Journal of Behavioral Medicine, Vol. 27, No. 6, December 2004 (
Effects of Choir Singing or Listening
on Secretory Immunoglobulin A,
Cortisol, and Emotional State
and Dorothee Grebe
Accepted for publication: November 11, 2003
The present study investigates the effects of choir music on secretory im-
munoglobulin A (S-IgA), cortisol, and emotional states in members of a mixed
amateur choir. Subjects participated in two conditions during two rehearsals
1 week apart, namely singing versus listening to choral music. Saliva samples
and subjective measures of affect were taken both before each session and 60
min later. Repeated measure analyses of variance were conducted for positive
and negative affect scores, S-IgA, and cortisol. Results indicate several sig-
niﬁcant effects. In particular, singing leads to increases in positive affect and
S-IgA, while negative affect is reduced. Listening to choral music leads to an
increase in negative affect, and decreases in levels of cortisol. These results sug-
gest that choir singing positively inﬂuences both emotional affect and immune
competence. The observation that subjective and physiological responses dif-
fered between listening and singing conditions invites further investigation of
KEY WORDS: singing; S-IgA; cortisol; emotion.
Department of Music Education, Johann Wolfgang Goethe-University Frankfurt am Main,
Department of Psychology, Johann Wolfgang Goethe-University Frankfurt am Main,
To whom correspondence should be addressed at Department of Music Education, J. W.
Goethe-University Frankfurt am Main, Sophienstrasse 1-3, D-60487 Frankfurt am Main,
Germany; e-mail: G.Kreutz@em.uni-frankfurt.de.
2004 Springer Science+Business Media, Inc.
624 Kreutz, Bongard, Rohrmann, Hodapp, and Grebe
Since the times of Plato, artists and scientists alike have been intrigued
by the power of music to elicit strong emotional responses in humans and
animals. The Greek philosophers were among the ﬁrst in the Western culture
to speculate about speciﬁc effects of music on bodily chemistry, and subjec-
tive feelings (Levman, 2000). For example, they were convinced that music
beneﬁted health and speciﬁc recommendations were formulated for using
music therapeutically against mental and physical illness (Bruhn, 2000).
Empirical research over the past decades has addressed the psychophys-
iological effects of music listening with some emphasis on the responses of
the autonomous nervous system (ANS) (e.g., Goldstein, 1980; Kreutz et al.,
2002a,b; Panksepp, 1995). In general, this research suggests that listeners’
subjective experience is at least in part mediated by physiological responses
to music stimuli (Bartlett, 1996). However, few studies were able to relate
peripheral ANS responses to emotional experiences of music (Krumhansl,
1997; Nyclicek et al., 1997). To date, this research did not yet provide re-
liable evidence for associations between music and health related ANS
It appears well established that the ANS profoundly affects immune
functions (Ader et al., 1991). Most of the studies reviewed below have
used secretory IgA (S-IgA) as a marker of immune competence (Stone
et al., 1987b). S-IgA is a protein considered as the body’s ﬁrst line of de-
fense against bacterial and viral infections of the upper respiratory pathway
(Tomasi, 1972). In particular, S-IgA was found more strongly inﬂuenced via
the sympathetic rather than the parasympathetic branch of the ANS (Ring
et al., 1999). There is general consensus that S-IgA is speciﬁcally responsive
to an individual’s emotional state (Rein and McCraty, 1995). Increases of
S-IgA were often observed in the context of positive and/or relaxing experi-
ences (e.g., Green and Green, 1987; Stone et al., 1987a), whereas S-IgA often
decreased in studies on the emotional impact of stressful events (Martin and
Dobbin, 1988) and intense physical effort (Mackinnon and Hooper, 1994).
Research on the effects of music listing on immune system and emo-
tional stress are receiving increasing attention in behavioral medicine (Pratt
and Spintge, 1996). Several studies have speciﬁcally looked at the relation-
ship between music listening, subjective mood, and immune competence.
Music listening may signiﬁcantly inﬂuence immune functions via the ANS
(McCraty et al., 1996). In particular, S-IgA increased in the context of music
listening and relaxation (Tsao et al., 1992; see also Van Rood et al., 1993).
Individual music preferences and context factors appear to be important in
mediating these effects. Therefore, music may beneﬁt patients in individ-
ual treatment formats (e.g., McKinney et al., 1997a). McCraty et al. (1996)
Effects of Choir Singing or Listening on Secretory Immunoglobulin A 625
concluded that music listening may enhance the beneﬁcial effects of self-
induced positive mood on immunity.
McKinney et al. (1997b) found that the combination of classical music
and spontaneous imagery led to signiﬁcant decreases in beta-endorphin, a
hormone which is believed to be related to emotional stress (Panksepp et al.,
1979). Gerra et al. (1998) extended these ﬁndings using classical and techno
music. They found correlations between personality traits such as novelty-
seeking or harm avoidance and musically-induced endocrine responses, also
In lieu of increasing evidence that music listening may inﬂuence immune
competence and physiological stress in adult listeners (Pratt and Spintge,
1996), there is no comparable research on the conceivably enhancing effects
of more active musical behaviors than listening. For example, the emotional
effect of singing on the organism of the singer is yet poorly understood, al-
though singing is probably the most common everyday musical activity ob-
servable in all cultures (Nettle, 2000). In a pioneering study, Beck et al. (1999)
looked at the endocrine effects of singing in professional chorale singers. The
authors were interested in the effects of three singing conditions (two dif-
ferent rehearsals and one performance) on changes of S-IgA and cortisol.
Cortisol is a hormone associated with emotional stress (Kirschbaum and
Hellhammer, 1994). Beck et al. (1999) found strong increases of S-IgA in
each condition. For instance, during the performance S-IgA levels went up
by more than 350% in nearly 25% of the singers. Levels of cortisol, by con-
trast, were found to decrease in the rehearsal conditions only, but increased
signiﬁcantly during the performance. These results suggested different ef-
fects of singing on S-IgA and cortisol. A further ﬁnding of the Beck et al.
study was that according to a multiple regression analysis several subjective
measures associated with positive attitudes toward singing predicted changes
in S-IgA. To explain these ﬁndings it was speculated that breathing patterns
induced by singing as well as positive mood change might contribute to the
observed S-IgA increases.
More recent studies tend to corroborate subjective positive mood ef-
fects and health beneﬁts of singing in groups (Clift and Hancox, 2001; Grape
et al., in press; Unwin et al., 2002; Valentine and Evans, 2001). However, it
is yet not clear whether and to what extent the observed effects could be
attributed to mere passive exposure to musical sound, rather than active
physical engagement in singing. As shown above, listening to music alone
may induce a variety of signiﬁcant endocrine effects, even irrespective of
subjects’ musical training (Bartlett, 1996; McCraty et al., 1996).
On the basis of these previous ﬁndings, the purpose of the present
study was to compare subjective and physiological responses produced by
group singing with those elicited by listening to music and to establish any
626 Kreutz, Bongard, Rohrmann, Hodapp, and Grebe
differences as subjects’ processed the same musical materials in these con-
ditions. It was hypothesized that both singing and listening enhance speciﬁc
immune functions as well as they lead to positive changes of affective states.
Therefore, we expected signiﬁcant increases in S-IgA and subjective positive
emotional state as well as signiﬁcant decreases of cortisol and negative emo-
tional state after singing and after listening to choral music, but that these
effects were more pronounced in the singing condition.
Thirty-one members (23 female) of an amateur choir participated in
this study. Participants’ age ranged from 29 to 74 years (M = 56.9 years,
SD = 14.8 years). As assessed by a questionnaire, none of the participants
reported smoking more than 10 cigarettes per day or drinking more than
5 alcoholic drinks per week. On a questionnaire, subjects did not indicate
acute health problems with respect to respiration or cardiovascular system.
All subjects gave informed consent individually.
Design and Procedure
After informed consent was obtained from all participants, the exper-
imental conditions for this study were realized in two sessions at the same
location in the rehearsal room of a church at the regular time of that choirs’
rehearsal between 6 and 7 p.m. The sessions were conducted 1 week apart
and lasted for 60 min each. Participants were instructed not to take in any
meals, or alcoholic drinks, and refrain from smoking within 1 h before the
start of the rehearsal.
Before the ﬁrst session started, each participant ﬁlled in a demographic
questionnaire. Moreover, before each of the two sessions, a psychometric
scale for the measurement of emotional state (Positive and Negative Affect
Schedule, PANAS; Krohne et al., 1996; Watson et al., 1988) was completed.
The PANAS consists of 20 items, 10 representing positive affect (e.g., “I feel
ﬁne”), and 10 items representing negative affect (e.g., “I feel depressed”).
Participants were asked to mark each of the items on a scale from 1 (“very
little or not at all”)to5(“extremely”) according to their current feeling.
The PANAS was ﬁlled in once again at the end of each session. Also, at
the beginning and at the end of each session, saliva was collected using a
standard procedure (see next section).
Effects of Choir Singing or Listening on Secretory Immunoglobulin A 627
The singing condition was initiated by a 10-min warm-up phase, in which
various breathing, stretching, and vocalization exercises were performed.
For the rest of the session, sections and pieces from Mozart’s Requiem were
rehearsed, and instructions by the conductor were given to the choir. Par-
ticipants stood during the warm-up, whereas they remained seated for the
rest of the time. Times of interruptions by the conductor were measured and
approximated 10 min of the rehearsal time.
During the second session 1 week later, the pieces from Mozart’s Re-
quiem were presented from CD, and articles on singing from an eighteenth
century encyclopedia of the arts (Sulzer, 1967) were read aloud. Participants
were seated during the entire session. When music was played, they were
instructed to listen to the music attentively as if they were engaged in singing.
Moreover, it was ensured that listening to speech and music under the lis-
tening condition had the same proportion as singing and listening to the
conductor under the singing condition.
Saliva Collection and Assaying
Saliva was collected with Sarstedt Salivettes
. This device consists of
a plastic tube containing a cotton wool swab. Subjects were asked to insert
the swab into their mouth and were instructed not to swallow saliva for a
5-min period. Afterwards this cotton wool swab was placed back into the
tube. Saliva samples were centrifuged at 4000 × g for 10 min and then were
kept at −30
C until assayed.
Measured parameters in saliva samples were immunoglobulin A, al-
bumin, and cortisol. Albumin levels served both as an exclusion criterion
for blood contaminated saliva samples and for correcting the S-IgA mea-
sures for effects of saliva ﬂow density. Because albumin leaks passively into
saliva from systemic sources, its concentration reﬂects mucosal membrane
permeability. The ratio of S-IgA to albumin thus provides an indication of
the local secretory immune response controlling for any serum leakage of
IgA (Cripps et al., 1991; Drummond and Hewson-Bower, 1996).
After thawing, saliva was analyzed for concentrations of S-IgA and
albumin by use of a fully automated nephometric analyses (BN100, Dade
Behring, Marburg, FRG). The assay protocol has been adapted to the ex-
pected range for saliva concentrations of S-IgA between 0 and 120 mg/dL
628 Kreutz, Bongard, Rohrmann, Hodapp, and Grebe
and albumin (0–27 mg/dL), respectively using highly speciﬁc monoclonal
antibodies for human S-IgA and albumin (Dade Behring). Previous mea-
sures revealed extremely high intra- and interassay precision which can be
expected in general for protein analysis and which justiﬁes single measure-
ments of samples in clinical practice.
Saliva cortisol was determined using a commercial luminescence-
immuno assay (IBL, Hamburg, FRG) especially designed for saliva sam-
ples and approved by the Food and Drug Administration (FDA). Pipetting
of standards, samples, and reagents was performed by a fully automated
system (Labotech, Freiburg, FRG).
Luminescence units were read by use of an automatic luminometer
(Beckmann, FRG). All samples were measured in duplicates with sufﬁcient
intra-assay precision (coefﬁcient of variance, CV < 6%). All samples were
analyzed with assays obtained from the same charge to reduce interassay
variation, which was lower than 10%.
Saliva analyses were conducted at the lab of Prof. Dr. J. Hennig at the
Department of Psychology, Justus-Liebig-University Giessen, Germany (for
more details see: Hennig et al., 1999).
Positive and negative affect sum scores were calculated for the two con-
ditions. To determine any signiﬁcant changes of positive and negative affect,
two repeated measures analyses of variance (ANOVA) were conducted for
each of the two scores. Similarly, S-IgA/albumin and cortisol values were
submitted to two separate repeated measures ANOVAs. In all analyses,
condition (singing versus listening) and time (baseline and after treatment)
served as independent variables. In addition, to determine statistical rela-
tionships between subjective and physiological changes, Pearson’s product
moment correlations were calculated.
Mean scores of positive and negative affect ratings before and after the
two conditions are presented in Table I. Data from three subjects were not
included due to large proportions of missing values.
An ANOVA for positive affect values indicated no signiﬁcant main
effect of condition, F(1, 27) = 3.08, p = 0.09, or time, F(1, 27) = 1.30,
Effects of Choir Singing or Listening on Secretory Immunoglobulin A 629
Table I. Means (and Standard Deviations) of Positive and Negative Affect Ratings for
the Two Experimental Conditions at Baseline and After Treatment
Positive affect Negative affect
Baseline After treatment Baseline After treatment
Singing 2.86 (0.51) 3.15 (0.64) 1.31 (0.4) 1.18 (0.24)
Listening 2.85 (0.67) 2.79 (0.81) 1.23 (0.25) 2.20 (0.31)
Note. Scores of each scale were divided by the number of items.
p = 0.26. However, there was a signiﬁcant interaction between time and
conditions, F(1, 27) = 6.41, p < 0.02. Follow-up Tukey’s HSD tests of sim-
ple effects revealed that positive affect increased signiﬁcantly after singing
(p < 0.05), but not after listening. An ANOVA which addressed nega-
tive affects scores revealed highly signiﬁcant main effects for condition,
F(1, 27) = 95.71, p < 0.001, time, F(1, 27) = 113.57, p < 0.001, and a signif-
icant interaction between the two factors, F(1, 27) = 145.91, p < 0.001. Post
hoc Tukey’s HSD-Tests of simple effects indicated a signiﬁcant decrease of
negative affect after singing ( p < 0.05), and a signiﬁcant increase of negative
affect after listening (p < 0.05).
Table II presents mean S-IgA/albumin and cortisol values at baseline
and after treatment.
An ANOVA of S-IgA/albumin values revealed a highly signiﬁcant main
effect of condition, F(1, 30) = 10.41, p < 0.005, but no signiﬁcant main
effect of time, F(1, 30) = 0.24, p = 0.62. As predicted, there was a signiﬁcant
interaction between time and condition, F(1, 30) = 4.32, p < 0.05 on S-
IgA/albumin. Follow-up Tukey’s HSD-Tests of simple effects indicated a
highly signiﬁcant increase of S-IgA/albumin for the singing condition (p <
Table II. Means (and Standard Deviations) of S-IgA/Albumin and Cortisol Values Before
and After Treatment for the Two Experimental Conditions
S-IgA/albumin Cortisol [ng/mL]
Baseline After treatment Baseline After treatment
Singing 3.66 (3.15) 5.28 (5.26) 0.75 (0.67) 0.59 (0.48)
Listening 4.10 (4.20) 4.49 (3.78) 0.81 (0.61) 0.48 (0.27)
Note. S-IgA/albumin is without unit because the units for both parameters are identical
630 Kreutz, Bongard, Rohrmann, Hodapp, and Grebe
Fig. 1. Means and standard errors of S-IgA/albumin values before and after singing choral
music and listening to choral music respectively.
0.005), but no signiﬁcant changes for the listening condition (p = 0.79).
Figure 1 illustrates the signiﬁcant condition by time interaction on mean
An ANOVA, which addressed cortisol values, revealed a signiﬁcant
main effect of time, F(1, 30) = 10.30, p < 0.005, but no further effects.
However, since we had speciﬁc hypotheses considering different effects
of singing versus listening on cortisol responses, we did pairwise compar-
isons of baseline and after treatment values for both conditions separately.
These analyses indicated that cortisol decreased signiﬁcantly from baseline
to after treatment in the listening condition, F(1, 28) = 12.14; p < 0.001,
but did not change signiﬁcantly in the singing condition, F(1, 30) = 2.56;
p > 0.1.
Pearson correlations between changes in subjective and physiological
measures were calculated separately for the two conditions. Out of eight
coefﬁcients, only one turned out to be signiﬁcant: changes of positive mood
during listening correlated signiﬁcantly with changes of cortisol levels, r =
0.40, p < 0.05.
Effects of Choir Singing or Listening on Secretory Immunoglobulin A 631
This study demonstrated psychophysiological effects of choral singing
and listening to choral music. We found different patterns of changes for
S-IgA, cortisol, and subjects’ emotional state with respect to the two ex-
perimental conditions. Singing led to a decrease in negative mood and an
increase in positive mood and S-IgA, but did not affect cortisol responses.
Listening on the other hand led to an increase in negative mood, a decrease
in cortisol, and no signiﬁcant changes in positive mood and S-IgA.
These results support the hypothesis, that choir singing inﬂuences posi-
tive emotions as well as immune functions in humans. They conﬁrm previous
ﬁndings which showed that singing inﬂuences subjective emotional states
positively (Unwin et al., 2002) and enhances the immune defence (Beck
et al., 1999). These studies corroborate the notion that musically-induced
changes of S-IgA are mediated by subjective mood (McCraty et al., 1996;
Rein and McCraty, 1995).
Contrary to expectations, we observed a decrease of cortisol only for
the listening condition but not for the singing condition. On one hand, de-
creases of cortisol levels suggest psychological deactivation, relaxation, and
stress reduction. On the other hand, it is known that cortisol levels decrease
during the waking hours of human subjects (Kirschbaum and Hellhammer,
1994). This decrease is relatively steep in the morning but slows down in the
afternoon. Given the fact that in the present study all measures were taken
between 6 and 7 p.m. it is rather unlikely that the observed decrease of about
60% within 60 min in the listening condition is only due to the diurnal ef-
fect. The observation that listening also led to an increase in negative mood
suggests that the listening condition was at least partly experienced as un-
exciting, boring, and deactivating by our participants. This interpretation is
very reasonable given the fact that the main objective for these amateur cho-
risters is the production but not the reception of music. The singing condition
on the other hand may have prevented against deactivation and decrease in
cortisol. Moreover, Beck et al. (1999) showed that the performance situation
(rehearsal versus public concert) inﬂuenced the direction of changes of cor-
tisol levels, which decreased during the rehearsals but increased during the
public performance. The authors reasoned that the latter were emotionally
more demanding than rehearsals.
The observed decrease of cortisol levels following the listening period,
while participants reported increased negative mood in the same condition,
is consistent with previous work (Davis and Thaut, 1989), which indicated
that music listeners can present contradictory responses on psychological
and physiological measures. One possible explanation for this dissociation
632 Kreutz, Bongard, Rohrmann, Hodapp, and Grebe
is that music expressing negative emotions, e.g., grief or sadness, is often
experienced as relaxing and soothing (V¨astfj¨all, 2002).
Positive emotions increased after singing, and negative emotions in-
creased after listening. Why did listening to the music not result in the same
subjective responses as singing? Many people report that they enjoy listen-
ing to music in a group setting such as attending a public concert. But again,
it must be kept in mind, that the primary goal of a regular choir rehearsal is
to practice singing. The experimental intervention required by the listening
condition, therefore, was in conﬂict with the routine rehearsal procedure,
and with the intensions and expectations of the individual choristers. In ad-
dition, choristers are more focused on vocal control, watching the music
sheet and the conductor, and listening to their fellow singers during singing
than during listening. Finally, previous studies have addressed the affective
impact of lyrics (Stratton and Zalanowski, 1994), but it is unclear, whether
and to what extent the contents of the lyrics are differentially perceived
during listening as compared to singing. We assume, that the emotionally
negative connotations of the requiem might have had a stronger impact on
affective responses during listening than during singing.
Limitations of the present study should be noted. First, in this study,
there was only one large piece of classical music included. Thus it remains
to be seen, whether our ﬁndings can be generalized across different styles
and genres of music as well as across the selection method of the musical
materials (Thaut and Davis, 1993). Second, as this study was conducted with
choral singers in a group setting, questions arise as to whether similar effects
may be found in solo singing (Valentine and Evans, 2001). Third, we did not
control for physical activity, which is known to inﬂuence mucosal immune
system responses (Mackinnon and Hooper, 1994). For our subjects singing
was physically more demanding than just listening. Future research should
investigate whether and to what degree the observed effect of singing on
S-IgA might be explained by different degrees of physical activity.
Finally, it seems worth to note that humans are not the only species
to exhibit relationships between singing and immune functions (Duffy and
Ball, 2002). One might speculate, that similar relationships as in this study
may be detected in other primates, as vocal production in these species is
directly related to emotional affect and stress-regulation (Grossmann, 2000;
In sum, the present study shows that amateur group singing leads to
increases in both positive affect and the production of salivary immunoglob-
ulin A, a protein considered as the ﬁrst line of defense against respiratory
infections. It replicates previous work demonstrating an association between
singing and immune function, and suggests a possible inﬂuence of musical
behavior on well-being and health.
Effects of Choir Singing or Listening on Secretory Immunoglobulin A 633
This study was supported by a grant of the Deutscher S ¨angerbund e. V.
(German Singers Association). We are grateful to two anonymous reviewers
for their valuable suggestions.
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