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   <front>
      <journal-meta>
         <journal-id journal-id-type="DOAJ">15041611</journal-id>
         <journal-title-group>
            <journal-title>Voices: A World Forum for Music Therapy</journal-title>
         </journal-title-group>
         <issn>1504-1611</issn>
         <publisher>
            <publisher-name>GAMUT - Grieg Academy Music Therapy Research Centre (NORCE &amp;
               University of Bergen)</publisher-name>
         </publisher>
      </journal-meta>
      <article-meta>
         <article-id pub-id-type="doi">10.15845/voices.v21i2.3044</article-id>
         <article-categories>
            <subj-group subj-group-type="heading">
               <subject>Interview</subject>
            </subj-group>
         </article-categories>
         <title-group>
            <article-title>An Interview with Dr. Dag Körlin</article-title>
            <subtitle>Discussing Music Breathing</subtitle>
         </title-group>
         <contrib-group>
            <contrib contrib-type="author">
               <name>
                  <surname>Shum</surname>
                  <given-names>Wei Wah Angela</given-names>
               </name>
               <xref ref-type="aff" rid="W_Shum"/>
               <address>
                  <email>abundantwellness2018@gmail.com</email>
               </address>
            </contrib>
         </contrib-group>
         <aff id="W_Shum"><label>1</label>Abundant Wellness Co. Ltd, Hong Kong</aff>
         <contrib-group>
            <contrib contrib-type="editor">
               <name>
                  <surname>Kim</surname>
                  <given-names>Seung-A</given-names>
               </name>
            </contrib>
         </contrib-group>
         <aff id="S_Kim"/>
         <contrib-group>
            <contrib contrib-type="reviewer">
               <name>
                  <surname>Honig</surname>
                  <given-names>Tim</given-names>
               </name>
            </contrib>
            <contrib contrib-type="reviewer">
               <name>
                  <surname>Woodward</surname>
                  <given-names>Alpha</given-names>
               </name>
            </contrib>
         </contrib-group>
         <pub-date pub-type="pub">
            <day>1</day>
            <month>7</month>
            <year>2021</year>
         </pub-date>
         <volume>21</volume>
         <issue>2</issue>
         <history>
            <date date-type="received">
               <day>24</day>
               <month>3</month>
               <year>2020</year>
            </date>
            <date date-type="accepted">
               <day>20</day>
               <month>5</month>
               <year>2021</year>
            </date>
         </history>
         <permissions>
            <copyright-statement>Copyright: 2021 The Author(s)</copyright-statement>
            <copyright-year>2021</copyright-year>
            <license license-type="open-access"
               xlink:href="http://creativecommons.org/licenses/by/4.0/">
               <license-p>This is an open-access article distributed under the terms of the
                     <uri>http://creativecommons.org/licenses/by/4.0/</uri>, which permits
                  unrestricted use, distribution, and reproduction in any medium, provided the
                  original work is properly cited.</license-p>
            </license>
         </permissions>
         <self-uri xlink:href="https://voices.no/index.php/voices/article/view/3044"
            >https://voices.no/index.php/voices/article/view/3044</self-uri>
         <abstract>
            <p>For many years, Dr. Körlin, a well-known practitioner and primary trainer of Guided
               Imagery and Music (GIM) has been developing the practice of Music Breathing (MB) as
               an adaptation of GIM. A semi-structured interview was conducted in English to deepen
               the learning experience from the MB training with him. The first part of Dr. Körlin’s
               comprehensive training program for MB was started in 2019, and since then more and
               more GIM therapists have been encouraged to practice MB clinically. A brief
               description of stages in MB, rationales behind this development and other innovators
               in adapting GIM techniques specific for psychiatric population are reviewed.
               Following the content of the interview transcript, the author will identify key
               merits of this technique and provide a web link to a short video clip for the purpose
               of promoting MB to clinicians and the general public. In conclusion, MB is a useful
               asset for music therapists.</p>
         </abstract>
         <kwd-group kwd-group-type="author-generated">
            <kwd>Music breathing</kwd>
            <kwd>Dr. Dag Körlin</kwd>
            <kwd>interview</kwd>
         </kwd-group>
      </article-meta>
   </front>
   <body>
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Introduction</title>
         <p>It is not unusual for people worldwide to be exposed to trauma. According to the World
            Mental Health surveys conducted by <xref ref-type="bibr" rid="KAGABBCDDGDFF2017">Kessler
               et al. (2017)</xref>, 70% of the 68,894 respondents in 24 countries had experienced
            some form of lifetime trauma. Therapists trained in Guided Imagery and Music (GIM) are
            therefore advised to equip themselves with additional skills to assist clients with
            traumatic experiences. </p>
         <p>With his background in medical and psychiatric training, Dr. Körlin combines breathing
            practice with music listening as a safe approach for his clients who have difficulty
            receiving GIM or Music Imagery (MI). This Music Breathing (MB) approach builds on
            clinical experiences and insights, and a holistic knowledge base (<xref ref-type="bibr"
               rid="K2019b">Körlin, 2019b</xref>). His contribution is recognized as showing how GIM
            can be applied in psychiatric settings (<xref ref-type="bibr" rid="A2019">Abbott,
               2019</xref>; <xref ref-type="bibr" rid="AH2019">Ahonen, 2019</xref>; <xref
               ref-type="bibr" rid="B2019">Beck, 2019</xref>; <xref ref-type="bibr" rid="M2012"
               >Maack, 2012</xref>). Dr. Körlin (<xref ref-type="bibr" rid="K2019a">2019a</xref>)
            has also written a chapter on neuropsychological theory of traumatic imagery, and is an
            expert in this field. </p>
         <p>According to Dr. Körlin (<xref ref-type="bibr" rid="K2019b">2019b</xref>), the aim of MB
            is to modulate arousal evoked by music listening in a non-ordinary state of
            consciousness. Clients with stress and trauma issues often have a limited Window of
            Tolerance (WoT) for musical elements that evoke memories of overwhelming events. If the
            WoT is exceeded, hyperarousal and swings between hyperarousal and hypoarousal may
            result. In such states, it is difficult to hold and process thoughts, emotions, and
            images. Breathing can be used to modulate the effect of music on arousal. MB involves
            first learning the meditative skills of Silent Breathing (SB) and then integrating these
            with music listening in a meditative state. MB requires the client to imagine a
            breathing volume from a small breathing center to a large breathing volume with
            adjustments and modulations in between. The small breathing center is the “geometric”
            focus of the meditative breathing volume, and is situated in the middle of the stomach,
            a few fingers below the navel (see Appendix, Figure 2). To select music, two variables
            are important: Level of Activation (A) and degree of Modulation (M). A/Ms have degrees
            ranging from 1–6 (see Appendix, Table 1). Low As support a low activation state with a
            small, centered breathing volume, which is the breathing center. An important part of SB
            and MB sessions is the painting of a breathing mandala, where the client depicts a body
            image of the imagined breathing volume and its breathing center.</p>
         <p>In fact, in Dr. Körlin’s training manual (<xref ref-type="bibr" rid="K2020"
            >2020</xref>), an overview of stages of MB is as follows: </p>
         <list list-type="ordered">
            <list-item>
               <p>Diagnostic interview: A standard interview should include personal life history,
                  psychiatric/psychological history, significant relations and present function
                  regarding work and family, as well as precipitating events prior to seeking
                  treatment. Of special interest is previous separation or intrusion trauma as well
                  as a history of the client’s coping with stress. These questions are sensitive but
                  need to be asked during initial sessions, due to the risk of eliciting flashbacks
                  or other trauma reminders when introducing music. This is also the main rationale
                  why first music choices should have low levels of Activation and degrees of
                  Modulation</p>
            </list-item>
            <list-item>
               <p>Discovery Breathing (DB): Spontaneous discovery, exploration and imagination of
                  the breathing, is followed by a painting of what is actually experienced. Minimal
                  directions from the therapist. No mandala circle is used. </p>
            </list-item>
            <list-item>
               <p>Silent Breathing (SB): Exploration of the body images of breathing volume and
                  center, with painting on paper using mandala circle from now on. This takes a
                  pedagogic explanation of these concepts in the first session. Clients also learn
                  about a “mindful” relation to disturbing experiences during the breathing. </p>
            </list-item>
            <list-item>
               <p>Music Breathing (MB): First, grounding, predictable music with low A/M’s is used
                  for an appropriate number of sessions (MB for Grounding). Then, increasing
                  modulation and complexity of the music (MB for Modulation) are introduced while
                  staying within the client’s WoT. In later sessions, higher A/M’s can be used (MB
                  for Working). The goal is to release pent up affects in a contained way with more
                  powerful music. In later stages two or three pieces of music can be used, with the
                  last piece having a lower A/M rating.</p>
            </list-item>
            <list-item>
               <p>The Bonny Method, with some regard to the breathing.</p>
            </list-item>
         </list>
         <p>DB is a new, additional stage to what Dr. Körlin had previously described for MB. It is
            actually a natural small step that fosters the client’s initial readiness for learning
            SB. In SB, Dr. Körlin’s advice is to start by first learning triangular breathing to
            facilitate locating the breathing center, then proceeding to biphasic breathing. A
            diagram for triangular breathing and biphasic breathing is provided in the appendix, and
            the author has obtained permission from Dr. Körlin to reproduce both images. If the
            client has dissociated experiences of breathing, with difficulty in locating the
            breathing center, a special protocol, “Music Breathing for Dissociation,” is used.</p>
         <p>In this semi-structured interview, Dr. Körlin describes briefly how he developed the
            practice of MB and how his approach evolved. He identifies some key features of his
            work, and how they are different from GIM, MI, and other types of breathing exercises
            such as Holotropic Breathwork (<xref ref-type="bibr" rid="T2003">Taylor, 2003</xref>).
            Generally, GIM refers to the Bonny Method of GIM. The current Association for Music and
            Imagery (AMI) definition of the Bonny Method of GIM is:</p>
         <disp-quote>
            <p>The Bonny Method of Guided Imagery and Music is a music-centered, consciousness
               expanding therapy developed by (Dr.) Helen Bonny. Therapists trained in the Bonny
               Method choose classical music sequences that stimulate journeys of the imagination.
               Experiencing imagery in this way facilitates clients’ integration of mental,
               emotional, physical, and spiritual aspects of well-being. (AMI, What is the Bonny
               Method?, n.d.)</p>
         </disp-quote>
         <p>GIM is a powerful intervention and may sometimes overwhelm the limbic alarm system of
            clients recovering from trauma (<xref ref-type="bibr" rid="G2019">Grocke, 2019</xref>).
            In GIM, the images provoked by music listening present not only as symbols that carry
            multiple meanings, but also as unprocessed sensory, bodily, and affective experiences.
            As these overwhelming physical and psychological experiences may not manifest in
            symbolic imagery, they may sometimes appear in a distorted manner or get disconnected
            from the re-experience in music. GIM has the potential to help clients access and
            reintegrate these traumatic experiences. It is key when working with these clients to
            avoid hyperarousal and stimulating symbolization, as proposed by Dr. Körlin (<xref
               ref-type="bibr" rid="K2019a">2019a</xref>). MB is considered a way to counteract
            autonomic dysregulation.</p>
         <p>In fact, many practitioners have presented different modified versions of GIM adapted to
            psychiatric populations. Beck (<xref ref-type="bibr" rid="B2019">2019</xref>) has
            thoroughly reviewed how GIM has been used and modified with psychiatric clients over the
            past 40 years. Among all these modifications, two innovators in developing MI
            adaptations are Summer (<xref ref-type="bibr" rid="S2002">2002</xref>) and Goldberg
               (<xref ref-type="bibr" rid="G1994">1994</xref>). Summer’s MI is widely recognized as
            supportive or resource-oriented MI, a modified form of GIM (<xref ref-type="bibr"
               rid="S2009">Summer, 2009</xref>, <xref ref-type="bibr" rid="S2015">2015</xref>).
            Summer (<xref ref-type="bibr" rid="S2015">2015</xref>) developed a continuum of MI with
            different levels of practice depending on the client’s needs. Even though the focus of
            MI can be on simply creating a positive experience in the here-and-now moment for the
            supportive level, the ambiguous quality of classical music may still pose a risk to some
            clients with mental health issues. She emphasized the importance of using contained
            music with minimal texture that is focused on exposition, with minimal development and
            greater simplicity in its orchestral textures (<xref ref-type="bibr" rid="S2002">Summer,
               2002</xref>). Goldberg (<xref ref-type="bibr" rid="G1994">1994</xref>) used
            non-classical music instead, with a distinctive feature of talk-over during the music as
            a safety measure when working with this population. She renamed her technique as Focused
            Music Imagery (FMI). The effectiveness of FMI was affirmed by Dimicelli-Mitran (<xref
               ref-type="bibr" rid="DM2020">2020</xref>) in her recent article that depicted its
            detailed steps and provided case examples. </p>
         <p>When Dr. Körlin practiced GIM in psychiatry, he foresaw the need for a more accessible,
            approachable method among people who have experienced trauma due to their stress
            sensitivity and tendencies to dysregulation of arousal. The benefits and specific
            features of MB will be highlighted in the following interview. Dr. Körlin has given his
            consent for this interview to be disseminated in written format. This article will
            include the majority of the transcript of the interview, conducted in Sweden, and serves
            as a contribution to expanding the understanding of, as well as a complementary resource
            to, his MB practice.</p>
         <boxed-text>
            <p>
               <bold>Angela: Dr. Körlin, can you tell me a bit more about how you found out about
                  GIM? And why do you use this instead of other types of psychotherapy approaches?
               </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I was originally trained as a psychodynamic therapist. In
               that [form of] therapy, you use [narrative] words mostly. Sometimes, people also free
               associate, but this is [usually] not fully let loose. We have so many other forms of
               cognition besides words [and linear logic]. For example, memory images of situations,
               perceptions, sensations, and emotions from our life. Images have another language. An
               image can be very concrete: e.g., a flash back [of trauma] that does not have any
               meaning beyond itself. It can also have symbolic meaning, layers of them. You can
               disentangle these layers by making a picture of your image, and then looking at it
               from various points of view. Each time you see something different. Each time you
               have a different view of your history. The image also includes your present state of
               mind; feelings, moods, body sensations, and degrees of alertness or relaxation. In
               all these states, the body reacts differently. You can, by making a picture of these
               states, look at them and analyze them. Later, you can see their meaning. </p>
            <p>
               <bold>Angela: When you developed Music Breathing, why did you choose this method of
                  breathing versus others? There are so many other available accepted types of
                  breathing exercises existing in the world. Why introduce Silent Grounding
                  Breathing? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I have practiced meditation since I was about twenty years
               old. I was trained in a formal meditation, called Soto Zen. The teacher I had
               emphasized the awareness of the Hara, which is described as a point situated in the
               middle of the stomach, a few fingers below the navel. He said that if you focus your
               breathing in this point, you will have the desired effect of meditation, that is to
               experience nothing. In this center the breathing is very small. This is how I came
               into contact with meditation and have practiced it for many years; every day. Being
               in this state helps me go beyond my body limits, to experience myself as part of the
               whole while still staying grounded. The goal is to reach that state. When you are
               breathing, you calm down, sink down. You can experience this as centered in the
               stomach, a little below the navel. Later, I tried to combine reaching this state
               while listening to music. It is quite difficult to do that, because when you are in a
               meditative state, the idea is to stop the thought. So, the thoughts and emotions
               cease, die out and become still. It is a paradox to combine that with listening to
               music. Music becomes the content of the experience. You are not in meditation
               anymore. But, I tried to solve this by making the music an object of mindful
               observation.</p>
            <p>
               <bold>Angela: What do you mean by that?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I mean I allow the music to flow through without trying to
               get caught by it. I observe it passing through myself. That way I can listen to music
               in the most pure and effective way. I can, for example, take in the timbre of the
               instruments in a more intensive way, but still in a calm way, since I am in a calm
               center. So, this is a sort of paradox, trying to achieve emptiness when you have
               music in your mind. I think this is specific for this meditation. It is not the
               silent meditation that my teacher taught me. It is another form of meditative effort.
               It is still very good and effective. </p>
            <p>
               <bold>Angela: So, if breathing itself has benefits, what is the benefit of adding
                  music? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Breathing can modulate the effect of the music to achieve a
               certain state of bodily [autonomic] activation. If you choose music that is very
               grounded, with low notes in it, you can imagine it as being in the center of the
               stomach. It is quite easy to do that. If the music is right for that state, you can
               just continue breathing slowly, with a small breathing volume. If the music expands,
               you need to expand the breathing space, so that the breathing contains the music.
               Loud music and fast music want to have a big breathing volume and a fast breathing
               rhythm containing the state of activation brought by the music.</p>
            <p>
               <bold>Angela: Will that counteract what you want? Don’t you want to be calm? If you
                  do lots of fast breathing when the music is fast, you are breathing too fast. Will
                  that counteract the calmness? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> But the point is, it is not about breathing with high energy
               all the time. People do that. For example, like Holotropic Breathwork, you
               intentionally play music that is very rhythmic, very strong, propelling breathing in
               motoric way. You do that for a long time, you breathe hard for 45 minutes to 50
               minutes. </p>
            <p>
               <bold>Angela: Oh, that long…</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes, that long. Then, you get to a widened state of mind, as
               a rule. You increase the level of oxygen, and decrease carbon dioxide in the blood.
               You can feel the tingling of your fingers. Your sensations change. You can get a
               feeling like you are both inside and outside of your body at the same time. You can
               experience a fusion with the world, which is called a transpersonal state. But, in
               Music Breathing, the point is to adapt the breathing to the music in every moment.
               Sometimes, the music will be slow and low, and then your breathing will be small. If
               the music expands, you expand the breathing, you follow it. If it falls back again,
               you decrease the breathing again. You modulate the breathing in tune with the
               modulations of the music. </p>
            <p>
               <bold>Angela: In that case, the music you choose for Music Breathing is very
                  important. My question would be how long should the music be? In a GIM program,
                  the music program can be </bold>
               <bold>as</bold>
               <bold> short as 20 minutes, or up to 45 minutes. I notice that you use the music in a
                  way similar to music imagery in a way, like 3-10 minutes. Is that the length you
                  usually use? Do you make </bold>
               <bold>it longer or shorter?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I think it depends. If I do it by myself, I can do it for
               10–15 minutes. But 15 minutes is the limit, because it is very taxing to do Music
               Breathing for that long. When you do it in a holotropic way, you do it in a group,
               and then get the support from the group. Everybody in a group is also breathing hard.
               You get energy from the group to continue. If you do it for yourself, for your own
               development, or if you do it for a client in a session, there is not that energy.
               Also, in a one-hour session, there are so many other things you need to have time
               for. You need to have time for pre-talk, to find out where the client is, what has
               happened since the last time. You will need to have time for the relaxation to go
               into the meditative state. After the breathing, you will paint the breathing mandala,
               and then you will have to talk about it. If you think about all these elements, only
               8-10 minutes are left for the music itself.</p>
            <p>
               <bold>Angela: That is why you suggest 8–10 minutes for Music Breathing?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> For a one-hour session. I think that if you have a longer
               time, you could do up to 20 minutes. You can use between one and three pieces of
               music. You can extend the session up to one and a half hours. </p>
            <p>
               <bold>Angela: So, it depends on the needs of the client whether you lengthen the time
                  for listening to the music? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes. It is also for economic constraints as well. Also, I
               think it is difficult to do more than 20 minutes using music having classical
               features where the music changes a lot. For example, Holotropic Breathwork uses music
               that is not so changing, it is more static, not so many things happening in the
               music. </p>
            <p>
               <bold>Angela: May I get back to the choice of music again? Do you use classical music
                  mostly, or do you use nonclassical music? How would you differentiate when to use
                  classical?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> It has to do with the concepts of level of Activation and
               level of Modulation. Clients have limits, levels of tolerance, low or high degrees of
               those two. Some clients cannot tolerate going to the full level of activation or
               listening to very complex music that changes every second. </p>
            <p>
               <bold>Angela: When you say Activation and Modulation, I know Modulation means the
                  level of variation and change in the music. Can you clarify what you mean by
                  Activation?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Activation—you can see it as a gliding scale between very
               low and very high [autonomic] bodily activity. Low is when you are resting as much as
               you can, lying on the bed, not moving. Just letting yourself sink into the bed, maybe
               getting a little bit drowsy. That is a very low state of activation and consumption
               of energy. Because the heart is calm, the circulation is slow.</p>
            <p>
               <bold>Angela: So, it is more like a bodily state, the level of activation?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes, right. So, the high level of activation approaches an
               alarm state, when you are running from something, or fighting something, you need to
               mobilize the whole body. The heart beats faster, blood vessels expand to get blood
               out to the body. You need to bring more oxygen to the body. When you think of the
               fight or flight response, the high level of activation is when you are in danger, you
               run like hell, you must climb a tree, or fight somebody. </p>
            <p>
               <bold>Angela: I understand it more. </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> So, it is like a gliding scale. And there is modulation. Low
               modulation is simple music, consists of few notes, not doing much, maybe just a
               stroll. The highest degree of modulation would be a symphony by, for example, Brahms
               or Mahler. </p>
            <p>
               <bold>Angela: In that case, do you use the music to match the client’s state or do
                  you always bring them to a low activation state? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I want them to start with the low activation state. Then,
               increase the activation and modulation to a level that they can tolerate, and then go
               back to the low activation again at the end. It is like a curve, begin at zero, then
               go up and go back again. It is a bit like Helen Bonny’s graph of the intensity of the
               music over a program. </p>
            <p>
               <bold>Angela: My question is, it would be hard to get one piece of music that will do
                  everything together, right? Do you use many pieces of music? Or how do you just do
                  one?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> If you want to do that, you can do that within a piece of
               music. You choose a piece of music that has a bit of intensity in the middle; it
               fades out and diminishes as the music ends. Most music pieces have that structure. In
               Western classical music, we have ABA, where B is more alien. Lisa Summer said it is
               more “not me.” It has more disharmony. It is more challenging in the B part, then you
               go back to the A part, which is by now the home that you left when you went into the
               B part. Back in the A part, the music diminishes the activity before it ends. That is
               the way most [Western classical] compositions are. </p>
            <p>
               <bold>Angela: In that way, is it more appropriate to use classical music, because
                  neoclassical music piece probably will not have such a dramatic change in music
                  form?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Both can be used, depending on the level of modulation you
               want to have. You listen to them beforehand, you will notice the level of
               complication and intensity, activation, and choose something that is suitable for
               this client. In the beginning of the Music Breathing session, you go for the low
               level of activation and low level of modulation. Like the client you reported to me,
               maybe you go a bit too far with the degree of modulation and drama. But, the client
               might have managed that at a later stage, if he had had more sessions and learned
               more on how to handle the tension that was produced by the music. </p>
            <p>
               <bold>Angela: I am just curious, will there be any side effects from doing Music
                  Breathing? You have clients who practice at home, right? If the person somehow
                  forgets what he is supposed to do, will that have any impact?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I think you have to know the client well enough, so that you
               can be sure if s/he can manage certain levels of music. Then, you take the next step.
               You see if the client can manage that. Of course, the client has to come back,
               otherwise you don’t have the data to choose the next piece of music. So, for example,
               Bach is generally predictable, the safest of all the composers. If you stay with
               Bach, you can be more certain not to exceed the limits. </p>
            <p>
               <bold>Angela: I see. So, when do you use GIM, how do you choose between Music Imagery
                  and Music Breathing? Do you use Music Breathing when people cannot handle GIM? How
                  do you decide when to use what?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> As Music Breathing was developed, it was invented in
               situations where people could not handle their images in GIM. They either had
               autonomic over-reaction, with panic and excitation, or they were overwhelmed by a lot
               of images. There were so many images that they could not integrate them. When too
               much happened, they could not make any order of it. They may be in an alarm state, or
               [alternately] get shut down. If they cannot “hear” and feel the music, they cannot
               use it either. </p>
            <p>
               <bold>Angela: Some people would use Music Imagery instead of GIM, right? What is the
                  difference between Music Imagery and Music Breathing?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> One difference is that clients can do Music Breathing by
               [themself]. You can also “prescribe” to train Music Breathing by yourself. That means
               that you don’t have to have a therapist in the room every time. You can do it by
               yourself, and then you can do it more times. Music Imagery is a single session that
               you do once a week. Then, you have to wait until the next week when you get back to
               the therapist. The next week, you will do it again. But, you cannot work with the
               music as much as you can with Music Breathing, where you don’t need the therapist in
               the room every time. You just need breathing and the music.</p>
            <p>
               <bold>Angela: I see what you mean. It sounds like Music Breathing can be a complement
                  to Music Imagery. </bold>
            </p>
            <p>
               <bold>Dr. Körlin: </bold>And Music Breathing is the safest one. </p>
            <p>
               <bold>Angela: The safest one? Even safer than music imagery?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes, because music imagery can also have a very strong
               effect while the client is in the music listening state, when you have no verbal
               contact. The client has directions before, but no tools when something unexpected
               happens in the music that [the client] cannot manage. But in Music Breathing, the
               client will have the breathing as a tool.</p>
            <p>
               <bold>Angela: May I ask you about Music Breathing’s processing of the imagery
                  afterwards, with mandala drawing? Do you instruct them to draw this bodily
                  sensation from breathing while listening to music? What happens if they draw
                  something that is not related to that, or something not within your expected
                  impact from that?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> It is part of the training of the client, to not forget the
               breathing. You process the mandala and its content, as you would do in Music Imagery.
               You also bring in the breathing in the processing. If you notice that the client
               doesn’t try to adapt the breathing to the music, you should be persistent and ask the
               client to do that. </p>
            <p>
               <bold>Angela: So, in that case, the drawing itself is almost like an assessment of
                  their experience as a result of breathing to the music, not something that goes
                  into the subconscious mind and provokes lots of memories or images, am I right?
               </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> That is right. For some clients, there is no obvious
               connection between the images and the experience of the breathing volume, which is a
               body image. But the expectation is that the images somehow should be related to the
               breathing. Sometimes, it isn’t. Sometimes, it is. If clients have a lot on [their]
               minds, are very troubled by something, or trying to find a solution, then the content
               of that situation and the emotions would be stronger and take over. Then, you allow
               that. </p>
            <p>
               <bold>Angela: So, it is more than just a body scan kind of image; it could be
                  something else. And it is still acceptable?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Right. What you do, you ask the client to note the
               connection between the images and the breathing and the music. It is a triad that
               your clients do all the time. For some sessions, you can’t. In some sessions, you
               have only the experience of the body space. In other sessions, you have only emotions
               and problems. </p>
            <p>
               <bold>Angela: Are you saying that they can practice this Music Breathing at home as
                  much as they want?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> No. Not as much as they want. Three to five times a week. </p>
            <p>
               <bold>Angela: Three to five times a week. Do you recommend that they do the drawing
                  or just listen to the music while breathing? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I recommend them to do the drawing also, to do at least one
               drawing in the meantime, between this session and the next session. They can do a
               drawing after every session by themselves at home if they want. </p>
            <p>
               <bold>Angela: But do you recommend them to do one?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> I demand at least one because there should be one. It is
               also the fact that the painting becomes a sort of memory, a sort of notebook. When
               you look at the painting, you remember the session and the experience. It is like a
               hook that brings back the process. Otherwise, you can just forget the experience
               until the next time. </p>
            <p/>
            <p>
               <bold>Angela: How long does it take for people to experience the benefit of Music
                  Breathing?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> You experience some benefits after 4 weeks, but this
               requires that you work at home both with the Silent Breathing and with the Music
               Breathing, and at the same time, you will see the therapist as indicated. </p>
            <p>
               <bold>Angela: May I clarify with you again about the Silent Breathing? You start with
                  the triangular breathing, breathing out, then holding, and then in. Then you go
                  with the exercise from an enlarged breathing space enlarged, which gradually
                  becomes a smaller breathing volume. This is what you call the Silent Breathing
                  exercise? </bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes. The purpose of triangular breathing is just to find the
               breathing center. After a while, you don’t need triangular breathing to find the
               center. You can find it with ordinary breathing. </p>
            <p>
               <bold>Angela: Is that why you usually teach the triangular breathing for the first
                  two times? Then go to the other biphasic one…</bold>
            </p>
            <p>
               <bold>Dr. Körlin: </bold>The first two or three times, you will try both triangular
               breathing and biphasic. </p>
            <p>
               <bold>Angela: Then do you gradually phase out the triangular breathing, and just
                  focus on the biphasic?</bold>
            </p>
            <p>
               <bold>Dr. Körlin:</bold> Yes. You will go into the music with the biphasic breathing.
               If you try for yourself to do the triangular breathing with music, you will find that
               it consumes a lot of attention. You don’t have so much space left for imagery. It is
               such a complex, gymnastic exercise for the brain. </p>
            <p>
               <bold>Angela: Do you think it consumes more energy, when you practice the Music
                  Breathing—consciously thinking of the breathing while listening to the music
                  listening, versus just breathing normally?</bold>
            </p>
            <p>
               <bold>Dr. Körlin: </bold>Yes, the least energy is consumed by breathing normally
               without thinking about it. I think that when you do it as an intentional activity, in
               the beginning, it consumes some energy because you have to consciously think and
               predict what the music is going to do and how you are going to follow with the
               breathing. After a while, you forget that. And you will do it automatically. </p>
            <p>
               <bold>Angela: What do you think is the impact of Music Breathing on a person in the
                  long run?</bold>
            </p>
            <p>
               <bold>Dr. Körlin: </bold>In the long run, you learn to lower the stress level, lower
               the amount of energy that you consume in an everyday state. You are doing Silent
               Breathing a lot and will start doing it without thinking about it. </p>
            <p>
               <bold>Angela: Thanks very much for your time. </bold>
            </p>
         </boxed-text>
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Conclusion</title>
         <p>After the interview, the author realized that SB is truly a very focus-oriented approach
            grounded in one’s bodily felt senses from the breathing mechanism. It re-strengthens the
            parasympathetic system of a person. Often, if one is doing SB correctly, the drawings
            from practicing SB usually contain supportive images, reaffirming a strong grounding
            sensation of a person. This grounding experience certainly explains why MB can offer a
            strong sense of safety, particularly if the client can intentionally dwell in the
            process of imaging breathing activity when accompanied by appropriately selected music.
            SB therefore provides a somewhat similar support level to MI. SB is definitely a good
            resource for many therapists. As a result, one can gain more understanding of and be
            clearer on the concepts of both SB and MB, particularly in the identification of the
            degree of activation from the music selection to regulate the WoT of the clients. One
            merit of MB is its accessibility, which allows clients to take more control of their own
            recovery. MB clients can do in-home practice that other modified GIM therapies do not
            offer. This in-home practice of MB is certainly good news for people with chronic
            illness.</p>
         <p>A short 3–minute video clip of an interview with Dr. Körlin prior to this in-depth one
            was recorded and uploaded as a reference. This video clip serves as a means of promoting
            MB to clinicians and the general public. One can access it at this YouTube web link:
               <uri>https://youtu.be/FdHNfQ0mrcM</uri>. None of this short version is transcribed
            nor included in this article.</p>
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>About the Author</title>
         <p>Angela Shum has been a registered nurse for more than 10 years, working in health care
            setting across different countries and cities, including Hong Kong, Canada, and the US.
            Her nursing clinical experience has been extensive in various settings, including
            hospital, nursing home, and university. </p>
         <p>After she earned her master’s degree in expressive therapy (specializing in music
            therapy and mental health counseling), she worked as a music/rehabilitation therapist at
            the Provincial/State hospitals in both Canada and the US. She has experiences working
            with clients with dementia, gambling addictions, stroke/traumatic brain injury,
            developmental disabilities, and in forensic psychiatry. Presently, she is residing in
            Hong Kong doing private practice, with her passion of promoting Focused Music Imagery,
            Music Breathing, GIM and Focusing Oriented Expressive Arts (FOAT®), and educating health
            care professionals, particularly psychiatric nursing about using these approaches for
            wellness.</p>
      </sec>
      <!-- sec lvl 2 end -->
   </body>
   <back>
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      <sec>
         <title>Appendix</title>
         <p>The following are excerpts from the current MB training manual (<xref ref-type="bibr"
               rid="K2020">Körlin, 2020</xref>):</p>
         <fig id="fig1">
            <label>Figure 1. Triangular Breathing</label>
            <caption>
               <p>“You breathe out, for a count of 4, letting the Breathing Volume contract
                  downwards to a small sphere in the stomach, with the intention of staying in this
                  small Breathing Center. Stay in the Center for another count of four, then release
                  and let the Volume expand upwards for an equal count of four”. Repeat this several
                  times for a period of 2-3 minutes.”</p>
            </caption>
            <graphic id="graphic1"
               xlink:href="Pictures/1000000000000258000001C2B34D11D95EE41F73.png"/>
         </fig>
         <fig id="fig2">
            <label>Figure 2. Biphasic Breathing</label>
            <caption>
               <p>“The normal breathing can be termed Biphasic. Move on to Biphasic Breathing as
                  soon as the client has found the Center with the help of Triangular Breathing.”
                  The small Breathing Center, below the navel, is the center of Silent Breathing
                  (SB). In Music Breathing (MB), concentrically wider Breathing Volumes up to a
                  maximal Breathing Volume are used to modulate the effects of music.</p>
            </caption>
            <graphic id="graphic2"
               xlink:href="Pictures/100002010000028C000001FF2560581AF60FD0D2.png"/>
         </fig>
         <table-wrap id="tbl1">
            <label>Table 1</label>
            <!-- optional label and caption -->
            <caption>
               <p>Examples of Music Breathing classifications provided by Dr. Körlin for this
                  interview. </p>
               <p>The following list is a selection made for the Music Breathing training in London
                  2019. For complete list of the original Music Breathing Music, please refer to
                  Table 1 in the chapter on Music Breathing (<xref ref-type="bibr" rid="K2019b"
                     >Körlin 2019b, p.539-540</xref>).</p>
            </caption>
            <table>
               <thead>
                  <tr>
                     <th>Name of Piece</th>
                     <th>Composer/Artist</th>
                     <th>Album/”Program”</th>
                     <th>Arousal/ modulation</th>
                  </tr>
               </thead>
               <tbody>
                  <tr>
                     <td>Spiegel im Spiegel</td>
                     <td>Pärt</td>
                     <td>Music Breathing I/II</td>
                     <td>A1/2, M1</td>
                  </tr>
                  <tr>
                     <td>Om Namoh Baghavate</td>
                     <td>Trad/Deva Premal</td>
                     <td>Music Breathing I/II</td>
                     <td>A1/2, M1</td>
                  </tr>
                  <tr>
                     <td>Dream 3 (In the midst…)</td>
                     <td>Richter</td>
                     <td>From Sleep</td>
                     <td>A1/2, M1</td>
                  </tr>
                  <tr>
                     <td>Om Namoh Shivaya</td>
                     <td>Trad/Astin</td>
                     <td>Earth Spirit</td>
                     <td>A1/3, M1</td>
                  </tr>
                  <tr>
                     <td>Humming Chorus</td>
                     <td>Puccini</td>
                     <td>
                        <italic>”Nurturing”</italic>
                     </td>
                     <td>A1/2, M2</td>
                  </tr>
                  <tr>
                     <td>O Mar</td>
                     <td>Madre Deus</td>
                     <td>Earth Spirit</td>
                     <td>A1/2, M2</td>
                  </tr>
                  <tr>
                     <td>Path 19 (Yet Frailest)</td>
                     <td>Richter</td>
                     <td>From Sleep</td>
                     <td>A2, M1</td>
                  </tr>
                  <tr>
                     <td>Opera intermezzo</td>
                     <td>Handel</td>
                     <td>Music Breathing I/II</td>
                     <td>A2, M2</td>
                  </tr>
                  <tr>
                     <td>"Rhosymedre" Prelude</td>
                     <td>Vaughan-Wiliams</td>
                     <td>
                        <italic>”Nurturing”</italic>
                     </td>
                     <td>A2, M2</td>
                  </tr>
                  <tr>
                     <td>Water Music, air</td>
                     <td>Handel/Bamert</td>
                     <td>Music Breathing I/II</td>
                     <td>A2, M2</td>
                  </tr>
                  <tr>
                     <td>Guitarra</td>
                     <td>Madre Deus</td>
                     <td>Ainda</td>
                     <td>A2/3, M2</td>
                  </tr>
                  <tr>
                     <td>Eyes Shut/Nocturne in C Mi</td>
                     <td>Arnalds &amp; Ott</td>
                     <td>The Chopin Project</td>
                     <td>A2, M3</td>
                  </tr>
                  <tr>
                     <td>I Giorno</td>
                     <td>Einaudi</td>
                     <td>Earth Spirit</td>
                     <td>A2, M2</td>
                  </tr>
                  <tr>
                     <td>Horn concerto #2.</td>
                     <td>Mozart</td>
                     <td>Music Breathing I/II</td>
                     <td>A2, M3</td>
                  </tr>
                  <tr>
                     <td>Water Music, air</td>
                     <td>Handel/Bamert</td>
                     <td>Music Breathing I/II</td>
                     <td>A2, M2</td>
                  </tr>
                  <tr>
                     <td>Passacaglia, Canon in D</td>
                     <td>Pachelbel</td>
                     <td>
                        <italic>”Group Experience”</italic>
                     </td>
                     <td>A2/3, M2</td>
                  </tr>
                  <tr>
                     <td>Come Sweet Death</td>
                     <td>Bach</td>
                     <td>
                        <italic>”Mostly Bach”</italic>
                     </td>
                     <td>A2/3, M3</td>
                  </tr>
                  <tr>
                     <td>Toccata Adagio and Fugue</td>
                     <td>Bach</td>
                     <td>”<italic>Mostly Bach</italic>”</td>
                     <td>A3/5, M3</td>
                  </tr>
                  <tr>
                     <td>Moment to Moment</td>
                     <td>Drala</td>
                     <td>Drala</td>
                     <td>A3, M2</td>
                  </tr>
                  <tr>
                     <td>Gloria, et in terra pax</td>
                     <td>Vivaldi</td>
                     <td>”<italic>Peak experience</italic>”</td>
                     <td>A 3-4, M3</td>
                  </tr>
                  <tr>
                     <td>Verses</td>
                     <td>Arnalds &amp; Ott</td>
                     <td>The Chopin Project</td>
                     <td>A3/5, M2</td>
                  </tr>
                  <tr>
                     <td>Afternoon of a Faun</td>
                     <td>Debussy</td>
                     <td>”<italic>Quiet Music”</italic>
                     </td>
                     <td>A2-5, M4</td>
                  </tr>
                  <tr>
                     <td>The Planets, Neptune</td>
                     <td>Holst</td>
                     <td>
                        <italic>”Quiet Music”</italic>
                     </td>
                     <td>A2/5, M5</td>
                  </tr>
               </tbody>
            </table>
            <table-wrap-foot>
               <p><italic>Notes:</italic></p>
               <p><bold>Level of Arousal (A)</bold>. If the music has a high degree of repetition in
                  melody, harmony, rhythm or other elements, it tends to hold Arousal at a steady
                  level, low or high, and the size of the Breathing Volume is relatively constant.
                  If emotions are evoked in a constant state of Arousal they tend to hold for longer
                  times before they change. It is easier to keep within the clients Window of
                  Tolerance (WoT). Listening and breathing requires a degree of meditative
                  discipline. </p>
               <p><bold>Degree of Modulation (M)</bold>. Complexity and change of harmonies and
                  speed of harmonic shifts also vary between musical pieces and can be ordered on a
                  continuum. There are not only different degrees of harmonic change and
                  transformation, but also different degrees of variation, development of melodies,
                  and changes in timbre. It is by definition impossible to sustain a continuous
                  level of Arousal at high degrees of Modulation. The Breathing Volume changes to
                  adjust to the various shifts in the music. There is a greater risk of exceeding
                  the clients WoT. An element of surprise entertains the listener, and less
                  meditative discipline is required.</p>
               <p><bold>Classification of pieces into A/M Categories</bold>. Every piece (or parts
                  of pieces) can be graded into six degrees of Arousal (A1-6) and degree of
                  Modulation (M1-6). The traditional Bonny Method of GIM programs are “italisized”
                  between citation marks. “Music Breathing 1 and 2” was programmed by Körlin (<xref
                     ref-type="bibr" rid="K2004">2004</xref>), “Earth Spirit” by Hall (<xref
                     ref-type="bibr" rid="H2015">2015</xref>) and “Awakenings” by Leslie (<xref
                     ref-type="bibr" rid="L2015">2015</xref>). The table is sorted by level of
                  arousal, reflecting the fact that the first priority is to find the musical
                  arousal level that the client can tolerate without dysregulating. When the client
                  is stabilized at a comfortable zone of arousal, different qualities and degrees of
                  modulation can be explored. </p>
            </table-wrap-foot>
         </table-wrap>
      </sec>
   </back>
</article>
