Feature with Dr. Robb

Reducing stress and improving survivorship in children is music to a researcher’s ears

Sheri RobbSheri Robb, PhD

By Candace Gwaltney

Nov. 30, 2022 

A music therapist strums her guitar and guides a distressed preschool-aged cancer patient in singing a familiar children's song. Slowly the child starts to open up, and the giggles that once were constant are shared again among the child, parent and therapist. The child isn't just engaging in a fun respite from treatment but is experiencing much-needed independence, choice and support. 

"There's nothing inherently therapeutic or magical about singing 'Five Little Speckled Frogs’—it's the way that the therapist is using the activities in that particular moment," said IU Simon Comprehensive Cancer Center researcher Sheri Robb, Ph.D. 

A nationally renowned music therapy researcher, Robb is exploring how music and play interventions can reduce stress, improve survivorship and boost the immune system in children ages 3-8 during cancer treatments. Robb is a professor at the IU School of Nursing and the Walther Professor of Supportive Oncology at IU School of Medicine. 

Awarded a $2 million grant from the National Institutes of Health, Robb is examining the effects of active music and play interventions on multiple biomarkers to provide a more holistic understanding of how music therapy reduces cancer-related stress. 

"The work that we're doing looks at the use of music play, which is an intervention that's delivered by a music therapist," Robb said. "It uses music and play as a way to address the distress that young children and their parents experience as they go through cancer treatment." 

Research is being conducted with 228 child and parent pairs in Indianapolis, Chicago and Kansas City, Mo. The children will be undergoing outpatient treatment for acute lymphoblastic leukemia and lymphoma.

With this grant, Robb and colleagues are measuring cortisol (a stress hormone) from saliva samples in both the child and parent as a biomarker for stress. The study will also use patient blood tests to explore if music therapy can lower biological markers of stress enough to also improve the child's immune function. Because child and parent distress is interrelated, researchers are aiming to reduce stress levels in both the patient and caregivers. 

With cancer treatment, oftentimes, you feel like you're losing choices and control, and children particularly can start to feel highly stressed when they feel like they don't have control," Robb said. "Supportive environments give that back to you.

"With cancer treatment, oftentimes, you feel like you're losing choices and control, and children particularly can start to feel highly stressed when they feel like they don't have control," Robb said. "Supportive environments give that back to you." 

The music play intervention is grounded in three elements: creating a structured environment, offering choice and control, and building supportive relationships. 

In a music play session, the therapist may offer a menu of activities so the child can guide the therapy by choosing songs and who will play which instrument. The therapist also works with the child and parent to set collaborative goals, which sets them up to develop the skills for using music to manage symptoms and stress. Simultaneously, the therapist uses improvisational strategies to change what she's doing with the music to match how the child is leading. The therapist is also leveling the elements of choice based on the child's stress levels. 

"One of the premises of why we think this therapy works is because we have the opportunity to bring something normalizing amid a not-normal-life experience to buffer the impact of cancer treatment for parents and kids," Robb said. Data from a previous trial led by Robb has shown that this buffering effect is benefitting parents of young children with cancer. 

Robb's project is part of the exclusive group of first research projects of the NIH's Sound Health Initiative to advance the understanding of music's mechanism of action in the brain and how it may be applied more broadly to treat symptoms of diseases like cancer and disorders such as stroke and chronic pain.  Robb also serves on the leadership team for the Sound Health Network

 "These initiatives are bringing together clinicians and scientific scholars from diverse fields, including music therapy, music perception and neuroscience to better understand uses of music for health," Robb said. “We have seen sustained national attention on the importance of music for health. It will be exciting to see the scientific and clinical advances that will result from these initiatives.”

Fast facts

  • As part of the initiative, Robb has shared the stage with singer-songwriter Ben Folds and world-renowned opera singer Renée Fleming to discuss the power of music therapy. 
  • Approximately 8,000 music therapists practice in the United States; many of the positions are funded by philanthropic dollars. Researchers such as Robb hope continued scientific data will grow access to music therapy services and arts in health programs.
Candace Gwaltney is the cancer center’s science writer.


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