Here is a little rap to remember, FAST

FAST FAST, I’ve got to think fast when my respect is on the line.
I’ve mastered the DEARMAN, but now I need more.
And if I don’t think FAST, they’ll walk out the door.

Fair is the way that I will treat them.
I’ll give no Apologies, or it might get grim.
I’ll stick to my Values, to my own self be true.
Being Truthful and honest will see me through.

FAST FAST, I’ve got to think fast when my respect is on the line.
I’ve mastered the DEARMAN, but now I need more.
And if I don’t think FAST, they’ll walk out the door.

by Rachel Williams MT-BC

Song for STOP skill

by Heidi Lowell MT-BC

Supplies:
Lyric sheets for song
Distress tolerance hand outs 3&4
Guitar
Recoded music
Egg shakers

Intervention:

1. Set room up in circle.

2. Distribute handout 3 and briefly discuss crisis situation and the negative coping that many often engage in. Explain that there are crisis survival skills to help manage short term pain and get through these crisis without using harmful behaviors.

Explain there are a few tools but today we will learn the STOP skill.

3. Then therapist hands out lyric sheets and sings this song
Set to the tune of You Gotta Be by Des’ree

STOP

Verse
Things may often upset you,
Pain can be hard to see through,
Strong emotions Make you want to end the pain.

Bad habits appeal to you,
But they won’t fix it for you,
Just remember that there is a skill to use.

You gotta stop,
Chorus
you gotta stop, to slow your mind,
Take a step back,
You gotta observe, to help your choice
And not jump to conclusions,
Then use wise mind to stay calm and
Proceed mindfully
All I know, all I know can fix my pain.

Repeat chorus

4. After completing song, distribute handout 4 and explain each part (stop, take a step back, observe, proceed mindfully).

5. Then to practice stop and take a step back give group egg shakers and have them shake along with recorded music and periodically stop it and have them physically take a step back and breath each time it stops. Have group discuss difficulties or ease of stopping and how the stepping back helped.

6. For observe have discussion about what to observe ( thoughts, urges, emotions, body sensations, surroundings, environment, other person) and how stopping and stepping back aid in calming emotions so the observation can be helpful at determining options.

7. Proceed mindfully, again explain concept and questions to ask one self and reiterate importance of wise mind and provide a role play example for the group.

8. Then replay STOP song encouraging group to sing to help strengthen retention.

9. Give assignment of identifying 2 times they used the STOP skill before the next session (assuming one week in between).

Walking the Middle Path Experienced through Music

Submitted by Charlay Yates MT-BC

“When you think in extremes, you often don’t get an accurate view of the world, which complicates decision-making. Finding the middle path will help you manage those wonderfully intense emotions and also not allow them to impair you in making effective decisions and choices.  Why is it effective to find the middle path in your thinking and behavior?”

And how do we find that middle path?

Have some percussion instruments or drums available for your group.

Each patient is then given a card with an “extreme” style of playing on it (fast, slow, loud, soft, complex, simple, steady, unsteady).

One patient will play something on their drum and the person with the other end of the extreme will respond. This way the patient must practice listening.

Patient will identify how they were able identify that they were the other extreme.

Each pair of patients will then complete an improvisation where they combine their two extremes to find the middle path.

Patients will discuss that process. Patients will also discuss the experience of shifting from extremes to the “middle path.”

For more about DBT informed Music Therapy visit dbtmusic.com

Tone Chimes for Reinforcing DBT Mindfulness

Submitted by Lindsey Landeck MT-BC

Use tone chimes in a pentatonic scale. (Use these  5 notes from a scale: 12456)  Have group members sit in a circle.  Give each person one of those 5 notes.   Each person has one tone chime.

Give the following instructions:  Each person will play their tone chime one time.  But they have to wait for the sound from the previous person’s tone chime to complete before they play.  Go around the circle playing one at a time, with each person waiting til the sound stops before beginning their turn.

 

They have to observe the sound and fight impulse to play before its time.

 

Next-

After talking about the DBT what and how skills use the same setup with these instructions:

“You can play at any time, whenever you feel your tone chime would sound good with everyone else.  The one thing I ask you not to do is to play your chime repeatedly like you’re calling someone home for dinner. Its not pleasing to the ear.  Other than that there are not any rules.”

Questions to ask after playing:

What did you hear?  This gives them a chance to describe things non-judgmentally.

Did you have any body responses to that?

 

What did you notice about your breathing?

Is there anything else you noticed?  (Sometimes you might get a response about noticing a pattern, where someone played after someone else)

Focus on describing it in a non-judgmental manner. Talk about how they observed, described, and participated in the exercise and did so one-mindfully.  Ask if anyone found themselves distracted and brought themselves back to the activity.

Thank you Lindsey.  These interventions support all of the mindfulness skills.

This one of the many interventions you’ll learn when you take the CMTE online class called DBT: Practical Life Skills Reinforced through Music Therapy.  

 

For more about DBT informed Music Therapy visit dbtmusic.com

 

 

 

 

Thoughts (and Urges) Come and Go- Mindfulness

This was submitted by Wan-Fang Hung

At the beginning of experiencing mindfulness, Therapist will give a short verbal instruction of the processes that will include: Taking a Breath, Notice Surrounding, Body Check, Label and Rate Emotion, Notice Thoughts, Notice Urges.

In order to make a space calm and comfortable, Therapist. will lead an experience of 10 times of “Humming”. Therapist will use “Singing Bowl” to indicate  each start time of “Humming”. Client will be asked to sit on the floor with a comfortable posture and close their eyes. Furthermore, Client will be able to focus on his/her breath through the “Humming” experience.

Taking a Breath

After experiencing “Humming”, Client will lie on the floor with both hands on the belly and closing eyes. Therapist will play the music “Kissing the Rain” by Yiruma while processing the breath experience. This music provides clear structure and music phrase. Therapist will use verbal instructions to guide the “Taking a Breath” (Breath in and out) with the music phrase. Client will learn the knowledge of “the air come and go” through feeling the expansions of belly. Therapist will take a moment of silence after the music ends.

Notice Surrounding

For the awaking, Therapist will play the music “Bolero” by M. Ravel. Therapist will also give a verbal instruction of physical stretches as the following steps: (a) feel the ground, (b) feel and move fingers/toes, (c) wave writs/ankles, (d) wave whole arms and legs, (e) feel shoulders, (f) turn heads, and (g) open eyes. Therapist will inform Clients to feel free to stand up, walk around and do a free stretch. Clients will also be encouraged to notice the environment (walls, doors, colors, decorations) and to interact with each other till the end of music. After the notice environment, Therapist will ask Clients to be seated and take a moment of calm and break before starting the “Body Check”.

Body Check

Therapist will lead a physical stretch with the music “Serenade to Spring” by Secret Garden. The clear music phrase and structure makes it easy for the Client to follow the instructions. Therapist will ask Client to notice the tensions of body parts, such as headaches, shoulder tension, and/or any painful feelings.

Lable and Rate Emotion

Therapist will then have Client label and rate his/her emotion on a scale of 1-5.

Notice Thoughts

Therapist will provide the “Singing Bowls” in the center of the room. Client will be encouraged to play the Singing Bowls when he/she notice his/her thoughts and feelings. The sounds of Singing Bowls will be clinch-ring-surround-decrease-disappear. It is like our thoughts: come (clinch) – stay (ring) – overwhelm (surround) – fly away (decrease) – forget/relief/let it go (disappear). Therapist will inform Client that it is the same that “thoughts/ feelings and sounds will all come and go”.

Notice Urges

Therapist will provide Client drum(s) and ask client to tap the drum while he/she notice(s) urges comes to his or her awareness. Therapist will inform Client that the urges, just as the sounds of the drum, will come (tap) and go (sounds decrease and disappear). Client will be asked to repeat experiencing till he/she gains the idea of “Urges come and go”.

Thank you Wan-Fang Hung.  I enjoyed this very much!- Deborah Spiegel MT-BC

For more about DBT informed Music Therapy visit dbtmusic.com

DBT Mindfulness- Getting a Clear Picture using Music Therapy

Tags

dbt, dbt mindfulness, dbt music, dbt music mindfulness, Dialectical Behavior Therapy, mindfulness, mindfulness exercises, music therapy, music therapy interventions

submitted by Alexandra Bricklin MT-BC

(created while studying the Skills System Instructor’s Guide by Julie Brown)

Step 1: Notice Breath: Use an accordion to exaggerate fast uncontrolled breathing moving to slow controlled breathing.

Step 2: Notice surroundings – Teach adapted version of Elvis Presley’s “ Stop Look and Listen” to affirm the process of remembering to check in with the “here and now”

“Stop Look And Listen” by Elvis Presley (1956)

When I was a little bitty boy

Sittin’ on my papa’s knee

I still remember every word my papa said to me

Now boy if you ever meet A pretty woman walking down the street… (

check it out on Youtube)

You’d better Stop real still, look both ways Listen or you’ll get in trouble

Adapted for DBT by Alexandra Bricklin (2013)

(D)When I’m about to lose control

(D) I will choose to remember my goal

(G) to take a breath and look around

(G) and to then listen to the sound

(C) So when I’m mad or when I’m sad,

(C) or when want to run real bad I should

(F) Stop real still, look both ways Listen or I’ll get in trouble!!!!!

Step 3: Body Check Teach the Macarena. A good clean youtube source is

Step 4: Label and Rate Emotions Use a familiar sound for each level

Examples: Level 1: purring kitten;

Level 2: Baby Laughing

Level 3: Ocean Waves

Level 4, Train whistle

Level 5, race-car engine

 Level 6 explosion-  Have group members create their own

. Step 5: Notice Thoughts

Play the first 30 seconds of a variety of songs familiar to group members. Ask participant what they think when they hear the song.

Step 6: Notice Urges Set up a series of frustrating experiences such as intentionally speak too soft to be heard clearly, or play the music too loud or stand in front of the group and do nothing for an unusual period of time. After each encounter, ask participant to share their urges.

For more about DBT informed Music Therapy visit dbtmusic.com

Life as a Song- Personal Melodies and Collective Rhythms (Video) -Mindfulness through Music Therapy

by Ami Kunimura, MT-BC

Music as a metaphor for life is a common thread in my work as a music therapist. Though I implement this practice with my clients to nurture their growth, I recently had the opportunity to cultivate this concept outside of the clinical setting. This past September, I was invited to lead a 2-hour music therapy experience for a group of psychiatrists.

The Southern California Psychiatric Society has a committee called the Art of Psychiatric Medicine. This committee aims to support the artistic nature of psychiatry, and hosts events with guest artists to promote creativity and community among clinicians. I discussed with Dr. Michelle Furuta, the event’s organizer, how music therapy could support this purpose. We conceptualized a project titled, “Life as A Song: Personal Melodies and Collective Rhythms.”

On a Sunday afternoon, the group gathered to share a creative music experience. The psychiatrists in attendance brought a wide range of clinical experience, knowledge, and musical interests. I felt inspired and honored to be in the presence of these dedicated medical doctors who were taking valuable time for their personal growth, connection, and artistic exploration.

My goal for the day was to use music as a lens to enhance self-reflection and as a bond to enrich positive social connections. We used music as a metaphor to explore individual traits and roles, and to celebrate the collective rhythms present in the group. We spent time with music on a personal level. Then, we created music together.

This seven-minute video captures the essence of our 2-hour session and the product of our creative efforts. Below the video is a brief explanation of the session and process (a full step-by-step guide for the interventions are available in my e-book, The Harmony Handbook, Vol. 1).

Prior to the songwriting experience captured in the video, the session opened by first exploring the elements of music in relation to the self and others. We looked at how our individual lives can be described in musical terms…our voices as melodies, the tempos at which we move, the dynamics we emanate and prefer, the harmonies that exist within and around us, and the rhythms in our everyday lives. These elements exist in unique combinations for all of us. Our group also explored how these elements differed in personal and professional roles.

With this musical language in place, we moved into improvisation, creating music spontaneously. The freedom of expression that improvisation brings allows for a non-verbal social connection and making music for enjoyment, with openness, cooperation, and fluidity. Here, the elements of music exist in pure form, and this allowed the group a break from words before getting into songwriting.

I chose the song “Times Like These” to facilitate a songwriting experience because of its universal themes, adaptability, and form. This song is structured so well for the encouragement of songwriting to describe oneself and reflect on the present moment. Originally written and performed by the band Foo Fighters, this song is also versatile and can be played as a rock or folk song, and I have even seen adolescents turn this song into hip-hop. Our group played the original version together to get a feel for the melody and rhythm, and then each person was encouraged to write his or her own lyrics to the song.

With these new lyrics, we collectively created a group song that represented each individual and the group as a whole. As seen in the video, each person chose a part of a verse they wrote, and together we wrote a group chorus. With this, we created our own version of the song that allowed each person’s voice to be heard, and for the group to unify. Their song flowed with honesty, vision, and courage, and the support and cohesiveness of the process was powerful to witness and share.

I admired each person’s willingness to reveal their creative side, as the nature of music requires a certain level of audacity, especially in the presence of peers or colleagues. This was also out of my comfort zone, and allowed growth for me as a clinician. Though I have worked with thousands of psychiatric patients over the years, to work with their doctors was new for me. In the end, I was left with a strong sense of gratitude and validation that music therapy may not only be recognized in psychiatry, but that there are clinicians also willing to take a step in.

This day was a compelling reminder that music is not only therapeutic and beneficial for those we as practitioners define as clients. For all of us, practitioners included, music is a catalyst that awakens an awareness of who we are and why we do what we do. Music connects us to each other and to ourselves.

_______________

Special thanks to the Southern California Psychiatric Society‘s Art of Psychiatric Medicine Committee, Dr. Michelle Furuta, Mindi Thelan, all of the participants, and videographer Tim Thelan.

Relationship Care Lesson through Music Therapy

 

 submitted by Stephan Baker MT-BC studying the book by Julie Brown

Mindfulness and Self Awareness

The therapist begins the group with a mindfulness/breathing exercise in order to create an environment of self-exploration. During the exercise the therapist may choose to play soothing music.

“We are going to begin by fostering our self-awareness.  Each one of us will have an opportunity to use “droning” as a way of connecting with ourselves and others.”

The therapist then demonstrates droning to the group, singing and holding one note for as long as possible.  The group then takes turns droning solo.  Any member who does not feel comfortable may be excused. They may be invited to participate later.  The therapist stresses the importance for each member to hold each note as long as they can, and if possible, to focus on steadiness, not allowing the note to waver.  The therapist may wish to aid a member who is having trouble simply by droning a steady note as a reference.

At the completion of the droning, the therapist opens a discussion

Self-awareness- While you are droning, concentrate on your breath and the sound you are making.  How does the sound feel coming out of your mouth or nose?  What presents itself to your awareness? How does droning make you more aware of yourself in the moment?

Self-acceptance- Did you feel as though you did a good job?  Are you comfortable with how you sound?  Were you worried about what others thought of you?

Self-trust- Did you feel as though you could do it successfully?  Were there any doubts?  If so, what might have worked to remove them?

Building relationships with others- Do you think this exercise helped your relationships with each other?  How did it help strengthen your relationships?  How may it have hindered your relationships?

Balancing Relationships with Others:

The therapist asks two group members to work together.  One member begins droning, and the other member joins in, attempting to match exactly the note of his/her partner.  The activity continues until all have had a turn droning with a partner. The therapist might stress: “Remember to try and match the note of the other person.  This requires listening to your partner, and making changes in your own note to accommodate him/her.

 

The therapist then urges discussion

Types of relationships- “What are our relationships in this group?  Did droning with a partner change the way you feel about your relationship with your partner?  Is it possible we may think our relationship with a person in our lives is different than the way they see it?”

Relationship behaviors- “What are some things we can do in our relationships to make them better? What have we been doing that has been hurting our relationships?”

Reciprocity- “While we were droning, did you sense a give and take relationship?  Was it easy to listen to the other person, or were we entirely focused upon ourselves?  Do you feel as though your partner was listening to you?  Can we think of a relationship in our own life that could benefit from two-way street thinking?”

Repairing or Ending Relationships:

The therapist then asks a member who is capable of droning a steady note to begin droning.  The therapist begins droning a dissonant note, and then begins a short discussion:  “How did my not sound with Charlene’s note?”  If those two notes represented a relationship, would you say it was on-track or off-track? We would agree that in order for the relationship between our notes to work, something needs to change in order to bring it on-track.  Let’s try again.  Charlene, could you drone your note again?” The therapist then drones in pitch with the group member. A discussion follows which centers on:

Repairing relationships-“By changing my note, and being flexible, the relationship improved.”

Finding middle ground- “If I couldn’t hit Charlene’s note because it was out of my range I might ask her to sing a lower note, within my range, in order to match her.”

Steps of responsibility- “I realized that I was the one who needed to change in order to hit her note.

Ending relationships with others- “If I were unwilling to change my note, and find common ground with Charlene, or if I was screaming my note, not listening to her, she has every right to end the relationship. Are there any relationships in our own lives that we should take a good long look at in order to assess if it is doing us more harm than good?”

For more about DBT informed Music Therapy visit dbtmusic.com

Songs That Can Be Used to Reinforce DBT Skills

This list of Songs was compiled by Emily Spears, MSCP TLLP with suggestions from many DBT Therapists.  The following list contains the name of the song,  DBT skills reinforced, and the YouTube link so you can listen.

There are many ways to use songs to reinforce DBT skills.  

How do you use them?

Brave by Sarah Bareilles – Interpersonal Effectiveness

Breathe In, Breathe Out, Move On by Jimmy Buffett – mindfulness, distress tolerance

“Closer to Fine” by the Indigo Girls. The lyrics are very powerful and seem to express dialectical thinking and walking the middle path.

Counting Stars by One Republic – Mindfulness, dialectics in the lyrics

Downtown by Petula Clark – Distract (with Activities)

Everybody Hurts by REM

Radical acceptance

Happy by Pharrell Williams – Creating opposite emotion

I Whistle a Happy Tune (from The King and I) – Opposite-to-Emotion Action

I Must Belong Somewhere by Bright Eyes – Radical Acceptance

Learn to Live by Darius Rucker – Great song to support/encourage practice of nonjudgmental and self-compassion.

Let It Go from Frozen – Can be a theme song when you focus on emotions. Also about emotional avoidance.

Living in the Moment by Jason Mraz – Mindfulness

My Favorite Things (from The Sound of Music) – Improve the Moment (with Imagery)

On and on it goes by Mary Chapin Carpenter – Dialectical thinking, self-compassion, radical acceptance of the world as it is, good and bad

Shake it Off by Taylor Swift – Radical Acceptance

Tubthumping by Chumbawumba

“I get knocked down, But I get up again, You’re never going to keep me down”. Persistence is important, take those setbacks into your stride.

Wake me up by Avicii –  distress tolerance

Watching The Wheels by John Lennon – Mindfulness

What Do you Hear in these Sounds by Dar Williams

Hope – May be useful in teaching validation part of Dear Man Gives as in the line “But oh how I loved everybody else when I finally got to talk so much about myself.”

ounds

 

For more about DBT informed Music Therapy visit dbtmusic.com

How will the band solve the problem?

submitted by Christina Grandoni-Barlow

Mindfulness Activity (for group)

Noticing subtle versus not-so-subtle tempo changes.

Have clients choose instruments (one drum, one rhythm, one melodic etc.) as if they are forming a ‘band’. Explain that you are going to play a tempo for them to follow (on either a tone bell, triangle, or other instrument with a distinctive sound.) It may help to have a metronome track in some headphones so you can be sure to change tempos accurately and smoothly, and to include both subtle and obvious changes) Have the clients follow you as you play, they have to REALLY listen for this one and can’t play too loud. Remind them that listening for subtle changes in tempo and responding is much like noticing subtle changes in your mood or how you feel, and responding appropriately if you need to.

Group Problem Solving-

For this activity, have the group reassemble as the ‘band’ they made at the beginning of the session. Then, take one of the instruments away. Explain that the band needs to play on despite the missing instrument, how can the group solve the problem of the missing instrument in a way that is best for ALL the band members? Will someone decide to sing instead of playing and instrument? Are there any instruments that can be shared or played in a different way so that more than one person can use them? Go over multiple options and talk about the positives and negatives of each. Present a scenario (such as telling one band member to sit out during some songs) that may not be in the best interest of EVERYONE involved and discuss why this may not be the best solution.

(Optional: come up with a positive band name related to problem solving; i.e ‘the solution sisters’ or ‘the problem pulverizors’)

Relate this to the process of solving problems in life. Explain that all factors (represented by the band members here) need to be considered when making a problem-solving plan. Explain that you need to come up with more than one solution and think through them to figure out which is best, just as you have done with the band/instrument problem.

End the session with a fun ‘jam’ to a song the group likes, or an improvisation if the group is more advanced.

For more about DBT informed Music Therapy visit dbtmusic.com