“…However, three mechanisms appear to be likely: First, up-regulation of activity within the mesolimbic dopaminergic system by the music (particularly by virtue of increased activity within the ventral tegmental area and the nucleus accumbens; Blood and Zatorre, 2001; Menon and Levitin, 2005; Koelsch et al, 2006a) with corresponding effects on the reactivity to stress and pain (Pani et al, 2000; Jääskeläinen et al, 2001). Second, down-regulation of activity of the central nucleus of the amygdala by the music (Blood and Zatorre, 2001; Koelsch et al, 2006a, 2008) with down-regulatory effects on (a) levels of fear and worries (LeDoux, 2000; Vollert et al, 2003), and (b) on activity of hypothalamic and brainstem nuclei involved in the generation of the endocrine (HPA-axis) and vegetative stress responses (Nieuwenhuys et al, 2007; such stress-related effects might also include modulations of beta-endorphin levels, McKinney et al, 1997b; Gerra et al, 1998; Vollert et al, 2003). Third, because musical information consumes cognitive (including attentional) resources (e.g., Koelsch and Siebel, 2005), participants of the music group might also have been more distracted from fearful and worrying thoughts, and from the perception of the surgical procedures (compared to participants of the control group).…”