Facilitated Music Listening: A Music Therapy Protocol for Invasive Cardiac Procedures

Music therapy during invasive cardiac procedures

Over the past few decades, medical music therapy and music medicine have drawn growing attention in both clinical practice and research (Dileo, 2016). A modest but promising body of research now documents how music influences physical and psychological outcomes. Music can regulate mood and emotions while also triggering changes in heart activity, blood pressure, and breathing (Koelsch and Jancke, 2015). Systematic Cochrane reviews report that music listening reduces stress and anxiety in patients with coronary heart disease, cancer (Bradt et al., 2013a, 2016), and those on mechanical ventilation (Bradt and Dileo, 2014). Additional systematic reviews and meta-analyses have found that music interventions before, during, and after surgery significantly lower anxiety and pain while increasing patient satisfaction (Bradt et al., 2013b; Hole et al., 2015; Kühlmann et al., 2018). One recent meta-analysis confirmed a significant decrease in both anxiety and pain in adults receiving music around surgical procedures (Kühlmann et al., 2018). During intracardiac catheterisation, researcher-selected music proved relaxing and calming for patients (Argstatter et al., 2006). These anxiety-reducing benefits appeared strongest when patients could select the music themselves (Bradt et al., 2013a).

Although the evidence base for music medicine and music therapy continues to expand‟and though their societal importance grows‟results from earlier studies must be viewed with caution because of potential bias, small sample sizes, or a lack of power calculations. In addition, many studies come from music medicine rather than music therapy, or they fail to clarify the distinction between the two (Gold et al., 2011). Music therapy entails a therapeutic process of assessment, treatment, and evaluation guided by a trained Music Therapist and grounded in evidence-based practice (Bruscia, 2014). Music medicine, by contrast, can be delivered outside any therapeutic relationship, relying solely on the music itself (Bonde, 2011; Bruscia, 2014; Dileo, 2016). Medical music therapy‟music therapy in somatic health care‟has been described as “the use of music and relationship in a reflexive therapeutic process to treat persons whose primary presenting problem is medical in nature” (Dileo, 2015: 3). Research has increasingly shown that music therapy may be superior to music medicine, and more studies involving a Music Therapist are needed (Bradt et al., 2016; Dileo, 2016; Hanser, 2014).

Despite the promising results of medical music therapy, its full potential as an adjunctive treatment remains underused and often unexplored. For the music therapy profession to mature, more research, interdisciplinary collaboration, and clinical protocols specific to particular somatic conditions and patient populations‟especially in peri-operative settings‟are essential (Dileo, 2016; Hanser, 2014; Koelsch and Jancke, 2015; Palmer et al., 2015; Robb and Carpenter, 2010). Future work on medical music therapy should emphasise the standardisation of assessments and outcome measures, detailed descriptions of music and relational involvement, and the development of individualised clinical protocols (Hanser, 2014; Koelsch and Jancke, 2015; Robb and Carpenter, 2010; Rolvsjord et al., 2005).

Medical context

The last two decades have seen rising demand for cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardiac defibrillators (ICDs), driven by an ageing population and updated guidelines on device indications (Kusumoto et al., 2017; Peal et al., 2018). As the number of implantations has grown, so has the need for lead extractions‟removing the electronic lead from the subclavian vein between the device and the heart‟due to complications, infections, and safety alerts (Bongiorni et al., 2016; Wazni and Wilkoff, 2016).

Oslo University Hospital Ulleval (OUH) runs a leading pacemaker centre, treating patients from all over Norway with approximately 150 lead extractions per year‟a number that continues to rise. Indications for extraction include infections, signs of lead fracture, and prophylactic removal during generator changes. At OUH, lead extractions are typically performed transvenously with local anaesthesia, lasting between two and six hours (Deharo et al., 2012). At the outset, patients receive analgesic and anxiolytic drugs intravenously, with additional doses as needed depending on procedure duration and the patient’s level of pain and anxiety. For complex cases, very anxious patients, or prolonged procedures, general anaesthesia may be required (Wilkoff, 2009). However, local anaesthesia is preferred at OUH because it uses fewer hospital resources and carries a lower risk of complications. Even with medication, most patients still experience some pain or anxiety during the procedure under local anaesthesia. Drug use is limited by factors including sedative side effects. Patients with high anxiety also report significantly worse pain intensity. Good communication and proper information are vital for patient satisfaction and anxiety reduction. Experts further recommend engaging patients as active partners in their own pain control and overall care (Al-Azawy et al., 2015). This principle ties directly into why the protocol lets patients choose their own music.

Introducing facilitated music listening

To improve stress management for patients during this invasive cardiac procedure‟potentially reducing both anxiety and pain‟we developed a clinical music therapy protocol based on a literature review, clinical observations, interdisciplinary discussions, and testing over two years. The intervention is called “Facilitated Music Listening” (FaMuLi). This article describes it in detail as a music therapy intervention protocol (or “the protocol”). The word “facilitated” signals that a trained Music Therapist tailors the listening session to the individual, remains in the room, and bears professional responsibility for the process. Because the intervention was developed for a hospital setting, we classify the clinical practice as medical music therapy.

Theoretical foundations

The epistemological traditions of medicine and music therapy differ sharply‟one rooted in positivism, the other in humanism‟and each emphasises different aspects of health and knowledge (Kristeva et al., 2018; Rolvsjord et al., 2005; Ruud, 2008). The FaMuLi protocol draws on a biopsychosocial approach that acknowledges how biological, personal, and social factors are always present, interdependent, and mutually influential in clinical encounters, ultimately shaping the patient’s experience (Engel, 1977; Frankel et al., 2003). George Engel (1980) proposed the biopsychosocial model to bridge the natural-science medical model and the humanistic model of science. Today, Engel’s work is regarded as an approach rather than a fully fleshed-out model or theory. Still, the biopsychosocial perspective has informed recent research and practice in several healthcare domains (Dileo, 2015; Falkum, 2008; Smerud, 2012; Stallvik, 2011). Examples include integrative health care, patient-centred care, medical humanities, and mind–body approaches‟all characterised by efforts to treat the individual patient’s needs from a broad, systemic perspective while reducing the dichotomy between scientific cultures in the service of patient well–being (Dileo and Bradt, 2005; Frankel et al., 2003; Hanser, 2014; Kristeva et al., 2018). The main elements of the biopsychosocial approach (Figure 1) appear in the fundamental understanding of health across music therapy and specifically in medical music therapy (Bruscia, 2014; Dileo, 2016; Hanser, 2014).

Detailed music therapy manuals grounded in theory have already been published for the psychiatric field, informed by resource-oriented, analytic, and psychodynamic frameworks (Hannibal et al., 2012; Rolvsjord et al., 2005). The present FaMuLi protocol was designed to optimise stress management for patients in internal medicine undergoing an invasive cardiac procedure. This article adds to the literature on music therapy in medical care by offering a practical, implementable intervention based on a biopsychosocial approach.

Theories of music therapy as procedural support and pain management played a central role in shaping this protocol, especially Melzack’s neuromatrix model of pain and Ghetti’s transaction model of music therapy as procedural support (Ghetti, 2012; Hanser, 2014; Melzack, 2001). In his neuromatrix model, Melzack (2001) highlights the multidimensional character of stress, coping, and pain by including sensory perception and biological and behavioural elements as both inputs and outputs. Some stress and pain effects on the autonomic nervous system stem from genetic heritage, yet even these can be modulated through sensory input. Hanser (2014) cites the neuromatrix model when arguing that music therapy, as a sensory input, can influence the autonomic nervous system through supportive interventions in cardiac care. She also stresses the importance of individualised treatment, which must be reflected in intervention protocols.

Ghetti (2012) likewise draws on the neuromatrix model in her writing on music therapy for invasive medical procedures. She presents a theoretical transaction model (Figure 2) that summarises key concepts.

Combining the biopsychosocial approach with Ghetti’s clinical model clarifies the dynamic forces underlying this protocol. In Ghetti’s model, biological, psychological, and social factors fall into categories of procedural inputs and outcomes. The inputs‟i.e., multifaceted moderators‟set the stage for the procedural experience and include personal variables, the procedure’s demands, and contextual variables. Together, these moderators shape the patient’s experience, which then leads to a response‟outcomes in the form of perception, coping, and moment–to–moment behaviour. The experienced situation evolves further as outcomes feedback into it. Within both moderators and outcomes, biological, psychological, and social elements can be identified. Adding a music therapy intervention‟therapist + music + patient responses‟provides three additional lenses through which biological, psychological, or social benefits can emerge. Ghetti (2012) outlines three main modes of music therapy as procedural support: music alternate engagement (refocusing), integration, and music-assisted relaxation. The current protocol centres on music-assisted relaxation delivered within a short-term, augmentative, or supportive framework (Bruscia, 2014; Dileo, 2015, 2016).

The distinct effects of music listening can be explained and examined at four functional levels: physiological, syntactic, semantic, and pragmatic (Bonde, 2009; Bruscia, 2014; Koelsch, 2010; Schäfer et al., 2013). The physiological and syntactic levels depict music as nature‟biological and structural elements with measurable, quantitative effects. The semantic and pragmatic levels connect the effects of listening to individual meanings shaped by personal history and sociocultural context. Biopsychosocial effects, arising from the dynamic relationship among patient, music, and Music Therapist, also contribute to the total experience. During music listening, these levels merge in complex perceptual processes, as captured by the transaction model.

Music therapy literature presents differing views on the importance of music preference and genre compared to generalised neurobiological effects (Koelsch and Jancke, 2015; Robb and Carpenter, 2010). Music listening can produce a natural sedative effect, helping a patient feel supported and relaxed through rhythm and timbre. Such stimuli may influence vital signs like respiration, pulse, and blood pressure. Music may reduce analytical thinking, meta-consciousness, and frontal–lobe activity (Fachner, 2016). A relaxed patient who focuses positively on the present can experience moments of flow, which in turn may lower stress hormones and pain levels (Bradt et al., 2013a, 2016; Ghetti, 2013). Better management of stress, anxiety, and pain can also reduce the amount of medication needed (Bringman et al., 2009). Alongside this biological perspective, an individualised focus‟reflected in both assessment and flexible delivery‟is critical for addressing psychological needs. A process that customises playlists and coping strategies to the patient’s preferences, personality, and history increases the patient’s sense of control and engagement (Koelsch and Jancke, 2015). The main social factors during an invasive cardiac procedure involve the patient’s personality, family support, hospital culture, individual differences among staff, the procedure’s demands, and the physical environment (Ghetti, 2012). A variety of relationships therefore come into play (Trondalen, 2016). Interdisciplinary communication and collaboration are considered vital for developing and implementing music therapy in somatic health care; central issues include logistics, professional roles, and cross–discipline information exchange (Heiderscheit, 2013). Within the broader question of interdisciplinary positioning, there is a need to develop practical roles for Music Therapists in medical care (Bonde, 2018; Dileo, 2016; Hanser, 2014; Pearson, 2018). These factors all feature in the clinical protocol.

Music therapy intervention protocol

This music therapy intervention is specifically designed for patients undergoing transvenous pacemaker or ICD lead extraction under local anaesthesia. It may also be applicable to other similar invasive procedures. A trained Music Therapist guides the intervention following a flexible yet standardised sequence, outlined below. We present the protocol in detail to facilitate clinical implementation and to strengthen replicability from a research standpoint. The protocol was developed and tested for patients meeting these criteria:

• A transvenous pacemaker or ICD lead extraction is planned under local anaesthesia.
• The patient is able and willing to communicate and cooperate.
• The patient has no significant hearing impairment.
• The patient has no current or past acute psychiatric diagnosis.
• The patient has no cognitive or mental deficits or impaired functioning.

The intervention has three parts:

1. Preparation given individually on the hospital ward the day before the procedure.
2. Music listening provided on the day of the invasive cardiac procedure.
3. Closing dialogue conducted 2 to 4 hours after the procedure.

The protocol follows these basic principles for biopsychosocial music therapy in somatic health care:

• Patient involvement and communication are central.
• The music listening is individualised using a limited set of prepared playlists, chosen through assessment and discussion of patient preference.
• The Music Therapist remains present throughout the peri-operative phase, inside the operating theatre during the operation.
• Relaxation techniques are integrated into the music listening experience.
• The protocol is standardised enough to embed within the existing medical procedure yet flexible enough to meet individual needs.

The biopsychosocial perspective holds that biological, psychological, and social factors are mutually dependent and interactive. These three domains inform patient treatment across all phases of admission, are reflected in the ongoing clinical observations, and shape the embodiment of the supportive musical and relational intervention. Through the empathic involvement of a trained Music Therapist who focuses on the patient’s experiences, expectations, and personal resources, the patient is recognised as a person with individual needs. The music therapy service operates as an integrated part of the interdisciplinary treatment.

Preparation

The patient receives an individual preparatory session lasting 30–45 minutes at the hospital ward the day before the invasive procedure. This session involves a dialogue between patient and Music Therapist, encompassing practical instructions and experiences with music listening and coping techniques designed to enhance relaxation and stress management. Ideally undisturbed, the preparation takes place in a room with a hospital bed or bench to simulate the upcoming procedure with music listening added. Insights gained through the dialogue are used to individualise the intervention.

Assessment: experience, expectations, coping and music preference

The Music Therapist conducts a brief assessment of the patient’s prior experience in similar situations, expectations for the next day’s procedure, and current needs. Relaxation techniques guide the patient toward greater awareness of bodily and emotional reactions, as well as coping resources. Assessing the patient’s previous musical experiences and preferences forms the basis of playlist selection (Bonny, 2002; Burke, 1997; Standley, 2000). The Music Therapist then discusses with the patient how and why the chosen music might differ from typical everyday listening in order to maximise effectiveness in this specific setting.

Presentation: playlists and digital devices

The playlists are available through an app called Music Star (Figure 3), originally developed for clinical use in psychiatric and somatic health care. A colourful star appears on the iPad, containing twelve playlists with musical tracks of varied complexity and genres. The development and selection of playlist content follows a taxonomy of music (Wärja and Bonde, 2014) suited to therapeutic settings, staying within musical parameters that foster relaxation and avoid stimulation (Grocke and Wigram, 2007; Lund and Bertelsen, 2016; Lund et al., 2016). The music is characterised by:

• Slow, constant tempo;
• Melodic and harmonic simplicity and predictability;
• Absence of dynamic fluctuation;
• Tonal harmonic structure with high predictability and repetition;
• Constant, thin orchestration.

The coloured triangles within the playlists form a continuum of increasing music stimulus complexity, from light blue to darkest red (Lund et al., 2016: 58; Hannibal et al., 2013). Guided by the therapist, the patient tests several playlists and chooses two or three preferred ones. Playback occurs via an AudioCura M2 loudspeaker (Figure 4), custom-made for hygienic clinical environments. A loudspeaker is preferred over headphones, as it gives the patient necessary and comfortable head mobility and allows communication with the medical team during the invasive procedure. The focused direction of sound toward the patient’s head creates a ‘private soundscape’ even at low volume, and the surgical team remains undistracted.

Experience: music listening and coping techniques

During the preparation phase, the patient lies on the bench to simulate the procedure while potentially experiencing physical relaxation through music listening. The therapist’s guidance is carefully adjusted based on clinical observation and therapeutic communication. The patient learns relevant coping strategies to enhance the music-listening effect: breathing techniques, muscle relaxation, or visualisation, drawn from receptive music therapy induction, pain treatment, and procedural support principles (Ghetti, 2012; Grocke, 2016; Grocke and Wigram, 2007; Hanser, 2014; Metzner, 2012; Schou, 2008). Together, patient and Music Therapist finalise the music-listening plan for the following day’s surgical procedure using the patient-chosen playlists. This plan can be altered at any time according to the patient’s wishes and needs.

Music listening

During the invasive cardiac procedure, the Music Therapist is present as part of the medical team, ensuring relational continuity and observing potential patient responses and procedural events. The therapist also operates the music devices:

1. Preoperative: Music listening begins preoperatively, 30 to 60 minutes before the patient enters the operating theatre. Pauses during the preoperative phase (when the patient is undisturbed) should be especially utilised for music listening. The music is turned off when communication with medical staff is needed. The Music Therapist reminds the patient of previously discussed coping strategies and guides him or her into a relaxed state of mind and body, supported by the containing flow and rhythm of the music.
2. Peri-operative: In the operating theatre, the loudspeaker is wrapped in a thin plastic bag and placed around the pillow, fastened to the operation bench for hygiene and stability. An extended cable allows the iPad to sit on a separate table at the foot of the bed. Music listening continues after the patient is connected to monitoring equipment, during sterilisation, and into the peri-operative and invasive phase of the procedure. The patient can start, stop, skip tracks, or change playlists at any time. The minimum total music listening duration before and during the operation is 30 minutes to be considered a complete intervention. For ongoing facilitation, the Music Therapist continuously observes the room and the patient’s responses, adjusting volume according to environmental noise (e.g., monitors, equipment) and medical-team conversation. If the patient falls asleep, the music should continue to maintain a consistent soundscape. Should medical complications, adverse patient reactions, or a need for complete silence arise, either the medical team or the Music Therapist can stop the music.
3. Post-operative: Music listening is offered to the patient during the immediate post-operative period. The device can be operated by the patient or supported by health personnel or the Music Therapist.

Closing dialogue

Within four hours of the invasive procedure, the Music Therapist initiates a debriefing with the patient at the post-operative unit. Experiences from the procedure and music listening are discussed, shared, and evaluated. The therapist may offer supportive suggestions to empower the patient and enhance self-awareness and coping strategies for the future.

Discussion

Patients can feel alienated by a hospital’s sterile setting with unfamiliar white noise and unpredictable electronic beeps. While the hospital’s main goal is recovery, it can also be a place associated with illness, pain, and existential concerns. Unlike the medical staff, the Music Therapist’s primary focus is supportive communicative care, addressing the patient’s experience and ability to cope. Patient involvement and empowerment are central to music therapy interventions that address psychosocial needs (Blichfeldt-Ærø and Leinebø, 2017; Frankel et al., 2003). Bringing music into a room changes the atmosphere through a new auditory stimulus; the music therapy intervention can offer the patient and staff a positive focus, modify the environmental soundscape, mask unpleasant noises, and even induce a possible altered perception of time (Bonde, 2011; Ghetti, 2012). From a biopsychosocial perspective, these elements aim to give the patient adequate control and involvement, bodily regulation, and psychosocial safety in a friendly environment, as captured by the neuromatrix model of pain and the model of music therapy in procedural support.

To enhance the effect of music listening, patients are guided through individually tailored relaxing and reinforcing coping techniques. This guidance draws on music-assisted relaxation, music listening, and Guided Imagery and Music, known to support altered states of consciousness (sedation), refocus the mind, and influence vital-sign regulation (Ghetti, 2012; Grocke, 2016). Coping strategies are most effective after repeated use, which presents challenges in short-term treatment. Given the limited time during a surgical procedure, the therapeutic relationship must be established quickly, and music listening must be used efficiently. Throughout this short-term treatment, the patient engages in a therapeutic process and relationship with both the Music Therapist and the music itself (Bonde, 2011; Grocke, 2016). To maintain study feasibility and address ethical concerns, the protocol does not endorse deeper exploration of emotions or life difficulties. Therapeutic focus stays in the ‘here-and-now,’ with guidance on coping strategies to support the invasive procedure.

By giving the patient experience of FaMuLi during the preparatory session, the therapist raises the patient’s awareness of coping skills. This preparation also sets up physical and psychological recognition of the music listening on the day of the operation. That may enhance the perception of music listening as a safe, supportive continuum during the procedure and facilitate processes of expectation and fulfilment (Bonde, 2009; Ghetti, 2012; Hodges, 2000). In FaMuLi, the central health point in the biopsychosocial model (Figure 1) relates to the procedural experience in the moment, acting as both a preventive and transformative experience that can enhance the patient’s future potential for empowerment and coping.

The debate between participant-selected versus therapist-selected music continues. Supporters of patient-selected music note decreased anxiety and pain (Bradt et al., 2013a, 2016; Burke, 1997). Others argue for limited choice among therapist-preselected music to ensure musical parameters most likely to promote a relaxing effect on the autonomic nervous system (Fachner, 2016; Hanser, 2014; Koelsch and Jancke, 2015). The playlist selection in the current intervention integrates both perspectives neurobiology and psychology: participants choose from a limited set available in the Music Star app. These playlists reflect awareness of music’s impact on neurobiological regulation, containing predictable, stable tracks associated with relaxation of body and mind; the patient’s ability to choose acknowledges the psychological importance of preference, involvement, and control (Lund et al., 2016; Wärja and Bonde, 2014). Using preset playlists does impose limitations. With more time, the patient and therapist could jointly tailor playlists more individually based on similar analytic methods (Wärja and Bonde, 2014). However, realistic implementation within this procedure’s short time frame requires some standardisation and feasibility. Preset playlists also strengthen the research rigour of the ongoing RCT study (Koelsch and Jancke, 2015). The Music Star app allows playlists to be altered and updated using the same professional standards and principles, making it a dynamic tool for future use.

Dileo (2015), Hanser (2014), and Heiderscheit (2013) argue that interdisciplinary work should be emphasised throughout a protocol’s development and that the Music Therapist’s role should be integrated into the team. This approach covers practical and logistical implementation considerations as well as mutual understanding across disciplines. Crucial to implementing this protocol is the timeline, particularly pauses during preoperative preparation. As patient stress responses may increase during inactive periods, these pauses are used to offer music listening as a stabilising, relaxing stimulus. The Music Therapist remains actively present during these times, guiding and communicating with the patient. Throughout the invasive operative phase, the therapist must, due to demands of the medical procedure, withdraw slightly while still modifying the music intervention based on ongoing reflexive observations. The protocol’s relational continuity and support come from both the music stimulus and the therapist’s presence.

To achieve the same effects as music listening, anxiolytic drugs (mainly midazolam) are given during an operation to reduce stress and anxiety by directly modulating biological regulation. Analgesics (fentanyl) are given to reduce pain. These drugs have side effects and carry high costs, neither of which applies to music therapy; interestingly, Bringman et al. (2009) found music therapy more effective than midazolam in reducing preoperative anxiety. Although music therapy might therefore reduce medication use, this protocol does not actively seek to do so. Interdisciplinary communication and cooperation are considered critical for developing the optimal balance of medical and music therapy support for the individual patient, just as they are for employing music therapy as a general resource (Dileo, 2015; Heiderscheit, 2013). The hospital ward where this study took place had no prior music therapy provision. The medical team was positive and cooperative during the study, but it is unclear whether they viewed the music therapy intervention as integrated into patient treatment or as a parallel service. Further investigation into a qualitative patient perspective and certain protocol implementation issues is needed.

Literature on medical music therapy often addresses the distinction between music medicine and music therapy (Bonde, 2011; Bradt et al., 2013a; Gold et al., 2011; Hanser, 2014). Research on music listening in general shows it can be offered in varied ways and with different provider or therapist roles across several forms and levels of practice. The descriptive term ‘facilitated,’ as used in this protocol, indicates the presence and professional judgement of an experienced Music Therapist. Still, some elements of the protocol resemble music medicine, such as the less active role of the Music Therapist on the day of the operation. However, more active involvement might be preferable during the peri-operative phase to maximise the patient’s benefit from receptive music therapy’s potential. Within this specific procedure, the Music Therapist’s role as described is both reasonable and implementable, yet undeniably less active than in most music therapy practices due to procedural demands. Nonetheless, because a Music Therapist facilitates the intervention, and the music experience is embedded in the therapeutic relationship, this protocol qualifies as music therapy (Bruscia, 2014; Dileo, 2015).

Beyond the formal research procedures designed to maintain an ethical framework for music therapy implementation, individual ethical considerations must be made within clinical intervention. For example, if a patient’s pulse and BP drop peri-operatively and an acute team is called, clinical decisions about music listening arise. Continuing the music in such a case might add stability to a medical-emergency situation or at least avoid introducing a disruptive factor by removing it. Still, the stress of such events and the range of patient needs must be accounted for. Ongoing ethical considerations identified the following elements as relevant and therefore reflected in the protocol:

1. The number and role of helpers around a patient;
2. The level of therapeutic involvement in this short-term situation;
3. Adjustment of the intervention during adverse events or emergencies in the operating theatre.

Preliminary findings from clinical implementation of the protocol indicate that nearly all approached patients wished to participate and receive FaMuLi. Some emphasised wanting to avoid overhearing conversations among the medical team during the procedure, having had negative experiences with such exchanges. Study patients reported overall satisfaction with music listening—for example, experiencing a relaxed state of mind and body, a positive focus, and a feeling of time passing more quickly. Experiences from interdisciplinary team meetings also indicate that the Music Therapist’s observations could inform the medical team’s work by providing the patient’s perspective and communication in the operating theatre. Thus, introducing a Music Therapist to the team could be valuable not only for the patient but also for more constructive communication between hospital staff. The role of the Music Therapist as described represents a means of professional integration within somatic health care.

This article has presented and discussed a clinical music therapy protocol situated within a biopsychosocial theoretical

The protocol advocates for a balance between standardisation and individualisation in both the choice of music and therapeutic guidance, aiming to make the intervention both effective and implementable. The article draws on familiar concepts and methods within music therapy, but it adds to the existing literature by demonstrating how the biopsychosocial approach can be actualised in a receptive music therapy intervention during medical invasive procedures. It simultaneously meets the need for detailed, individualised clinical descriptions in medical music therapy and the need for further development of concrete, implementable roles for music therapists in somatic health care.