MICO Music Imagery in Child Oncology



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When music and imagery play a significant role in providing comfort and relieving side effects

MICO, Music and Imagery in Child Oncology, is a Scandinavian research project aiming at evaluating the effect of music therapy, as a non–medical supplement, on side effects of chemotherapy in children at the ages 7–17 with cancer. The MICO research project is the first of its kind (in the world) and is being conducted at five university hospitals in Denmark, Norway, and Sweden (Aarhus, Copenhagen, Oslo, Tromsø, and Lund). In the project we investigate whether music therapy can reduce nausea, vomiting, and other side effects of chemotherapy. In addition, the project focuses on the psychological significance of music therapy in terms of enhancing participants' inner resources, resilience, and overall well–being in relation to their courses of treatment.

Each year approximately 200–250 children are diagnosed with cancer in Denmark, Norway, and Sweden, respectively. The treatment consists to a high degree of chemotherapy, often in combination with surgery and radiation therapy. The courses of treatments are often intensive, long, and imply substantial bodily, emotional, and social consequences for the child and the child´s family. The side effects of chemotherapy include nausea, vomiting, fatigue and other feelings of disturbances. These are often experienced as extremely stressful, and are precisely the focus of this music therapeutic research project.

The MICO project consists of two scientific randomized controlled trials. The music therapy is age–adjusted and consists of:
   1) Specially composed music imagery narratives for children, 7–12 years
   2) Three variations of relaxation, active music listening, and imagery for teenagers, 12– years

The two age–adjusted forms of music therapy are specially developed and have been tested out in children with cancer during the prepratory phase of the project. In both studies the key elements of the music therapy are relaxation, active music listening and imagery in an altered state of consciousness plus verbal dialogue. The music imagery narratives that are especially applied in the youngest age group (children 7–12 years) consist of an initial relaxation exercise and a narrative read out to specially composed classical music and relaxing nature sounds. The music is composed, recorded, and produced specifically for the MICO project. The narratives constitute a secure framework that the listener can easily relate to – for example to imagine being at a beach on a sunny day or flying in a magic hot air balloon. For the teenage group, the music therapy consists of three variations of active music listening and imagery. One of these consists of the music imagery narratives, while the two other variations afford more flexibility in terms of choosing the starting point and contents of the inner music and imagery journey.

Both music therapy interventions are resource–oriented and informed by the psychotherapeutic music therapy method The Bonny Method of Guided Imagery and Music (BMGIM). All involved music therapists are trained in BMGIM (min. Level II/III) in addition to their Bachelor and/or Master degrees in music therapy.

Also both music therapy interventions are being based on classical music that is selected or specially composed on the basis of musical parameters that afford deep bodily relaxation and at the same time stimulation of positive inner images. For both age groups the music therapy aims at:

  • Creating a free space from treatment, admission, and disease

  • Training the brain in recalling and maintaining pleasant bodily sensations

  • Evoking positive emotions and memories

  • Building inner resources and strengthening the resilience of the participants in terms of their courses of treatment

The participants in the MICO project are randomly assigned to either a music group or a control group. The participants in the music group receive two individual sessions with a music therapist in their hospital rooms during 2–4 courses of chemotherapy. In this way the children learn how to use the music imagery narratives/music listening and imagery in different ways and for different purposes. In addition, the participants are provided with a loudspeaker and an iPad with a recorded version of the music narratives/music listening and imagery. This allows them to use this self–help material as needed at home and during admissions – and the child´s family can also participate with advantage. After completing participation in the research study, the children assigned to the control group are offered a number of music therapy sessions during subsequent admissions.

Finally, all participants (both groups) receive a recorded version of the self–help material as a thank you for their involvement in, and support of the project.

The vision of the MICO project is to generate new knowledge and evidence–based clinical guidelines that can subsequently be implemented and improve clinical practice at Nordic children's cancer wards. In addition, the project also aims at expanding and strengthening the interdisciplinary research collaboration at the involved hospitals and universities in Sweden, Norway, and Denmark.


The research project is the first of its kind in the world with paediatric patients and aims at investigating whether and how music therapy can be used as an effective non-medical supplement to reduce side effects of chemotherapy in 7– to 17–year–olds.

Did you know?

  • By October 2018, 70 children and teenagers have been recruited in the project and have listened to the specially composted music imagery narratives.

  • The MICO project is the first of its kind in the world combining systematic use of music and visualisation with children and teenagers during chemotherapy. 

  • All children benefit from participating in the MICO project, including those in the control groups who are offered a number of sessions with a music therapist during admissions after having completed participation in the study. Likewise, all participants receive a recorded version of the specially developed self–help material for their own use (music narrative/music and imagery) upon completion of the project.

  • New music imagery narratives are being developed (by Ilan Sanfi) during the course of the research project. At this point, there are 8 different music narratives that the participants can choose from. So far, the music narratives are recorded in Danish, Norwegian, and Swedish for the MICO project and will be released commercially in several languages during 2020–2021 after completion of the project.

  • One of the music therapists in the MICO project (Catharina Messell, Rigshospitalet in Copenhagen) has applied the music narratives continuously with the health personnel in short sessions in order to promote and introduce the music intervention. On the basis of the positive feedback from the personnel Catharina is now in the process of founding a separate a pilot study on the influence of music imagery on work–related stress in the health care system.

  • The project team has presented the MICO project several times at international conferences. The last major presentation was in Japan at The 15th World Congress of Music Therapy.

  • The involved music therapists are highly specialised and experienced clinicians, who have undergone training in the music therapy method The Bonny Method of Guided Imagery and Music (min. Level 2/3) in addition to their Bachelor and/or Master´s degrees in music therapy. 

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The Participants Say

The music narratives helped me sleep and eased the feeling of nausea during the night. It was really nice to listen to the music stories when the chemo started and, I didn´t feel the unpleasant things caused by the chemotherapy
If you need a little sleep during the day, but find it hard to find peace, the music stories are a sure winner. You even sleep better and wake up more energized
The music stories have inspired me to use relaxing music to be calm down or fall a sleep easier
— 12 - year - old boy in cancer treatment
For me, participation in the project has taught me a lot about my own psyche and how to control it better
It has been a wonderful and needed escape from reality every time the music therapist gave us a session with music imagery stories. Stress and worries disappear like dew in the sun for a while and it gives the body and brain a break to regain energy. Subsequent sleep becomes more calm after a music story
The music stories have helped me to calm down in the evening. It was also a positive thing to be able to listen to them with my siblings

The Story Behind

How it All Started...

In his final master's thesis in 2007 at the Music Therapy Program at Aalborg University, Ilan Sanfi developed and composed his first specially designed music imagery narrative, The Fairy Tale about Samson and the Silver Flute, which was recorded by Randers Chamber Orchestra. 
He developed the music narrative with inspiration from American research studies with adult cancer patients showing that 30 minutes of music listening can reduce nausea and vomiting due to chemotherapy. Given that 30 minutes of music listening is too long to concentrate for most children, Ilan combined music and narrative in a way that the child´s own imagination could come into play.

Besides the music narrative Samson and the Silver Flute, Ilan's thesis also comprises a pilot study with interviews of three children (6–12 years) with cancer and their families, who used the musical narrative during admission at Aarhus University Hospital.
In 2014 Ilan developed his music concept further and recorded new music narratives – this time with Aarhus Symphony Orchestra.

Feel free to listen to selected excerpts from the music narratives here and see photos from the recordings with ASO in our Gallery.