Effect of Combined Music Therapy and Mindfulness-Based Stress Reduction on Patients with Uterine Adenomyosis Following HIFU Treatment

Music therapy combined with mindfulness-based stress reduction may improve the postoperative psychological state of patients with uterine adenomyosis, helping in their recovery and quality of life. The data from this study can be obtained by contacting the corresponding author. JinJin Yang: Developed and planned the study, performed experiments, and interpreted results. Edited and refined the manuscript with a focus on critical intellectual contributions, provided substantial intellectual input during the drafting and revision of the manuscript. Ya Chen: Participated in collecting, assessing, and interpreting the data. Made significant contributions to date interpretation and manuscript preparation. This experiment was approved by Women’s Hospital, School of Medicine, Zhejiang University Ethics Committee (No.IRB-20250224-R). We secured a signed informed consent form from every participant. This study was supported by Zhejiang Provincial Department of Education General Research Project (Natural Science Category) 2024(No. Y202455116). The authors declare no conflicts of interest.

Compared with other surgical treatments, HIFU surgery for Uterine Adenomyosis is far less invasive and has a lower incidence of postoperative complications.[ 15 ] Patients undergoing surgery often experience stress and anxiety due to procedure uncertainty, potential complications, fertility issues and postoperative concerns and recovery.[ 16 ] Stress or anxiety can affect a patient’s health to a certain extent and increase the risk of postoperative complications.[ 17 ] Furthermore, patients with elevated preoperative anxiety are prone to experiencing high levels of stress pain.[ 18 ] Postoperative anxiety and depression can impair immune function and slow wound healing, which increases the complication risk and prolongs patient recovery.[ 19 ] The combined group showed significantly lower VAS and PSQI scores than the mindfulness group ( P < 0.05). This finding implies that music therapy with mindfulness-based stress reduction reduces pain and improves sleep quality. The music likely helped calm the patients’ postoperative tension and along with mindfulness therapy, stabilised their emotions. This combination led to reduced pain and improved sleep quality. Both groups exhibited significantly decreased SDS and SAS scores after care, with a greater reduction noted in the combined group. Meanwhile, the two groups displayed notable differences existed in terms of the self-care and anxiety/depression dimensions of ED-5Q ( P < 0.05), with patients in the combined group having superior self-care and lower anxiety/depression. However, the two groups showed no significant difference in terms of mobility, usual activities and pain/discomfort. This outcome may indicate that the current combined regimen has limitations in improving patients’ physiological functions. Future enhancements can involve refining care through the incorporation of a postoperative rehabilitation program to improve patients’ postoperative quality of life. Meanwhile, the utility value of the mindfulness group (0.437 ± 0.153) was significantly lower than that of the combined group (0.602 ± 0.161) ( P < 0.05), which indicates that the music therapy combined with orthomolecular therapy effectively improved patients’ self-care and lowered anxiety levels. This finding was observed possibly because music helped ease the patient’s postoperative anxiety, whereas mindfulness-based further reduced their negative emotions. Using both approaches together more effectively lowered the patient’s anxiety levels,[ 20 ] which in turn led to improvements in their self-care. Patients’ psychological state after surgery influences their recovery and physical health and effectively reducing psychological anxiety or stress can enhance these outcomes.[ 21 ] Music can help people regulate their emotions effectively[ 22 ]; it is a valuable tool for regulating emotions and alleviating feelings of isolation, especially during the new crown pneumonia epidemic,[ 23 ] similar to our findings. In addition, mindfulness-based stress reduction nursing care is highly effective in the treatment of depression because this method effectively improves mood strategies.[ 24 25 ] However, this study is limited by being a single-centre, retrospective analysis involving a small sample size and a single data source. Meanwhile, the grouped comparison approach and the combined approach can still be improved. Therefore, a multicentre prospective study can be conducted in the future to explore a more ideal combination protocol, which will provide more data support for the effective improvement of the postoperative psychological status of patients with uterine adenomyosis.

This retrospective study analysed the data of patients with adenomyosis treated with HIFU at our hospital from January 2024 to December 2024. The data were used as study subjects. The sample size was based on post-care anxiety and depression scores, as reviewed in the literature[ 6 ] and was expected to reach 56.41 ± 8.79 points[ 6 ] in the control and 5.02 points lower in the music therapy group, with a two-sided α of 0.05 and a test efficacy of 90%. Based on the sample size formula: n  = [( Z 1-α/2  + Z 1-β ) 2  × 2 σ 2 ]/ δ 2 , the sample size calculated for each group was 64, which resulted in the inclusion of a minimum of 128 study participants. We initially included 159 cases in the study. Thirteen cases were excluded: three patients were unable to complete the mindfulness therapy program in its entirety, three were unable to complete the music therapy program in its entirety, six were excluded due to incomplete questionnaire information and one was excluded due to severe liver function impairment. Ultimately, 146 patients were included, and they were divided into two groups based on different nursing methods implemented as follows: a mindfulness group ( n  = 68) and a combined group ( n  = 78). The study received approval from Women’s Hospital School of Medicine Zhejiang University’s Ethics Committee (Ethics No.IRB-20250224-R). The inclusion criteria were as follows: (1) diagnosis of adenomyosis in accordance with the guideline for the diagnosis and treatment of endometriosis (third edition)[ 7 ] and HIFU surgery for adenomyosis; (2) aged ≥18 years; (3) no hearing impairment; (4) cooperation in completing various questionnaires and complete and accurate questionnaire information; (5) informed consent of patients and their family members and signed consent form. The exclusion criteria comprised the following: (1) inability to complete the full course of mindfulness or music therapy; (2) concurrent hepatic or renal impairment; (3) other concurrent malignant tumours; (4) concurrent infectious diseases, etc. Both patient groups underwent conventional postoperative care for adenomyosis HIFU, which included monitoring of their vital signs (blood pressure and heart rate), providing information on postoperative diet and exercise and encouraging early mobilisation based on their individual conditions. The mindfulness group was subjected to mindfulness-based stress reduction. Therefore, before the start of training, the patients were instructed to select an object of attention for joint use, such as words, music and forms of movement and then maintained a seated position with eyes closed. The patients were guided to perform abdominal breathing. Initially, the patient’s attention was gradually directed towards the selected object. Next, the patients were guided to focus entirely and shift all their attention to that object. Lastly, the patients gently achieved a state of relaxation. The above training was performed for 15 minutes/session, and the patients were given a rest period of 2–10 minutes after training, which was carried out at 10:00 AM and 8:00 PM, respectively. The combined group received combined music therapy care with mindfulness-based stress reduction as follows: (1) patients selected five music pieces based on their preferences for treatment. The nursing staff then added 15 more tracks, which increased the library tracks to 20, with each track lasting 3–4 minutes. All tracks were pure music and included Chinese and Western classical music; natural music (the sound of rain, flowing rivers, waterfalls, birdsong in the forest, etc.) and light music (radioactive, journey and summer, etc.). (2) The time of music therapy, which was conducted once a day, was selected as 20:00–22:00 every day, and the volume of music playing was 40–45 dB, with each session time lasting 30 minutes. The nurse assisted the patients in breathing adjustment and muscle relaxation before discharge. (3) When discharged from the hospital, the nurse instructed the patients on music therapy care, including selecting an appropriate environment, music, frequency of treatment, breathing mode and muscle relaxation. After discharge, the patients carried out music therapy care alone, with family members assisting from the sidelines. Information on the daily care of all patients after discharge was collected through an online WeChat group chat, including 10:00 AM and 8:00 PM punch cards for positive stress reduction therapy (meditation app clocking in) and daily tracks and times for music therapy. (1) Comparison of baseline data: Through the collection of patient medical records, comparison was conducted on the age, body mass index (BMI), maternity history, leiomyosarcoma volume (by using the ellipsoidal formula [D1*D2*D3*0.5233],[ 8 ] course, education level and marital status of the two groups. (2) Comparison of pain scores: Scoring was performed using the Visual Analogue Scale (VAS).[ 9 ] Pain levels ranged from 0 (no pain) to 10 (very severe), with categories 1–3 for mild, 4–6 for moderate and 7–9 for severe pain. Data were gathered via paper questionnaires on Days 1 and 3 postsurgery. Cronbach’s α was 0.94.[ 10 ] (3) Comparison of psychological status: Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to assess the psychological status of the patients.[ 11 12 ] The SDS and SAS scales consist of 20 items, with each rated on a 4-point scale. The total score was calculated by summing all item scores and then multiplying by 1.25 to obtain the standardised score. A standardised score below 50 is considered normal, 50–60 indicates mild anxiety, 61–70 signifies moderate anxiety and above 70 reflects severe anxiety. For depression, a standardised score below 53 is normal, 53–62 indicates mild depression, 63–72 suggests moderate depression and above 72 denotes severe depression. Data collection was conducted through an online electronic questionnaire before and 14 days after care. Cronbach’s ɑ coefficients for SAS and SDS were 0.777 and 0.782, respectively. (4) Comparison of sleep quality: Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of patients.[ 13 ] This scale comprises the following seven dimensions: sleep quality, sleep onset latency, sleep duration, sleep efficiency, sleep disturbances, hypnotic medication use and daytime dysfunction, across 18 items. Each item is scored from 0 to 3, with total scores ranging from 0 to 21. A high score denotes poor sleep quality. The scale had a Cronbach’s α of 0.87 and split-half reliability of 0.87. Data were gathered through an online electronic questionnaire prior to and 14 days after care. PSQI had a Cronbach’s ɑ coefficient of 0.68. (5) Comparative quality of life: The quality of life of the patients was scored using the EuroQol Five Dimensions Questionnaire (EQ-5D). The scale consists of the following five dimensions: mobility, self-care, daily activities, pain/discomfort and anxiety/depression. Further, each dimension comprises the following five levels: having no problems (denoted by 1), having slight problems (denoted by 2), having moderate problems (denoted by 3), having severe problems (denoted by 4) and having extreme problems (denoted by 5). A total of 3125 health states can be measured, with each consisting of five numbers. Different health states can calculate their corresponding health utility values through the utility value conversion table. The values were collected via an online electronic questionnaire before and 14 days after care. The EQ-5D had a Cronbach’s ɑ coefficient of 0.857. This study utilised the EQ-5D-5L Chinese utility value system established by Luo et al .,[ 14 ] which ranges from −0.391 to 1.000, to convert the health utility value of patients with uterine leiomyosarcoma. A high utility value indicates a good quality of life. A patient with a questionnaire result of 4, 5, 5, 4, 5 has a health utility value = 1−0.287−0.116−0.107−0.252−0.258 = −0.02, which indicates a poor quality of life. Data were processed with SPSS 27.0 (International Business Machines Corporation, Armonk, New York, USA). The measurement information underwent Kolmogorov–Smirnov normality tests and Levene’s tests for homogeneity of variances. Measurement data were expressed as x̄±  s , and t -test was performed for group comparisons. Count data ratios were expressed as [ n (%)], and the χ 2 test or Fisher’s exact test was applied for comparison. Differences were considered statistically significant at P < 0.05.

Music therapy effectiveness can be improved through the addition of personalised music. The effectiveness of music therapy combined with mindfulness-based stress reduction can be evaluated using various indicators. Music therapy combined with mindfulness-based stress reduction can boost patients’ psychological well-being and quality of life.

No significant differences were observed between the two patient groups in terms of age, BMI, leiomyosarcoma volume, course, literacy level, maternity history and marital status ( P > 0.05) [ Table 1 ]. Comparison of general information of the two groups patients [ n (%)] Note: * indicates the use of Fisher’s exact test. BMI, body mass index. Comparison of VAS scores between the two groups revealed no significant difference on Day 1 postoperatively ( P > 0.05). Meanwhile, on postoperative Day 3, the VAS scores of both groups decreased significantly compared with those observed on Day 1 ( P < 0.05). The VAS score of the combined therapy group on postoperative Day 3 (2.04 ± 0.47) was significantly lower than that of the mindfulness group (2.72 ± 0.62) ( P < 0.05) [ Table 2 ]. Comparison of VAS scores on postoperative Days 1 and 3 in the two groups Note: VAS, visual analogue scale. Before care, no significant differences were detected in the SDS and SAS scores between the two groups ( P > 0.05). Following nursing care, both groups demonstrated significantly reduced SDS and SAS scores compared with their precare levels ( P < 0.05). The combined group exhibited lower SDS (37.97 ± 4.23 vs. 43.63 ± 5.06) and SAS scores (40.14 ± 5.45 vs. 47.22 ± 5.63) than the mindfulness group ( P < 0.05) [ Table 3 ]. Comparison of SDS and SAS scores of the two groups before and after care Note: * P < 0.05 compared with the same group before care. SAS, Self-rating Anxiety Scale; SDS, Self-rating Depression Scale. Before care, no significant difference was noted in the PSQI scores between the two groups ( P > 0.05). After care, the PSQI scores of both groups decreased significantly compared with their precare levels ( P < 0.05). The combined group demonstrated lower PSQI scores than the mindfulness group (6.79 ± 1.65 vs. 7.50 ± 1.82) ( P < 0.05) [ Table 4 ]. Comparison of PSQI scores of the two groups before and after care of patients Note: PSQI, Pittsburgh Sleep Quality Index Table 5 and Figure 1 show the comparison of the levels and utility values of the EQ-5D dimensions between the two groups. The results reveal no significant difference in mobility, daily activities and pain or discomfort between the two groups ( P > 0.05), but a notable difference was observed in the levels of self-care and anxiety/depression ( P < 0.05). The highest percentage of self-care dimensions in the combined group was ‘a little difficult’ (69.23%), which was higher than that of the mindfulness group (42.65%). By contrast, 45.59% of the mindfulness group experienced moderate anxiety/depression, which was higher than the 32.05% observed in patients in the combined group with the same dimensional level. The utility value of the mindfulness group (0.437 ± 0.153) was considerably lower than that the combined group (0.602 ± 0.161) ( P < 0.05) [ Table 5 ]. Levels of EQ-5D dimensions in the two patient groups [ n (%)] Comparison of dimension scores and utility values for the two patient groups. Note: * P < 0.05 compared with the mindfulness group.