Author	D.E. Fancourt
Author	A. Steptoe
Author	L.A. Carvalho
Abstract	Research into the health benefits of music has rapidly expanded over the last decade with recent studies showing early evidence of the ability of music to alter biomarkers of the neurochemical and neuroendocrine systems. However, it is not clear to what extent music can alter the response of the immune system. This thesis explores psychoneuroimmunological responses to music, in particular focusing on how participatory music interventions can modulate inflammatory responses. The biomarkers investigated include cortisol, a neuroendocrine stress marker, a range of pro- and anti-inflammatory cytokines within the immune system, the social bonding hormone oxytocin and the neuropeptide beta-endorphin. Study 1 involved a six-week drumming intervention for mental health service users, and showed that drumming was associated with short-term increases in positive affect and cytokine activity and reductions in cortisol, and longitudinal improvements in depression, mental and social wellbeing, and reduced pro-inflammatory response. Study 2 replicated study 1 with a control group, showing comparable results at 6 weeks but also showing that if the intervention is extended to 10 weeks, there are also reductions in anxiety and all results are then maintained for 3 months following the end of the intervention. Study 3 aimed to explore the mechanisms of these effects in more detail. A randomised control trial comparing group drumming to three different control conditions showed that drumming, unlike the control conditions, leads to changes in a range of moods and emotions and the accompanying biological responses show signs of being associated with these emotions rather than with the physical parameters of group drumming. Study 4 extended the work of the previous mental health studies to explore how participatory music interventions can interact with the psychobiology of both mental health and physical health by studying patients affected by a chronic disease: cancer. A single session of group singing was found to be associated with reduced levels of cortisol, increased cytokine activity and, surprisingly, reduced levels of both beta-endorphin and oxytocin, again with associations between biological responses and emotions. Given the prevalence of mental health conditions such as depression, either as a primary or secondary diagnosis, and evidence that such conditions are associated with heightened inflammation, participatory music interventions could offer novel opportunities for managing mental health and optimising immune function in patients.