Drumming for Clinical Outcomes

Ready for a Brand New Beat?
An evidence-based approach to drumming for clinical outcomes
By Christine Stevens, MSW, MT-BC

I got hooked on drumming after a miraculous music therapy drumming experience in a small room on an Alzheimer’s unit of a long term care center with a very confused, hard-of-hearing late-stage dementia client named Arthur O’Malley. Based on the work of Claire and Bernstein, once a week, I took two Remo paddle drums to Arthur’s room to work on social interaction, communication, and anxiety reduction.

Arthur was reclusive, hard-of-hearing, and refused to leave his room for any of the social activities offered on the unit. But Arthur had rhythm! Arthur’s drumming had the natural rhythm of a jig, showing his Irish heritage.

One day, his daughter and son-in-law arrived to visit Arthur during our drumming time. Sadly, Arthur didn’t recognize them or remember their names. They were amazed to see Arthur’s upbeat spirit expressed on the drum, the social interaction and communication taking place through rhythm was inspirational to them.

Naturally, I ran down to the activity room and came back with two more drums. We all started drumming together, reaching out and playing each other’s drums, laughing and smiling until suddenly Arthur began to sing, “My Bonnie Lies Over the Ocean….” I looked over to see tears in his daughter’s eyes. It turned out that her name was Bonnie and he had named her after that song.

It was an unforgetable demonstration of the power of rhythm to break through memory loss and access the limbic and emotional cortex where a father’s connection to his daughter was preserved.

A Quintet of Interdisciplinary Collaboration

The use of drum circles in clinical music therapy settings has developed through the unique collaboration of five separate disciplines connected by the drum. I’d like to address them chronologically.

First, indigenous cultures bring the spiritual tradition of drumming. In my time studying Lakota Native American drumming for over eight years, I’ve learned songs and drum beats for ceremony, healing, and gratitude. As my teacher Uncle Manny Eagle Elk Council Pipe said to me, “the drum is not considered a music instrument to our people. It is considered sacred for ceremonies.”

Second, from percussionists come techniques on world percussion instruments and cultural rhythms. The breadth of world percussion instruments offers music therapists and clinicians unique sounds and easy playing techniques, as percussion and drums are one of the most accessible instruments with a very fast learning curve. People are amazed they can do it.

Third, music therapists bring metaphors and clinical understanding such as the meaning of an instrument choice by participants. Music therapists bring therapeutic outcomes, such as listening skills, self-expression, exercise, social interaction, peace-building, and conflict-resolution. We bring adaptability for disabled participants and wheelchair-bound residents (such as Velcro wrist or ankle bells and shakers) to allow every person to make music.

Fourth, drum circle facilitation offers orchestration techniques, developed by Arthur Hull, using hand signals to conduct a group’s unfolding song.

Fifth, from the field of scientific research, specifically psychoneuroimmunoltogy, comes evidence-based research performed by Barry Bittman’s research team in five published studies by peer-reviewed journals. This recent addition to the quintet has brought drum circles into the forefront of evidence-based techniques for clinical and health outcomes.

The Scientific Foundation of Drumming

In a ground-breaking study published in 2001, Barry Bittman, MD, discovered that just listening to music did not produce the biological benefits that were achieved through active drumming. Using a protocol called HealthRHYTHMS™, the one-hour drumming program integrated proven therapeutic strategies including ice-breakers, laughter, improvisation, and even guided visualization while drumming.

Blood samples taken before and after drumming showed an increase in NK (natural killer) cells, circulating white blood cells that seek out and destroy cancer and virally infected cells, after one hour of the group drumming protocol (Bittman et al, 2001).

Perhaps the most intriguing element of this research is that all subjects had NO prior experience playing drums. In fact, participants were excluded if they had drummed before. Rhythm is simply human and transcends the need for musical training or reading notes.

Beating Burnout

In a subsequent study, Bittman and colleagues tested long term care center employees participating in weekly drumming sessions following the same HealthRHYTHMS™ protocol. Results of 112 subjects showed a 46 percent improvement in mood states and a significant reduction in burnout in just six weeks.

A six week follow up test without the drum programs showed a sustained effect of 62 percent improvement in mood states. In addition, an independent economic analyst projected that the program could save an institution $89,000 annually in a typical 100-bed facility by reducing costs associated with employee turnover.

Testing another burned out population; Bittman’s team replicated the study with 70 nursing students (Bittman et al, 2004) and found a 28.1 percent improved mood states on the POMS profile of mood states. Economic Impact projections showed the retention of two students annually per a typical 105-student program, resulting in a projected annual savings of $29.1 million to U.S. nursing schools. Projected cost savings of $322,000 for the typical acute care hospital, and more than $1.5 billion for the U.S. healthcare industry.

Once again, the study was replicated in Japan by a new team directed by Wachi et al (2007). Results showed enhanced mood, lower gene expression levels of the stress-induced cytokine interleukin-10, and higher NK cell activity when compared to the control.

The Therapeutic Foundation of Drumming

1. Drumming is accessible. Everyone can do it!

2. Drumming is aesthetic. Drumming is a portal to musical expression and creativity.

3. Drumming is expressive. Drumming allows us to say in music what words alone cannot express.

4. Drumming is physical. Drumming uses upper body muscles and coordination. It is exercise.  It is a creative workout for mind, body, and soul.

5. Drumming is powerful. Drumming connects us to primal archetypes.

6. Drumming is communication. Drumming allows for conversations between people in the universal language of music, speaking from the heart.

7. Drumming is social. Group drumming creates social unity, nurturing, support, and camaraderie.

8. Drumming is meditative. Drumming is a natural form of active meditation. When you drum, time flies. Drumming brings us into the present moment.

9. Drumming is spiritual. Drumming has a rich spiritual history across cultures. Drumming helps us connect to the divine, the higher power.

10. Drumming is transformational. Drumming provides an opportunity for catharsis and moving beyond the perceived limitations of life’s challenges.


HealthRHYTHMS™ is an evidence-based protocol for health outcomes using group empowerment drumming. Sponsored by the Valencia, Calif.-based Remo Drum Company, weekend training programs are offered internationally five times a year in various locations.

The program weaves together proven health strategies, including: visualization, spirituality, self-expression, camaraderie and support, nurturing, exercise and music-making. Today, HealthRHYTHMS™ sessions are offered as wellness programs at rehabilitation centers, hospitals, cancer support groups, medical centers, churches, corporations, yoga centers, YMCAs, and weekend retreats.

The benefits include stress reduction, team building, creative expression, spiritual connection, exercise, nurturing and support, and music making.


Contraindications of using drumming include sound sensitivity, PTSD, and psychotic disorders. Consult a professional in these specific fields when asked to bring drumming to these populations. After the Columbine High School shooting, I was invited to lead a healing drum circle at the school.

This was contraindicated, since the sounds of drums might create an auditory trigger of gunshots and the trauma experienced by the students. However, one year later, it was a perfect choice to bring together children and parents at a memorial ceremony, for the goals of expression, communication, and relationship building.


Bittman et al. (2003) Recreational Music-Making: A Cost-Effective Group Interdisciplinary Strategy for Reducing Burnout and Improving Mood States in Long-Term Care Workers. Bittman et al. Advances in Mind-Body Medicine – Fall/Winter, 2003.

Bittman et al. (2001) Composite Effects of Group Druming Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal Subjects. Bittman et al. Alternative Therapies, January, 2001, Vol. 7. No.1.

Bittman et al. (2004). Recreational Music-Making: An Integrative Group Intervention for Reducing Burnout and Improving Mood States in First Year Associate Degree Nursing Students: Insights and Economic Impact. International Journal of Nursing Education and Scholarship. Vol. 1 Article 12.

Stevens (2005) The Healing Drum Kit, Sounds True.

Stevens (2003) The Art and Heart of Drum Circles, Hal Leonard, DVD and book

Wachi et al. (2007). Recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees. Medical Science Monitor. 13(2): p. 57-70.

— Christine Stevens, MSW, MT-BC is an author, music therapist, and founder of UpBeat Drum Circles in Boulder, Colo. She trains therapists world-wide in Remo’s HealthRHYTHMS.

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