Use of Drum Circles Use of Drum Circles forfor

Stress Relief and Social Stress Relief and Social IntegrationIntegration

Mary Sokolowski BSN, RNMary Sokolowski BSN, RN

Kent State UniversityKent State University

September 24, 2008September 24, 2008

DRUM?DRUM?

drumdrum is a member of the is a member of the percussionpercussion group, group, technically classified as a technically classified as a membranophonemembranophone

(http://en.wikipedia.org/wiki/drum)(http://en.wikipedia.org/wiki/drum)

Percussion/Rhythm Instruments –Percussion/Rhythm Instruments – Djembe/conga/cocktail/snare/tom-tomDjembe/conga/cocktail/snare/tom-tom ClavasClavas MaraccasMaraccas TambourineTambourine CastinetsCastinets Shaker eggsShaker eggs Electric Drum padsElectric Drum pads

CIRCLECIRCLE simple simple shapesshapes of of Euclidean geometryEuclidean geometry

consisting of those consisting of those pointspoints …which are at a …which are at a constant constant distancedistance, …from a fixed point, , …from a fixed point, called the called the centercenter

((http://http://en.wikipedia.org/wiki/Circleen.wikipedia.org/wiki/Circle))

so . . .so . . .

Drum CircleDrum Circle

drum circle = any group of people playing drum circle = any group of people playing (usually) (usually) hand-drumshand-drums and and percussionpercussion in a in a circlecircle..

http://en.wikipedia.org/wiki/Drum_circlehttp://en.wikipedia.org/wiki/Drum_circle

Group of people from many backgrounds:Group of people from many backgrounds:

Races, ages, cultures, ethnicity, Races, ages, cultures, ethnicity,

education levelseducation levels

With or without musical abilityWith or without musical ability

++ Facilitator: Leads groupFacilitator: Leads group

Music Therapist – uses music and selfMusic Therapist – uses music and self

Drum CirclesDrum Circles

History: Drum CirclesHistory: Drum Circles

First rhythm – heartbeatFirst rhythm – heartbeat Drum circles – various Drum circles – various

cultures/worldwidecultures/worldwide Ancient times – ritualsAncient times – rituals

Healing - reduce pain, sufferingHealing - reduce pain, sufferingCommunicationCommunication

(Sacks, 2006)(Sacks, 2006)

Now:Now:Websites for Sex: 185 million sites Websites for Sex: 185 million sites

Websites for Music: 131 million sitesWebsites for Music: 131 million sites(Kemper & Danhauer, 2005)(Kemper & Danhauer, 2005)

PrinciplesPrinciples Sound – objects vibrateSound – objects vibrate Human Body –Human Body –

Vibrates/AbsorbsVibrates/Absorbs Entrainment: Entrainment: Strong rhythm (vibration) causes otherStrong rhythm (vibration) causes other rhythms to fall in syncrhythms to fall in sync Noise vs. MusicNoise vs. Music Psychophysiologic response – pitch, rhythmPsychophysiologic response – pitch, rhythm

Limbic system/Neurohormonal systemLimbic system/Neurohormonal system Altered states of consiousnessAltered states of consiousness

(Dossey & Keegan, 2009)(Dossey & Keegan, 2009) Collaborative creativityCollaborative creativity

Camaraderie, non-threatening Camaraderie, non-threatening environmentenvironment

BenefitsBenefits Psychologic:Psychologic:

DistractionDistraction Self AwarenessSelf AwarenessDecreased AnxietyDecreased Anxiety Improved MoodImproved MoodComfort/RelaxationComfort/Relaxation Emotional ReleaseEmotional Release

Social:Social:CohesivenessCohesiveness ReconnectionReconnectionInterpersonal supportInterpersonal support

Spiritual:Spiritual:Altered ConsciousnessAltered Consciousness Higher Power Higher Power (Secular)(Secular)

(Winkelman, 2003)(Winkelman, 2003)

Benefits:Benefits:

Physiologic:Physiologic:

∆ ∆ Neuronal activity – Neuronal activity –

lateral temporal/cortical areaslateral temporal/cortical areas

∆ ∆ RR, HR variabilityRR, HR variability

↓ ↓ Salivary cortisolSalivary cortisol

↑ ↑ Opiate receptor expressionOpiate receptor expression

↑ ↑ Interleukin 6, salivary IgAInterleukin 6, salivary IgA(Kemper & Danhauer, 2005)(Kemper & Danhauer, 2005)

Effects:Effects:

MusicMusicTempo, Pitch, RhythmTempo, Pitch, Rhythm

PeoplePeopleListener CharacteristicsListener Characteristics

CircumstancesCircumstancesLive vs RecordedLive vs RecordedActive vs PassiveActive vs PassiveRecreation/Work/TherapyRecreation/Work/Therapy

(Kemper & Danhauer, 2005)(Kemper & Danhauer, 2005)

TypesTypes

RecreationalRecreational CorporateCorporate DiversityDiversity Health/WellnessHealth/Wellness Music StoreMusic Store TherapeuticTherapeutic

Stress ResponseStress Response

JungJung

Psyche’s attempt to self-regulatePsyche’s attempt to self-regulate

Problem somaticizedProblem somaticized(McClary & Rebecca, 2007)(McClary & Rebecca, 2007)

SelyeSelye

General Adaptation Response General Adaptation Response (GAR)(GAR)

Reactive ResponseReactive Response PsychoneuroimmunlogyPsychoneuroimmunlogy

(McCance & Huether, 2006)(McCance & Huether, 2006)

Stress ResponseStress Response

Effects of StressEffects of Stress

SleepSleep AppetiteAppetite GrowthGrowth BehaviorBehavior DigestionDigestion Wound healingWound healing Every organ system – Every organ system –

Neuroendocrine, CV, Immune systemNeuroendocrine, CV, Immune system(Kemper & Danhauer, 2005)(Kemper & Danhauer, 2005)

Concept:Concept: Social IntegrationSocial Integration

Definition: Definition: Perceived/Received sense of Perceived/Received sense of

supportsupportfrom othersfrom others

Includes:Includes:Social support functions Social support functions Network structureNetwork structure

(Hutchison, 1999)(Hutchison, 1999)

AntecedentsAntecedents

Social Network Social Network PeoplePeople

Social EmbeddednessSocial EmbeddednessConnectednessConnectedness

Social ClimateSocial ClimateHelpfulness, ProtectionHelpfulness, Protection

(Hutchison, 1999)(Hutchison, 1999)

Consequences:Consequences:

Feeling of being: Feeling of being: LovedLovedEsteemedEsteemedRespectedRespected

Sense of belonging to groupSense of belonging to group(Hutchison, 1999)(Hutchison, 1999)

Nursing DiagnosisNursing Diagnosis

Social Isolation:Social Isolation:Definition: Aloneness experienced by the Definition: Aloneness experienced by the individual and perceived as imposed by individual and perceived as imposed by others and as a negative or threatened others and as a negative or threatened statestate

Characteristics: Expressed feelings of Characteristics: Expressed feelings of aloneness, rejection, feeling different from aloneness, rejection, feeling different from others; inadequate sense of purpose; others; inadequate sense of purpose; inability to meet expectations of othersinability to meet expectations of others

(Wilkinson & Wilkinson, 2005)(Wilkinson & Wilkinson, 2005)

Related FactorsRelated Factors

R/T: PopulationsR/T: PopulationsChemical DependencyChemical Dependency

Addictive BehaviorAddictive BehaviorPsychologic ImpairmentPsychologic Impairment

Alzheimer’s DiseaseAlzheimer’s DiseaseTreatment-imposed IsolationTreatment-imposed Isolation

TraumaTraumaStressful OccupationsStressful Occupations

Corporate culture, LTC worker, Corporate culture, LTC worker, StudentsStudents

(Wilkinson & Wilkinson, 2005)(Wilkinson & Wilkinson, 2005)

ResearchResearch Normal Subjects:Normal Subjects:

111 subjects: 6 groups111 subjects: 6 groups2 control – listening, reading2 control – listening, reading4 group drum – 4 group drum –

basic, impact, shamanic, compositebasic, impact, shamanic, compositeMeasure: Measure: Blood tests + Anxiety/Depression ScalesBlood tests + Anxiety/Depression Scales

Results: Results: ↑ DHEA:Cortisol level, ↑NK cell activity, ↑ DHEA:Cortisol level, ↑NK cell activity, ↑lymphocytes; No ∆ Depression/Anxiety Scales↑lymphocytes; No ∆ Depression/Anxiety Scales

Conclusion: Conclusion: Neuroendocrine and neuroimmune Neuroendocrine and neuroimmune hormones hormones ↑ in direct opposition to normal stress ↑ in direct opposition to normal stress responseresponse

(Bittman, Berk, Felten, Westengard, Simonton, & Pappas, 2001)(Bittman, Berk, Felten, Westengard, Simonton, & Pappas, 2001)

ResearchResearch

Alzheimer’s Disease – Alzheimer’s Disease – ↓↓ Motivation, Motivation, ↓↓ initiative for social interaction; decline in initiative for social interaction; decline in

psychomotor, cognitive, communicative, social, psychomotor, cognitive, communicative, social, emotionalemotional

Purpose: Test value of musical instrument to elicit Purpose: Test value of musical instrument to elicit responses responses

in a group musical sessionin a group musical sessionMethod: 2 groups; 24 sessions (1/week)Method: 2 groups; 24 sessions (1/week)

1 early/moderate, 1 later Alzheimer’s1 early/moderate, 1 later Alzheimer’sParticipant observationParticipant observation

Results: Results:

Musical perception still present; able to learn new Musical perception still present; able to learn new material; enhances social interaction; AD responds to material; enhances social interaction; AD responds to structure of movement, rhythm; Best – djembe in lapstructure of movement, rhythm; Best – djembe in lap

(Cevasco & Grant, 2006)(Cevasco & Grant, 2006)

ResearchResearch

Stress Induction/Amelioration:Stress Induction/Amelioration:32 healthy volunteers32 healthy volunteers

Method: Method: Blood tests pre/post protocolBlood tests pre/post protocol

All – puzzle for stress induction; 1 group – All – puzzle for stress induction; 1 group – continued, continued,

1 group rested, 1 group engaged in RMM 1 group rested, 1 group engaged in RMM protocolprotocol

Results: Subjects with RMM protocol - 19/45 Results: Subjects with RMM protocol - 19/45 peripheral blood gene analysis markers peripheral blood gene analysis markers demonstrated reversal compared with 6/45 in demonstrated reversal compared with 6/45 in control and 0/45 in ongoing stressor groupscontrol and 0/45 in ongoing stressor groupsAntiviral, immunologic effectsAntiviral, immunologic effects

(Bittman, Berk, Shannon, Sharaf, Westengard, & Guegler, 2005)(Bittman, Berk, Shannon, Sharaf, Westengard, & Guegler, 2005)

ResearchResearch

Stroke PatientsStroke Patients40 patients - motor impairment after stroke – paresis 40 patients - motor impairment after stroke – paresis of UEof UE

Method: Restricted unimpaired arm and exposed to Method: Restricted unimpaired arm and exposed to repetitive movements with piano, electric drumrepetitive movements with piano, electric drum

Result: improvement in movements – fine motor Result: improvement in movements – fine motor (piano) and gross motor (drum); functional (piano) and gross motor (drum); functional reorganization noted on PET scanreorganization noted on PET scan? Influence from motivational factors after stroke ? Influence from motivational factors after stroke (group)(group)

(Schneider, Schonle, Altenmuller, & Munte, 2007)(Schneider, Schonle, Altenmuller, & Munte, 2007)

ResearchResearch

Drug AddictionDrug AddictionAddicts are self-centered, disconnected, isolated in Addicts are self-centered, disconnected, isolated in

subculturesubculture4 separate studies in 20014 separate studies in 2001

Method: Observation, Interview (counselor), Pilot Method: Observation, Interview (counselor), Pilot program, Online discussionprogram, Online discussion

Results:Results: Unity, purpose, connectedness, deep relaxation, Unity, purpose, connectedness, deep relaxation,

emotional emotional release, altered state of consciousness, release, altered state of consciousness, “rush of “rush of energy”, “eraser” to remove effects of energy”, “eraser” to remove effects of trauma. trauma. Entrains brain to feel pleaurable effects without Entrains brain to feel pleaurable effects without drugs. drugs. Reintegration of selfReintegration of self

(Winkelman, 2003)(Winkelman, 2003)

ResearchResearch LTC WorkersLTC Workers

Turnover rates for LTC workers: 40-100%/yr with Turnover rates for LTC workers: 40-100%/yr with burnout, depressed moodburnout, depressed mood

125 subjects – several groups over 1 yr period; 125 subjects – several groups over 1 yr period; Method:Method:6 session/ RMM presented as employee enrichment 6 session/ RMM presented as employee enrichment activityactivityGroup Empowerment Drumming ProtocolGroup Empowerment Drumming ProtocolTool: Maslach Burnout Inventory & Profile of Mood Tool: Maslach Burnout Inventory & Profile of Mood StatesStatesResults: Significant Results: Significant ↓ burnout and ↑ mood↓ burnout and ↑ mood

Cost savings: $ 8100/ea X 60 workers = $89,100Cost savings: $ 8100/ea X 60 workers = $89,100Cost of program: $10,300 (over 5 yrs)Cost of program: $10,300 (over 5 yrs)

(Bittman, Bruhn, Stevens, Westengard, & Umbach, 2003)(Bittman, Bruhn, Stevens, Westengard, & Umbach, 2003)

Other uses:Other uses: Community DrummingCommunity Drumming

Sense of connection to selfSense of connection to selfSense of family connectionSense of family connectionSense of community connectionSense of community connection

(Camilleri, 2002; Stone, 2005)(Camilleri, 2002; Stone, 2005)

Corporate DrummingCorporate DrummingTeam building – support and Team building – support and

expressionexpressionEmployee SatisfactionEmployee SatisfactionCollaboration/CreativityCollaboration/CreativityInterdisciplinary RespectInterdisciplinary Respect

(http://www.findbliss.com/Magazine/Detailed/60.shtml)(http://www.findbliss.com/Magazine/Detailed/60.shtml)

Adverse EffectsAdverse Effects

None reported in literatureNone reported in literature

One article mentioned ? precipitation One article mentioned ? precipitation of seizures with music of of seizures with music of ↑ tempo↑ tempo

(Stouffer, Shirk, & Polomano, 2007)(Stouffer, Shirk, & Polomano, 2007)

Caution in culture of substance Caution in culture of substance abuseabuse

InterventionIntervention

Music Therapy: using music to help Music Therapy: using music to help achieve a specific change in achieve a specific change in behavior, feeling, or physiologybehavior, feeling, or physiology Define the specific change in behavior Define the specific change in behavior

or physiology that is desiredor physiology that is desired Inform the individual of purpose of Inform the individual of purpose of

music experiencemusic experience Facilitate the individual’s active Facilitate the individual’s active

participationparticipation(Dochterman, Bulechek, Butcher, & University of Iowa, 2008)(Dochterman, Bulechek, Butcher, & University of Iowa, 2008)

Drum CircleDrum Circle

Silence – allows for centeringSilence – allows for centering Unstructured rumble – use different Unstructured rumble – use different

parts of hands for different soundsparts of hands for different soundsExpress feelingsExpress feelingsChance for leadership – controlChance for leadership – controlAssert feelingsAssert feelingsAmplify emotionsAmplify emotions

(Camilleri, 2002)(Camilleri, 2002)

Drum CircleDrum Circle

Introduce self with drum – Introduce self with drum – Group mirrors the soundGroup mirrors the sound Self expressionSelf expression Voice to emotionVoice to emotion Immediate gratification and feedbackImmediate gratification and feedback

(Camilleri, 2002)(Camilleri, 2002)

Drum CircleDrum Circle

Listening/Imitating GamesListening/Imitating Games Mirror Games - Mirror Games -

1 starts, group copies back – pride of 1 starts, group copies back – pride of ownershipownership

Echo Games –Echo Games – 1 starts, sound around group in wave – 1 starts, sound around group in wave –

chance for idea to be heard; no right/wrongchance for idea to be heard; no right/wrong(Camilleri, 2002)(Camilleri, 2002)

Drum CircleDrum Circle

Leader RoleLeader Role Introductions – group processIntroductions – group process ABC’s of drumming – drums, techniquesABC’s of drumming – drums, techniques Ice Breaker – getting to know othersIce Breaker – getting to know others Entrainment Building – listening, Entrainment Building – listening,

assimilatingassimilating Insight – create connectionsInsight – create connections Conclusion – summarize lessons learnedConclusion – summarize lessons learned

(Bittman, Bruhn, Lim, Neve, Stevens, & Knudsen, 2004)(Bittman, Bruhn, Lim, Neve, Stevens, & Knudsen, 2004)

Recipe – Drum CircleRecipe – Drum Circle

Define PurposeDefine Purpose Select group/time/placeSelect group/time/place Individuals select instruments Individuals select instruments Start – silenceStart – silence Ice breaker Ice breaker ABC’s of drummingABC’s of drumming Unstructured rumbleUnstructured rumble

Recipe – Drum CircleRecipe – Drum Circle

Individual introduction with drumIndividual introduction with drum Mirror gameMirror game Echo gameEcho game Rhythm connections – led by leaderRhythm connections – led by leader Cool down – slower rhythmCool down – slower rhythm Insight Insight ConclusionConclusion

Evaluation Evaluation

OutcomesOutcomes Leisure Participation: use of relaxing, Leisure Participation: use of relaxing,

interesting, and enjoyable activities to interesting, and enjoyable activities to promote well-beingpromote well-being

Evaluation:Evaluation: Participates in leisure activitiesParticipates in leisure activities Uses appropriate social interaction skillsUses appropriate social interaction skills Exhibits creativity through leisure Exhibits creativity through leisure

activityactivity Expresses satisfaction with leisure Expresses satisfaction with leisure

activitiesactivities (Moorhead, 2008)(Moorhead, 2008)

SummarySummary Drum Circles use the process of Drum Circles use the process of

entrainment – rhythms falling in sync – entrainment – rhythms falling in sync – to reduce stress and social isolationto reduce stress and social isolation

The act of making music in a group The act of making music in a group fosters team building and creates fosters team building and creates connections to promote social integrationconnections to promote social integration

Research shows that reducing Research shows that reducing psychosocial stress has a physiologic, psychosocial stress has a physiologic, immunoenhancing effect, proving a immunoenhancing effect, proving a mind-body connectionmind-body connection