top of page


Impact on the Immune System Study


Strengthens the Immune System



Composite Effects of Group Drumming Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal Subjects (2001) Bittman MD, Berk LS,Felten DL,Westengard J,Simonton OD,Pappas J,Ninehouser M Alternative Ther Health Med 2001: 7:38-47


Context: Drum circles have been part of healing rituals in many cultures throughout the world since antiquity. Although drum circles are gaining increased interest as a complementary therapeutic strategy in the traditional medical arena, limited scientific data documenting biological benefits associated with percussion activities exist.


Objective: To determine the role of group-drumming music therapy as a composite activity with potential for alteration of stress-related hormones and enhancement of specific immunologic measures associated with natural killer cell activity and cell-mediated immunity.


Design: A single trial experimental intervention with control groups.


Setting: The Mind-Body Wellness Center, an outpatient medical facility in Meadville, Pa.


Participants: A total of 111 age- and sex-matched volunteer subjects (55 men and 56 women, with a mean age of 30.4 years) were recruited.


Intervention: Six preliminary supervised groups were studied using various control and experimental paradigms designed to separate drumming components for the ultimate determination of a single experimental model, including 2 control groups (resting and listening) as well as 4 group-drumming experimental models (basic, impact, shamanic, and composite). The composite drumming group using a music therapy protocol was selected based on preliminary statistical analysis, which demonstrated immune modulation in a direction opposite to that expected with the classical stress response. The final experimental design included the original composite drumming group plus 50 additional age- and sex-matched volunteer subjects who were randomly assigned to participate in group drumming or control sessions.


Main Outcome Measures: Pre- and postintervention measurements of plasma cortisol, plasma dehydroepiandrosterone, plasma dehydroepiandrosterone-to-cortisol ratio, natural killer cell activity, lymphokine-activated killer cell activity, plasma interleukin-2, plasma interferon-gamma, the Beck Anxiety Inventory, and the Beck Depression Inventory II.


Results: Group drumming resulted in increased dehydroepiandrosterone- to-cortisol ratios, increased natural killer cell activity, and increased lymphokine-activated killer cell activity without alteration in plasma interleukin 2 or interferon-gamma, or in the Beck Anxiety Inventory and the Beck Depression Inventory II.


Conclusions: Drumming is a complex composite intervention with the potential to modulate specific neuroendocrine and neuroimmune parameters in a direction opposite to that expected with the classic stress response. (Altern Ther Health Med. 2001;7(1):38-47)


Impact on the Immune System Study

Effectiveness for Employee Burnout & Turnover Reduction


Improves Mood States and Reduces Burnout



Recreational Music-Making: A Cost-Effective Group Interdisciplinary Strategy for Reducing Burnout and Improving Mood States in Long-Term Care Workers (2003) Bittman MD, Karl T. Bruhn, Christine Stevens, MSW, MT-BC, James Westengard, Paul O. Umbach, MA

Advances in Mind-Body Medicine Fall/Winter 2003, Vol. 19 No. 3/4


Hypothesis​: a cost-effective Yamaha Clavinova-based HealthRHYTHMS® Recreational Music-Making protocol reduces burnout and improves mood states in long-term care workers.


What we studied: At Westbury United Methodist Retirement Community we studied 112 employees’ mood states (POMS-Profile of Mood States & MBI-Maslach Burnout Inventory) including: tension/anxiety (T/A), depression/dejection (D/D), anger/hostility (A/H), vigor/activity (V/A), fatigue/inertia (F/I) and confusion/bewilderment (C/B). Total Mood Disturbance (TMD) is the sum of the above mood parameters weighing V/A negatively.


What we found: A 46% improvement in total mood disturbance and 62% improvement 6 weeks post intervention. Economic Impact projections – a typical 100 bed long-term care facility would expect to experience an 18.3% overall reduction in employee turnover. Retention of 11 of 60 positions predicted to be lost each year would result in an average cost savings of $89,100 per year. 


Total annual savings to the industry based on an 18.3% decrease in turnover at every long-term care facility is therefore projected at $1.46 billion. 


Reducing Student Drop-Out Rate


Retains Students: Mood Improvement & Burnout Reduction



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 (2004)Barry Bittman MD, Cherie Snyder MSS, Karl T. Bruhn, Fran Liebfried BSN, M.ED, RN Christine K. Stevens MSW, MT-BC, James Westengard BS, Paul O. Umbach MA International Journal of Nursing Education Scholarship: Vol. 1: No. 1, Article 12


Hypothesis: a cost-effective Mind-Body Wellness Exercise-based HealthRHYTHMS Recreational Music-Making protocol reduces burnout and improves mood states in First Year Associate Degree Nursing Students. 


What we studied: At Allegany College of Maryland we studied 75 first year associate degree nursing students’ mood states (POMS-Profile of Mood States & MBI-Maslach Burnout Inventory) including: tension/anxiety, depression/dejection, anger/hostility, vigor/activity, fatigue/inertia and confusion/bewilderment. Total Mood Disturbance (TMD) is the sum of the above mood parameters weighing V/A negatively.


What we found: A 28.1% improvement in total mood disturbance. Economic Impact projections – a typical 105 -student program would expect to retain 2 additional students each year. This improvement in retention rates would result in a projected annual savings of $29.1 million to US Nursing Schools. Extending this analysis to the healthcare arena, these projected retention improvements could result in cost savings of $322,000 for the typical acute care hospital, and more than 1.5 billion for the US healthcare industry.



Indidualized Genomic Stress Insuction Signature Impact


Retains Students: Mood Improvement & Burnout Reduction



Recreational music-making modulates the human stress response: a preliminary individualized gene expression strategy

Barry Bittman, Lee Berk, Mark Shannon, Muhammad Sharaf, Jim Westengard, Karl Guegler, David Ruff

Med Sci Monit 2005; 11(2):BR31-40

ICID: 14140

Meadville Medical Center, Mind-Body Wellness Center, Meadville, PA, U.S.A.

Department of Health Promotion & Education, School of Public Health and Department of Pathology, School of Medicine, Loma Linda University, Loma Linda, CA, U.S.A.

Applied Biosystems, Foster City, CA, U.S.A.

Department of Pathology, School of Medicine, Loma Linda University, Loma Linda, CA, U.S.A.


Background: A central component of the complex human biological stress response is the modulation of the neuro-endocrine-immune system with its intricate feedback loops that support homeostatic regulation. Well-documented marked gene expression variability among human and animal subjects coupled with sample collection timing and delayed effects, as well as a host of molecular detection challenges renders the quest for deciphering the human biological stress response challenging from many perspectives.


Material/Methods: A novel Recreational Music-Making (RMM) program was used in combination with a new strategy for peripheral blood gene expression analysis to assess individualized genomic stress induction signatures. The expression of 45 immune response-related genes was determined using a multiplex preamplification step prior to conventional quantitative Real Time Polymerase Chain Reaction (qRT-PCR) mRNA analysis to characterize the multidimensional biological impact of a 2-phase controlled stress induction/amelioration experimental protocol in 32 randomly assigned individuals.


Results: In subjects performing the RMM activity following a 1-hour stress induction protocol, 19 out of 45 markers demonstrated reversal with significant (P=0.05) Pearson correlations in contrast to 6 out of 45 markers in the resting control group and 0 out of 45 in the ongoing stressor group.


Conclusions: The resultant amelioration of stress-induced genomic expression supports the underlying premise that RMM warrants additional consideration as a rational choice within our armamentarium of stress reduction strategies. Modulation of individualized genomic stress induction signatures in peripheral blood presents a new opportunity for elucidating the dynamics of the human stress response.


Effectiveness for Employee Burnout & Turnover Reduction
Reducing Student Drop-Out Rate
Indidualized Genomic Stress Insuction Signature Impact

Corporate Employee Wellness Impact


Strengthens the Immune System of Corporate Reduction



Recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees Masatada Wachi, Masahiro Koyama, Masanori Utsuyama, Barry  Bittman, Masanobu  Kitagawa, Katsuiku Hirokawa Med Sci Monit 2007; 13(2):CR57-70 ICID: 473761


Background: With growing evidence linking job stress to illness, finding an effective means of stress management has become a challenging international endeavor. Although music therapy has attracted the attention of various fields as a promising method for alleviating stress, lack of standardization and paucity of data have served as impediments to widespread utilization.


Material/Methods: The effects of a Recreational Music-Making (RMM) group drumming protocol was evaluated on Japanese male corporate employees. A total of 20 volunteers participated in a one-hour RMM session while 20 volunteers engaged in leisurely reading for one hour (controls). After a six-month interval, the groups switched activities and underwent one session each. Pre- and post-intervention data were collected using mood state questionnaires and blood samples. Individual and group mean values for natural killer (NK) cell activity, NK cell percentage, and cytokine gene expression were analyzed.


Results: NK cell activity in the RMM group increased among individuals with low pre-intervention levels, and decreased among those with high pre-intervention levels. A significant correlation was established between changes in NK cell activity and the changes in the level of gene expressions for interferon- γ and interleukin-10. The RMM group demonstrated enhanced mood, lower gene expression levels of the stress-induced cytokine interleukin-10, and higher NK cell activity when compared to the control.


Conclusions: Based upon documented changes in NK cell activity, coupled with gene expression changes for interferon-γ, interleukin-10, and improved mood, this RMM protocol has significant potential for utilization in the corporate wellness environment.


Corporate Employee Wellness Impact
Creativity & Bonding in Seniors

Creativity & Bonding in Seniors


Recreational Music-Making Inspires Creativity & Bonding
in Long-Term Care Residents


Bittman, B., Bruhn, K., Lim, P., Neve, A., Stevens,C. Knudsen, C. , 2003

This study demonstrates the efficacy of recreational music-making as a means of inspiring creativity and helping long term care residents bond. Residents reported that RMM activities produced far more favorable effects, when compared with antidepressants or mood-stabilizing drugs.

To test this hypothesis, two real-world laboratories were established at Wesbury United Methodist Retirement Community, Meadville, Pa., a facility with independent living, skilled nursing, assisted living, and memory support (skilled and assisted); and Fredericka Manor, Chula Vista, CA., a retirement campus with independent living, assisted living, and skilled nursing, including 60 beds for persons with dementia.

While ongoing RMM programs are currently offered at both facilities, the data collection period extended from 2002 through 2003. A total of 550 seniors participated in the study. All subjects (or family members when appropriate) signed informed consents, and the protocol was approved by the Institutional Review Board for Human Studies of Meadville Medical Center. The program was conducted by an interdisciplinary facilitation team that included a physician, two music therapists, a music teacher, musicians, and members of the facilities’ activities staffs. The program included a Yamaha Clavinova Keyboard assisted drum circle which followed the HealthRHYTHMS Protocol. 

Resident Observations: After completion of the program, many residents noted the immediate benefits of creating connections with staff and other residents. Participation in just one RMM session often promoted identifiable and meaningful connections. The predominant conclusion was that there are no “strangers” at the end of an RMM session. Several residents remarked that their ability to more effectively deal with the loss of a loved one or friend was enhanced through RMM sessions. The acknowledgement of a person who had recently passed on served as an effective means for honoring an important relationship through empathetic group support. A number of participants commented that RMM positively influenced their overall perspectives and expectations for living in a long term care environment. In addition, residents reported that RMM activities produced far more favorable effects, when compared with antidepressants or mood-stabilizing drugs.


Quality-of-Life Improvements in Inner-City Adolescents

Quality-of-Life Improvements in Inner-City Adolescents


Creative Musical Expression as a Catalyst for Quality-of-Life Improvement in Inner-City Adolescents Placed in a Court-Referred Residential Treatment Program


Barry Bittman,MD; Larry Dickson,MA; Kim Coddington,PhD 



Background: Obstacles to effectively rehabilitate inner-city adolescents in staff-secure residential treatment centers should not be underestimated. Effective evidence-based protocols are lacking to help juveniles who are often angry, detached, frustrated, and in direct conflict with their peers. Facing a myriad of issues ranging from youth delinquency offenses to trauma, abuse, drug/ alcohol use, peer pressure/gang-related activities, lack of structure in home environments, mental health diagnoses, and cognitive functioning difficulties, these adolescents present extraordinary challenges to an over-stressed juvenile justice system. 


Material/methods: A randomized controlled crossover study is utilized to comprehensively evaluate the effectiveness of a novel creative musical expression protocol as a catalyst for nonverbal and verbal disclosure leading to improvements in quality of life for inner-city youth in a court-referred residential treatment program. A total of 52 (30 females and 22 males) African-American, Asian, Caucasian, and Puerto Rican subjects ranging in age from 12 to 18 (mean age 14.5) completed the study. 


Results: Dependent variable measures included the Child and Adolescent Functional Assessment Scale (CAFAS), the Adolescent Psychopathology Scale (APS), the Adolescent Anger Rating Scale (AARS), the Reynolds Adolescent Depression Scale, 2nd edition (RADS 2), and the Adolescent Visual-Analog Recreational Music Making Assessment (A-VARMMA). Statistically significant (experimental vs control) improvements in multiple parameters include school/work role performance, total depression, anhedonia/negative affect, negative self-evaluation, and instrumental anger. In addition, extended impact (experimental vs control) is characterized by statistically significant improvements 6 weeks after completion of the protocol, for school/work role performance, behavior toward others, anhedo-nia/negative affect, total anger, instrumental anger, anger, and interpersonal problems. 


Limitations: The primary limitations of this study include an extended follow-up period of only 6 weeks post completion of the protocol, and the inability to blind the counselors performing standardized assessments. 


Conclusions: This study is the first of its kind to test a replicable creative musical expression protocol as a catalyst for nonverbal and verbal disclosure leading to improved quality of life for inner-city youth in a court-referred residential treatment program. With substantial potential for widespread dissemination, this innovative protocol for adolescents can be readily utilized by behavioral health professionals without prior musical experience. 


Used by Permission

ADVANCES Spring 2009,VOL. 24, NO. 1 Creative Musical Expression


Stress: Impact Research Summary

Stress: Impact Research Summary


Why should you take action to reduce stress in your life when everyone has stress? "Stress is really a component of every disease," says James Rosenbaum, MD. Take a look at the adverse health effects of chronic stress:


Cardiovascular illnesses. Chronic stress has been shown to increase the heart rate and blood pressure, making the heart work harder to produce the blood flow needed for bodily functions. Long-term elevations in blood pressure, also seen with essential hypertension (high blood pressure not related to stress), are harmful and can lead to myocardial infarction (heart attack), heart failure, abnormal heart rhythms, and stroke. (Journal of the American Medical Association, 2007)


Obesity. "We have known for over a decade that there is a connection between chronic stress and obesity," Herbert Herzog, PhD, of the Garvan Institute of Medical Research in Sydney, Australia, says in a news release. "We also know that NPY(a molecule the body releases when stressed ) plays a major role in other chronic stress-induced conditions, such as susceptibility to infection. Now we have identified the exact pathway, or chain of molecular events, that links chronic stress with obesity." (WebMD Medical News, 2007) Excess abdominal fat and obesity are risk factors for heart disease and diabetes, and this type of fat secretes copious proinflammatory chemicals, worsening inflammation. (Arthritis Today, 2005)


Diabetes. Obesity is a leading cause of diabetes, but the chemical imbalances caused by stress, regardless of obesity, can also trigger type 2 diabetes development. Researchers at the University of Washington, Seattle, found that increased levels of fear, lack of control and depression raise levels of glucose and insulin, each of which are danger signs for diabetes.


Drug Abuse. Many clinicians and addiction medicine specialists suggest that stress is the number one cause of relapse to drug abuse, including smoking. Now, research is elucidating a scientific basis for these clinical observations. In both people and animals, stress leads to an increase in the brain levels of a peptide known as corticotropin releasing factor (CRF). The increased CRF levels in turn triggers a cascade of biological responses. (National Institute on Drug Abuse, 2005)


Cognitive Impairment. Chronic stress can impair memory and may impair cognitive function. (McEwan B., Sapolsky R., 1995) Pioneering research of Bruce McEwen, PhD, head of the Neuroendocrinology laboratory at the world-renowned Rockefeller University in New York proposed that repeated stress can lead to the body’s inability to turn off its major biological stress pathway; a factor that can directly lead to significant memory loss.(New England Journal of Medicine, 1998).


Chronic Pain. Stress alters neurotransmitters that regulate mood and emotion, leaving a person more susceptible to depression and anxiety. Depression can also worsen inflammatory conditions. For example, a study out of Stanford University Medical Center, Calif., discovered that people who are depressed experience two times more chronic pain than those who are not depressed. 


Premature aging. Connections among stress, premature aging and decreased lifespan were recently identified in a University of California, San Francisco (UCSF) review of women, aged 20 to 50, who were caregivers to children living with a chronic illness, such as autism. Compared to women of the same age who were caring for healthy children, chronic stress levels speeded up the deterioration of vision and hearing, increased aging of the skin, mental decline and failing organs in the women caring for sick children. (Stein, R., 2004)


Depression. Recent estimates suggest that loss of a loved-one, and the physical/emotional changes associated with aging result in depression, a condition that is severely underestimated and present in about 65% of the elderly in our society. (Bittman, B., 2008) Researchers at the University of Washington and Group Health Center for Health Studies shows that depressed older adults use more health care services and have 43-56 percent higher health care costs than their peers who do not suffer from depression.(Sowers, P., 2003)


Published, peer-reviewed research has demonstrated that HealthRHYTHMS Group Empowerment Drumming significantly reduces stress, reduces burnout rates, improves mood states and increases natural killer cell activity. 


bottom of page