Dustin PolitteLiterature Review It is fairly common for students to be stressed as they transition from High School to college. There are several large adjustments for them to make all while taking on larger work loads at a school that they are not used to. While many aspects of college are thought to be exciting and fun, this does not entirely overshadow the fact that many for many students, how they do in college will shape the rest of their life. The pressure of this along with other difficulties of many students being on their own for the first time in their lives can cause large amounts of stress. It was reported that a significant negative correlation was shown between stress and life satisfaction in college students (Holinka 2015). This shows that stress is not just an unfortunate part of college but is also effecting student’s quality of life. A few things should be taken into account when reading Holinka’s study. The students were promised extra credit for their participation in the study as part of a college class. Out of 144 students originally participating in the study only 83 students’ answers could be used as the rest either did not complete the survey or had inconsistent answers which the researcher infers meant that they rushed through the survey. These flaws do not mean that this experiment should be discounted. Regardless of the study’s flaws the findings were still definitive and simply means that more research should be done. Bhujade published a meta analysis of a large number of studies about different age groups from adolescents to college students all having to do with stress, anxiety, and depression (2017). It states that a large portion of college populations are experiencing difficulties coping with such a large transition into college. “At any given time if one examines the student well-being one can find that every 10 students, one will have emotional conflicts severe enough to merit professional help.” These and many more statistics that Bhujade has gathered together in a single place demonstrate just how poor the mental health of our college students are. This is not something that can simply be ignored because there are far more students effected than previously realized. Ferrer et. al (2014) points out that some students may not know how to cope with the demands of college life which can lead to reduced academic performance. This can lead to prolonged stress which can cause plenty of other psychological problems. Music therapy is defined by the American Music Therapy Association (2011) as the clinical and evidence-based use of music interventions to accomplish individualized goals with a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Ferrer also pointed out that music therapy was appropriate for this population as it is, “safe, enjoyable, and inexpensive.” This study attempts to show a relationship between a music therapy intervention and stress reduction in a college class. It should be noted that most would not consider the act of listening to a song as music therapy unless it was being used in a deliberate way and was specifically picked by a music therapist in collaboration with their client. In this study this seems to have been the easiest way to keep everyone involved and control as many variables as possible. The entire class would take turns picking a song for each class period for the class to listen to and then everyone would fill out a survey which included perceived stress levels before and after listening to the song. It is possible that the fact that the questions specifically asked stress levels before and after the song that it could have affected the data collected. A significant overall decrease in stress was shown in the study. Lee et. al (2016) did a similar study in which college students were asked to do various stressful tests. Their blood pressure and pulse was taken at various stages and the experimental group was allowed to listen to music during a short break while the control group simply got a break. As in the previous study a significant decrease in blood pressure and pulse was found in the experimental group. This reaffirms the previous study’s findings. This study shows how beneficial music can be in stress reduction, but it raises the question of if a more involved music therapy intervention would be more or less beneficial. Thus far interventions involving passive listening to music have shown promising results. Jurcau et al. showed that not only does music affect us psychologically but also physiologically. In their study participants were asked to do a short intense session of physical exercise on the cycle ergometer. The experimental group listened to W.A. Mozart’s Concerto No. 21 for an hour before the session as well as throughout the session. Data was collected the day before the session, 30 minutes before the session, 15 minutes after the session, and 24 hours after the session. Collected data included salivary cortisol levels as well as a self reporting survey on anxiety. It was found that a significant correlation between music listening and cortisol levels as well as anxiety. Both the tests directly before and after the exercise were significantly lower which shows that music listening helps before as well as during any kind of stressful event. The weakness of the study was the small sample size as well as the ambiguity of where the participants came from. The study states that all participants were voluntary but it didn’t say anything about being randomly selected or randomly assigned which can also effect the outcome. In a study by Ilie and Rehana (2013) researchers measure cortisol levels in undergraduate students when in stressful situations if they use a musical app to relieve stress. 54 participants were randomly assigned to a stressful situation or non-stressful situation as well as listening to Twinkle Twinkle little star, playing it, or doing nothing. The participants had to go through a rigorous mock interview where they had eight minutes to prepare a five minute speech in which they were not allowed any written materials. If they did not take up all five minutes they were asked questions based on what their topic was. Once the full five minutes were finished they were asked to count backwards aloud from 1013 by 7’s while maintaining eye contact with the researcher. The results showed that playing an instrument did result in acute stress reduction although the researchers realized that their choice of instrument could have caused this result. It has been shown that playing an instrument can slow down breathing to match that of the music which in turn will relieve stress as slower breathing slows down the heart and relaxes the body. In future studies the researchers suggest that non-wind instruments should be used in order to control this confounding variable. A study by Gingras et al. Attempted to find a relationship between cortisol levels and mantras during music therapy. Shamanic mantras have been associated with positive psychological effects. Thus this study tried to see if shamanic mantras would have a greater correlation with lowered cortisol levels than simple relaxation instructions during music listening. Four groups consisting mostly of Biology students from the University of Vienna where the study was taking place participated in a relaxation intervention. Each group had a different pair of the four variables tested for this study. Shamanic mantras and relaxation instructions were two as well as repetitive drumming and relaxing instrumental music were another. The study showed that there was a significant decrease in cortisol levels for all four groups, but aside from subjective experiences of the participants there were no significant differences between them. It seems that the sole cause for such drops in cortisol levels is the music itself regardless of what kind of music it is or what is being said during the music.One popular music therapy intervention is group drumming, which Fancourt et al. found to be beneficial in several different ways. The participants were 45 adults who accessed mental health services and were recruited from their hospital. They regularly participated in community based events which allowed the control group to be better controlled. The experimental group participated in ten weeks of group drumming with a professional musician who was well versed in leading drum groups such as this as well as support from three students from the Royal College of Music. The sessions were 90 minutes long and consisted of learning the basics of the djembe and progressed through the ten weeks culminating in a larger drumming piece that used the rhythmic patterns and techniques they had been learning during the course of the study. It was shown that a signifiant positive difference was shown in regards to Anxiety, depression, and social resilience in the experimental group over the ten weeks of the study. It was also recorded that these results held true in a follow-up examination three months after the end of the study. One problem with previous studies is that all of them were set over an extended period of time which does not control variables pertaining to time. The next study was done over the course of two hours which unfortunately traded one set of confounding variables for another. A two hour session causes maturation to become an issue as well as the taking a pre-test as well as a post-test so close together can effect the answers one way or another. It is worth noting that the participants were social work students which could effect how they tested. The last problem with this research design is the lack of a control group as well as the small sample size. These points aside Maschi and Bradley (2007) did have similar findings to previous studies and made their shortcomings known. At risk youth can be very difficult to help and are a great example of a population under many stressors. This population is very similar to college students in the fact that they are close in age, have many stressors, and at risk youth could potentially become college students in a few short years. The next study was done over the course of twelve weeks with ten at risk students at a private school. Every other session was recorded by a videographer which was then watched and analyzed by a psychology of education researcher who then coded observable behaviors into themes which were then recorded for later analysis. At the end of the twelve weeks questionnaires were given to the students to be filled out. They reported that the study helped them relieve stress, control their anger, focus their attention, and increase in self-esteem. It is difficult to show significant results in a qualitative study, but if there was a way I believe that this would be it. Both the surveys as well as the videotapes which were analyzed showed some significantly positive results that simply can not be measured easily. One of the most beneficial studies in this area is Bittman et al’s. This study extensively sought out the different variations on group drumming interventions. Four different drum groups were facilitated as well as a control group with varying levels of instruction versus playing. One of the groups also had a shamanistic approach as well. The study measured various hormones including plasma cortisol, plasma dehydroepiandrosterone, plasma cortisol-to-dehydroepiandrosterone ratio, natural killer cell activity, plasma interleukin-2, and the plasma interferon-gamma. The participants also took the Beck anxiety inventory and the Beck depression inventory. The composite drumming group which was the main experimental group showed a significant increase in the DHEA to cortisol ratio which proved their hypothesis correct. As for the Beck inventory scales, there was no significant difference. This may have been due to the fact that the study said nothing about anyone having any signs of depression or anxiety. If the participants were not experiencing any signs of either then they would not have shown much of a difference between the pre and post-test. There is plenty of research done on the subject of music and stress relief, but there seems to be a gap in research specifically about group drumming interventions along with stress relief. The few that have been done are not quantitative in nature or have one or more significant flaws that if re-evaluated could strengthen the study significantly. Very little research focuses on college students who would significantly benefit from such findings as new ways to reduce stress in such a trying time. This calls for more research that can fill in the gaps and bring new light to the questions of group drumming in college students to reduce stress.Participants:This study is designed as a randomized control group study. Twenty students will be recruited from the counseling center at five different colleges in the St. Louis Area based on perceived stress levels. Applicants will be asked to take the Perceived Stress Scale. Applicants will be accepted for the study if they score a 30 or higher out of 40. Participants will then be randomly assigned to two groups, one of which will receive the intervention while the other participates in a comparable activity. Participants will be required to meet certain criteria. They must live on campus, be a first year full time student, and attend weekly sessions with a campus counselor. Students are to be referred by campus counselors who will be made aware of the study and asked to refer students that met the criteria for the study. All participants must sign an informed consent form prior to the study. The research team will consist of two certified music therapists, two licensed personal counselors, two medical technologists, as well as the researcher. Data Collection:We will use a mixed method data collection method. Before and after each session participants’ salivary cortisol levels will be taken. The participants’ test scores for their perceived stress are then recorded and they will take the test again every four weeks before their sessions in order to record their progress. The perceived stress scale consists of ten questions on a zero to four scale with zero being never and four being very often. Each question asks about their ability to cope as their emotional competency. Participants will be asked to keep a journal and make entries after each session This will be reviewed later by the researchers for common themes. There will also be a volunteer focus group at the end of the study which will be recorded and reviewed for themes as well. Procedure: The study will take place over the course of 16 weeks. The sessions will be held in a music room so that both groups can have the same environment. The sessions will be once a week for one hour in a group of ten. Both groups will meet on different days but at the same time in the evening. Each group will be assigned two professionals to facilitate the intervention. The experimental group will have two certified music therapists running an hour long drumming session. The sessions primarily use djembes as well as various hand percussion instruments. The sessions include learning the techniques for the instruments, learning traditional rhythms, and working on group cohesion. Extended rhythmic ostinatos are used to reach a meditative state. Improvisation can be used once participants were comfortable with the instruments. As the group gains competency with their instruments they will be introduced to progressively more difficult rhythms and styles as a way to keep them challenged and engaged. This will give the participants a sense of accomplishment and help them grow as a group in order to help them build connections. These connections will be another way to help them with stress reduction as that group connectedness can help with this. The control group will receive group therapy as a substitute for music therapy. This will take the form of a kind of support group for college students. Each student will be invited to share problems they are having over the course of the semester and as a group will discuss solutions. They will also learn coping skills in order to self soothe when they are stressed outside of the group.Data Collection:We will use a mixed method data collection method. Before and after each session participants’ salivary cortisol levels will be taken. The participants’ test scores for their perceived stress are then recorded and they will take the test again every four weeks before their sessions in order to record their progress. The perceived stress scale consists of ten questions on a zero to four scale with zero being never and four being very often. Each question asks about their ability to cope as their emotional competency. Participants will be asked to keep a journal and make entries after each session This will be reviewed later by the researchers for common themes. There will also be a volunteer focus group at the end of the study which will be recorded and reviewed for themes as well. Before and after each session mouth swabs will be taken in order to test the participants salivary cortisol levels. This will show if the intervention had any short term biological effects throughout the session as well as the longer term effects throughout the study. Each participant then will take the perceived stress level questionnaire again and compare it to the one they took in order to be eligible for the study. This test will be given before each session as it is a test of the long term effects of the study rather than the change over each session as the salivary cortisol levels are. ReferencesBhujade, V. M. (2017). Depression, anxiety and academic stress among college students: A briefreview. Indian Journal Of Health & Wellbeing, 8(7), 748-751. Bittman, B. B., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. C., Pappas, J., & Ninehouser, M. (2001). Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Alternative Therapies In Health And Medicine, 7(1), 38-47. Fancourt, D., Perkins, R., Ascenso, S., Carvalho, L. A., Steptoe, A., & Williamon, A. (2016). Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users. Plos One, 11(3), e0151136. doi:10.1371/journal.pone.0151136FERRER, E., LEW, P., JUNG, S. M., JANEKE, E., GARCIA, M., PENG, C., & … TAM, C. F. (2014). PLAYING MUSIC TO RELIEVE STRESS IN A COLLEGE CLASSROOM ENVIRONMENT. College Student Journal, 48(3), 481-494.Gingras, B., Pohler, G., & Fitch, W. T. (2014). Exploring shamanic journeying: repetitive drumming with shamanic instructions induces specific subjective experiences but no larger cortisol decrease than instrumental meditation music. Plos One, 9(7), e102103. doi:10.1371/journal.pone.0102103HOLINKA, C. (2015). STRESS, EMOTIONAL INTELLIGENCE, AND LIFE SATISFACTION IN COLLEGE STUDENTS. College Student Journal, 49(2), 300-311.Ilie, G., & Rehana, R. (2013). Effects of Individual Music Playing and Music Listening on Acute-Stress Recovery. Canadian Journal Of Music Therapy, 19(1), 23-46. Jurc?u, R., & Jurc?u, I. (2012). Influence of music therapy on anxiety and salivary cortisol, in stress induced by short term intense physical exercise. Palestrica Of The Third Millennium Civilization & Sport, 13(4), 321-325.Lee, K. S., Jeong, H. C., Yim, J. E., & Jeon, M. Y. (2016). Effects of Music Therapy on the Cardiovascular and Autonomic Nervous System in Stress-Induced University Students: A Randomized Controlled Trial. Journal Of Alternative & Complementary Medicine, 22(1), 59. doi:10.1089/acm.2015.0079 Maschi, T., & Bradley, C. (2010). Recreational Drumming: A Creative Arts Intervention Strategy for Social Work Teaching and Practice. Journal Of Baccalaureate Social Work, 15(1), 53-66.Snow, S., & D’Amico, M. (2010). The drum circle project: A qualitative study with at-risk youth in a school setting. Canadian Journal Of Music Therapy, 16(1), 12-39.