as a therapeutic inter-
vention. Reducing the anxiety of mothers with the use
of Gregorian chant can be explained by a quantitative
analysis of electrical activity in epilepsy patients, through
an increased beta frequency - deep sleep (30). Based on the
concept that the increase in beta frequency corresponds
to deep sleep, one can infer that this group showed a sig-
nicant relaxation as they listened to the Gregorian chant.
It should be noted that the one-way analysis of
ANOVA to compare the scores between the age groups
presented homogeneity of variance. The scores of the
trait anxiety scale presented difference between age
groups of mothers who were younger than 30 years and
those who were older than 40 years of age. The other
variables showed no difference between the mean ages.
The t-test revealed a signicant correlation between
anxiety scores and the fact that the mother had a child
hospitalized with chronic illness. When comparing mean
scores and the fact that the mothers lived in São Paulo,
there was no difference between the average score for
the STAID in the rst listening session. However, the
level of signicance was borderline, rather than rejected
(p = 0.049). It was believed that this correlation was
41
Gregorian chant: reducing anxiety of mothers with hospitalized children
Acta Paul Enferm. 2012;25(1):36-42.
important due to the fact that the mothers felt more
tranquil, even in the process of hospitalization, by being
in closer proximity to their home. In the correlation of
the difference between scores in the simple paired t-test,
it was afrmed that the mean score of E1 (score of the
state anxiety scale before rst hearing the music) was
higher than the mean score of the E2 (score of the state
anxiety scale after the rst listening session). The same
thing occurred for the E3 (score of the state anxiety scale
before the second hearing music) and E4 scores (score of
the state anxiety scale after the second listening session).
This nding implies that there was a decrease of anxiety
scores after each listening session to Gregorian chant.
The present study leads us to conrm what other
researchers and writers have reported: the inuence of
music on our body is real. It is worth mentioning that
these mothers were accommodated within a private room
and listened to the music with headphones, a fact that
prevented the inuence of ambient noise. It reminds us,
also, that Florence Nightingale, even after so many years,
still permeates our research and it proves that after more
than a century, she was correct when she said that “the
use of music is an intervention for health” (10).
FINAL CONSIDERATIONS
By means of this study, although it does not allow gen-
eralizations because of the number of mothers who were
studied, we can conclude that the use of Gregorian chant
decreased the state of anxiety of the mothers of hospitalized
children in a quaternary care pediatric hospital, accommo-
dated in single rooms. As limitations of this study, we con-
sidered: the small number of mothers who met all inclusion
criteria for this study (n = 28); the study found no reduc-
tion of anxiety in the medium to long term; and it did not
investigate possible residual effects of the Gregorian chant.
Understanding that maternal anxiety due to a hos-
pitalized child creates great suffering makes us question
whether we are caring holistically for the mother – child
dyad. It is necessary to investigate the possible effects of
Gregorian chant in other hospital environments, in order
to investigate the possibility of its use with other types
of patient accommodations. No studies were found in
the literature using Gregorian chant for the reduction of
anxiety, to enable the completion of a comparative analysis.
It is intended that the results of this study encourage
the use of music therapy in nursing practice. However, it
is necessary that a professional is motivated, is qualied
and trained to safely carry out the intervention, according
to ethical principles, respecting the questions of human-
ity and art. It is necessary to extend the study of musical
styles for their applicability in nursing care to mothers in
health care units. Although music has an ancient context,
and is part of human history from pre-historical time, we
still have many questions to resolve and to know about
its effects on human biology.
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