Attending a concert reduces glucocorticoids, progesterone and the cortisol/DHEA ratio

Abstract

Corresponding author. Centre for Performance Science, Royal College of Music, London, UK.

Full text

Short Communication
Attending a concert reduces glucocorticoids,
progesterone and the cortisol/DHEA ratio
Daisy Fancourt
a,b
, Aaron Williamon
a,b,*
a
Centre for Performance Science, Royal College of Music, London, UK
b
Faculty of Medicine, Imperial College London, London, UK
article info
Article history:
Received 9 September 2015
Accepted 14 December 2015
Available online xxx
There is a fast-growing interest in the impact of the arts on the
health and well-being of individuals. The past two decades
have seen a burgeoning of studies exploring how arts
engagement, from therapy to education to everyday settings,
can impact on psychological and physiological health pa-
rameters.
1
In particular, there have been increasing numbers
of studies examining the impact of both making and listening
to music on biological response, with recent reviews high-
lighting the effects of music variously on hormones, neuro-
transmitters, and cells and proteins within the immune
system.
2
Over 30 controlled studies examining biological responses
to music listening have been reported in the literature.
2
However, these have all been carried out either under labo-
ratory conditions or in clinical settings, such as hospital
waiting rooms, and have nearly all involved recorded music
rather than live performance. To date, there have been no
studies exploring the impact of listening to live singing
through attending a public concert. This is despite the sig-
nificant attention given to the impact of attending cultural
events and visiting cultural venues among policy makers.
3,4
Our study explored the impact of attending a live, public
concert on steroid hormone response. As this was the first
study to investigate the impact of listening within a cultural
space, we ran the experiment twice, four months apart, in two
separate venues. For both concerts, the performers,
conductor, length of concert, genre of music and key pieces
within the programme were kept the same in order to repli-
cate the listening experience as closely as possible.
Immediately before each concert and in the interval 60 min
later, participants were asked to provide a saliva sample
through a straw into a polypropylene cryovial. Subsequently,
samples were stored at 20 C for three weeks prior to anal-
ysis using high performance liquid chromatography-tandem
mass spectrometry (LC-MS/MS) with Atmospheric Pressure
Chemical Ionization (APCI) coupled with on-line solid phase
extraction (SPE), for the steroid hormones cortisol, cortisone,
dehydroepiandrosterone (DHEA), progesterone and testos-
terone. Cortisol and cortisone are both glucocorticoids
involved in stress response; DHEA is a steroid hormone
involved in immune enhancement; and higher ratios of
cortisol/cortisone and cortisol/DHEA are indicative of higher
stress levels. Progesterone and testosterone are both sex
hormones also involved in stress response. The biological data
were logarithmically transformed to correct for positive skew
and analysed using a repeated measures analysis of variance
(ANOVA) comparing changes across time (pre vs post perfor-
mance) and, in the case of DHEA, between men and women.
Correlation analyses were performed using Pearson's product-
moment correlation coefficient.
Concert 1. Forty-nine adults attending a performance of
music by composer Eric Whitacre were recruited for the
study: 15 men and 34 women (mean age ¼38.6 years,
SD ¼15.0, range 18e59). They were volunteers from among
an audience of 700 people at the London concert venue Union
Chapel. The participant group was representatively mixed in
their musical backgrounds and experiences, comprising
*Corresponding author. Centre for Performance Science, Royal College of Music, London, UK.
E-mail address: aaron.williamon@rcm.ac.uk (A. Williamon).
Available online at www.sciencedirect.com
Public Health
journal homepage: www.elsevier.com/puhe
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0033-3506/©2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Fancourt D, Williamon A, Attending a concert reduces glucocorticoids, progesterone and the cortisol/
DHEA ratio, Public Health (2016), http://dx.doi.org/10.1016/j.puhe.2015.12.005

regular concert-goers attending up to 120 concerts per year
and those who had not attended a concert in the previous six
months, as well as people who had no experience making
music themselves and some with as long as 57 years'expe-
rience. When asked to rate how familiar they were with the
music of Eric Whitacre, the mean familiarity was 6.79 (of 10,
SD ¼2.92, range 1e10).
Across the 60 min, there was a drop in glucocorticoid
levels, with significant decreases in cortisol (F
1,39
¼23.251,
P<0.001), cortisone (F
1,48
¼27.286, P<0.001) and the cortisol/
cortisone ratio (F
1,39
¼9.604, P¼.004) (see Fig. 1A). There was
no significant change in DHEA nor for the cortisol/DHEA ratio,
but there was a near-significant time sex interaction for
DHEA, with men experiencing an increase across the perfor-
mance and women a decrease. However, retrospective power
calculations indicated that there were insufficient participant
numbers to assess DHEA robustly. No significant changes
were found in testosterone and progesterone, although the
latter showed signs of a downwards trend from pre to post
performance. Overall, correlation analyses revealed that these
results were not statistically related to age, sex, familiarity
with the music, musical experience or frequency in attending
concerts.
Concert 2. Sixty-eight adults volunteered to take part from
among an audience of 800 attending a matched performance
of Eric Whitacre's music at Gloucester Cathedral, given as part
of the 2015 Cheltenham Music Festival: 26 men and 42 women
(mean age ¼55.01 years, SD ¼13.8, range 18e82). The sample
size was increased intentionally to allow for greater power in
the statistical analyses. Again, the participant group was
representatively mixed in their musical backgrounds and ex-
periences, comprising regular concert-goers attending up to
40 performances per year and those who had not attended a
concert in the previous six months, as well as people who had
no experience making music themselves and some with as
long as 73 years'experience. When asked to rate how familiar
they were with the music of Eric Whitacre, the mean famil-
iarity was 5.31 (of 10, SD ¼3.10, range 1e10).
Across the 60 min, there was a drop in glucocorticoid
levels, with significant decreases in cortisol (F
1,64
¼27.055,
P<0.001), cortisone (F
1,65
¼66.003, P<0.001) and the cortisol/
cortisone ratio (F
1,64
¼6.024, P¼.017), replicating the findings
from Concert 1 (see Fig. 1A). Also as in Concert 1, there were no
significant changes in DHEA from pre to post performance;
however, with greater statistical power, the cortisol/DHEA
ratio showed a significant decrease over time (F
1,62
¼27.846,
P<0.001) (see Fig. 1C). Furthermore, the analyses showed a
significant time sex interaction for DHEA (F
1,62
¼6.295,
P¼.015), with post hoc pairwise comparisons revealing a non-
significant decrease for women (P¼.144) but a significant
increase for men (P¼.047) (see Fig. 1B). Moving beyond glu-
cocorticoids, there was also a drop in progesterone
(F
1,59
¼14.832, P<.001) (see Fig. 1C); however, as in Concert 1,
no changes were found in testosterone levels.
Fig. 1 eLevels before and after of (A) Cortisol, cortisone and the cortisol/cortisone ratio for Concert 1 (left panel) and Concert
2 (right panel), and for Concert 2 only (B) Dehydroepiandrosterone by sex, (C) Progesterone and the cortisol/DHEA ratio (all
with standard error).
public health xxx (2016) 1e42
Please cite this article in press as: Fancourt D, Williamon A, Attending a concert reduces glucocorticoids, progesterone and the cortisol/
DHEA ratio, Public Health (2016), http://dx.doi.org/10.1016/j.puhe.2015.12.005

For the two concerts, our results suggest that attending a
live performance leads to lower secretion of glucocorticoids
and a reduced cortisol/cortisone ratio, indicating lowered
biological stress. These results are in line with 22 previous
studies showing that listening to music in the controlled
setting of either a laboratory or a hospital can reduce cortisol
levels.
2
However, this study has extended previous results.
Firstly, it showed that decreases are also found in the partner
glucocorticoid cortisone, which demonstrates a wider gluco-
corticoid involvement. Secondly, this is the first time that
such decreases have been found not only in tightly controlled
laboratory settings but in the naturalistic setting of a public
concert in a cultural space.
Furthermore, there are indications from these results that
concert engagement can lead to changes in more general ste-
roid hormone response, including DHEA and progesterone.
DHEA is the most abundant steroid hormone in the body.
Acting as an antagonist of glucocorticoids, it leads to enhanced
immune function, lowered cholesterol and improved muscle
deposition and has been associated with emotional responses
such as ‘warm-heartedness’.
5
Under stressful conditions, as
cortisol increases, DHEA has been found to decrease, leading to
an overall increase in the cortisol/DHEA ratio. Conversely, as
people relax, cortisol goes down, DHEA goes up and this ratio
decreases.
6
The finding from Concert 2 of the decrease in the
cortisol/DHEA ratio is further evidence of a general relaxation
effect of attending a live performance. It is intriguing that,
despite experiencing a decrease in this ratio, men actually
experienced an increase in absolute levels of DHEA while
women's levels decreased. This may suggest that the women
experienced greater relaxation than men when attending the
concert, but as there was no sex differences in any of the other
measures, this is clearly not the complete answer and further
investigation is needed in future studies.
There has been less research into the effects of stress and
relaxation on progesterone and more conflicting results. Some
studies have proposed that progesterone increases in
response to feelings of closeness,
7
while others have found no
association.
8
However, there have been suggestions that
progesterone and cortisol increase and decrease together and
are both released following adrenal activation, with proges-
terone being capable of acting as a negative feedback mech-
anism for down-regulating stress response.
9
In this study,
there was no correlation between progesterone and cortisol,
but the two did decrease together, supporting the idea that
progesterone may have been involved in a relaxation
response.
This is the first preliminary evidence that attending a cul-
tural event can have an impact on endocrine activity. It is of
note that none of these biological changes were associated
with age, musical experience or familiarity with the music
being performed. This suggests there is a universal response
to concert attendance among audience members. Fancourt
et al. have demonstrated that, for adults taking part in a 6-
week music making intervention, reductions in glucocorticoid
activity are matched with increases in immune response,
most notably increases in cytokines and chemokines
responsible for communicating between cells and within the
brain.
10
Further research is needed to ascertain whether such
an inverse response also occurs in participants attending a
cultural event, such as a concert, and consequently whether
such cultural engagement over time could lead not only to
reductions in biological stress response but also to enhance-
ments in immune activity.
There are several limitations to this study. It was uncon-
trolled and instead relied on replication to confirm findings.
The study also focused solely on the effects of relatively calm,
classical music; more research will be needed to ascertain
whether other genres of music elicit different effects or
whether attending other types of cultural events has different
endocrine impact. Nevertheless, this study opens up the
question of how engaging with music and the arts in cultural
settings can influence biological and psychological states and,
consequently, the potential of cultural events to enhance
people's broader health and well-being.
Author statements
Acknowledgements
We wish to thank Eric Whitacre, Claire Long and Megan
Davies, as well as colleagues at London's Union Chapel and
the 2015 Cheltenham Music Festival, for their support in
recruiting participants and running the study.
Ethical approval
The study was approved by Conservatoires UK ethics com-
mittee, and participants provided informed consent prior to
participating.
Funding
This research was carried out as part of ‘Creative Practice as
Mutual Recovery’, a Connected Communities project funded
by the UK's Arts and Humanities Research Council (grant ref.
AH/K003364/1). The sponsors had no involvement in the study
design, data collection or write up.
Competing interests
None declared.
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Please cite this article in press as: Fancourt D, Williamon A, Attending a concert reduces glucocorticoids, progesterone and the cortisol/
DHEA ratio, Public Health (2016), http://dx.doi.org/10.1016/j.puhe.2015.12.005