Using Music to Help Recover from Transplant

Presenter:  Erin Seibert MA, MT-BC, John Hopkins All Children’s Cancer and Blood Disorder Institute

This is a video workshop presented at the 2019 Celebrating a Second Chance at Life Survivorship Symposium

Presentation is 55:20 minutes.

Summary:

Music is one of the only phenomena that stimulates both sides of the brain. When used intentionally, it can help soothe anxiety and improve brain function. Music therapists work as part of the healthcare team to improve a patient’s quality of life.

Transcript of Presentation

00:00  Thank you all for choosing to be a part of this presentation today. It's my pleasure to be here. I love being a music therapist. That is my full-time job; but one of the things that I love even more is being able to present about music therapy to people like you and to kind of provide some education and advocacy around the benefits of using music in order to help us heal, whatever that might mean for us. I see a lot of people are kind of gathering in the back, and this is an interactive workshop, so you're going to need to find at least... I mean, you can sit in the back but, you will at some point need an instrument here, so feel free to get comfortable if you would like.

This presentation is going to be talking about using music to recover from transplant. And I also just want to highlight that this presentation is based on a music therapy perspective. So like Janet said, we will do a little bit of a lecture here to start out just so that we're all kind of on the same page in regards to our knowledge about music, and then we will get into some experientials here.

So first we will kind of just talk about what is music therapy. We will talk about what is the music experience. We will dive a little bit, not too deeply, into the neuroscience behind music. We will have an experiential. We can kind of talk about that experience and what that was like for us. We will have another experiential that will be different than the first one. And then hopefully, we can kind of discuss and have some takeaway music coping tools that can get you moving forward into the future.

02:03  So I always like to start out with, "What is music therapy?" Has anybody heard of the profession of music therapy before this very moment?

02:12  Yes.

02:12  Yeah, okay. Has anyone received music therapy before?

02:16  Yeah.

02:17  That's a lot more head nods than I usually get so that's awesome.

02:24  Well, for those of you who are not familiar with music therapy, I always like to kind of start with the beginning. I think a lot of us are probably here in this room because we have some kind of connection, some kind of awareness of what music does to us. But if we look back to how music therapy, as a profession got started, most people, when I talk with them, and they learn about what it is that I do every day, everyone pretty much assumes that this is a brand new profession, when in fact, it's actually been around since the World Wars.

Historically, what happened was that people were coming back from experiencing war and they were in the hospitals receiving treatment, a lot for a lot of what we now know as being Post-Traumatic Stress Disorder. The hospitals thought it would be a great idea to bring in musician. So musicians came in and played for these soldiers and these patients at the hospitals; and it was actually the musicians who quickly realized that they needed a lot more training in order to use music to help these people. That's actually where music therapy, as a degree program and a profession, came about.

So technically, the definition of music therapy is, "The clinical and evidence-based use of music interventions to achieve individualized, non-musical goals." I like to give that very specific and formal definition because essentially, what it means is that we use music with intention and with purpose, and we work towards a goal that has nothing to do with music. We use music as the medium in order to affect change and to get to where we want to be.

For each area, each population, each clinical situation that I work with as a music therapist, each one of us has very different needs. We have different needs depending on the day, the moment, or anything else that's happening situationally, and I, myself, as a music therapist, come in and meet you where you're at in that moment, and we use the music to address that need.

 So, one of the reasons why our definition for music therapy is so formal and kind of general is because sometimes it's hard to capture what music therapy is for one person compared to another person, compared to another person, but I like to put it out there. That way we can all have an understanding moving forward that it's really based on the individual person.

05:34  Just as some additional background information because I'd hate for you to be here and wondering if I know anything about what I'm talking about and presenting to you all today. As a Board- Certified Music Therapist, I have completed a bachelors and a master’s degree specifically in music therapy. Music therapy is a specific degree program.

It also requires us to accomplish a six-month clinical internship. At my hospital, I actually have interns who are there, and learning, and completing that internship, and from there, we are eligible to take that Board Certification Exam. So that's what it means to be Board Certified Music Therapists.

06:18  Lastly, I know many of you mentioned that you were familiar with music therapy or have either received it; but music therapy, when you see us in the hospital systems, in hospice care, in the educational systems, we are a part of the team, the team working on your care, on your treatment plan. We can co-treat easily with anybody else in the hospital. We consult with medical teams in order to really identify those goal areas that music can be helpful with. Any questions so far? Okay. I like to just make it... oh, yes. Yes.

07:05  What do you mean by... I know you'll explain it later on, but what does evidence-based mean?

07:08  Oh, that's an excellent question. Yes. I did not point out what evidence-based means. So, evidence-based means that we actually have a lot of research. There's a lot of research about the role of music and how we can use music to achieve non-musical goals: so, music therapy as a profession has a lot of research out there, whether that's researching how music therapy affects people with anxiety and depression or how music therapy affects those with a traumatic brain injury. So, based on our research is how we make decisions and how we apply the use of music to those non-musical goals. Great question.

07:56  Okay. Thank you.

07:59  So, one of the things that I love is to try to explain is what music is. If we think about it, music is a very complex phenomenon, so I wanted to kind of break it down with you a little bit here. So, to me, we start with the elements of music. What comprises music? We have rhythm, melody, harmony, timber, so like the tone, form, texture, and dynamics. You all with me on that?

Mm-hmm (affirmative).

Yeah. Those are all the things that make music how it sounds. So, then we take it a level further. Whenever we have all of those elements of music occurring at one time, we have then mental activities. All of these elements of music, of course go into this listening section. We are listening. We are being able to hear all of those elements of music happening at one time; but we also have sensing, that feeling that we get when we hear something that we recognize, and then we get goosebumps, or we sense that, "Ooh, I just love how this beat feels."

We also have learning, so when we sing the ABCs and we learn the alphabet through the use of music, there's a component of learning. We also have remembering. "Oh, I love this song. It totally reminds me of when I was in college and I was doing X, Y, and Z." And then there's the performing itself. Are we singing along? Are we the musician who's making this music right now? We have all of those mental activities.

10:11  Now we're going to take it a step further. So, we have our limits in music. We have our mental activities and then we have our engagement. So, you can see that listening kind of goes into perception. Perception, that's like a totally different lecture. It's like over my head, when you start to think about how I perceive a sound compared to how you perceive a sound. Are we perceiving the same sound? I don't know. It gets very complex, but we can recognize that perception is a pretty deep experience to look into. We also have familiarity, kind of going back to that learning and remembering. But we also have emotion, our memory, the connection to music, that more visceral aspect of music that becomes very difficult to describe to somebody else, that connection that we have with music.

11:16  We also have our participation type. Are we actively engaging in music? Are we playing the music ourselves or are we are passively engaging in music? Is it just on in the background and we are kind of aware that it's there?

11:33  This other component that I skipped at the beginning: entrainment. Entrainment is the phenomenon of when we find ourselves tapping our toes to the music that we didn't even realize was playing. Has anyone ever experienced that? Like, "Oh, why am I moving suddenly to the... oh, there's music on? I had no idea." What entrainment is our brain finds the rhythm and matches it, and automatically starts to follow along. That's your toe tapping. That's if you were walking at one pace and then suddenly music started, and then you're like, "Oh, okay. This is where we're going." That is entrainment. That is a subconscious type of engagement that happens without us even knowing. And we all have it, it's not just like a natural talent, it exists for all of us.

12:33  And then lastly, there's just one little level. Like I was saying, perception. That's kind of like the highest level of understanding of what's going on in our brains when we experience music. Again, music cognition scientists, neuroscientists are all trying to understand this phenomenon of perception. What we do know is that we all perceive pitch, dynamics, duration, the length of things, timbre, how it sounds, where it's localized around our bodies... We all perceive that differently; but some of it must be the same because we all can experience and connect this together. All of that is to say, the reason why I go through every single component of this, is that it's important for us to know that despite having numerous things that occur when we engage in music is that all of this is happening at the same time in our brains. Our brains are so powerful that all of these things can be occurring at the same time, and that is the music experience.

14:00  One of the awesome things about music is that it's one of the only phenomenon in life that is processed on both sides of the brain at one time. When you engage in music, if you think back to what was occurring in those elements of music, of rhythm, and melody, and harmony, and timbre, all of those things activate different parts of the brain at one time. You have your auditory cortex that is taking in the sounds, and the texture, and the harmonies. Then you have the language component that's lighting language areas in your brains. And then we have that entrainment phenomenon that's creating the need to move along to the music. All of this is happening at one time. To me, it's mind boggling, and I can go down this rabbit hole of really thinking about it, but I'll try to stay surface level with you guys.

15:04  Why it's important is because using music intentionally, whether within music therapy with a music therapist or in using music on your own individually, it's important to kind of know these factors in order to have a deeper intentionality with what purpose you want music to serve for you, so we consider what music is.

We think about all of those different components we just went over. What is music? And then we look at what we know about the brain. What have we learned in research these days about the structure of our brain and music cognition? There's a lot of really cool research coming out from people who study music cognition, from neuroscientists who are super interested in seeing what is happening in a musician's brain when they play their guitar. They have studies where they will stick a musician in an MRI in order to see what's going on. Some of the things that we have learned about our engagement in music is that music changes our brain structure; which is really cool if we think about if we've had some kind of deficit or some kind of change to our brain because of a medical necessity, because of a traumatic incident, anything. We can use music to change how our brain functions.

16:44  One piece of research that has come out is that- well, actually a lot of research shows this- our brains have neuroplasticity, which means that they have the ability to change and adapt over time. So if we purposefully engage in exercises and activities that increase our neuroplasticity, that helps our brain remain young, and make changes, and adapt. One cool piece about research is that it shows that musicians and people who engage in active music making actually have a thicker corpus callosum, which is the white fiber tract in your brain that keeps the two hemispheres together.

So, what that tells us is that people who have a thicker corpus callosum actually have a brain that works faster. Neurons are moving faster between the hemispheres because of that. In a similar type of research, musicians or others who are engaging in active music making have thicker myelin sheaths, which is the fibers that surround the axons in a nerve cell and, make the axons and the nerves fire more rapidly as well. If you think about an electrical cord and if you have electricity running, it's going to run more efficiently, and smoother, and faster if it is covered and protected. That's the myelin sheath.

18:24  So those situations when you see someone who has lost the ability to speak but can still sing, what is happening is the brain is rewiring itself through these active exercises, through the practice of singing. Singing is allowing us to build that neuroplasticity, find new routes, strengthen the myelin sheath, and make neurons in the brain move faster. So, we know things about music. We know things about the structure and the cognition of our brains-

19:01  Oh, I have a medical question.

19:01  Sure.

19:01  The myelin sheath is in the brain. People with MS and those myelin sheaths... their things are interrupted. How does music affect that or can it?

19:16  So the question was people like...

19:19  Oh, I'm sorry.

19:20  ... who may have MS, the myelin sheath is actually...

19:26  It's interrupted. It's...

19:27  It's interrupted, yes.

19:28  Yeah.

19:28  Thank you. And so, her question was, "In those situations, what can music do for that?" I'm not a neuroscientist so this is just my best educated guess, but I think like any other deficit in the brain, music finds new neural pathways. They will go around the areas that are damaged because music is activating all of those different parts of the brain, so if there's a blockage, or an issue with one area, it's going to go around. Now, it's not perfect. It's not instantaneous. It's a practice. It's an exercise just like anything else, so my guess is that with someone with MS, it wouldn't heal them. It wouldn't make MS go away, but it may prolong abilities that would decline faster.

20:26  Okay.

20:28  All right.

20:29  Thank you.

20:30  So that question is actually in line with exactly where we're at today. Myself and other people who are interested in this phenomenon where we're at is trying to piece what we know together, what we know about music, what we know about the brain, and how we can use that relationship in order to affect change and make progress. So, let's do music.20:59  I have another.

21:00  Yes, another question. I think we're supposed to technically use the microphone because it's being recorded, so there you go.

21:06  It's actually not a question. It's a comment. I've always heard that music is the universal language, so music is important because we hear it and we all speak it if it's music.

21:26  Absolutely. So, I think that's a great thing to keep in mind is that despite our differences, despite what is going on situationally with us, we all have the connection of enjoying and being able to connect with some aspect of music. Someone may love R and B. Someone may love country. Someone else may love classic rock. Whatever. It doesn't matter because it is all the same at the end of the day despite its differences.

22:05  So one of the things that I wanted to do with you all today is to kind of experience an aspect of active music making and an aspect of passive music making, so you'll see I have a lot of instruments around the room. My favorite part about these instruments is that there is no previous education or experience required in order to be successful with them. They merely require a shake, or a tap, or a beat, or... actually, yours is the only one that might need some explaining. You fold it in half.

22:42  That's what I thought.

22:42  You fold it in half. Well, perfect. It's good. Anyone else have a question about the instrument that's in front of them and how they may make noise with it?

22:53  What is this one?

22:54  That one, the mallet is... you pull the mallet out. All right. Perfect. So, in music therapy, I never make or force anyone to participate, but participation is certainly...

23:11  Encouraged.

23:12  ... encouraged, thank you, because I would love for you to be able to experience both sides and be able to have any thoughts or responses about what that is. So, we're going to do two exercises that you may find if you were joining a drum circle, perhaps. I'm also mindful of the fact that there's a presentation happening in that room, so I'm just going to ask that this drum circle aspect be a little pulled back or just-

23:44  Subdued.

23:45  Yes, subdued. That's a beautiful word for that but that doesn't mean that I don't want you to participate. All right. So, feel free. You have these instruments. I hear a couple of you. Just give your instrument a little whirl. Just get familiar with it. See what happens. Oh, my gosh. That is such a beautiful subdued sound. That's like a perfect volume. Yeah. All right. Good. Okay. We're just going to do a tiny little warmup here. Do I have any percussionists in the room out of curiosity?

24:22  Anyone?

24:22 Any percussionists? Any drummers?

24:24  [crosstalk 00:24:24] drummers.

24:25  Like Kristen.

24:25  Oh, my gosh. This is wonderful because this means that you all will be percussionists after this. This is great. Okay. So, what we're going to do is we're just going to kind of practice playing our instruments together, so it's very simple. Whenever I say the word drum, as in what is in front of me, drum, I want you just to give me one tap or one shake, so it'll just sound like... drum. Yeah, just practice that. Just drum. Good. Okay. So, I'm just going to say a phrase, and again, just play on the word, drum. Are you ready?

25:08  Mm-hmm (affirmative).

25:08  Sure.

25:10  All right. It goes like this. Let's all play the drum. Good. Let's all play the drum. Let's all play the drum. Good. Let's all play the drum. let's all play the drum. Let's all play the drum. Let's all play the drum. Let's all play the drum.

25:19  Play the drum. Play the drum. Play the drum. Play the drum. Play the drum. Play the drum.

25:22  I'll play the drum. I'll play the drum. I'll play the drum. I'll play the drum. I'll play the drum. I'll play the drum. I'll play the drum. Good. Good.

26:30  Try this. Let's all play the drum because it's so much fun. Let's all play the drum because it's so much fun. Good. Let's all play the drum because it's so much fun. Let's all play the drum because it's so much fun. Let's all play the drum because it's so much fun. Good. Let's all play the drum because it's so much fun. Yeah. Excellent. You guys are professionals. Also, I don't really know how well we monitored our sound for next door, but let's just ask for forgiveness later. We're going to do one more drumming exercise here. This one I will ask us, and I'll try to reign it in myself because I get excited. Let's try to be a little bit more quiet. Just medium level on this one because I can see that we might end up getting pretty excited with it. What we're going to do is we're just going to rumble, so what I mean by rumble is we take our instrument, and we just give it a good like... a low rumble. Yeah. Nice, good. Okay. All right.

27:47  So what we're going to do, I'm just going to be the director of the rumble so if you find that you are in alignment with me and my body, you're going to give me a rumble. You might find that you're fading in and out depending on how I'm moving. Just kind of be aware of where I'm at and follow along in that regard. All right. So, we will all start. Let's all rumble. I'm going to rumble over here. Rumble over here. Good. And now we're going to rumble over here. Rumble over here. Good. Back over here. We're going to get a little... maybe a little bit over here. Good. Good and let's all rumble. Rumble. Oh, good. You're following me. I like it. Good.

28:58  And stop. Very nice. That was like the most controlled rumble I've ever experienced. Very nice work. Any thoughts, responses to what it felt like to just drum, just to play for three minutes?

29:42  Fun.

29:45  Fun.

29:46  Exhilarating.

29:46  Exhilarating.

29:48  Stress relief.

29:49  Stress relief. Do any of you mind kind of expanding a little bit more about that word?

29:58  Which word?

29:58  Stress relief, exhilarated, fun.

30:01 It took my mind off other things because it's concentrating on this and follow you.

30:07  Yes, taking your mind off other things because you are fully concentrated on this in the moment. Absolutely. What about exhilarating?

30:16  It's a form of enjoyment. You enjoy doing this and it's fun.

30:21  Yes, enjoyment, fun. Kind of like an aspect of letting go a little bit.

30:26  Curing. Curing.

30:26  Yes, okay. Did anyone hate it? I would be not offended if you were like, "Yes, that was the worst. Please don't make me do that again."

30:38  It was fun.

30:40  No one was at that spot? Okay, you can tell me privately later.30:44  Maybe next door but not us.

30:45  Maybe next door, yeah. Maybe next door. Any other words come to mind just being able to play an instrument for a couple of minutes? Any comments to what it felt like to do this as a group and a group of people that don't necessarily know each other very well?

31:01  Kind of leveled the playing field. We were all on the same level.

31:04  All on the same level. Yes, there's an aspect of when we come together and, we engage in music where everything just kind of goes away. It doesn't really matter who you are. We're just doing this today.

31:21  It's a voluntary participation.

31:23  Voluntary participation. Absolutely. Well, I mean, you all were welcome to not participate but I kind of didn't really give you a choice, but you did beautifully. Very nice. So, going back to this idea of music, music being very complex, a phenomenon that is multi layers and can kind of lead us astray when we really start to think about all the aspects of it, but now let's kind of focus on these feelings. When we engage in music, what are we assisting with? What kinds of needs, therapeutic areas can we address by engaging in music?

There's anxiety. We can decrease our anxiety. We are focused on something other than our anxiety. It addresses fear, especially if you have a fear of working with a group, of you being in a group of people and then suddenly, we all even out the playing field. It improves our mood. I could go on and on about the research that shows how our mood is affected with music. Long story short, it helps it make it better. It also can address pain. When we're experiencing pain, there's only so much that we can think about, and pain is at the forefront, but what we know about music in that it's processed in all of these areas of the brain is that music can overcome these feelings of pain.

33:04  It doesn't necessarily make it go away, but it may relieve it for a period of time, and that can be a very big deal depending on your level of pain. It affects our energy. It affects our physiology. If we're very stressed, and we come, and we beat a drum for five minutes, suddenly our heart rate, our respiratory rate, those have gone down. Our oxygen saturation has gone up. We've taken a deep breath. Suddenly our physiology has totally changed. It addresses isolation. It can decrease our isolation by being with a group of people engaged in music.

Grief and loss. We're not doing music at this moment that incorporates words but so much of music does incorporate words. Self-esteem, having a self-empowerment, doing something you never thought you could do before, and yet, you did it anyway. Increases coping and connectedness. It normalizes the environment. Suddenly, we're doing something that is not medical, and this is a little bit more normal. Stress. It also affects our memory, any agitation or discomfort that we have. It improves our cognition because we're exercising our brain in such a big capacity. Can also address burnout and overall resiliency, mostly from all of those other aspects, and then also, it can help give us hope.

34:41  So let's try something a little bit different here. We're going to set our... well, you will set your instruments aside. I will get another instrument out here, and I want to walk you through, this time a more passive music experience. What this will require is just your listening skills. So, I want to walk you through a short but hopefully helpful bit of music-assisted relaxation and a little bit of guided imagery.

Has anyone done guided imagery before? All right. So, what I'm going to ask is that you all find the most comfortable position that you can in your current seats. I'm sorry I don't have a couch to lay down for you, but we will try to do our best getting in these chairs in a comfortable position. So, I'm going to provide a little bit of music, a little bit of words. Going to just walk you through this and all you have to do is listen. If you are comfortable, I recommend that you close your eyes, but if you'd rather just look down at the floor, at the top of the table, what that will do is help you to stay focused.

36:19  So the first thing we want to do is take in a deep breath. Let it out. Keep breathing at a pace that feels comfortable for you. Don't force anything. Just meet yourself wherever you're at today and if you find yourself wandering, just bring your attention back to your breath. It's always the place where we can re-center ourselves. We are going to send loving kindness to somebody else, to ourselves, and to all of us collectively. Focus on somebody that you are grateful for. I'll give some statements and repeat these statements in your mind. Focus on this person. May you be happy. May you be peaceful. May you be healthy. May you live with ease. (singing)

38:57  Now place your hands on your chest. We will repeat these statements to ourselves. May I be happy. May I be peaceful. May I be healthy. May I live with ease. (singing) Release your hands and keep your palms out. Focus on all of us collectively as a group. Focus on your community extending out to world. May we all be happy. May we all be peaceful. May we all be healthy. May we all live with ease. (singing) Knowing that you've taken a moment just for yourself today, begin to bring yourself and your attention back to the present, but know that this place is a place that you can reach at any time with closing your eyes. Take in another deep breath and only when you're ready, begin to bring yourself back to this room with opening your eyes at the very end.

43:25  Thoughts, responses, feelings to that experience?

43:32  Very peaceful.

43:33  Peaceful.

43:39  Floating in thin air.

43:41  Floating in thin air. I love that.

43:45  Happy.

43:46  Happy. Any feelings of sadness?

43:53  Happy.

43:58  I saw a couple heads nodding.

44:00  I think it's just another tool in my toolbox towards self-healing.

44:07  Why?

44:09  Because I'm at that place where I'm loving myself.

44:16  It's much easier for us to help somebody else than to help ourselves, and to take that time. How many minutes did we spend doing that specific exercise?

44:32  Four?

44:32 Yeah, five.

44:34  Five?

44:34  Five, mm-hmm (affirmative). Yeah.

44:37  You lose track of time being engrossed in the music.

44:40  Yes, losing track of time being engrossed in the music.

44:46  It takes you through different moods, and very peaceful, and calming.

44:57  I was distracted by the words.

45:00  Yes.

45:00  I mean when you were singing, yeah but [inaudible 00:45:04].

45:03  Why?

45:05  Because I'm used to... I'm pretty comfortable with and familiar with those phrases, and I'm used to either having no music or instrumental music, so then when there were words, I was like, "Oh, I'm supposed to be thinking about what these words are and it was too much stimulus for me."

45:26  And I think that's... you bring up such an important aspect that for each of us, our experience is individualized. For some... I'm actually right there with you. That would be way too many words for me as well. So, for some of us, knowing that about ourselves can help us create that tool so that it is more personalized, and individual, and assists us with reaching that goal that we want to. For others, having that many words are maybe what helped you get to that state of being. Absolutely.

46:03  On the contrary, I found the words very appropriate and comforting.

46:10  So the words were helpful in some regards.

46:13  I did too, and it was even more calming listening to your lovely voice, and it was very peaceful, and happy feeling to-

46:25  I'm glad to hear that that was helpful for you.

46:27  Yes.

46:28  Yes. That brings up another aspect to that. For so many of us, when we don't sit down and really understand our own relationship to music, we may find that the music that we choose is, perhaps, more harmful than helpful depending on the lyrics, depending on if whether there are lyrics or there aren't lyrics.

Some people are very uncomfortable with instrumental music because it gives you too much space and time to think. Not everyone is comfortable with that. For others, sometimes we don't realize that the music that we are listening to has lyrics that maybe are not helping us, but, are instead perpetuating a feeling. So that intentionality and that purposefulness behind the music itself that we choose and that to engage with can really make or break whether or not it is helpful, so thank you for bringing that point up. Yes.

47:42  I used to like loud music and stuff like that but, [inaudible 00:47:46] I prefer a softer version now, I happen to love country western, and although there's a lot of sad things that go on in there, it's not jarring and I don't like music that jars my nerves, and all of a sudden, you hear a sound. I like it and I don't listen that much to symphony. I should or would love to be more interested in listening to it, but I find... I keep country in my truck all the time, and that is relaxing to me. If I shut it off, I hear all these other sounds and have too much time to think, but with that on, it's just, to me, that's very relaxing.

48:32  Absolutely, and that is another wonderful point in that how we connect with music certainly changes over time, certainly can change with our different life experiences. I also definitely want you all to feel empowered that whatever music works for you is the most beneficial. If you think that hard rock is the most relaxing music on the planet, by all means, utilize hard rock. Don't feel like you need to be sitting listening to Mozart because that's what's relaxing. Whatever music is the music that you enjoy the most is always going to be the most helpful for you.

49:19  Another thing was I was in the group yesterday where you sat around in a circle and talked about the type of cancer and stuff you had, and pros and cons about things that were affecting you, and then the facilitator asked what was our favorite song, and I, of course, raised my hand because I happen to love Garth Brooks and Ask Me How I Know, and so nobody in the circle had heard that one, so I found it on YouTube and I played it for them, and I don't know what my demeanor was when I was originally sitting in the circle, but they said, "Boy, you should listen to more music," because I was going with the music...

50:08  Totally changed for you.

50:09  ... and it just automatically changed who I was and they all noticed it and commented, so that's why I came here today because it wasn't on my list originally but-

50:22  Well, thank you for being here. Thank you for sharing. I saw you had your hand up. You want to pass the mic back.

50:29  Just that it's interesting because I've been listening to a lot of cello music, and not just Yo-Yo Ma, but there are two brothers from one of the Middle East countries that are fantastic, but then I listened to Andrew Bocelli and I'm in another mood, and then my granddaughter walks in, and put on Havana, and she's shaking her booty, and I'm like, "Okay, I'm with you now," and so whatever's happening, I found over the years that all of a sudden, I'm listening to just about everything that comes in except that hard rock. I'm sorry. I can't deal with that.

51:06  Well, we're also not here to judge one another for their...

51:09  No metal.

51:10  ... music preferences. Absolutely.

51:13  I can't do that.

51:13  No, I'd love something that I could understand.

51:15  Sure.

51:17  I'm with you. No hard rock.

51:22  All right. Well, we certainly will have time for a couple more questions here but just some last takeaway thoughts, perhaps as we move forward out to the rest... our normal lives after today. I wrote down some coping tools that will not be a surprise of you. That's kind of the purpose. I want to just remind you of the things that work for you, the things that you've already had some kind of interest in, and my challenge to you is just to bring that intentionality back into whatever works for you, so ways that music can be helpful to us just by listening.

Creating a purposeful playlist. This is the selection of music that I want to listen to when I'm feeling this way. Discussing music with other people. Engage in those conversations. Maybe they will give you some thoughts, ideas that you had not considered before or new artists that you've never heard of. I cannot stress this enough. Sing, hum, and whistle. You don't have to do it in front of anybody. I won't make you, but the amazing thing about doing that is that when we sing, hum, or whistle, it forces us to breathe, and breathing makes a world of a difference.

53:02  Practice even breathing exercises to music, even as simple as what we just did today by reminding ourselves to take a deep breath, or, look into actual breathing exercises that you can do. There are so many apps for guided imagery. Look into them. See if any of them work for you. See if any of them are something that you can connect to.

Never too late. Learn an instrument or maybe relearn an instrument. You don't have to take lessons. There's a lot of resources out there for you. You don't have to perform for anybody. Do it just for the sake of yourself and finding something new that you can enjoy. Write song lyrics. You don't have to share them with anyone. You don't have to try to win a Grammy.

53:50  Perhaps, just put down to paper, or on your tablet, or whatever, things that you're feeling, things that you would express, how it would sound if you were to put it into a song. Join a community choir. If that's something that's interested you or it's something you've done in the past, maybe revisit that. That is another very intentional thing. We have to show up for practice. You have to force yourself to breathe and you have to engage with other people, or perhaps, you just want to attend concerts. Experience that live music. That can range, if you prefer, the symphony to, I think Slayer is coming into town next week, so if you want to go to that, by all means, go to that.

54:35  Participate in a drum circle. When you start looking for them, they are everywhere. I promise you. Challenge yourself to discover new music. Maybe look up styles, artists that you've never heard before. See if anything is another connection for you. Lastly, be intentional. When we're intentional with our music, we create coping skills, which allow us to reclaim something that, perhaps, has been lost or just hidden, and that builds our resiliency, and that ultimately leads us to recovery. Any final questions?

55:17  Thank you.

55:20  My pleasure. I'll be around if anybody else wants to ask me some more personal questions. Thank you.