Investigating the dose-response relationship between music and anxiety reduction: A randomized clinical trial

Anxiety is one of the most frequently reported mental health conditions worldwide, yet access to effective treatments such as medication and cognitive behavioral therapy (CBT) remains limited due to cost, time, and potential side effects. Music-based digital therapeutics, particularly when combined with auditory beat stimulation (ABS), may offer a complementary approach to mainline anxiety treatment by offering acute relief of anxiety symptoms. Prior research suggests that music combined with ABS provides greater anxiety relief than music alone or a pink noise control. This study examined whether this advantage over pink noise could be replicated, as well as whether music with ABS demonstrated a dose-response relationship-operationalized as time spent listening-in the acute relief of anxiety among individuals with moderate trait anxiety who are taking medication to manage their symptoms. We also assessed changes in affect as a secondary outcome. A total of 1,310 participants were recruited via Prolific and completed a pre-screening survey. Of these, 144 eligible participants were randomly assigned to one of four groups: 24-minute pink noise (control group), 12-minute music with ABS, 24-minute music with ABS, or 36-minute music with ABS. Anxiety and affect were measured before and after the intervention using the STICSA and PANAS, respectively. All music with ABS conditions resulted in greater reductions in anxiety and negative affect compared to the control, replicating earlier findings. The largest reduction in negative affect was observed in the 36-minute condition, which was significantly greater than reduction in the 12-minute condition, suggesting a dose-response effect. These findings support music with ABS as a possible addition to existing anxiety treatments, especially when access to common behavioral health interventions is limited. Future studies should aim to increase the generalizability of the findings and further investigate the dose-effect of music on anxiety reduction. This study was retrospectively registered on ISRCTN (ISRCTN47181782).