The present study proposes that Compassion Focused Therapy (CFT) may offer one such lens. The intention is not to explain music solely through compassion, nor to suggest that compassion is the only mechanism underlying musical benefit. Rather, CFT provides a framework through which relational, emotional, and interpersonal dimensions of musical encounters may be examined. In this sense, CFT helps illuminate aspects of patient experience that have often remained difficult to account for when music is treated primarily as an acoustic stimulus.

It is well noted across various fields of music literature that the psychological relationship between a performer and an audience holds therapeutic value, with several studies highlighting that the intentional, physical presence of a live musician can function as a powerful psychological mechanism of safety and comfort [12,13].

Beyond having benefits for patients, live music in oncology settings has also proven beneficial to staff and carers [14]. However, the psychological and relational processes underpinning these outcomes remain incompletely understood.

Psychobiological research confirms that experiencing compassionate intent and feeling cared for by another human being triggers robust physiological regulation, directly modulating the autonomic nervous system, the hypothalamic-pituitary-adrenal (HPA) axis, and immune responses [15].

Compassion is defined in this context as a sensitivity to stress or suffering in the self and others, paired with a commitment to alleviate and prevent it [16]. Interactions that are oriented to addressing states of suffering and distress, with specific actions are classified as compassionate interactions [16].

The aim of the present study is not to evaluate the clinical efficacy of live music interventions, but to explore whether CFT concepts offer a useful interpretive framework for exploring patient experiences reported during a music-based intervention delivered by Arts-in-Health musicians within an outpatient oncology setting [17].

The musicians involved in this study were professional orchestral musicians functioning as Arts-in-Health practitioners rather than music therapists. They played live, patient-selected music within an outpatient oncology setting as a complementary component of patient care.

Musicians completed the American Institute of Music and Healing (AIMH) “Awakening the Inner Gift” training program, which prepares professional musicians to work appropriately within healthcare environments [18]. The curriculum addresses patient communication, professional boundaries, ethical considerations, repertoire selection, compassion science, and self-care. Musicians typically performed in pairs, most commonly violin and viola, or violin and a woodwind instrument such as flute or clarinet. Performances took place within the infusion areas of an outpatient cancer centre. Patients were invited to select music from a curated repertoire, and the resulting musical interaction formed the basis of the patient reflections examined in this study.

The observations presented here were collected as part of the ongoing quality-of-care tracking for the AIMH “Awakening the Inner Gift” program. All patients verbally consented to share their reflections following their personalised musical experience from their interactions with the musicians and music choice.

The semi-structured interview guide was not designed as a psychometric instrument, but rather as a mechanism for capturing patient reflections on their experience of live music within the infusion unit.

The primary dataset comprises semi-structured interviews from a qualitative sample of 18 oncology patients (n = 18) collected over two distinct, randomly selected tracking dates. A descriptive thematic reading of the responses identified recurring references to autobiographical memory, family relationships, spirituality, gratitude, comfort, encouragement, nostalgia, and social connection. These recurring patterns were subsequently considered through the interpretive lens of Compassion Focused Therapy.

All patients were offered the opportunity to select one or more pieces of music from a curated repertoire list divided into various genres, including Film Music, Religious Music (hymns), TV themes, Folk Songs, Pop Songs, Classical Music, and Irish music, and given 5-10 minutes time to browse the list. While a small cohort chose not to choose a piece (patients were either asleep, uninterested, or responded with “anything is fine”), most were interested in choosing a specific piece of music. Following the musical interaction, participants who consented were invited to take part in a brief semi-structured interview. All completed semi-structured interviews across both visits were included in the analysis (n = 18); no responses were excluded.

Data were collated by a third party to reduce potential researcher bias. The semi-structured interview comprised three questions: an initial music-selection question (“What piece would you like to hear today?”), followed by two open-ended questions: (1) “Can you tell us why you chose this particular song/piece?” and (2) “Do you have anything else you would like to share about the experience?”

The patient feedback in this study was gathered as part of regular quality-tracking for the AIMH “Awakening the Inner Gift” program. Because live music was already provided as a routine, non-invasive component for patients receiving chemotherapy, this project was classified as a Healthcare Service Evaluation rather than an experimental clinical trial. As such, formal IRB review was not required under the applicable institutional procedures.

At all times, patient rights were strictly protected. We used an opportunistic approach to find participants during their regular treatment. A clinical coordinator first made sure each patient felt well enough and motivated to engage. We then used a two-stage verbal consent process: patients first agreed to choose a song to listen to, and later agreed to answer our three brief questions. Everything was completely anonymous, and patients knew they could say no at any time without it affecting their medical care.

We analysed responses from 18 patients (9 women and 9 men; see Table 1 below). They spanned a wide age range across the adult lifespan: two in their 30s, four in their 40s, three in their 50s, one in their 60s, four in their 70s, and three in their 80s (with one age unrecorded).

Although exploratory and based on a small sample, younger participants often selected music associated with contemporary family experiences, whereas older participants more frequently selected repertoire connected to longstanding autobiographical memories.

Patient responses were reviewed descriptively to identify recurring patterns of meaning relating to memory, comfort, emotional regulation, social connection, spirituality, nostalgia, and personal significance. These recurring patterns were subsequently considered through the interpretive framework of CFT), particularly Gilbert’s three flows of compassion, which are: 1. the degree to which people experience compassion from others, 2. the degree to which they feel compassionate towards others and 3. the degree to which they are moved to treat themselves with compassion.

Patients frequently selected music associated with significant life events and personal identity. Examples included wedding memories (“My wife and I danced to this at our wedding”), childhood and family memories (“My father used to sing this to me”), and past musical participation (“I used to play trombone back in high school”). Hence, there was an experience of emotional-based social memory.

Several participants described music as comforting during treatment, particularly through religious repertoire and familiar songs. Patients thanked musicians and referred to encouragement, hope, feeling better, and having their spirits lifted.

For the most part the experience gave rise to 1. feeling socially connecting rather than disconnecting or isolating; 2. as calming rather than threatening; and 3. as personally meaningful rather than arbitrary. One observed dimension was that the process of creating and experiencing music in this context functioned as a form of compassionate communication, closely aligning with core CFT processes such as affiliative warmth, compassion for others, and self-compassion [17].

Elements consistent with compassion received from others were suggested by the gratitude expressed in patient feedback. Comments such as “Thanks for spreading joy” and “I appreciate you coming out today” may be interpreted as instances in which patients directed warmth and appreciation toward the musicians.

The third compassion flow was the observation of compassion directed toward oneself. Patient accounts frequently suggested that when given the opportunity to select their preferred repertoire, they often reported emotionally a sense of meaningful social connectedness with memories, and reflections evoked by the musical experience. Patients appeared to use the musical encounter in ways consistent with self-soothing, selecting repertoire associated with comfort, supportive relationships, spirituality, or positive autobiographical memories.

Additionally, informal staff comments, not included in the formal dataset, suggested improvements in mood and atmosphere during musician visits. From a CFT perspective, it is unsurprising that healthcare staff also reported improved mood and atmosphere during the musicians’ presence, as cues of safeness and affiliation tend to diffuse through social environments, supporting co-regulation and collective emotional tone [20].

This study was designed as a small-scale, practice-based qualitative inquiry rather than an evaluation of clinical efficacy or outcome durability. Its purpose was to explore how patients experienced live, patient-selected music, using Compassion Focused Therapy as an interpretive framework. Accordingly, the findings should not be interpreted as evidence of universal benefit, comparative effectiveness, or sustained therapeutic impact.

Participation in both the music sessions and the semi-structured interview was voluntary, introducing the possibility of self-selection bias, whereby individuals with a more positive orientation toward music may have been more likely to engage and respond. Patients who declined music, were asleep, or expressed disinterest were not interviewed, and their perspectives are therefore beyond the scope of the present analysis. This does not constitute a methodological deficit but rather delineates the boundaries of the phenomenon under investigation: the subjective experience of music when it is actively chosen and received. The study prioritised participants’ own accounts of meaning, memory, and emotional response, without attempting to standardise demographic or clinical variables that were not central to the research question. As such, the material should be understood as illustrative rather than representative, offering insight into how music may function as a vehicle for self- compassion and self-regulation for some patients within real-world healthcare settings. Responses were gathered at a single time point, precluding examination of longer-term effects or changes over repeated exposures. Finally, the findings are context-specific and may not be generalisable to other healthcare settings, patient populations, or forms of musical delivery. It should also be noted that the musicians delivering the intervention had received elementary training in compassion science, mind-body medicine and principles of Compassion Focused Therapy—including attention to relational presence, emotional safety, and the psychophysiological dynamics of soothing. This contextual feature may have shaped the nature of the musical encounter and should be considered when interpreting the findings or comparing them with studies involving musicians without comparable training.