Lived Experiences of Audible Sound-Based Practices: A Qualitative Phenomenological Study with Implications for Medical Education

Summary

This qualitative phenomenological study explores how individuals experience audible sound-based practices and examines their perceived bodily, emotional, and cognitive effects to inform medical education and interdisciplinary research.

Abstract

Audible sound has long been embedded in human healing, learning, and cultural practices, yet its role within contemporary medical discourse remains narrowly defined and often contested. While mechanobiology has demonstrated that biological systems are responsive to mechanical forces such as vibration and oscillation, little is known about how audible sound-based practices are experienced subjectively and how participants interpret these experiences in relation to emerging scientific explanations. To address this gap, the present study explored lived experiences of audible sound-based practices and their perceived bodily, emotional, and cognitive effects. Using a qualitative phenomenological design, in-depth semi-structured interviews were conducted with 15 participants who had sustained engagement with audible sound-based practices. Data were analysed using reflexive thematic analysis. Three interrelated themes emerged. First, participants experienced sound as a bodily and tactile phenomenon characterised by internal vibration, resonance, warmth, and muscular release. Second, sound was described as facilitating emotional regulation and cognitive quieting, including reduced anxiety, mental stillness, and heightened self-awareness. Third, participants demonstrated reflective scepticism, carefully distinguishing personal benefit from scientific proof and expressing discomfort with exaggerated or universal healing claims while seeking mechanobiological or psychophysiological explanations. The findings suggest that audible sound-based practices are best understood as experiential regulatory processes rather than therapeutic cures. Importantly, participants displayed epistemic maturity, challenging assumptions that engagement with alternative practices reflects uncritical belief. For medical and health professions education, these findings support the use of sound-based practices as critical case studies for teaching bodily regulation, critical appraisal, and ethical reasoning under scientific uncertainty. Future research should integrate qualitative insight with carefully designed experimental studies to further examine audible sound within a rigorous interdisciplinary framework.

Introduction

Audible sound has long occupied a significant role in human culture, healing traditions, and educational practices, yet its position within contemporary biomedical discourse remains narrow and often contested. In medical contexts, sound is typically associated with diagnostic imaging, auditory neuroscience, and high-frequency ultrasound applications, where its function is clearly defined and technologically mediated. In contrast, audible sound-based practices such as sound baths, tuning fork sessions, vibrational chanting, and resonance-focused interventions are frequently positioned outside formal medical frameworks and categorized as complementary or alternative approaches. This separation has contributed to an epistemic divide in which sound is either dismissed as unscientific or promoted through overstated therapeutic claims, leaving limited space for careful academic examination of how sound is actually experienced and understood.

Sound has been used across cultures for communication, ritual, learning, emotional regulation, and well-being long before the emergence of modern medicine^1,2,3. Despite this long-standing role, contemporary biomedical discourse has largely restricted sound to highly specialized diagnostic and therapeutic applications^4,5. Within these frameworks, sound is commonly conceptualized as a clinical tool rather than as an embodied experiential phenomenon. Outside formal healthcare systems, audible sound-based practices continue to be widely used in wellness and complementary health settings^1,6. These practices frequently emphasize concepts such as vibration, resonance, frequency, and bodily awareness, with participants reporting perceived effects on physical sensations, emotional states, and cognitive experiences^7,8. However, discussions surrounding these practices often remain polarized, with sound-based approaches either dismissed as lacking scientific credibility or promoted using claims that exceed available evidence^1,6.

Recent developments in mechanobiology have created new opportunities for examining sound from a biological perspective^9,10. Mechanobiological research has demonstrated that cells and tissues respond to mechanical forces such as pressure, vibration, stretch, and oscillation^11,12. Through mechanotransduction processes, these forces can influence cellular signaling, tissue behavior, and biological regulation^11,12. In parallel, emerging research in acoustic stimulation and sonobiology has begun investigating the effects of audible and low-frequency sound on biological systems^13,14. Preliminary findings suggest that sound may influence living tissues under specific experimental conditions, although the extent, consistency, and clinical significance of these effects remain uncertain^4,13. Consequently, current evidence supports biological plausibility rather than therapeutic certainty.

Despite growing scientific interest, the literature examining audible sound as a mechanobiological phenomenon remains limited. Reviews have highlighted a scarcity of studies, considerable methodological variability, and a lack of standardization across investigations⁴. In addition to sound-based wellness practices, sound has also contributed to a variety of innovative medical and technological applications, further demonstrating its relevance across healthcare contexts^5,15. Nevertheless, most existing research focuses on biological mechanisms or experimental outcomes rather than on how audible sound is experienced and interpreted by individuals who engage in sound-based practices. As a result, an important gap exists between emerging mechanobiological explanations and the lived experiences that frequently motivate participation in these practices.

This gap has important implications for medicine and health professions education. Patients increasingly engage with complementary and alternative health practices, including audible sound-based approaches, and may discuss these experiences with healthcare professionals^16,17. However, opportunities to critically examine such experiences within health professions education remain limited^18,19. Understanding how individuals interpret and make meaning of their experiences does not imply endorsement of these practices. Rather, it supports critical appraisal, ethical communication, patient-centered care, and informed discussion of emerging or contested health practices^16,20. Incorporating experiential perspectives may therefore strengthen educational discussions surrounding sound-based practices while promoting scientific rigor and professional reflection.

A further limitation in the literature is the lack of phenomenological research examining audible sound-based practices from the perspective of participants themselves^1,21. Existing discussions often focus on theoretical mechanisms, therapeutic claims, or broader cultural interpretations, while comparatively little attention has been given to documenting how individuals experience audible sound at bodily, emotional, and cognitive levels^11,13. Without such qualitative evidence, mechanobiological concepts may be overextended to support unverified claims or excluded entirely from discussions of sound-based practices. Understanding lived experience is therefore essential for clarifying what participants perceive, how they interpret those perceptions, and how they distinguish personal benefit from scientific evidence.

Phenomenological inquiry provides an appropriate framework for addressing this gap because it focuses on how individuals experience, interpret, and assign meaning to phenomena in everyday life. Previous research in sound studies, anthropology, and health professions education suggests that audible sound may be associated with bodily awareness, emotional regulation, reflective engagement, and meaning-making processes^1,3,22,23,24. Systematically exploring these experiences can contribute to a more nuanced understanding of sound-based practices while avoiding assumptions regarding therapeutic efficacy or biological causality.

The purpose of the present study was therefore to explore audible sound-based practices from a phenomenological perspective by examining how individuals describe and interpret their lived experiences. Rather than evaluating clinical efficacy, the study sought to investigate bodily sensations, emotional and cognitive experiences, and participants’ perspectives regarding health, healing, and scientific credibility. By documenting these experiences, the study aims to contribute qualitative insight to an emerging interdisciplinary conversation involving mechanobiology, sound studies, complementary health practices, and health professions education^20,21. In doing so, it seeks to provide greater conceptual clarity while maintaining clear distinctions between lived experience, biological plausibility, and scientific evidence.

The study was guided by three research questions. First, how do participants describe their lived bodily experiences during and after audible sound-based interventions? Second, what emotional and cognitive changes do participants associate with exposure to audible sound therapies? Third, how do participants make sense of audible sound practices in relation to health, healing, and scientific credibility?

Protocol

This study was conducted in accordance with institutional guidelines regarding research involving human participants. Ethical approval for this study was obtained from the University College Fairview Research Ethics Committee (UCF-REC) (Reference No. UCF/REC/2026/06-089; approval date: October 30, 2025). Written informed consent was obtained from each participant prior to the commencement of the study. All participants were informed of the voluntary nature of the study, their right to decline to answer any question, and their right to withdraw from the study at any stage. To ensure participant privacy and confidentiality, pseudonyms and participant codes were used in all transcripts and reports generated from this study. Audio recordings of the interviews were obtained using a Sony ICD-PX470 digital voice recorder or through Zoom. All audio recordings, transcripts, notes, and electronic files were stored on a password-protected and encrypted drive accessible only to the research team. These files will be retained for five years following completion of the study, after which they will be permanently deleted. No data from this study will be shared with third parties without participant consent or unless required by applicable regulations²⁰.

To ensure participant protection and well-being throughout the study, several measures were implemented. All interviews were conducted in a comfortable environment designed to minimize participant discomfort. Participants were informed of the purpose of the interviews and advised that the interviews would not be used to evaluate the effectiveness of sound-based practices as a form of therapy. Should any participant experience discomfort during or after the interview, a protocol was in place to manage participant distress. No adverse events or participant complaints occurred during the study.

Interview transcripts were created using NotebookLM software. According to the software developer, the software is capable of transcribing audio-recorded interviews. The transcripts were subsequently reviewed manually to ensure that the transcribed content accurately reflected the original audio recordings. Following transcript preparation, reflexive thematic analysis was conducted using ATLAS.ti 25 software. Although the qualitative data analysis software provided tools to assist with data organization and coding, the researchers remained responsible for all analytical decisions and interpretation of the interview transcripts. Ethical principles, including respect for persons, beneficence, non-maleficence, justice, and responsible stewardship of data, were adhered to throughout the study²⁰.

Research Design

Given the contested and emerging nature of audible sound-based practices, a phenomenological research design was employed to explore experiences associated with these practices as an embodied phenomenon that remains incompletely understood. Phenomenology seeks to examine a phenomenon as it is experienced by participants, focusing on perception, meaning, and lived experience rather than evaluating the phenomenon itself^25,26. Because audible sound-based practices remain an emerging area of inquiry with no established consensus regarding their purpose or effects, phenomenology provided an appropriate framework for exploring participants’ experiences without making assumptions regarding their use or efficacy as a treatment modality²⁵.

Epistemological Positioning

This study was informed by the understanding that experiences are contextual, subjective, and inherently interpretable^26,27. Within this perspective, the researcher’s background and interpretive lens are recognized as important components of the research process²⁸. The primary researcher is an academic with interests in phenomenology, educational research, and interdisciplinary research related to health and the body. Although the researcher is familiar with audible sound-based practices and their proposed mechanisms, the researcher does not use these practices as a therapeutic modality. Accordingly, the experiences reported by participants were approached as phenomena worthy of exploration and understanding rather than as evidence supporting therapeutic efficacy or biological validity.

Reflexivity was considered throughout the study to minimize undue influence on the data collection and analysis processes. Following each interview, the researcher recorded reflexive memos documenting observations, preliminary interpretations, and assumptions regarding participant experiences. These memos served as part of an audit trail, documenting the considerations that informed data coding and theme development. Through this process, efforts were made to ensure that the findings remained grounded in participants’ experiences rather than researcher assumptions. This approach acknowledges the role of the researcher as both interpreter and observer of participant experiences^20,28,29,30. Given the interdisciplinary and sometimes contested nature of audible sound-based practices, an interpretive phenomenological approach was considered appropriate for understanding these experiences within the unique personal and social contexts of individual participants.

Participants and Sampling Strategy

A purposive sampling strategy was employed to ensure that participants had sufficient experience with the phenomenon of audible sound-based practices³¹. Fifteen participants who met predefined inclusion criteria were recruited for the study. To be eligible, participants were required to have attended at least three audible sound-based practice sessions, demonstrate a willingness and ability to describe their experiences in detail, and represent diverse professional and educational backgrounds.

Participants were recruited between November 2025 and January 2026 through advertisements posted in Facebook groups, WhatsApp communities, and Telegram channels focused on sound-based wellness, meditation, mindfulness, and related health practices. These online communities included individuals with either prior experience of or an interest in audible sound-based practices. Individuals who expressed interest in participating were provided with information about the study and subsequently screened through email and messaging platforms to determine eligibility.

Twenty-one individuals expressed interest in participating in the study. Six individuals were excluded during screening. Three individuals had participated in fewer than three audible sound-based sessions, two were unable to discuss their experiences in sufficient detail, and one declined participation prior to the scheduled interview because of time constraints. Fifteen individuals met the eligibility criteria and provided informed consent to participate in the study.

Although recruitment through online communities may have introduced self-selection bias, this approach was considered appropriate for phenomenological and qualitative research because it facilitated access to individuals with direct and sustained experience of the phenomenon under investigation^25,31. Qualitative research prioritizes the depth, richness, and contextual understanding of participant experiences rather than statistical representativeness^25,31. Consequently, the objective of the sampling strategy was to obtain reflective and information-rich accounts of audible sound-based practices rather than to generate findings that are generalizable to a wider population.

Given the aims of phenomenological inquiry, participants were selected on the basis of their ability to provide detailed accounts of their lived experiences. In addition to direct experience with audible sound-based practices, participants were required to demonstrate a willingness and capacity for reflection. Efforts were also made to recruit individuals from diverse professional and educational backgrounds to enrich the range of perspectives represented in the study. Such diversity supports phenomenological inquiry by facilitating a broader exploration of lived experience while maintaining focus on the phenomenon under investigation^17,25,26.

The final sample consisted of fifteen participants. This sample size was considered appropriate for phenomenological research, which emphasizes depth of inquiry and richness of description rather than statistical representation^17,25,26. The relatively small sample enabled in-depth exploration of participants’ experiences with audible sound-based practices. Participant demographic characteristics and prior experience with audible sound-based practices are summarized in Table 1.

Participant Code	Gender	Age Group (Years)	Duration of Exposure to Audible Sound-Based Practices
P1	Female	30–39	2–3 years
P2	Male	40–49	4–5 years
P3	Female	30–39	1–2 years
P4	Female	50–59	6–8 years
P5	Male	40–49	3–4 years
P6	Female	30–39	2–3 years
P7	Male	50–59	8–10 years
P8	Female	40–49	4–6 years
P9	Female	30–39	1–2 years
P10	Male	60–69	Over 10 years
P11	Female	40–49	5–7 years
P12	Male	30–39	2–3 years
P13	Female	50–59	6–8 years
P14	Male	40–49	3–5 years
P15	Female	30–39	1–2 years

Table 1: Demographic characteristics and prior experience of study participants. This table summarizes participant demographic characteristics, including gender, age group, and duration of engagement with audible sound-based practices. Participants were purposively recruited based on prior experience with audible sound-based interventions and their ability to provide detailed reflections on associated bodily, emotional, and cognitive experiences. The sample comprised 15 participants representing a range of ages, genders, and durations of engagement.

The participant group comprised nine females and six males, providing a balanced range of gender perspectives without overrepresentation of any single group. Participants ranged in age from their early 30s to their late 60s, with most participants between 30 and 49 years of age. This age distribution is consistent with adult populations who are more likely to engage in sustained self-reflective wellness and experiential practices and who can articulate embodied, emotional, and cognitive experiences in depth.

All participants reported a minimum of one year of engagement with audible sound-based practices, with several reporting involvement extending beyond five years. This level of exposure ensured that participants’ accounts reflected repeated and sustained experiences rather than novelty effects. Consequently, participants were able to describe changes over time, compare different sessions, and articulate nuanced perceptions of bodily sensations, emotional regulation, and cognitive shifts associated with sound-based interventions.

From a methodological perspective, diversity in age, gender, and duration of engagement enhanced the breadth of experiential perspectives while remaining consistent with phenomenological principles that prioritize depth and richness of lived experience over statistical representativeness. The inclusion of participants with varying levels of experience strengthened the study’s ability to capture both early interpretive responses and longer-term meaning-making processes, thereby supporting credible and trustworthy insights into audible sound as an experiential phenomenon.

Data Collection Procedures

Between January 2026 and March 2026, individual semi-structured interviews were conducted with participants. Interviews were conducted either in person or remotely according to participant preference. A total of fifteen interviews were completed, of which six were conducted in person and nine were conducted remotely via an online meeting platform. Interviews ranged from approximately 45 to 75 min in duration, as documented in the completed COREQ checklist (Supplementary File 1). Semi-structured interviews were selected to ensure consistency across participants while maintaining sufficient flexibility to explore individual experiences and perspectives related to audible sound-based practices³². The interview guide used for the study is provided in Supplementary File 2. The guide included questions exploring participant background, bodily experiences, emotional and cognitive responses, perceptions of health and healing, and meaning-making processes related to audible sound-based practices (Supplementary File 2).

All interviews were audio-recorded with participant consent to ensure accurate capture of the discussion. In-person interviews were recorded using a digital voice recorder, whereas remote interviews were recorded using the recording function of the online meeting platform. Audio recordings were transcribed verbatim following each interview.

The semi-structured interview format enabled the research questions to be explored consistently across participants while allowing flexibility to pursue relevant topics that emerged during the interviews³². Interview questions focused on participants’ bodily sensations, emotional experiences, cognitive responses, and perceptions associated with audible sound-based practices. Follow-up questions were used, when appropriate, to obtain clarification and elicit richer descriptions of participant experiences³².

Field notes were recorded following each interview to document contextual observations and preliminary reflections. Participants were subsequently provided with copies of their interview transcripts for review. Any clarifications provided by participants were incorporated into the transcripts. No participant expressed disagreement with the content of their transcript²⁴. Representative anonymized transcript excerpts are provided in Supplementary File 3.

The interview transcripts and field notes were used for subsequent analysis. Together, these data sources supported the completeness, credibility, and authenticity of the findings^20,24.

Data Analysis

Data were analyzed using reflexive thematic analysis following the principles described by Braun and Clarke^29,30. Coding and theme development were conducted by a single researcher consistent with a reflexive thematic analysis approach (Supplementary File 1). Interview transcripts were read repeatedly to facilitate familiarity with the data. During the initial stage of analysis, inductive coding was conducted to identify participants’ experiences, interpretations, and meanings associated with audible sound-based practices. Particular attention was paid to participants’ descriptions of bodily sensations, emotions, thoughts, and the meanings they attributed to their experiences³³. Related codes were subsequently grouped and refined into themes that reflected shared patterns across participant accounts^29,30. A summary of the thematic coding framework and code definitions is provided in Supplementary File 4. The final themes and their supporting coded excerpts are presented in Supplementary File 5.

Interview transcripts, participant-reviewed clarifications, and field notes were analyzed together to provide a comprehensive understanding of participant experiences²⁴. Throughout the analytical process, reflexive memos were maintained to document emerging interpretations, analytical decisions, and reflections regarding the data^29,30. These memos contributed to an audit trail and supported the confirmability of the findings^20,24. Examples of reflexive memos and audit trail documentation are provided in Supplementary File 6^20,24. Themes were reviewed and refined iteratively to ensure that they accurately reflected the experiences described by participants and remained grounded in the data^29,30.

The combination of verbatim transcription, participant transcript review, field notes, and reflexive memoing contributed to the completeness, credibility, and trustworthiness of the findings^20,24.

Ensuring Trustworthiness and Rigor

To enhance the trustworthiness of the study, strategies were implemented in accordance with the criteria proposed by Lincoln and Guba²⁴. Credibility was supported through prolonged engagement with the data, repeated review of interview transcripts, and the use of rich, detailed descriptions of participant experiences. Emerging themes were continuously compared with the original data to ensure that interpretations accurately reflected participant perspectives.

Dependability was supported through maintenance of an audit trail documenting methodological and analytical decisions throughout the study. Reflective memos were used to document researcher assumptions and interpretations during data analysis. Transferability was enhanced through detailed descriptions of participants, study settings, and experiential contexts, allowing readers to evaluate the applicability of the findings to other settings²⁴.

Analytical transparency was further strengthened through discussions among members of the research team regarding interpretation, reflexivity, and theme refinement. Coding and theme development were conducted by a single researcher consistent with reflexive thematic analysis (Supplementary File 1). These discussions helped ensure that interpretations remained grounded in participant accounts rather than researcher expectations. Additional details regarding the procedures used to enhance trustworthiness are provided in Supplementary File 1^24,32. Representative coded excerpts supporting theme development are provided in Supplementary File 5.

Table 1 summarizes the strategies used to enhance each aspect of trustworthiness. A completed COREQ checklist is also provided in Supplementary File 1 to further document the measures taken to support the rigor, credibility, and transparency of the study.

Results

Figure 1 presents the thematic relationships among the three research questions, major themes, and associated experiential codes derived from the reflexive thematic analysis. No formal subthemes were identified during the analysis. Instead, the themes were supported by clusters of related codes that captured recurring patterns across participants’ lived experiences. The figure illustrates how participants’ accounts progressed from bodily awareness and emotional regulation to reflective considerations concerning legitimacy and scientific credibility, ultimately contributing to an overall interpretation of audible sound-based practices as embodied and regulatory experiences rather than therapeutic interventions.

Figure 1. Thematic map of participants’ lived experiences with audible sound-based practices. This figure illustrates the relationships among the three research questions, the three themes identified through reflexive thematic analysis, their associated codes, and the overall interpretation of participant experiences. Theme 1, Sound as a Bodily Encounter Rather Than an Auditory Event, includes bodily vibration, internal resonance, pressure and warmth, and muscle release. Theme 2, Emotional Regulation and Cognitive Quieting, includes emotional calming, reduced anxiety, mental stillness, and heightened self-awareness. Theme 3, Negotiating Meaning, Legitimacy, and Skepticism, includes cautious belief, experience versus science, discomfort with exaggerated claims, and desire for grounded explanations. The figure presents conceptual relationships among research questions, themes, codes, and interpretive findings derived from participant interviews. No subthemes were identified. Source: Developed by the authors based on reflexive thematic analysis of participant interviews. Please click here to view a larger version of this figure.

Research Question 1: How do participants describe their lived bodily experiences during and after audible sound-based interventions?

To provide a structured overview of the embodied experiences reported by participants, Table 2 summarizes the key theme and associated codes derived from the analysis addressing Research Question 1. The table illustrates how audible sound was experienced as a bodily and tactile phenomenon rather than a purely auditory event, highlighting recurring physical sensations and shifts in bodily awareness described by participants. This tabulated summary supports the narrative findings by linking the overarching theme to its associated experiential codes.

Theme	Description				Associated Codes
Theme 1: Sound as a Bodily Encounter Rather Than an Auditory Event	Participants consistently described audible sound as a bodily and tactile experience rather than an experience limited to hearing. Sound was perceived as something that moved through the body, producing physical sensations that were spatially located and temporally sustained beyond the listening period. Participants frequently reported sensations of vibration travelling through the chest, abdomen, or spine. These sensations were often described as grounding, stabilising, or centring. Several participants emphasised that their awareness shifted from external listening to internal bodily sensation, suggesting that sound was experienced as a physical encounter rather than a purely auditory stimulus.				Bodily vibration; Internal resonance; Pressure and warmth; Muscle release

Table 2: Theme and associated codes derived from the analysis addressing Research Question 1. This table presents the theme identified in relation to Research Question 1 and the associated inductive codes generated through reflexive thematic analysis. The theme reflects participants’ descriptions of audible sound as an embodied and tactile experience characterized by physical sensations, internal resonance, and perceived bodily responses extending beyond auditory perception. Associated codes represent recurrent experiential patterns identified across participant accounts. No formal subthemes were identified during the analysis.

Participants consistently described their experiences of audible sound as deeply embodied and physically felt rather than confined solely to auditory perception. Across interviews, sound was repeatedly characterized as something that entered the body, moved through internal spaces, and produced tangible physical sensations that extended beyond the listening experience. Participants did not frame sound as an external stimulus received through hearing alone; rather, they described it as an internal event that reorganized bodily awareness. This experiential orientation supports the theme of sound as a bodily encounter rather than an auditory event, highlighting how sound was experienced through touch, pressure, vibration, and spatial sensation within the body. The theme and supporting quotations from selected participants are exemplified below.

Theme 1: Sound as a Bodily Encounter Rather Than an Auditory Event

Participant P3 (female, 30–39 years, 1–2 years of exposure) explained:

“It wasn’t like I was listening to the sound. It felt more like the sound was moving inside my chest and down my spine, almost like a vibration that settled there.”

Participant P7 (male, 50–59 years, 8–10 years of exposure) explained:

“I could feel a kind of humming inside my body, especially around my stomach area. It was warm and steady, not loud, but very physical.”

Participant P11 (female, 40–49 years, 5–7 years of exposure) explained:

“After the session, my body felt heavier in a good way, like my muscles had finally let go. I felt more grounded, like I was fully inside my body again.”

Participants described a shift in attentional focus from the external characteristics of sound to internal bodily awareness. Rather than perceiving sound primarily as music or noise, participants became increasingly aware of how vibrations and sensations were experienced within the body. This heightened awareness was often described as occurring naturally rather than through deliberate effort. Several participants reported that their attention gradually moved away from listening to the sound itself and toward sensations of resonance, relaxation, and muscular release. These observations reinforce the codes of internal resonance and muscle release and further support the interpretation that audible sound was experienced as an embodied phenomenon rather than merely an auditory event.

Research Question 2: How do participants associate emotional and cognitive changes with exposure to audible sound-based practices?

Table 3 presents the second major theme addressing Research Question 2 and summarizes the codes associated with emotional regulation and cognitive quieting. Across participants, audible sound-based practices were consistently described as experiences associated with changes in emotional tone, attentional focus, and reflective awareness rather than as interventions that directly resolved illness or emotional distress. Four interconnected codes emerged from the analysis: emotional calming, reduced anxiety, mental stillness, and heightened self-awareness. Together, these codes suggest that participants experienced audible sound primarily as a contextual and experiential regulator of internal states.

Theme	Description				Associated Codes
Theme 2: Emotional Regulation and Cognitive Quieting	Audible sound was commonly experienced as a regulator of emotional and cognitive states rather than as a direct healing or curative intervention. Participants described changes in mood, attention, and mental clarity that occurred during or after sound-based sessions. Many participants reported feeling emotionally calmer, with a noticeable reduction in anxiety and mental agitation. Cognitive quieting was frequently described as a slowing or softening of internal dialogue, allowing greater focus or reflective awareness. These effects were particularly associated with low-frequency instruments, which participants perceived as encouraging relaxation and inward attentional focus.				Emotional calming; Mental stillness; Reduced anxiety; Heightened self-awareness

Table 3: Theme and associated codes derived from the analysis addressing Research Question 2. This table presents the theme identified in relation to Research Question 2 and the associated inductive codes generated through reflexive thematic analysis. The theme reflects participants’ descriptions of audible sound as a perceived regulator of emotional and cognitive states, including experiences of emotional calming, reduced anxiety, mental quieting, and increased self-awareness. Associated codes represent recurrent experiential patterns identified across participant accounts. No formal subthemes were identified during the analysis.

The following section presents the theme alongside representative quotations from selected participants.

Theme 2: Emotional Regulation and Cognitive Quieting

A dominant pattern across participants was the experience of emotional calming and reduced anxiety. Participants frequently described a transition from emotional tension, stress, or restlessness toward feelings of calmness and emotional balance.

Participant P2 (male, 40–49 years, 4–5 years of exposure) explained:

“I usually carry a lot of tension without realising it, but during the sound sessions I feel my emotions settle down. I'm not fixing anything, but I feel calmer and less reactive.”

Similarly, participant P9 (female, 30–39 years, 1–2 years of exposure) explained:

“There's a sense of emotional softening. I feel less anxious, like the edges of my stress are smoothed out.”

Participant P11 (female, 40–49 years, 5–7 years of exposure) explained:

“I still have worries, but after the sessions I feel emotionally lighter. Things don't disappear, but I don't feel overwhelmed by them anymore.”

These descriptions suggest that participants perceived changes in the intensity of emotional reactions rather than the elimination of emotional challenges. Emotional regulation was therefore experienced as moderation and balance rather than cure.

Participants also consistently described experiences of cognitive quieting and mental stillness. Rather than reporting an absence of thought, participants referred to a reduction in intrusive or repetitive thinking and an increased capacity for attentional focus.

Participant P6 (female, 30–39 years, 2–3 years of exposure) explained:

“My mind doesn't stop completely, but it becomes quieter. The thoughts slow down, and there's more space between them.”

Participant P12 (male, 30–39 years, 2–3 years of exposure) explained:

“Normally, I think about many things at once. During the sessions, I feel less mentally crowded and more able to focus on the present.”

Likewise, participant P14 (male, 40–49 years, 3–5 years of exposure) explained:

“It is not like my thoughts disappear. They just become less noisy, and I become more aware of what I am thinking.”

These accounts indicate that participants experienced changes in the quality and pace of their thoughts rather than cognitive suppression. Such descriptions reinforce the codes of mental stillness and heightened self-awareness and suggest that audible sound was associated with greater attentional presence and reflective awareness.

Several participants further associated these experiences with prolonged exposure to low-frequency instruments and sustained resonant sounds.

Participant P4 (female, 50–59 years, 6–8 years of exposure) explained:

“The deeper sounds seem to surround me. They make me feel grounded and less distracted by everything happening around me.”

Participant P7 (male, 50–59 years, 8–10 years of exposure) explained:

“The low sounds help me pay attention to what is happening inside rather than outside. I feel more settled afterwards.”

Participant P10 (male, 60–69 years, over 10 years of exposure) explained:

“The experience gives me a chance to slow down mentally. I become more aware of myself and less caught up in external pressures.”

These descriptions suggest that participants interpreted low-frequency sounds as facilitating inward attention and emotional balance. Importantly, participants generally refrained from attributing these experiences to specific healing mechanisms or universal effects. Instead, they consistently framed them as subjective and context-dependent experiences that varied among individuals and across sessions.

Taken together, the findings addressing Research Question 2 indicate that participants associated audible sound-based practices with emotional calming, reduced anxiety, mental quieting, and increased self-awareness. These experiences were interpreted as supportive and regulatory rather than curative in nature. Accordingly, Theme 2 suggests that participants understood audible sound as an experiential resource that promoted feelings of calmness, focus, and present-moment awareness without implying therapeutic efficacy or scientific certainty.

Research Question 3: How do participants make sense of audible sound-based practices in relation to health, healing, and scientific credibility?

Table 4 presents the third major theme addressing Research Question 3 and summarizes the codes associated with participants’ negotiations of meaning, legitimacy, and skepticism. Four interconnected codes emerged from the analysis: cautious belief, distinctions between experience and science, discomfort with exaggerated claims, and a desire for grounded explanations. Together, these codes illustrate that participants did not interpret audible sound-based practices uncritically. Instead, they actively negotiated the relationship between personal experience, scientific evidence, and broader understandings of health and healing.

Theme	Description				Associated Codes
Theme 3: Negotiating Meaning, Legitimacy, and Skepticism	Participants actively engaged in sense-making processes that balanced personal experience with critical reflection. Rather than accepting sound-based practices uncritically, participants demonstrated thoughtful negotiation of meaning and legitimacy. Participants were generally open to mechanobiological or psychophysiological explanations for their experiences, particularly those grounded in vibration and bodily regulation. However, many expressed discomfort with mystical, absolute, or universal healing claims. A clear distinction was made between acknowledging personal benefit and asserting scientific proof, indicating reflective and sceptical engagement rather than uncritical acceptance.				Cautious belief; Distinction between experience and science; Discomfort with exaggerated claims; Desire for scientific explanation

Table 4: Theme and associated codes derived from the analysis addressing Research Question 3. This table presents the theme identified in relation to Research Question 3 and the associated inductive codes generated through reflexive thematic analysis. The theme reflects participants’ efforts to interpret and evaluate their experiences with audible sound-based practices while balancing perceived personal benefit, scientific uncertainty, and critical reflection. Associated codes capture perspectives related to legitimacy, skepticism, distinctions between lived experience and scientific evidence, and preferences for grounded explanatory frameworks. No participants reported adverse experiences, complete rejection of audible sound-based practices, or viewed these practices as substitutes for conventional medical care. Disconfirming perspectives primarily involved skepticism regarding exaggerated claims and distinctions between personal experience and scientific evidence.

Across participants, personal benefit was rarely equated with scientific proof. Participants frequently acknowledged subjective experiences of calmness and emotional regulation while simultaneously expressing reservations regarding claims of therapeutic efficacy. The theme identified in this study, together with illustrative quotations from selected participants, is presented below.

Theme 3: Negotiating Meaning, Legitimacy, and Skepticism

Participant P4 (female, 50–59 years, 6–8 years of exposure) explained:

“I know the sessions help me feel calmer and more grounded, but I wouldn't say it's healing anything in a medical sense. That feels like a different claim altogether.”

Similarly, participant P10 (male, 60–69 years, over 10 years of exposure) explained:

“I trust my experience, but I don't automatically trust the explanations that come with it. Feeling better doesn't mean I understand the science behind it.”

Participant P11 (female, 40–49 years, 5–7 years of exposure) explained:

“Just because something helps me relax doesn't mean I can say it works for everyone. I think those are two different things.”

These accounts demonstrate that participants consistently differentiated experiential validation from scientific certainty. Rather than rejecting science, participants appeared to maintain clear boundaries between personal meaning and empirical evidence, supporting the code of cautious belief.

Participants also expressed discomfort with exaggerated, universal, or mystical claims surrounding sound-based practices. Several participants described distancing themselves from narratives that portrayed sound as capable of curing all physical or emotional conditions.

Participant P8 (female, 40–49 years, 4–6 years of exposure) explained:

“When people start saying sound can fix everything, that's where I pull back. It makes me question the credibility of the whole practice.”

Participant P14 (male, 40–49 years, 3–5 years of exposure) explained:

“I become suspicious when people make very big promises. It makes me less confident about what is actually true.”

Likewise, participant P9 (female, 30–39 years, 1–2 years of exposure) explained:

“Some explanations sound too absolute. I prefer people to say that it might help some people rather than claim that it works for everyone.”

These reflections suggest that skepticism itself formed part of participants’ meaning-making processes. Rather than accepting all claims associated with audible sound-based practices, participants demonstrated a critical awareness of the limitations and uncertainties surrounding such practices.

At the same time, many participants expressed a desire for explanations that could account for their experiences without resorting to mystical or absolute narratives.

Participant P12 (male, 30–39 years, 2–3 years of exposure) explained:

“If there's an explanation that talks about vibration or how the body responds to it, that makes more sense to me than spiritual language. I want to understand what is actually happening.”

Participant P7 (male, 50–59 years, 8–10 years of exposure) explained:

“I don't need to believe everything people say. I just want explanations that are reasonable and make sense with what I feel.”

Similarly, participant P2 (male, 40–49 years, 4–5 years of exposure) explained:

“I think there should be more research. Having a good experience and having scientific evidence are not necessarily the same thing.”

These accounts suggest that participants did not view experiential understanding and scientific reasoning as mutually exclusive. Instead, they sought explanations that respected both subjective experience and scientific uncertainty. Their reflections indicate that meaning-making involved continuous negotiation rather than unquestioning acceptance or outright rejection.

Taken together, the findings addressing Research Question 3 indicate that participants approached audible sound-based practices with epistemic caution and reflective awareness. Personal experiences of benefit were acknowledged, but these experiences were not interpreted as proof of efficacy or universal applicability. Theme 3 therefore suggests that participants positioned experiential meaning and scientific credibility as related but distinct domains of understanding, highlighting the coexistence of subjective experience and critical skepticism.

Across all three research questions, participants described audible sound-based practices primarily as experiences associated with bodily and emotional regulation rather than as interventions intended to treat disease. Importantly, consideration was also given to perspectives that challenged or qualified the generally positive interpretations of audible sound-based practices. Although no participants reported adverse experiences or rejected the practices outright, several participants emphasized that feelings of calmness, awareness, or emotional balance should not be interpreted as evidence of therapeutic efficacy.

Some participants noted that negative emotions and intrusive thoughts diminished during or following exposure to audible sound-based practices but did not disappear completely. For example, participant P6 (female, 30–39 years, 2–3 years of exposure) stated:

“My mind doesn’t stop completely, but it becomes quieter. The thoughts slow down, and there’s more space between them.”

Similarly, participant P10 (male, 60–69 years, over 10 years of exposure) stated:

“Feeling better doesn’t mean I understand the science behind it.”

These perspectives function as disconfirming or qualifying cases that challenge interpretations portraying audible sound-based practices as universally effective. Such accounts reinforce participants’ broader view that these practices should not be regarded as substitutes for conventional medical treatment and that subjective perceptions of benefit do not constitute evidence of universal efficacy. The inclusion of these perspectives strengthens the credibility of the findings by demonstrating that participants maintained critical awareness of the limitations and uncertainties associated with audible sound-based practices.

Data Availability:

The anonymized materials provided in Supplementary Files 1–6 constitute the underlying qualitative evidence supporting the findings reported in this study. Full identifiable interview transcripts are not publicly available due to ethical and confidentiality obligations under approval granted by the University College Fairview Research Ethics Committee (Reference No. UCF/REC/2026/06-089).

Supplementary File 1. Completed consolidated criteria for reporting qualitative research (COREQ) checklist. This file provides the completed COREQ checklist documenting methodological and reporting elements related to the research team, study design, data collection, analysis, and reporting of findings.Please click here to download this file.

Supplementary File 2. Semi-structured interview guide. This file contains the interview protocol, participant information statements, consent procedures, interview questions, and prompts used during semi-structured interviews exploring participant experiences with audible sound-based practices.Please click here to download this file.

Supplementary File 3. Representative anonymized interview transcript excerpts. This file contains selected anonymized excerpts from participant interviews illustrating experiences and perspectives that contributed to thematic development during analysis.Please click here to download this file.

Supplementary File 4. Thematic coding framework and codebook. This file presents the thematic coding framework used during reflexive thematic analysis, including themes, associated codes, and operational definitions applied during data interpretation.Please click here to download this file.

Supplementary File 5. Summary coded dataset supporting theme development. This file provides representative participant quotations, associated codes, and thematic classifications illustrating how coded data contributed to the development of the final themes.Please click here to download this file.

Supplementary File 6. Reflexive memos and audit trail documentation. This file contains representative reflexive memos, analytical notes, and audit trail records documenting the progression from initial coding through theme development and refinement.Please click here to download this file.

Discussion

The findings related to the research questions indicate that audible sound-based practices are experienced primarily as embodied and regulatory experiences rather than as curative interventions targeting specific disease conditions. Across all three research questions, participants described audible sound in relation to bodily, emotional, cognitive, and meaning-making experiences, without attributing curative effects or disease-specific therapeutic outcomes to these practices. These findings are consistent with the literature describing audible sound as an embodied and affective phenomenon rather than solely an auditory or curative one^3,15,21. Participants consistently reported bodily sensations and feelings of calmness associated with audible sound-based practices, suggesting that the perceived regulatory effects of sound constituted the primary experience associated with these practices.

These findings contribute to the scientific discussion surrounding embodiment and experience in relation to audible sound. The sensations described by participants, including vibrations, feelings of pressure, warmth, and the release of muscular tension, are often associated with the application of physical stimuli to the body. While mechanobiological research has demonstrated that biological systems can respond to physical stimuli such as pressure, oscillation, and stretch in a variety of ways^7,9,10, audible sound-based practices were not evaluated mechanistically within the present study. Consequently, the findings do not provide evidence regarding the biological or mechanobiological systems that may be affected by audible sound-based practices. Rather, the findings provide insight into the bodily sensations experienced in relation to audible sound and how those sensations are incorporated into participants’ understandings of audible sound as a regulatory and beneficial practice. Although emerging research in the field of sonobiology suggests that audible sound may exert biological effects, including the enhancement of cellular activity and changes in gene expression, the current scientific evidence related to audible sound-based practices remains heterogeneous¹². Therefore, while the present findings do not demonstrate biological or mechanobiological effects, they may contribute to future scientific discussions regarding the potential mechanisms underlying such experiences.

The findings of this study also contribute to the existing qualitative literature on sound-based practices. Previous ethnographic and phenomenological studies have documented experiences of grounding, calming, and inward-directed attention associated with sound exposure^1,2,34. The present findings extend this literature by demonstrating that most participants did not attribute mystical or curative properties to the sound-based practices they engaged in. Throughout the interviews, participants distinguished their personal experiences from scientific validation, expressing reluctance to ascribe curative effects to audible sound-based practices^1,6,15,34. These findings suggest that individuals may experience such practices as grounding, calming, and personally meaningful while simultaneously maintaining skepticism regarding claims of therapeutic efficacy or cure.

Biomedical research concerning the sound-based practices discussed in this study has similarly reached conclusions that align with the present findings. Systematic reviews of biomedical research on sound-based practices indicate that, although scientific interest in the potential benefits of such practices has increased, the existing evidence remains heterogeneous with respect to study design, methodology, and reported outcomes⁴. Participants’ reluctance to attribute curative properties to audible sound-based practices is therefore consistent with the current biomedical literature. Furthermore, because the aim of the present study was not to investigate physiological mechanisms or biological effects, the findings provide insight only into participants’ understandings and interpretations of these scientific issues rather than evidence regarding the efficacy of the practices themselves.

These findings may also have relevance for the field of health professions education. Many health professions education programs emphasize communication, critical thinking, ethics, and patient-centered care alongside scientific and biomedical knowledge^16,18,20. The findings of this study may therefore contribute to educational discussions regarding how health professionals engage with patients who participate in sound-based practices and other complementary health approaches. Specifically, audible sound-based practices may serve as useful case studies for examining patients’ lived experiences, the interpretation of health-related experiences, and the importance of communicating appropriately about interventions for which scientific evidence remains limited or evolving²². Although no participants reported adverse experiences or complete rejection of audible sound-based practices, several responses reflected perspectives that challenged overly positive interpretations of these practices. For example, some participants reported continuing experiences of emotional tension or intrusive thoughts before or after participating in audible sound-based practices despite the intention of such practices to promote emotional regulation. Participants also emphasized that perceived personal benefits should not be interpreted as scientific proof of efficacy. These perspectives provide important disconfirming viewpoints and reinforce the distinction between subjective experience and scientific validation.

Several limitations should be considered when interpreting the findings of this study. First, only fifteen participants were recruited, and all participants were recruited through online communities associated with audible sound-based practices. Consequently, the sample may not reflect the perspectives of individuals who have not engaged with such practices or who hold different views regarding their value. Second, the findings are limited to participants’ reported experiences and should not be interpreted as evidence regarding the efficacy of audible sound-based practices. Third, although no adverse experiences were reported, the inclusion of skeptical and dismissive perspectives regarding exaggerated claims strengthens the credibility of the findings by demonstrating that participant accounts were not uniformly favorable.

Future research could integrate qualitative and experimental methodologies to examine relationships between subjective experiences and measurable physiological outcomes. For example, mixed-methods studies could investigate whether exposure to specific sound frequencies is associated with changes in heart rate variability, autonomic regulation, perceived stress, or other psychophysiological indicators. Such approaches may help clarify relationships between experiential reports and measurable biological responses while maintaining appropriate scientific rigor.

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Audio Recording Device	Sony Corporation	ICD-PX470	Used to record in-person participant interviews.
Computer	Dell Technologies	N/A	Used for interview transcription, data storage, coding, and analysis.
Online Interview Platform	Zoom Video Communications, Inc.	N/A	Used to conduct and record remote interviews.
Transcription Software	Google LLC	NotebookLM	Used to generate initial interview transcripts from audio recordings.
Qualitative Data Analysis Software	ATLAS.ti Scientific Software Development GmbH	ATLAS.ti 25	Used for coding, data management, memoing, and reflexive thematic analysis.
Field Notes Template	Author-generated	N/A	Used to document contextual observations, methodological notes, and reflexive reflections following interviews.
Reflexive Memo Template	Author-generated	N/A	Used to document analytical decisions, emerging interpretations, and researcher reflexivity during analysis.
Informed Consent Form	Author-generated	N/A	Used to obtain written informed consent prior to participation.
Participant Information Sheet	Author-generated	N/A	Used to provide study information and participant rights before enrollment.
Participant Screening Form	Author-generated	N/A	Used to assess eligibility against predefined inclusion criteria.
Recruitment Advertisement	Author-generated	N/A	Used to recruit participants through Facebook, WhatsApp, and Telegram communities.
Semi-Structured Interview Guide (Supplementary File 1)	Author-generated	N/A	Used to ensure consistency across participant interviews while allowing exploratory follow-up questions.
Participant Transcript Review Form	Author-generated	N/A	Used during transcript verification and participant clarification procedures.
COREQ Checklist (Supplementary File 2)	Tong A, Sainsbury P, Craig J	N/A	Used to document reporting quality and methodological transparency.