Although binaural beat therapy (BBT) has been demonstrated to alleviate symptoms of anxiety and depression, but the effects of BBT of different frequencies on college students have not been thoroughly explored. This study explored the effects of BBT with different frequencies on autonomic nervous system regulation (i.e., anxiety reduction) among college students.

This was a quasiexperimental study. Participants were recruited from a university in southern Taiwan. Each of the participants received interventions with different frequencies (theta frequency, 6 Hz; alpha frequency, 10 Hz; and beta frequency, 25 Hz). For each intervention, participants were subjected to 20 min of natural sounds embedded with binaural beats of a specific frequency. A pretest and posttest were conducted to measure blood pressure (BP) and heart rate variability.

A total of 65 participants were recruited. The mean age of participants was 20.15 years. Heart rate and systolic and diastolic BP were significantly lower after intervention with theta-frequency binaural beats (p < 0.05). Systolic BP was significantly lower after intervention with alpha-frequency binaural beats (p < 0.05). Heart rate, systolic BP, and nLF were significantly lower and nHF was significantly higher after intervention with beta-frequency binaural beats (p < 0.01). No significant differences were observed between the effects of the three interventions on ANS regulation among the participants.

BBT, in which participants were subjected to theta-frequency, alpha-frequency, and beta-frequency binaural beats for 20 min, contributed to reducing anxiety. No significant differences were observed between the effects of each frequency.

The transition from adolescence to early adulthood can be challenging, and maintaining good mental health during this transition is essential to ensure good health in adult life [1]. However, college students undergoing this transition experience higher levels of anxiety and greater depressive tendencies than do adults in the general population [2]. Untreated anxiety and depression can have negative effects on students [3]. One study asserted that in Taiwan, 1 out of every 5 college students (18.7%) experiences marked anxiety or depression [4]. College students experience anxiety or depression for various reasons, such as academic stress, parental expectations, moving to an unfamiliar place [5], forming new interpersonal relationships [5, 6], financial burdens [7], and planning for life after graduation [2]. These factors can cause moderate to high levels of anxiety or depression [8, 9]. Negative emotions have been associated with poor learning outcomes [10], poor sleep quality, obesity [11], and suicidal ideation [12]. Therefore, identifying an effective and practical method for alleviating negative emotions is essential.

Binaural beat therapy (BBT) has been shown to regulate the autonomic nervous system (ANS) and alleviate anxiety and depression [13, 14]. BBT is a form of music therapy that involves listening to a different sound frequency in each ear. Through an auditory brainstem response, the brain perceives a third beat frequency that is the difference between the 2 original frequencies. A phenomenon known as the frequency-following response occurs when the brain generates electrical activity that matches the frequency of the external auditory stimulus. For example, when an individual listens to binaural beats at a frequency of 10 Hz, their brainwave activity at 10 Hz will increase. Therefore, patients with depression or anxiety may benefit from BBT; studies have indicated that BBT can alleviate stress and anxiety, enhance concentration, and relieve pain [13,14,15]. One meta-analysis [15] explored the effects of a BBT intervention on anxiety in patients who had undergone surgery. The results of that meta-analysis indicated that BBT using theta-frequency beats helped reduce anxiety. Another study observed improvements in indicators of quality of life, stress, anxiety, and insomnia in healthy adults after exposure to theta binaural beats for 15 and 30 min during the day and before bedtime, respectively, for 3 weeks [16].

B Isik, A Esen, B Büyükerkmen, A Kilinc and D Menziletoglu [17] investigated the effects of BBT on anxiety among patients undergoing dental surgery and discovered that exposure to music with alpha binaural beats for 10 min before surgery significantly decreased levels of anxiety. H-C Sung, W-L Lee, H-M Li, C-Y Lin, Y–Z Wu, J-J Wang and T-L Li [18] reported a significant increase in normalized high-frequency heart rate variability (HRV) among older patients with depression after they listened to familiar old songs with alpha binaural beats for 30 min for 5 consecutive days, suggesting that the music induced a state of relaxation. However, P Daengruan, R Chairat, R Jenraumjit, D Chinwong, A Oon-Arom, J Klaphajone and P Arunmanakul [19] reported that when patients with depression listened to music with alpha binaural beats, their negative emotions were not significantly alleviated. Based on the above studies, these findings indicate that theta binaural beats effectively decrease anxiety. However, the effects of theta binaural beats on patients with depression remain unclear. Furthermore, few studies have explored the effects of beta binaural beats on patients with depression.

College students must undergo the transition from adolescence to adulthood. The capacity of college students to physically and psychologically cope with stress may differ from that of adults in the general population [20, 21]. Additionally, college students with symptoms of depression may differ from their peers with respect to their ANS regulation and other physiological mechanisms [22]. Few studies have investigated the effects of BBT on anxiety levels among college students. Therefore, the aim of this study was to (1) compare the effects of a BBT intervention with different frequencies on ANS regulation (ie, anxiety reduction) among college students and (2) investigate whether the effects of the intervention differed among different subgroups with depression.

This quasi-experimental study recruited students from various academic programs at a university in southern Taiwan between September 2021 and September 2022. Participants were recruited through university-wide announcements via online bulletin boards and email invitations. Each participant underwent 3 interventions: 1) theta frequency, 6 Hz (intervention A); 2) alpha frequency, 10 Hz (intervention B); and 3) beta frequency, 25 Hz (intervention C). The intervention order was determined using a Latin square randomization method, ensuring that all participants experienced the three conditions (theta frequency, 6 Hz; alpha frequency, 10 Hz; and beta frequency, 25 Hz) in different sequences. For example, participant 1 underwent the interventions in the order A-B-C, participant 2 in the order A-C-B, and participant 3 in the order B-A-C. A 1-week washout period separated each intervention to minimize potential carryover effects. This crossover design aimed to enhance the reliability of the findings by allowing independent evaluation of each intervention, as similar approaches have been shown to effectively control residual effects in related studies [23, 24]. All participants gave their informed consents before participating in the present study.

This study implemented questionnaire-based interviews with the participants prior to the intervention. Demographic characteristics and scores for the Beck Depression Inventory (BDI) were collected using the questionnaire. The intervention steps were as follows. The pretest blood pressure (BP) and HRV of participants were measured after the participants had rested in a sitting position for 10 min. A BBT intervention was then implemented for 20 min. Subsequently, the participants’ posttest BP and HRV were remeasured. All the interventions were conducted in a quiet room at a moderate temperature between 9 and 11 am. This study enrolled participants aged ≥ 20 years who had not taken antidepressant medication within 3 months before the intervention. This study excluded participants with a history of mental illness, a current acute illness (eg, common cold), a history of epilepsy, eye problems, vertigo (including Meniere’s syndrome), or hearing impairment. While no monetary rewards were provided, participants were given feedback on their results and informed of the potential benefits of binaural beat therapy to encourage voluntary participation. The study was approved by the Research Ethics Committee of China Medical University Hospital, Taichung, Taiwan (Approval Number: CMUH110-REC3-021) on April 17, 2021. The study procedure is illustrated in Fig. 1.

Flow chart of participants through study

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The participants were seated with their eyes closed wearing over-ear headphones and were exposed to natural sounds embedded with 6 Hz, 10 Hz, or 25 Hz binaural beats for 20 min. This duration was chosen based on previous studies demonstrating that 15 to 30 min of binaural beat exposure is sufficient to produce measurable effects on autonomic nervous system regulation and anxiety reduction [15, 24]. Limiting the session to 20 min also minimized the risk of participant fatigue or discomfort, ensuring reliable data collection. To prevent the participants from falling asleep or having an adverse reaction, the study asked the participants whether they felt comfortable 10 min into the intervention; participants who reported any discomfort were withdrawn from the intervention. However, no participants reported discomfort, and all 65 participants successfully completed the intervention.

The questionnaire collected demographic characteristics, namely the participants’ sex, age, and religion; the number of times per week that they exercised for longer than 30 min; and their perceived health status. The BDI was adopted to measure the severity of depression among participants. The BDI screening was conducted by the authors, who were trained in administering psychological assessments, following standardized procedures to ensure consistency and reliability. The BDI is a 21-item scale developed by Beck et al. in 1961 in which respondents self-evaluate their feelings of depression within the previous 2 weeks [25]. Each item is measured using a 4-point Likert-type scale with endpoints ranging from 0 to 3. Total scores range from 0 to 63 points, with higher scores indicating greater severity of depression. These scores are classified as follows: 0 to 13 points, no depression; 14 to 19 points, mild depression; 20 to 28 points, moderate depression; and 29 to 63 points, severe depression. The Chinese version of the BDI has acceptable reliability and validity [26].

A BP monitor (Omron HEM-9700 T; Omron Healthcare, Kyoto, Japan) was used to measure heart rate and BP (systolic and diastolic BP). A state of relaxation was indicated by decreased heart rate and BP. HRV was assessed in accordance with the standard deviation of all normal to normal intervals (SDNN), the normalized low-frequency (nLF) and normalized high-frequency (nHF) indices of HRV, and the low-frequency to high-frequency (LF/HF) ratio, which were measured using an SA-3000p analyzer (Medicore, Seoul, Korea). Higher SDNN indices indicate more favorable HRV and better cardiac ANS regulation. nLF indices indicate the level of contribution of the sympathetic nervous system (SNS) to heart regulation; higher values indicate higher levels of contribution. nHF indices indicate the level of contribution of the parasympathetic nervous system (PNS) to heart regulation; higher values indicate higher levels of contribution (ie, greater relaxation). The LF/HF ratio reflects the balance between the SNS and PNS; higher ratios indicate a greater effect of the SNS, and lower ratios indicate a greater effect of the PNS.

Statistical analyses were conducted using SPSS 22.0 for MacOS (IBM, Armonk, NY, US). Statistical significance was indicated at α = 0.05. Demographic characteristics were analyzed using descriptive statistics. The 3 types of interventions and changes in BP (systolic and diastolic BP) and HRV parameters (SDNN, nLF, nHF, and LF/HF) were compared using paired t tests and the Wilcoxon signed-rank test. Participants were classified as having depression (BDI score > 14) or not having depression (BDI score: 0 to 13) for subgroup analysis.

A Wilcoxon rank-sum test was used to assess differences in the effects of the intervention between the participants with and without depression. Repeated measures analysis of variance (ANOVA) and the Friedman test were applied to verify whether the differences between the 3 types of interventions were statistically significant with respect to the variations in each index.

The demographic characteristics of the participants are presented in Table 1. In total, 9 men and 56 women participated, and the mean age was 20.15 years. Most participants were not religious, exercised 1 to 2 days per week, perceived themselves as healthy, and had BDI scores indicating no depression (scores of 0–13).

Table 2 presents the mean, standard deviation, and paired t-test results for pretest and posttest heart rate, BP, and HRV for all participants. Heart rate and systolic and diastolic BP were significantly lower after intervention A (P < 0.05). Systolic BP was significantly lower after intervention B (P < 0.05). Heart rate, systolic BP, and nLF were significantly lower after intervention C, but nHF was significantly higher after intervention C (P < 0.01).

Table 3 presents the heart rate, BP, and HRV (median and interquartile range) of the participants stratified by depression status and the results of the Wilcoxon signed-rank test. Among the participants without depression, systolic BP was significantly lower after intervention A (P < 0.05), systolic BP and nLF were significantly lower after intervention B (P < 0.05), and systolic and diastolic BP and nLF were significantly lower after intervention C (P < 0.05); however, SDNN and nHF were significantly higher after intervention C (P < 0.05). Among the participants with depression, systolic BP and nLF were significantly lower after intervention A (P < 0.05), heart rate and systolic BP were significantly lower after intervention B (P < 0.05), and heart rate was significantly lower after intervention C (P < 0.05).

A Wilcoxon rank-sum test was conducted to compare the changes in heart rate, BP, and HRV between the participants with and without depression. The results indicated a significant difference in the change in diastolic BP after intervention C between the participants with and without depression (P < 0.05). The participants without depression had a greater decrease in diastolic BP after intervention C than did those with depression (Table 4).

Repeated measures ANOVA was implemented to determine whether the changes in heart rate, BP, and HRV differed significantly between the 3 interventions. The results, which are provided in Appendix 1, results indicated no significant differences between the 3 interventions. A subgroup analysis by depression status also revealed no significant differences between the 3 interventions (Appendix 2).

BBT involving theta and alpha binaural beats has been shown to alleviate symptoms of anxiety and depression [15]. The present study is the one of the few to explore the effects of beta binaural beats. The study by M Garcia-Argibay, MA Santed and JM Reales [15] involved mostly healthy adults. To our knowledge, few studies have examined college students. In the present study, the 3 frequencies affected the heart rate, BP, and HRV parameters to varying extents; however, the differences between the extents of the effects of the 3 frequencies were nonsignificant. The present study found that beta binaural beats decreased diastolic BP more effectively among college students without depression than among those with depression.

Consistent with those of other studies [23, 24], the findings of the present study indicate that heart rate and diastolic BP decreased significantly after exposure to theta or alpha binaural beats (Table 2). In addition, the results indicated that BBT with low-frequency binaural beats could alleviate stress and mitigate physiological responses. Exposure to low-frequency (ie, theta or alpha) binaural beats better enables individuals to relax and enter a tranquil state compared with high-frequency binaural beats. Low-frequency brain waves are indicative of a state of deep relaxation, whereas beta-frequency brain waves are indicative of normal alertness [27]. Consequently, exposure to beta binaural beats is generally employed to enhance cognitive ability and memory capacity [28, 29].

Beta binaural beats have rarely been used to alleviate anxiety or depression. In this study, exposure to beta binaural beats yielded improvements among college students with respect to heart rate, BP, BP, SNS response, and PNS response. The reason the beta-frequency intervention led to significant improvements (ie, relaxation) in heart rate, BP, and HRV compared with other frequencies is unclear; we suggest that such improvements may have arisen because beta and alpha brain waves are more prominent in young adults than in adults in early middle age, late middle age, and late adulthood [30,31,32]. The findings of this study align with H Engelbregt, N Meijburg, M Schulten, O Pogarell and JB Deijen [33], who reported that beta binaural beats modulated emotional states and enhanced cognitive performance, particularly in individuals with higher emotionality. Similarly, our study found that beta binaural beats significantly influenced physiological responses, such as heart rate and diastolic BP. These findings suggest that beta binaural beats may uniquely affect both emotional and physiological states through autonomic nervous system regulation. Future research should explore their effects in relation to emotionality and depression severity. In addition, according to JD Lane, SJ Kasian, JE Owens and GR Marsh [34], beta-frequency brain waves are associated with decreased negative emotions. Therefore, the exposure of young individuals to binaural beat music with beta frequencies has the potential to induce resonance, resulting in frequency-following responses and subsequent effects on physiological indices.

As presented in Tables 3 and 4, this study revealed that exposure to beta binaural beats more effectively decreased diastolic BP among participants without depression than among those with depression. Findings vary with regard to the stability of brain waves in patients with depression. Several studies [35, 36] have asserted that patients with depression have stable brain waves. Other studies have argued that patients with depression have relatively unstable brain waves [37, 38]. In the present study, the interventions were less effective among participants with depression than among those without depression. Further research is required to verify the effects of BBT among patients with depression.

The results indicated no significant differences between the 3 binaural beat frequencies regarding their effects on the examined indices of the college students, possibly because exposure to binaural beats with any of these frequencies is likely to decrease heart rate and BP and alleviate stress and anxiety [39,40,41]. This phenomenon may explain the absence of significant differences between the effects of the 3 interventions.

Several limitations should be considered when interpreting the results of this study. First, the explanatory power of this study is limited because all the enrolled participants were from a university in southern Taiwan. Second, this study did not analyze the participants’ demographic characteristics, but variables such as sex, dietary habits, and stress may also affect heart rate, BP, and HRV. Third, the posttest implemented immediately after exposure to only 20 min of binaural beats may not have accurately captured dynamic changes or subsequent effects. Future studies with longer follow-up periods are warranted. Fourth, this study used a dichotomous approach to classify participants as depressed or not depressed based on BDI scores > 14, following standard clinical diagnostic criteria. However, this method may have limited our ability to detect more nuanced effects of depression severity on intervention outcomes. Future studies with larger sample sizes and enhanced designs should consider treating BDI scores as a continuous variable to explore whether the effects of binaural beat therapy are more pronounced for individuals with higher levels of depression severity. Fifth, the emotions and HRV of the participants may have been affected by the external environment because the experiment was conducted midsemester. Future studies should implement randomized controlled experiments, enroll a larger sample size, and investigate causal relationships. This study examined the effects of BBT with different frequencies on ANS regulation among college students with and without depression. The results may be used as a reference for the application of BBT for the treatment of anxiety or depression among college students.

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We thank all the participants and research assistants for their contribution to the study.

The authors declare no competing interests.

Shang-Yu Yang, Jiun-Yi Wang and Pin-Hsuan Lin contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Shang-Yu Yang, Jiun-Yi Wang, and Cheng Liu. The first draft of the manuscript was written by Shang-Yu Yang and Jiun-Yi Wang. All authors (Shang-Yu Yang, Jiun-Yi Wang, Cheng Liu, and Pin-Hsuan Lin) commented on previous versions of the manuscript and approved the final version for submission.

Correspondence to Pin-Hsuan Lin.

The study was approved by the Research Ethics Committee of China Medical University Hospital (CMUH110-REC3-021). Clinical trial number: Not applicable.

The authors declare no competing interests.

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