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com J Tradit Chin Med 2014 April 15; 34(2): 159-161
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Effects of five-element music therapy on elderly people with season-
al affective disorder in a Chinese nursing home
Xifang Liu, Xin Niu, Qianjin Feng, Yaming Liu
aa
Xifang Liu, Xin Niu, Qianjin Feng, Yaming Liu, School of
Basic Medical Sciences, Beijing University of Chinese Medi-
cine, Beijing 100029, China
Supported by the Assistance Project for the Developing
Country Funded by the Ministry of Science and Technology
of China (No. KY201302010); the National Major Foundation-
al Research Development Project (973 project) (No.
2011CB505404); the Beijing University of Chinese Medicine
Innovative Group (No. 2011-CXTD-05); the National Science
and Technology Project in '12th Five Year Plan' Funded by
the Ministry of Science and Technology (No.
2012BA125B05); the National Basic Research Program of Chi-
na (No. 81173381)
Correspondence to: Prof. Xin Niu, and Prof. Qianjin Feng,
School of Basic Medical Sciences, Beijing University of Chi-
nese Medicine, Beijing 100029, China. NXFQJ66@126.com;
lxflxf6666@126.com
Telephone: +86-10-57219426; +86-10-57217969
Accepted: December 25, 2013
Abstract
OBJECTIVE: To explore the effects of five-element
music therapy on elderly patients with seasonal af-
fective disorder in a Chinese nursing home.
METHODS: The patients (n=50) were recruited
from a Shijingshan district nursing home in Beijing,
China. They were randomly assigned to two
groups, a treatment group and a control group,
with 25 participants in each group. The patients re-
ceived music therapy for 1-2 h each week over an
8-week period. The music therapy involved four
phases: introduction, activities, listening to the Chi-
nese five-element music, and a concluding phase.
The participants in the control group did not listen
to the five-element music. This study consisted of
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ISSN 0255-2922
© 2014 JTCM. All rights reserved.
CLINICAL STUDY
TOPIC
two parts: (a) a qualitative study that used focus
groups to understand the feelings of the patients
with seasonal affective disorder; (b) a quantitative
study that involved administration of the self-rat-
ing depression scale (SDS) and Hamilton depres-
sion scale (HAMD) before and after treatment.
RESULTS: (a) Qualitative analysis results: strength
derived from the five-element group music therapy
and emotional adjustment. The five-element group
music therapy can reduce patients' psychological
distress and let them feel inner peace and enhance
their life satisfaction. (b) No significant difference in
SDS and HAMD scores was found between the two
groups (P>0.05) prior to treatment. After treatment,
the mean SDS score of the control group was 49.9±
18.8, while the treatment group's score was 40.2 ±
18.1. The HAMD score of the control group was
11.2±3.1, and the treatment group's score was 8.8±
4.9. Following 8 weeks of music therapy, the SDS
and HAMD scores of the treatment group were
significantly lower than those for the control
group (P<0.05).
CONCLUSION: Five-element music therapy alleviat-
ed the symptoms of seasonal affective disorder in
the elderly patients.
© 2014 JTCM. All rights reserved.
Key words: Five-element music; Seasonal affective
disorder; Nursing homes
INTRODUCTION
Aging is a worldwide issue in our society. Elderly peo-
ple living in nursing homes may suffer from sadness,
159 April 15, 2013 | Volume 34 | Issue 2 |
 Liu XF et al. / Clinical study
pain and isolation. Many of them may experience sea-
sonal affective disorder (SAD). SAD is a common con-
dition where individuals present with depressed
mood, loss of interest or pleasure, feelings of guilt,
disturbed sleep and/or appetite, low energy and poor
concentration.1,2
While much research has focused on SAD, no studies
have yet investigated the use of five-element music ther-
apy with elderly SAD patients. Music therapy has been
recognized as an effective method in helping the elder-
ly improve both their physical and mental health. The
music therapy used in this study was accredited by the
American Music Therapy Association.
Researchers note that music therapy can have a positive
influence on the regions of the brain responsible for
managing anxiety and stress.3 In addition, it has been
found that music therapy can relieve stress experi-
enced by elderly people who suffer from neurological
disorders.4
Many clinicians have adapted and employed music
therapy with their clients for the last 20 years.5 Never-
theless, few published studies have used five-element
music therapy with SAD patients. Based on the theory
of Traditional Chinese Medicine (TCM), ancient prac-
titioners was believed to have used five-element music
in China to combat the condition of SAD. The goals
of this research were to evaluate the effect of five-ele-
ment music therapy on elderly people with SAD.
METHODS
Participants
Participants were recruited from a nursing home in Shi-
jingshan district, Beijing, China, between November
2012 and February 2013. Participants were recruited
based on the following criteria: (a) aged 50 years or old-
er; (b) conformed to the SAD diagnostic criteria in the
DSM-III-R;6 (c) experienced symptoms of depression
for at least 2 years, with these symptoms being noted
to be more serious in autumn/winter and to ease in
spring/summer; (d) fond of Chinese classical music
and willing to be interviewed in a group setting; (e)
did not suffer from any other mental illnesses or experi-
ence other social/psychological difficulties that would
confound the study results. This study was approved
by the ethics committee in Beijing University of Chi-
nese Medicine. Informed consent was obtained from
the participants who were aware that they had the right
to withdraw from the study at any time. Using a ran-
dom numbers table, the participants were assigned to
either the treatment or control group, with 25 individ-
uals in each.
Treatment
The treatment group received music therapy for 1-2 h
each week, from November 2012 to February 2013.
The music therapy comprised both active and passive
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content, and every session was divided into four parts:
the beginning period, activities, listening to Chinese
five-element music, and the concluding phase. The
control group did not listen to Chinese five-element
music. The researcher took field notes and noted im-
portant observations during the music therapy, especial-
ly any key words which might lead to further discussions.
Data collection
The Self-rating depression scale (SDS) and Hamilton
depression scale (HAMD) were administered before
and after the treatment.7 SDS is a 20-item self-report
instrument. Each item of the scale is associated with de-
pression syndrome including psychological and somat-
ic symptoms. The scale yields a total score that ranges
from 20 to 80, and can be used to indicate the severity
of depression. HAMD is a 17-item scale with factors
including anxiety, cognitive disturbance, diurnal varia-
tion, mental retardation, sleep disturbance and feelings
of hopelessness.
Data analysis
All data were analyzed using SPSS (version 13.0; IBM,
Armonk, NY, USA). Mean scores ± standard deviation
were given. T-tests were used to evaluate the difference
between group means. A significance level of P<0.05
was used.
RESULTS
Quantitative statistical results
No significant difference was found between the mean
ages of the two groups (P>0.05). Before the treatment,
the SDS score of the control group was 56.2 ± 19.3,
while the score of the treatment group was 56.2±19.1.
There was thus no significant difference in SDS scores
between the two groups before treatment (P>0.05).
The HAMD score of the control group was 14.7±4.5,
and for the treatment group was 15.1±5.9 prior to in-
tervention. Again there was no significant difference in
the HAMD scores of the two groups before treatment
(P>0.05). The SDS scores of the two groups were sig-
nificantly different after treatment (control group:
49.9±18.8; treatment group: 40.2±18.1, P<0.05). The
HAMD score of the control group was 11.2±3.1, while
the score of the treatment group was 8.8±4.9. After 8
weeks treatment, HAMD scores of the two groups
were significantly different (P<0.05).
Qualitative analysis results
Strength derived from the five-element group music
therapy and emotional adjustment. The five-element
group music therapy can reduce patients' psychological
distress and let them feel inner peace and enhance their
life satisfaction.
DISCUSSION
The findings of our study indicate that Chinese five-el-
160 April 15, 2014 | Volume 34 | Issue 2 |
 Liu XF et al. / Clinical study
ement music alleviated the patients' SAD symptoms.
There may be several reasons for this phenomenon.
Compared with other music therapy, five-element mu-
sic therapy is not only a kind of musical healing modal-
ity but also a special musical prescription based on
TCM.
According to Emperor Canon, Chinese classical five-el-
ement music can cure disease.8 The five elements in-
clude Gong, Shang, Jue, Zhi and Yu. Each element
links with a specific organ: Gong to the spleen, Shang
to the lung, Jue to the liver, Zhi to the heart, and Yu to
the kidney. In TCM psychology, five-element music
can regulate mood and improve health. The vibration
of music is thought to correspond to the physiological
vibrations of the human body, such as heart rate,
breathing, blood pressure and pulse. Research suggests
that classical music training can play a positive role in
brain function.9-15 Intensive, long-term and repetitive
music training affects the music information process-
ing network system of the cerebral cortex, and demon-
strates the plasticity of the human brain. Music has sev-
eral functions including emotional adjustment and in-
tegration function. It works together with the central
nervous system, dominated by the autonomic nervous
system and peripheral tissue organs' physiological re-
sponses. Nitric oxides also play an important role in
music, and emotional-physiological reaction pathways.
Several studies have shown that somatosensory music
vibration transmission in the human body is via bone
conduction, soft tissue conduction and meridian trans-
mission.16 This is the fundamental theoretical basis of
five-element music therapy.
While engaging in the group activity, the elderly pa-
tients gradually focused on the music rather than on
their pains and troubles. The results of the present
study may be generalized to other elderly populations,
and offer useful information for music therapists who
treat elderly SAD patients. One key effect of relaxing
music is to help patients enter a comfortable mood. To
ensure its positive effect, the music therapist might ad-
vise the group members to listen to relaxing music be-
fore they go to bed.
The current study has several limitations. The research-
er was also the music therapist, and this double role
might have had an effect on the positive outcomes
achieved. To avoid such problems in future studies, the
analysis should only begin once therapy has ended. In
addition, the study sample is small. More research
should be done to draw a more precise picture. The
present research could serve as an experiment that
serves as a base for further studies. Furthermore, it is
important to detect the effect of five-element music
therapy for a longer period of time and to compare the
music therapy with other kinds of therapy to confirm
the specificity of this type of treatment effect.
Based on the results of this study, we concluded that
five-element music therapy is able to reduce the severi-
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ty of SAD symptoms in elderly patients. Five-element
music therapy is a noninvasive and safe treatment
method for SAD.
ACKNOWLEDGMENTS
We would like to express our gratitude to all the partici-
pants who provided the information in this study.
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