隨著快速的生活步調，許多壓力也油然而生，這些壓力不但衍生出許多現代文明病，也使國人的精神健康指數亮起紅燈。然而許多研究指出，音樂治療可緩解壓力，其中又以I. M. Altshuler所提出的同質原理(sound identity theory, ISO)最為知名。因此本研究將以健康成年人及焦慮患者為對象，期望藉由客觀的心率變異度(heart rate variability, HRV)指標與主觀的問卷量表探討同質原理之音樂治療效益及其有效性，並觀察不同形式之音樂介入，對受測者情緒反應、情緒改善與自主神經系統之影響。
健康成年人(health subjects)之實驗於國立陽明大學醫學工程研究所之聽力室進行，實驗人數為控制組(control)10人、異質音樂組(non-ISO music)10人、同質音樂組(ISO music)12人，實驗時間總計約60分鐘，包含問卷填寫、數學測驗與音樂聆聽；焦慮患者之實驗地點於羅東平和身心診所進行，實驗人數為控制組20人、異質音樂組12人、同質音樂組11人，實驗時間總計約40分鐘，包含問卷填寫與音樂聆聽。
實驗結果顯示，健康成年人可在安靜環境中自主性回復至放鬆情緒，但焦慮患者則無法像正常人一樣自主調控情緒，而單以會談方式與在安靜環境中休息並不會對其改善緊張情緒有所幫助。在音樂介入的狀況下，同質性音樂的聆聽可顯著地改善焦慮患者之緊張情緒，並且可以改善其疲勞、憂鬱程度及提升放鬆程度，相對而言，聆聽同質性音樂對健康成年人緊張情緒的改善則沒有差異；當聆聽異質性音樂時，健康成年人能隨著音樂逐漸降低緊張情緒，而焦慮患者聆聽異質性音樂雖緊張情緒也能獲得些許之改善，但其程度則不及同質性音樂所造成之影響。

Many people are suffering with the problem of mental disorder due to the social pressure. Being a method to release pressure, music therapy is used to improve or to maintain health in various health care settings. ISO-principle is a well-known thoery, which proposes to play music first matching the mood of the patient and to conduct patient to the desired mood gradually. The principle was proved to easily change patient's anxious state. The purpose of this research was to determine the effects of ISO-principle of musical therapy in health subjects and in anxiety disorder patients assessed by physiological parameters of heart rate variability.
This study has two experiments. The first experiment consisted of thirty two health participants (10 subjects for control group, 10 subjects for non-ISO music group, and 12 subjects for ISO music group have 12 subjects) recruited from National Yang-Ming University. The total experiment time spent approximately 60 minutes, including to write questionnaire, to proceed mathematical test and to listen music. The second experiment consisted of forty three anxiety disorder patients (20 subjects for control group, 12 subjects for non-ISO music group and 11 subjects for ISO music group ) recruited from Ping Ho Mental Clinic. The total experiment time spent approximately 40 minutes, including to write questionnaire and to listen music.
The result showed that health subjects could recover from anxiety state to relaxation state by themselves in silence. However, anxiety disorder patients could recover from anxiety state to relaxation state by themselves in silence. ISO musical intervention decreased the anxiety level significantly in patients but no significant change was found in health subjects. Non-ISO musical intervention decreased anxiety level in health subjects and patients but didn’t show statistically significant changes.

致謝 I
中文摘要 II
Abstract IV
目錄 V
圖目錄 VII
表目錄 VIII
附錄目錄 IX
第一章 緒論 1
1.1 前言 1
1.2 研究動機與目的 2
1.3 論文架構 4
第二章 文獻回顧 5
2.1 情緒與疾病 5
2.1.1 壓力 5
2.1.2 焦慮 6
2.1.3 憂鬱 8
2.2 音樂治療背景 10
2.2.1 音樂治療的歷史起源 10
2.2.2 音樂治療的定義 12
2.2.3 音樂治療的理論基礎 13
2.2.4 音樂治療的方法 16
2.3 音樂與生理 18
2.3.1 心率變異度與自律神經系統 18
2.3.2 心率變異度的分析方法 21
2.3.3 音樂與心率變異度之臨床應用 24
第三章 研究方法與工具 26
3.1 研究工具 26
3.1.1 心率變異度之計算 28
3.1.2 數學測驗平台 30
3.1.3 評估問卷 34
3.2 實驗設計 36
3.2.1實驗對象與環境 36
3.3實驗流程 39
3.3.1 實驗一 (健康成年人) 39
3.3.2 實驗二 (焦慮症病人) 41
3.4 資料分析與統計 44
第四章 研究結果與討論 45
4.1 研究結果 45
4.1.1 數學測驗對健康成年人情緒引發效果之評估 45
4.1.2 不同音樂介入對健康成年人之情緒影響評估 47
4.1.2.1 同質性音樂對健康成年人之情緒影響評估 47
4.1.2.2 異質性音樂對健康成年人之情緒影響評估 49
4.1.2.3 安靜無音樂環境對健康成年人之情緒影響評估 50
4.1.3 不同音樂介入方式對焦慮病患之情緒影響評估 53
4.1.3.1 同質性音樂對焦慮病患之情緒影響評估 53
4.1.3.2 異質性音樂對焦慮病患之情緒影響評估 56
4.1.3.3 安靜無音樂環境對焦慮病患之情緒影響評估 58
4.2 研究討論 61
4.2.1 數學測驗平台對情緒之影響 61
4.2.2 不同音樂介入對健康成年人之情緒影響 63
4.2.3 不同音樂介入對焦慮患者之情緒影響 66
第五章 結論與未來展望 70
5.1 結論 70
5.2 未來展望 74
參考文獻 76
中文文獻 76
英文文獻 77
附錄 80

中文文獻
胡海國（2003），期許精神健康基金會與社會大眾共創一個美麗境界。載於財團法人精神健康基金會2001-2002 年報（頁2-5）。台北：財團法人精神健康基金會。
篠田知璋 加藤美知子 (2003) ，標準音樂治療入門, 台北:五南。
崔光宙 (1993)，音樂學新論, 台北:五南。
胡月娟、吳美茜、張錫珍 (1984)，護理實務導論,台北：合記。
林莉萱、江漢聲、邱泓文 (2003)，探討術前音樂對體外震波碎石術病患的影響。台北醫學大學醫學研究所碩士論文。
陳美娟、邱碧如、江漢聲 (2006)，音樂治療對慢性肺疾病患者脫離呼吸器時焦慮之影響。輔大醫學院護理研究所碩士論文。
黃玉珠 (2005)，鑼聲若響—談音樂與照護的共鳴，護理雜誌，52(4)，16-22
莊婕筠 (2004)，音樂治療。心理：台北。
蔡榮美、李從業 (2001) ，音樂治療對安胎孕婦接受無加壓監測時其焦慮及生理反應成效之探討。國防大學醫學院護理研究所碩論。
彭佩儀、馬素華 (2005) ， 音樂療法對血液惡性腫瘤病人的焦慮程度及生理反應之成效。長庚大學護理學研究所碩士論文。
董湘玉、李琳（2003），中醫心理學基礎，北京：北京科學技術。
蕭佳蓉（2002），淺談精神科之音樂治療，松德醫訊，48，8-10。
李選、劉麗芳、陳淑齡（1999），音樂治療在國內護理專業領域之臨床應用，護理雜誌，46(1)，25-30。
英文文獻
Altshuler I. (1948) A psychiatrist’s experience with music as a therapeutic agent. D. Schullian und M. Schoen (Hrsg.) Music and Medicine.New York:Henry Schuman.
Beck A. T.(1967) Depression Clinical, experimental, and theoretical aspects ,New York :Hoeber.
Beck A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
Beck S. L. (1991). The theory use of music for cancer-related pain. Oncology Nursing Form, 18(8), 1327-1337.
Bruscia K. E. (1991). The fundamentals of music therapy practice. In K.E.Bruscia (Ed.), Case studies in music therapy (pp.3-13).NH: Barcelona.
Brunges M. J. and G. Avigne (2003), Music therapy for reducing surgical anxiety. AORN J, ,78(5):p.816-8
Brown T. E., (1993). Beightol L. A., Koh J., Eckberg D. L., Important influence of respiration on human R-R interval power spectra is largely ignored. J Appl Physiol;75:2310-7.
Burdick W. P. (1915). The use of music during anesthesia and analgesia. In The American yearbook of anesthesia and analgesia, edited by F. H. McMechan. New York : Surgery Publishing.
Corsini R. (2002). Dictionary of psychology. Brunner-Routledge.
Cook J. D. (1986). Music as an intervention in the oncology setting. Cancer Nursing,9(1), 23-28
Crasset V., Mezzetti S., Antoine M., Linkowski P., Degaute J. P., VandeBorne P. (2001), Effects of aging and cardiac denervation on heart ratevariability during sleep. Circulation;103:84-8.
Davis W. B. (1993). Keeping the dream alive: Profiles of three early twentieth-century music therapists. Journal of Music Therapy 30:34-35.
Dishman R. K., et al., (2000) Heart rate variability, trait anxiety , and perceived stress among physically fit men and women. Int J Psychophysiol, 37(2): p. 121-33.
Dossey B. (1996). Help your patient break free from anxiety. Nursing, 60(10), 52-54.
Field T., Martinez, A., et al (1998). Music shifts EEG in depressed adolescents. Adolescence, 33 (129), 109-116
Feder E., and B. Feder. (1981). The expressive arts therapies. Englewood Cliffs, NJ:Prentice Hall.
Fromm-Reichmann F. (1960). Psychiatric aspects of anxiety. In M. V. Steinidich A. J. White D.M. (Eds). Identity and Anxiety. Glencoe, III, Free Press.
Greden J. F. (2001). The burden of disease for treatment-resistant depression. Journal of Clinical Psychiatry, 62(16), 26-31.
Guzzetta C. E. (1989), Effects of relaxation and music therapy in a coronary care unit with presumptive acute myocardial infarction. Dimensions of Critical Care Nursing,14,295-304.
Harold I. Kaplan, Benjamin J. Sadock（1998）. Synopsis of Psychiatry: Behavioral Sciences. Clinical Psychiatry, 8th Edition. Maryland: William ＆ Wilkins.
Ilsen I. M. (1926). How music is used in hospitals. Musician 31:15-30.
Jensen-Urstad K., Storck N., Bouvier F., Ericson M., Lindblad L. E., Jensen-Urstad M., (1997), Heart rate variability in healthy subjects is related to age and gender. Acta Physiol Scand;160:235-41.
Lai H. L. and M. Good, (2002). An Overview of Music Therapy. The Journal of Nursing 49(2): 80-84.
Mancia G., et al. (1999), Effect of sinoaortic denervation on frequency-domain estimates of baroreflex sensitivity in conscious cats. Am J Physiol, 276(6 pt 2):p. H1987-93.
Mcglinn J. A. (1930). Music in the operating room. American Journal of Obstetrics and Gynecology 20:678-683.
Mornhinweg G. C. (1992), Effects of music preference and selection on stress reduction. J Holist Nurs. 10(2):101-109,
National Association for Music Therapy, (1960). Music therapy as a Career. Brochure.Washington, DC: National Association for Music Therapy
Nakagawa M, Iwao T, Ishida S, Yonemochi H, Fujino T, Saikawa T, Ito M. (1998). Circadian rhythm of the signal averaged electrocardiogram and its relation to heart rate variability in healthy subjects. Heart; 79:493-6
Pagani M.,et al. (1989). Spectral analysis of R-R and arterial pressure variabilities to assess sympatho-vagal interaction during mental stress in humans. J Hypertens Suppl, 7(6): p. S14-5.
Podolsky E. (1954). Music therapy. New York : Philosophical Library
Purdie H., Hamilton, S. & Baldwin, S. (1997). Music therapy : facilitating behavioral and psychological change in people with stroke – a pilot study. International Journal of Rehabilitation Research 20, 325-327.
Robinson L. (1990). Stress and anxiety. Nursing Clinics of North America, 25(4), 935-943.
Ryan S. M., Goldberger A. L., Pincus S. M., Mietus J., Lipsitz L. A., (1994), Gender-and age-related differences in heart rate dynamics: are women morecomplex than men? J Am Coll Cardiol;24:1700-7.
Schachter S. C., (2004), Vagus nerve stimulation: mood and cognitive effects. Epilepsy Behav., 5 Suppl 1: p. S56-S59.
Schulberg C. H. (1986) . The music therapy sourcebook: A collection of activities categorized and analyzed. NY: Human Sciences Press
Spielberger C. D. (1983). State~Trait anxiety inventory (Form Y). California: Mind garden.
Tamir E. (2002). The human body made simple : a guide to anatomy, physiology and disease ,Eran Tamir .Vol. Edinburgh ; New York:2nd, p.214-215 Elsevier.
Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) :Heart rate variability:standards of measurement, physiological interpretation,and clinical use. Circulation
Taylor D. B. (1981). Music in general hospital treatment from 1900 to 1950. Journal of Music Therapy 18:62-73.
Van der Kooy K. G., et al., (2006). Differences in heart rate variability between depressed and non-depressed elderly. Int. J. Geriatr. Psychiatry, 21(2): p. 147-150.
Weinstein A. A., Deuster P. A., and Kop W. J., (2007). Heart rate variability as a predictor of negative mood symptoms induced by exercise withdrawal. Med.Sci.Sports Exerc. 39(4): p.735-741.