Music as a biological signal of safety: A polyvagal perspective on compassionate musician–patient interaction in healthcare.

Abstract

Healthcare environments present significant environmental and psychological stressors that can trigger a patient's autonomic threat-detection systems, resulting in sustained sympathetic arousal that impairs recovery and emotional regulation. While live music is widely recognized as a comforting intervention in clinical settings, it is often framed merely as subjective entertainment, obscuring the neurophysiological mechanisms through which musical encounters may influence patient regulation. This perspective paper establishes a theoretical framework combining compassion science and Polyvagal Theory (PVT) to explain how live musical encounters may function as potent cues of environmental safety capable of supporting autonomic regulation and co-regulation. By examining the training curriculum of the American Institute for Music and Healing (AIMH) ‘Awakening the Inner Gift’ program, we illustrate how live musician–patient interactions may function as stabilizing regulatory processes within healthcare environments. These encounters demonstrate patterns consistent with Polyvagal Theory that are interpreted through anecdotal observations from patients and musicians. To ground this theoretical framework in clinical reality, we present anecdotal narrative feedback from 18 patients and performing musicians in an outpatient cancer center. These brief clinical observations demonstrate experiential themes of emotional regulation, autobiographical memory activation, and relational reciprocity. Ultimately, This paper suggests that a foundational understanding of Polyvagal Theory should form part of the education of music-in-health practitioners, equipping musicians with a neurophysiological framework for understanding how compassionate musical interactions may support autonomic regulation and patient wellbeing.

Keywords: Polyvagal Theory, Compassion Science, Music and health, Arts and health, Music in healthcare, Music and wellbeing