Effect of cardio drumming on stress and self-esteem in an inpatient psychiatric hospital





cardio drumming, recreation therapy, severe and persistent mental illness, stress, self-esteem


Background: Individuals living with serious mental illnesses have profound rates of stress and often poor self-esteem, which may affect their inpatient psychiatric experience. Several interventions have been shown to decrease stress and improve self-esteem; however, few of these interventions have been examined within the inpatient psychiatric setting. Cardio drumming is a novel, engaging full body aerobic intervention that can improve mental and physical health outcomes. The purpose of this study was to examine the outcomes of a cardio drumming intervention on stress and self-esteem among inpatients at a psychiatric facility. The specific aims of this study were to (1) examine the effectiveness of cardio drumming on stress levels and self-esteem scores among psychiatric inpatients and (2) assess demographic differences in stress levels and self-esteem scores.

Methods: A pilot study using a single group pre- and post-test design was conducted with a convenience sample of 64 adult psychiatric inpatients obtained from a 239-bed state psychiatric facility in Kentucky. The cardio drumming intervention consisted of five routines, which is followed by stretching and cool down movements lasting 45 minutes. Participants’ ratings on stress and self-esteem before and after the intervention were obtained. Paired sample t-tests were used to assess changes in the stress and self-esteem scores.

Results: Study participants were mostly male (84.4 percent) and White non-Hispanic (81.3 percent), had a psychotic disorder diagnosis (51.6 percent), and were 36.9 (standard deviation [SD] = 13.5) years of age on average. The mean stress levels of the sample decreased from 2.97 (SD = 1.86) to 1.95 (SD = 1.41), t [63] = 4.30 (p < .0001), before and after the intervention. In a similar fashion, the mean self-esteem scores increased from 3.94 (SD = 1.72) to 4.69 (SD = 1.59), t [63] = 4.11 (p < .0001), before and after the intervention. The decreases in stress scores and increases in self-esteem scores were higher in male participants compared to female participants. Furthermore, the decreases in stress scores were greater among those with a psychotic disorder compared to those without.

Conclusion: Our findings suggest that cardio drumming may be an appropriate intervention to consider as part of recovery-based programing within the inpatient psychiatric setting to improve stress and support self-esteem for patients. Future studies may examine gender and diagnostic differences in the experience of cardio drumming among patients living with serious mental illnesses.

Author Biographies

Jessica M. Herwig, BS Ed, CTRS

Recreation Therapist, Eastern State Hospital, Lexington, Kentucky

Vanessa E. Gennaro, BS, CTRS

Recreation Therapist, Eastern State Hospital, Lexington, Kentucky

Andrew S. Layne, BS, CTRS

Recreation Supervisor, Eastern State Hospital, Lexington, Kentucky

Chizimuzo (Zim) T.C. Okoli, PhD, MPH, MSN, APRN

Eastern State Hospital, Lexington, Kentucky


APA: US adults report highest stress level since early days of the COVID-19 pandemic. February 2, 2021, 2021. Available at https://www.apa.org/news/press/releases/2021/02/adults-stress-pandemic. Accessed February 21, 2022.

Puangsri P, Jinanarong V, Wattanapisit A: Impacts on and care of psychiatric patients during the outbreak of COVID-19. Clin Pract Epidemiol Ment Health. 2021; 17: 52-60. DOI: 10.2174/1745017902117010052.

Li L: Challenges and priorities in responding to COVID-19 in inpatient psychiatry. Psychiatric Serv. 2020; 71(6): 624-626.

González-Sanguino C, Ausín B, Castellanos M, et al.: Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. 2020; 87: 172-176. DOI: 10.1016/j.bbi.2020.05.040.

Selye H: Stress without distress. In Serban G (ed.): Psychopathology of Human Adaptation. New York City: Springer, 1976: 137-146.

Yaribeygi H, Panahi Y, Sahraei H, et al.: The impact of stress on body function: A review. EXCLI J. 2017; 16: 1057-1072. DOI: 10.17179/excli2017-480.

Walker ER, McGee RE, Druss BG: Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry. 2015; 72(4): 334-341. DOI: 10.1001/jamapsychiatry.2014.2502.

Seabury SA, Axeen S, Pauley G, et al.: Measuring the lifetime costs of serious mental illness and the mitigating effects of educational attainment. Health Aff. 2019; 38(4): 652-659. DOI: 10.1377/hlthaff.2018.05246.

Rosenberg M: Self-attitudes and other attitudes. In Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965: 3-15.

Branden N: The 6 Pillars of Self-Esteem. New York, NY: Bantam Books, 1994: 27.

Mann M, Hosman CMH, Schaalma HP, et al.: Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res. 2004; 19(4): 357-372. DOI: 10.1093/her/cyg041.

West ML, Yanos PT, Smith SM, et al.: Prevalence of internalized stigma among persons with severe mental illness. Stigma Res Action. 2011; 1(1): 3-10. DOI: 10.5463/sra.v1i1.9.

Salsali M, Silverstone PH: Low self-esteem an psychiatric patients: Part II—The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients. Ann Gen Hosp Psychiatry. 2003; 2(1): 3-3. DOI: 10.1186/1475-2832-2-3.

Martland R, Mondelli V, Gaughran F, et al.: Can high intensity interval training improve health outcomes among people with mental illness? A systematic review and preliminary meta-analysis of intervention studies across a range of mental illnesses. J Affect Disord. 2020; 263: 629-660. DOI: 10.1016/j.jad.2019.11.039.

Ashdown-Franks G, Sabiston CM, Stubbs B: The evidence for physical activity in the management of major mental illnesses: A concise overview to inform busy clinicians’ practice and guide policy. Curr Opin Psychiatry. 2019; 32(5): 375-380. DOI: 10.1097/YCO.0000000000000526.

Creech A, Hallam S, Varvarigou M, et al.: Active music making: A route to enhanced subjective well-being among older people. Perspect Public Health. 2013; 133(1): 36-43. DOI: 10.1177/1757913912466950.

Hars M, Herrmann FR, Gold G, et al.: Effect of music-based multitask training on cognition and mood in older adults. Age Ageing. 2014; 43(2): 196-200. DOI: 10.1093/ageing/aft163.

Silverman MJ: Music therapy and clients who are chemically dependent: A review of literature and pilot study. Arts Psychother. 2003; 30(5): 273-281. DOI: 10.1016/j.aip.2003.08.004.

Chang BH, Chen BW, Beckstead JW, et al.: Effects of a music-creation programme on the anxiety, self-esteem, and quality of life of people with severe mental illness: A quasi-experimental design. Int J Mental Health Nurs. 2018; 27(3): 1066-1076. DOI: 10.1111/inm.12414.

Lyn Gorbett L, Trason W, Allison W, et al.: Efficacy of therapeutic recreation-based Drumtastic® and kid yoga rocks in an early childhood public school setting. Ther Recreat J. 2021; 55(1): 60-77. DOI: 10.18666/TRJ-2021-V55-I1-10128.

Ascenso S, Perkins R, Atkins L, et al.: Promoting well-being through group drumming with mental health service users and their carers. Int J Qual Stud Health Well-being. 2018; 13(1): 1484219-1484219. DOI: 10.1080/17482631.2018.1484219.

Ekins C, Owens DP: Drums Alive®: A research-based, multi-disciplinary drumming fitness approach to brain and body health and wellness. Palaestra. 2018; 32(4): 22-28. Available at https://www.drums-alive.com/wp-content/uploads/2019/01/Palaestra-2018-Vol.-32.No_.-4.pdf. Accessed September 6, 2023.

Ekins CWP, Schulz H, Wright P, et al.: Effects of a Drums Alive® kids beats intervention on motor skills and behavior in children with intellectual disabilities. Palaestra. 2019; 33(2): 25.

Yang Q, Yang J, Keener E, et al.: Drums-Alive intervention effect on the motor and functional skills in youth with intellectual disabilities and autism spectrum disorder: A pilot study. Adv Phys Educ. 2021; 11(1): 35-46.

Elo A-L, Leppänen A, Jahkola A: Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003; 29(6): 444-451. DOI: 10.5271/sjweh.752.

Robins RW, Hendin HM, Trzesniewski KH: Measuring global self-esteem: Construct validation of a single-item measure and the Rosenberg Self-Esteem Scale. Pers Soc Psychol Bull. 2001; 27(2): 151-161. DOI: 10.1177/0146167201272002.

Litchke L, Finley C: Social-emotional benefits of Drumtastic Ability Beats® dyadic partnership between a college veteran with PTSD and an elementary student in a special education setting. Ther Recreat J. 2019; 53(2): 175-184. DOI: 10.18666/TRJ-2019-V53-I2-9129.

Matthews RA, Pineault L, Hong Y-H: Normalizing the use of single-item measures: Validation of the single-item compendium for organizational psychology. J Bus Psychol. 2022; 37(4): 639-673.

Allen MS, Iliescu D, Greiff S: Single item measures in psychological science. Eur J Psychol Assess. 2022; 38(1), 1-5.

Ahmad F, Jhajj AK, Stewart DE, et al.: Single item measures of self-rated mental health: A scoping review. BMC Health Serv Res. 2014; 14(1): 1-11.

Brailovskaia J, Margraf J: How to measure self-esteem with one item? Validation of the German Single-Item Self- Esteem Scale (G-SISE). Curr Psychol. 2020; 39(6): 2192-2202.

Kamarck T, Mermelstein R, Cohen S: A global measure of perceived stress. J Health Soc Behav. 1983; 24(4): 385-396. DOI: 10.2307/2136404.

Rosenberg M: The measurement of self-esteem. In Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965: 16-36.

Hickey ME, Mason SE: Age and gender differences in participation rates, motivators for, and barriers to exercise. Mod Psychol Stud. 2017; 22(2): 10-19.

Portela-Pino I, López-Castedo A, Martínez-Patiño MJ, et al.: Gender differences in motivation and barriers for the practice of physical exercise in adolescence. Int J Environ Res Public Health. 2020; 17(1): 168. DOI: 10.3390/ijerph17010168.



How to Cite

Herwig, J. M., Gennaro, V. E., Layne, A. S., & Okoli, C. (Zim) T. (2023). Effect of cardio drumming on stress and self-esteem in an inpatient psychiatric hospital. American Journal of Recreation Therapy, 22(1), 31–38. https://doi.org/10.5055/ajrt.2023.0277