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Singing is good for you: an examination of the relationship between singing, health and well-being.

I come to the field of education with a passion for art. I am an artist, a musician, a writer, and a teacher. I love it all. As an educator, it is my hope that I can help my students develop passions of their own. It is imperative that everyone, young and old, at all levels of education, have access to arts programming. Therefore, I have chosen to pursue research in this field. The central focus of my research is singing and wellness, and how these two relate to one another. I am particularly interested in how singing in a group effects individual well-being.

Before proceeding with an investigation of the literature, I feel it is important to define the key terms, as I understand them. The World Health Organization (WHO, 2013/2014) defines health as a "state of complete physical, mental and social wellbeing, and not merely the absence of disease" (para 2). The WHO clearly stipulates that mental health and well-being are directly linked with overall health. Well-being is often used interchangeably with wellness. For the most part, the literature examined within this review utilizes the term well-being. The WHO uses well-being in its definition of mental health:

[Mental health] is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. (para 1)

There are two common definitions of well-being. First, a hedonistic perspective is a subjective experience of happiness and life satisfaction. Second, a eudaimonic perspective involves positive psychological functioning, good relationships, and self-realization (Perkins & Williamson, 2013; Glick, 2011). Hedonism is about pleasure and enjoyment. It seems that positive psychological functioning can be achieved through acts that bring pleasure and joy into our lives. Therefore, my understanding of wellness or well-being is an amalgam of both the hedonistic and eudaimonic perspectives.

The following review of the literature examines the physiological and psychological benefits of singing. The psychological benefits include the hedonistic and eudiamonic perspectives of well-being as well as the some of the possible cognitive benefits.

Singing and Physiological Health and Well-Being

A considerable volume of research exists about the physiological benefits of active and passive exposure to music. Active exposure involves playing an instrument, whereas passive exposure simply requires listening to music. Only a small portion of this research examines the benefits of singing, an active exposure to music. However, there is some evidence demonstrating that singing may have some physiological benefits. Such benefits include: the promotion of the development of healthy respiratory functioning through exercise of the lungs, diaphragm, and abdominal muscles (Wade, 2002; Clift & Hancox, 2001); an increased air flow and subsequent oxygenation of the blood (Clift & Hancox, 2001); a reduction in cortisol levels and an increase in secretory immunoglobulin (SIgA) production, which in combination are used as indicators of immuno-suppression or stress reduction (Beck et al, 2000; Beck, Gottfried, Hall, Cisler, & Bozeman, 2006; Kreutz et al., 2004; McKinney et al., 1997); and an endorphin release, which can reduce physical pain (Kenny and Faunce, 2004, Tanner, 2006).

It has long been understood that singing promotes healthy respiratory functioning. A series of papers outlining such benefits were published in The Etude at the turn of the twentieth century, though claims were not supported by scientific evidence at the time of publication (Hunter, 1999). More recently, Wade (2002) examined the possible respiratory benefits for children with asthma in a quantitative study comparing active (singing) and passive (group listening) exposure to music. Nine children (five girls and four boys) with the average age of nine years participated in both group singing and 15-minute music listening sessions; participants served as their own controls. The listening sessions also utilized progressive muscle relaxation (PMR) techniques. The intervention occurred two times per week over four weeks. Lung functioning was measured by a peak flow metre. The data revealed that lung functioning increased or was maintained after group singing. Lung functioning increased when singing followed PMR. The PMR technique only proved effective when it was completed ahead of singing or listening exercises.

Clift and Hancox (2001) explored the perceived benefits of active choral singing at the higher education level through two exploratory studies. The first study involved 84 members of a university college choral society. Participants completed a brief open-ended questionnaire, which explored the personal benefits of participating in choral singing as well as their perceptions of the physical heath benefits of singing. Questions pertaining to the physiological benefits of singing were met with a response rate of 84%. Responses yielded common themes regarding the possible heath benefits of singing, including improved breath and lung functions, feelings of alertness, improved posture, improved feelings of physical fitness, strengthening the cardiovascular system, and aiding in breathing difficulties or asthma. In the second study 91 members of the choir were given a structured questionnaire. This questionnaire consisted of 32 statements that were prompted by responses in the first study. In response to questions pertaining to physiological heath, 77% of participants believe that singing stimulates adrenalin, 83% perceive singing as aiding in the development of increased lung capacity, 72% believe singing strengthens the diaphragm, and 68% believe singing leads to improved posture. The data gathered from Clift and Hancox supports the notion that singing has physiological benefits though they are limited due to the perceptive nature of the responses.

Active singing has been known to aid in stress reduction (Beck et al., 2000; Beck et al., 2006; Kreutz et al., 2004). While stress impacts healthy psychological functioning, it also directly impacts the body's immune system. The immune system is the body's primary agent in maintaining physical health. Therefore, an exploration of the impacts of singing on the immune system is noteworthy. Research linking music to the reduction of stress has in large part been centred on instrumental music. However, a number of studies explore the potential benefits of active singing on immuno-health.

Beck et al. (2000) examined Secretory Immunoglobulin A (SIgA) and cortisol levels in professional singers. A high production of SIgA (found in the saliva) is related to positive mood increases and the body's ability to combat respiratory infections. High levels of the steroid hormone cortisol indicate an increase in stress, emotional or otherwise (Beck et al., 2000). For this study, thirty-two participants (men and women with an average age of 46-years) were randomly selected from a professional choir. Participants were to have no underlying medical conditions that might impact the immune system. Saliva samples were collected directly before and after rehearsals and one performance. Samples were tested for both cortisol and SIgA levels. Researchers found that when compared to a control group, SIgA increased both after rehearsals and performance, noting that the increase was higher after the performance. Cortisol was found to have decreased after singing, though baseline levels were too low for the results to be significant (Beck et al., 2000). As a follow up to this study, Beck et al. (2006) explored this relationship in solo-singers in a 10-week study of eight college-aged singers. Results indicated that SIgA did not increase after rehearsals, but did increase after performances. Cortisol levels were found to have decreased after rehearsals and slightly increased after performance. The context of a particular singing experience can impact stress levels. If the stakes of a performance are high, stress levels may increase, undermining any change in SIgA or cortisol as a result of singing. However, the results of these studies overall do reveal that singing can lead to lower stress levels, which in turn can positively influence immuno-health. Corroborating these findings, Kreutz et al. (2004) conducted a quantitative study examining thirty-one members of an amateur choir (eight men, twenty-three women), which sought to determine whether or not passive listening experiences contributed to a reduction in cortisol levels, and an increase in SIgA levels in comparison to active singing. While there were no changes in SIgA and only a slight decrease in cortisol after listening to music, results indicated that SIgA increased and cortisol decreased after singing.

Exposure to music may be linked to the body's ability to tolerate pain. In an examination of literature pertaining to patients suffering from acute or chronic pain and cancer pain, Tanner (2006) concluded that passive listening experiences with music resulted in a reduction in pain levels, and subsequently patients required lower doses of opioids (morphine). However, the reduction in pain levels was small. Therefore, the medical use of exposure to music remains unclear. Kenny and Faunce (2004) examined the use of active experiences with music, exploring the use of vocal music to help reduce pain in 77 chronic pain patients. Researchers compared group singing with music listening. Patients were randomly assigned to active singing or passive listening groups. The intervention was used in combination with the standard treatment of chronic pain. Group singing sessions, conducted by a vocal music teacher, consisted of vocal warm-ups followed by the singing of lively songs; listening sessions took place while patients exercised. Pain and coping abilities were measured at baseline, post-treatment, and six months. Researchers found no significant differences between music listening and singing when comparing baseline and post-intervention pain scores. However, pain scores did improve amongst both groups, although patients experienced only marginally significant increases in their abilities to cope with pain after the intervention. Kenny and Faunce (2004) concur with Tanner's (2006) assessment of the benefits of musical exposure, suggesting that the effectiveness of the standard pain treatments may render the musical benefits moot.

While many of these studies have yet to establish an irrefutable causal link between respiratory health, cardiovascular health, stress, stress reduction, immune function and singing, research has indicated that a causal link may exist. Further research is needed to convincingly prove or disprove these potential connections.

Singing and Psychological Health and Well-Being

The body of research that solely focuses on singing and its benefits is less than that which explores the benefits of involvement with instrumental music, music, and art in general. However, there is some research that supports the notion that singing positively impacts well-being. Research examining such benefits is largely perceptive in nature. However, findings are consistent, strengthening the reliability of the research. Singing has been known to positively impact social, emotional, and cognitive processes. This section will explore these benefits to well-being through three subgroups: (a) hedonistic well-being, exploring singing and feelings of joy or happiness, (b) eudiamonic wellbeing, exploring singing and healthy psychological functioning, healthy relationships or social connections, and self-realization, and (c) the cognitive implications for singing.

Hedonistic Well-Being

Clift and Hancox (2001) explored both the hedonistic and eudiamonic conceptualizations of well-being in their two-part exploratory study pertaining to the perceived benefits of singing at the higher education level. Eudiamonic responses will be unpacked in a later section of this review. In the first study, participants noted feelings of happiness, worthwhileness, and spiritual harmony. In the second study, asking participants to rate their agreement on a 5-point Likert scale, Clift and Hancox found that no fewer than 93% of participants agreed that singing improves their mood. Additionally, 89% reported feeling happier, and 64% reported a more positive attitude as a result of singing. Kenny and Faunce's (2004) study comparing the impact of active and passive music experiences on pain also examined mood. Although researchers found no significant difference between singing and listening to music when comparing baseline and post-intervention mood scores, results showed that with each intervention (both singing and listening) mood improved.

Balsnes (2012) conducted a case study examining the connections between choral singing, health, and quality of life. Balsnes explored the experiences of one member (Diana) of a Norwegian mixed amateur choir. Data collection consisted of participant observation and interviews. Analysis of the data illustrated ways in which singing in a choir can aid in the development of competency and empowerment, promote healthy living, and promote the development of healthy relationships, as well as providing a method for which one can find meaning and develop a balanced life. Diana described an uplifted mood, with feelings of elation and joy: "When [the song] got going, it lifted me right up. I can't explain it, I had such good feelings inside me" (Balsnes, 2012, p. 255).

Unwin, Kenny, and Davis (2002) also explored mood changes through a comparison of singing and music listening. They hypothesized that if changes in mood were to occur after singing, they would be greater than after listening to music due to the physical nature of singing. Eighty-one participants, aged 55- to 65-years, were recruited from the community and randomly assigned to singing (experimental) and listening (control) groups. The singers participated in a 30-minute vocal music session consisting of vocal warm-ups and unfamiliar songs in nonnative languages, while the listeners listened to the singing group. The Profile of Mood States (P.O.M.S.) questionnaire was administered before and after singing, as well as one week later. A Multiple Analysis of Variance (MANOVA) was conducted for each subset of the P.O.M.S. (tension, anger, fatigue, vigour, and confusion). Results showed improvements in mood immediately following brief interactions with music, both with singing and listening. Additionally, researchers reported some effects of the P.O.M.S. were evident one week later, though the report did not specify what those effects were. There were no indications that singing had greater effect than listening. Unwin, Kenny, and Davis (2002) suggest that in order for singing to have had a greater effect it must be more physically taxing.

In a phenomenological study examining the adaptive characteristics of group singing for members of a choir for homeless men, Bailey and Davidson (2002) proposed that active participation in music, by way of singing, could positively influence emotional, social, and cognitive processes. Membership in the choir was restricted to men only because the choir was sponsored by a Catholic mission for men and rehearsals were held at the mission. (Bailey and Davidson (2005) addressed this gender gap in a later study that examined the perceived benefits of singing for marginalized women and men.) The participants were 7 active members of the all male Homeless Choir. Their ages ranged from 45 to 62 years, and all of them had experienced periods of homelessness ranging from a few months to 11 years. All participants suffered from mental illness and/or addiction to drugs or alcohol, and all were dealing with some form of loss (relationships with loved ones, or the death of a loved one). All but one participant had no musical training prior to joining the choir. A comprehensive semi-structured interview was used to determine each singer's perceptions of life in the choir. Interviews were broken down into five sections: (a) early life; (b) education, employment, and events that led to homelessness; (c) motivations for joining the choir; (d) choristers' perceptions of singing; (e) personal changes that occurred after joining the choir. The perceived benefits of singing in this choir fell into four categories: (a) therapeutic benefits; (b) audience-to-performer; (c) group participation; and (d) focus on completion of a task. The psychological benefits pertaining to hedonism were described as feelings of excitement and joy. Members were able to share their excitement and joy with their audience, further amplifying these feelings.

As a follow up to the study examining the Homeless Men's Choir, Bailey and Davidson (2005) sought to ascertain whether findings of increased emotional health would be replicated in a second phenomenological study of 8 men and women marginalized by mental illness, substance abuse and/or poverty participating in a choir. This study compared the perceived benefits of group singing for marginalized and middle class groups. Results indicate that the perceived benefits of singing are similar across socio-economic groups, although the interpersonal and cognitive outcomes have different meanings for the two groups. Interviews highlighted similar results to the homeless men's choir. Participants noted feelings of joy and relief from the challenges of day-to-day living during singing.

Much of the literature pertaining to singing's extra-musical benefits examines the impact of singing for groups characterized as being marginalized, criminal, and elderly. In response, Judd and Pooley (2014) examined the psychological benefits of participating in group singing for members of the general public who regularly participate in choral singing. Using an in-depth qualitative design, Judd and Pooley sought to capture the meaning and importance of group singing for 10 participants (six females, four males) aged 33- to 72-years (with the average age being 54). Participants were interviewed about their personal experience of singing in choirs and the role that being a member of a choir played in their daily lives. Interviews were conversational in nature, always beginning with "How did you first come to join a choir?" (p. 272). An interpretative thematic analysis was used to analyze the data. Three themes emerged: individual, group, and mediating factors. Psychological implications were found in the individual and group themes, and mediating factors explored areas that were touched upon by both the individual and group themes. Eight sub-themes were identified: psychological, musical, physical, ethos, group dynamic, past experiences, type of choir, and musical director. Data pertaining to the social benefits of participating in choir is outlined under eudiamonic well-being, below. Hedonistic outcomes of this study included feelings of fulfilment and joyfulness. Participants found singing to be uplifting, especially in times of major life changes, depression and during recovery from illness. The psychological benefits described by the participants emphasize the need for further exploration into the benefits of singing for the general public

Eudiamonic Well-Being

In their two-part exploratory study on the perceived benefits of singing in higher education, Clift and Hancox (2001) found that participants attributed social and emotional benefits to singing. In the first study, participants noted that singing aided in the reduction of emotional stress through feelings of relaxation and calmness that were produced during singing. These responses were confirmed by the second study in which 80% of participants agreed that singing helped them to relax. Participants also noted that they were better able to cope with outside stresses, such as work, when they were singing. In the first study participants also highlighted the opportunity for community building, which came out of being a choir member through fellowship before and after rehearsals. However, the second study revealed that the community aspect of participating in a choir was more important to some than others, depending largely on the age of the members.

Baslnes's (2012) case study examining the experiences of Diana described the social benefits of singing in a choir. The choir provided Diana with opportunities for fellowship. She was able to build relationships with other members and to become a part of a greater community: "Choral singing is a democratic activity where everybody can take part and all are treated equally" (p. 257). The choir worked cohesively as a team to successfully tackle a difficult repertoire. Successes like these left Diana with feelings of accomplishment, which contributed to her overall well-being.

Bailey and Davidson (2002) explored the perceived benefits of singing through their examination of a choir for homeless men. Data from interviews with participants revealed that active participation in group singing alleviated depression for many of the men as well as provided relief from the day-to-day challenges associated with homelessness. Members of the choir were not permitted to use drugs or alcohol; using resulted in being asked to leave the group. This change in behaviour resulted in physical health benefits. Choristers were better able to interact socially, within the choir itself as well as with the general population. A community among members developed. Together members developed more appropriate interpersonal behaviours, allowing for the accomplishment of group goals. Reciprocity between the choir and the audience gave choristers a sense of self-satisfaction. This reciprocity allowed choristers to bridge the gap that segregated them from normal social networks. This sentiment was echoed in Bailey and Davidson's (2005) study examining the perceived mental health benefits for marginalized groups. After participating in the choir for a period of time, some members were able to successfully participate in society, through obtaining gainful employment as well as housing (Baily & Davidson, 2002). In order to actively and successfully participate in society individuals must be healthy both physically and mentally. Outcomes, such as the ones described by Bailey and Davidson (2002), suggest that a relationship between healthy psychological functioning and singing in a choir does exist.

In Judd and Pooley's (2014) study examining the psychological benefits of singing for the general public, eudiamonic well-being characteristics were found. Participants found that singing promoted positive emotions and helped to decrease feelings of stress, noting that in times of difficulty--whether it is in the form of trouble in relationships, the loss of a loved one, or issues with work--singing provided an outlet for stress-relief. Choir provided participants with a safe space, a community in which they felt they could fully express themselves and let their true selves shine through. Not only were participants able to express themselves and feel as though others accepted and understood them, they were able to reciprocate this relationship, nurturing the development of a community. These feelings of self-fulfillment were mediated by factors such as the level of the choir (auditioned or un-auditioned) and the style of the musical director. The personality and musical style of the musical director can have a positive or negative impact on the dynamic of a choir. Bailey and Davidson (2002) also outlined the impact a musical director can have on the musical and interpersonal success of a choir. In that case, participants stated that the relationship of the director and the singer, the balance of rehearsal style (rules and regulations) was key to the success of the choir and personal success of its members.

Judd and Pooley (2014) reported that the level (auditioned or un-auditioned) of a choir could impact relationships between choir members. Over half of the participants that belonged to auditioned choirs noted the competitive nature of professional choirs tended to get in the way of music making as well as the development of positive relationships among members. Judd and Pooley (2014) set out to illustrate the perceived benefits of choral singing for the general public. The data clearly showed that the general public and not only those groups who would be categorized as marginalized felt the psychological benefits of singing.

Cognitive Implications

The cognitive benefits of singing were explored on a limited basis by Bailey and Davidson (2002, 2005). In their 2002 study examining the perceived benefits of singing for homeless men, the concentration required to learn and perform the repertoire served as a stimulus for mental engagement. Having the opportunity to focus on and complete a healthy activity, such as singing in a choir, provided choristers with the satisfying feeling of completing a task. This cognitive exercise could translate into other areas of their lives. Bailey and Davidson (2005) touched on similar cognitive benefits in their study comparing the benefits of singing for marginalized groups of middle class persons. Both cases provided opportunities for cognitive stimulation, though they were different. For those classified as marginalized, singing provided opportunities for concentration and stimulation as well as the development of ordered thought processes. Singers classified as middle-class saw cognitive stimulation through the challenge and achievement of learning music, the opportunity to develop a new skill set, and to increase their musical knowledge.

Discussion

The act of singing itself is a physical one; therefore, singing must have physiological effects. Singing can lead to increased heart-rate, which in turn means that there is an element of cardio-vascular exercise taking place during singing (Clift & Hancox, 2001). Breathing hugely impacts singing; air passing through the vocal chords is what produces sound. As we sing, we exercise our lungs and diaphragm. This exercise has been known to improve lung function in asthma patients (Wade, 2002). Singing may impact the body's ability to tolerate pain, by way of an endorphin release (Clift & Hancox, 2001; Kenny & Faunce, 2004; Tanner, 2006). However, studies exploring the use of singing as an addition to the standard pain management plan do not entertain the notion that singing could simply serve as a distraction from pain. These studies note that the extent to which singing helps with pain management is only marginally significant (Kenny & Faunce, 2004; Tanner, 2006). Singing also benefits immuno-health. Healthy immune functioning largely contributes to the body's overall health. Singing has been known to result in lowered cortisol levels and increase secretory immunoglobulin levels (SIgA). Lowered cortisol levels translate to lower stress levels, while increased SIgA is related to improved mood and helps the body fight respiratory infection. In combination, lowered cortisol and high SIgA, produces healthy immune functioning (Beck et al., 2000; Beck et al., 2006; Kreutz et al., 2004). It is widely understood in the medical community that high stress levels negatively impact our overall physical health.

Although Bailey and Davidson (2002, 2005) briefly discuss singing's perceived cognitive benefits, stating that the concentration required to learn a piece of music served as cognitive stimulation, there is little research examining the cognitive benefits of singing. However, there is a body of research that examines the cognitive benefits of learning to play and playing music. One study examining the benefits of playing music in an ensemble suggests that task-switching and attending are exercised while playing in an ensemble. Playing in an ensemble requires the musician to focus on their individual part while simultaneously maintaining an awareness of the piece as a whole (Keller, 2001).This could be said for singing in a choir as well; however, there is no research to support this.

The literature clearly shows that singing has numerous psychological benefits. Singing has been known to positively impact social, emotional, and cognitive well-being. In addition, singing in a group provides people with the opportunity to build relationships and community, which are vital to a person's overall well-being (Bailey & Davidson, 2002, 2005; Baslnes, 2012; Clift & Hancox, 2001; Judd & Pooley, 2014). Singing makes people happy; it is a pleasurable activity. Numerous studies reported that participants noticed improvements in their overall mood and were left feeling uplifted and joyful while singing (Bailey & Davidson, 2002, 2005; Kenny & Faunce, 2004; Unwin, Kenny, & Davis, 2002; Clift & Hancox, 2001; Baslnes, 2012; Judd & Pooley, 2014). Singing can act as a coping mechanism. Many of these studies reported that participants felt they were better able to cope with loss as well as difficulties at home and at work as a result of singing (Bailey & Davidson, 2002, 2005; Baslnes, 2012; Clift & Hancox, 2001; Judd & Pooley, 2014). Singing provides an opportunity for feeling a sense of accomplishment. Learning and performing a piece of music can be incredibly challenging, and successfully accomplishing that challenge can be highly rewarding. Additionally, working with a group to learn and perform a piece of music solidifies community and amplifies that sense of accomplishment (Bailey & Davidson, 2002, 2005; Baslnes, 2012; Clift & Hancox, 2001; Judd & Pooley, 2014).

This review of the literature, for all intents and purposes, confirms what I already understand intuitively as a musician and artist: singing can positively impact a person's mental and physical well-being. This review of the literature is by no means comprehensive; it only scratches the surface of a growing body of research about the extra-musical benefits of singing. However, it is a starting point for discussion for those involved in singing, as wells as a support for those educators who strive to develop a more holistic understanding of music in education.

References

Bailey, B.A., & Davidson, J. W. (2002). Adaptive characteristics of group singing: perceptions from members of a choir for homeless men. Musicae 4(2), 221-256.

Bailey, B.A., & Davidson, J.W. (2005). Effects of group singing and performance for marginalized and middle-class singers. Psychology of Music, 33(3), 269-303.

Baslnes, A.H. (2012). Choral singing, health and quality of life: The story of Diana. Arts & Health 4(3), 249-261.

Beck, R.J., Cesario, T.C.,Yousefi, A., & Enamoto, H. (2000). Choral singing, performance perception, and immune system change in salivary immunoglobulin A and cortisol. Music Perception, 18, 87-106.

Beck, R.J., Gottfried, T.L., Hall, D.J., Cisler, C.A., & Bozeman, K.W. (2006) Supporting the health of college solo singers: The relationship of positive emotions and stress to changes in salivary IgA and cortisol during singing. Journal for Learning through the Arts: A Research Journal on Arts Integration in Schools and Communities, 2(1). Retrieved from: http://escholarship.org/uc/item/003791w4

Clift, S.M., & Hancox, G. (2001). The perceived benefits of singing: Findings from preliminary surveys of a university college choral society. The Journal of the Royal Society for the Promotion of Health, 121(4), 248-256.

Glick, M.L. (2011). Singing, health, and well-being: a health psychologist's review. Psychomusicology: music, mind & brain, 21(1-2), 176-207.

Hunter, B.C. (1999). Singing as a therapeutic agent, in The Etude, 1891-1949. Journal of Music Therapy, 36(2), 125-143.

Judd, M., & Pooley, J.A. (2014). The psychological benefits of participating in group singing for members of the general public. Psychology of Music, 42(2), 269-283.

Keller, P.E. (2001). Attentional resource allocation in musical ensemble performance. Psychology of Music, 29, 20-38.

Kenny, D.T., & Faunce, G. (2004). The impact of group singing on mood, coping and perceived pain in chronic pain patients attending a multidisciplinary pain clinic. Journal of Music Therapy, 41, 241-258.

Kreutz, G., Bongar, S., Rohrmann, S., Hodapp, V., & Grebe, D. (2004). Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of Behavioural Medicine, 27, 623-635.

McKinney, C.H., Antoni, M.H., Kumar, M. Tims, F.C. & McCabe, P.M. (1997). Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychology, 16(4), 390-400.

Tanner, J. (2006). Music for pain relief. The Journal of Perioperative Practice, 16(7), 314.

Unwin, M.M., Kenny, D.T., & Davis, PJ. (2002). The effects of group singing on mood. Psychology of Music, 30, 175-185.

Wade, L. M. (2002). A comparison of the effects of vocal exercises/singing versus music-assisted relaxation on peak expiratory flow rates of children with asthma. Music therapy perspectives, 20(1), 31-37.

World Health Organization [WHO]. (2013/2014). Mental health: a state of wellbeing. Retrieved from: http://www.who.int/features/factfiles/mental_health/en/

Katryn (Katie) Hurst is currently pursuing her Master's of Education at Queen's University in Kingston, Ontario, Her thesis work will explore the impact of singing on well-being for members of an un-auditioned choir for higher education students, She is a graduate of the vocal program at the Marcel A, Desautels Faculty of Music at the University of Manitoba andthe Queen's University Consecutive Teacher Education Program, Katie is also a singer-songwriter, private music teacher, and host of Indie Wake Up Call on CFRC 101.9 FM's Queen's campus-community radio,
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Title Annotation:principal themes
Author:Hurst, Katryn
Publication:Canadian Music Educator
Date:Jun 22, 2014
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