Alexa Terry: [00:00:00] BAST founder Line Hilton is joining us again this week. Line is a multifaceted voice, performance and resilience coach with a unique background in nursing, jazz performance and performing arts medicine. She works holistically to help voice users foster a growth mindset and robust mental and physical health for the benefit of elevated and confident performances.

Line is here to give us a little taster of this niche field of performing arts medicine.

Line Hilton, if you had to play any sport, what would it be?

Line Hilton: At school I was always swimming or playing tennis. Yeah,, I still can swim. Tennis not so easy. You need to have a lot of strength and your shoulder needs to be in good working order.

Alexa Terry: I think I was in armbands until I was about 23. So swimming is not for me, but tennis, I kind of got into it a bit recently. Well, I, I say got into, but really I've watched about three matches and all of them featured Andy Murray. [00:01:00] And more so because I found it just poignant watching him in the last matches of his career. And. I've also watched some of the documentaries about how Andy Murray has been navigating injury throughout his career. And in these programs, you see sports medicine in action, really with coaches, physiotherapists, doctors that kind of surrounded him at this time.

And likewise in performance, we have a similar branch, the performing arts medicine branch, so to speak. So can you help us understand what that is and why it's important?

Line Hilton: Yeah, Performing Arts Medicine, it's very similar to sports medicine in as much as you have health care professionals, be they doctors, nurses, physiotherapists, nutritionists, whatever, , who are specifically interested in working in the arena of the performing arts. So we look at how [00:02:00] does the art impact on the performer? And what sort of things does does the performer have that might impact their art in terms of health and well being? So it can be psychological, could be physical, could be a related injury to the job they're doing. Or it could be unrelated, whether it's an injury or an illness, but it's impacting the performer's ability to do their work.

So it's quite a small field, but it's starting to grow, certainly not as lucrative as sports medicine is. But yes, we definitely are working in the direction of

thinking about a very multidisciplinary approach to the health and well being of the performer.

Alexa Terry: Arguably, someone like Andy Murray and also Celine Dion, her documentary is also out with how she's been navigating stiff person syndrome. They might have access to such professionals because of their [00:03:00] profile. But for somebody who is an amateur or just starting their training, how can they have access to these people as well?

Line Hilton: Yes , admittedly, it can be challenging , even to professionals, by the way. We're fortunate in the UK, we have BAPAM, which is the British Association of Performing Arts Medicine. And they offer a free service cause it's a charity to anyone who is a student of performance or a performer professional, whether they're employed or not to get started, and they have a list of clinicians who are interested or specialize in working with performers.

So it gets a little bit difficult, really, when you get into the amateur arena. And I suppose in many ways, certainly one of my ambitions is to help educate singing teachers better so that they can take a little bit more of a holistic approach in understanding the various [00:04:00] health and wellbeing issues that might impact their students and their performances. So it can be a bit of a struggle. There are a few places that you can go to here here in the UK, we've got the Voice Care Centre. There's also little pockets around the place of people who, whether they're psychologists or nutritionists who will work specifically with performers. If you do a little bit of a search on Google, you might be able to find somebody specifically. The problem is knowing who and what is going to be useful, given your symptoms, and that can be a challenge as well, trying to figure out is that symptom related to a heart problem or is it reflux? Is that symptom related to hypermobility or have I got anxiety? Is it psychological or is it to do with my immune system or skeletal system? So that side of things can be challenging if I'm [00:05:00] honest.

Alexa Terry: So what would be your top tip for singing teachers to make sure that they're sending their singers in the right direction?

Line Hilton: Have a look around to see if there's any information out there. You can go to the British Association of Performing Arts Medicine website. There's also PAMA, Performing Arts Medicine Association in the States. So , Some countries may have their own kind of association, which has Performing Arts Medicine focus. And there's usually information there. And there might be somebody that you can actually connect with to just get started asking questions about what you could be telling your student in order to help them. The other thing which I always say is to let the student know that it's okay to get more than one opinion and also to be very clear about what it is that they're doing.

Say for instance, we've talked about this before. If a singer goes to an ear, nose and throat surgeon who doesn't have a laryngology background, they have to [00:06:00] be really clear that this is what they do with their voice. They sing. And so they need to be able to sing through their range and need to sustain long notes, maybe be in a show and be dancing at the same time, all of these things. So it might be that the student aka the patient, has to let their doctor know a little bit more about what it is that they do and what they're going to be using their voice or their body for, so that the doctor has a better idea as well. So you need to maybe advocate for yourself a little bit more. And I would actually say that of any patient, regardless of whether they were a performer or not.

Alexa Terry: When a teacher is putting together maybe a networking list so that they can branch out and be more multidisciplinary, who would you advise is on that list and whose contact details should we be collating?

Line Hilton: BAPAM if you're in the UK. because there you automatically have a list of clinicians from a variety of different [00:07:00] fields, listed. You want to start with an ENT laryngologist and speech therapist. Physiotherapist, in particular somebody who may be already trained in vocal manual therapy or massage. You might look for a masseuse who has that kind of training in vocal massage. Nutritionist. necessarily have to be someone who has a performance background, but it can help because if you're working with a performer who is gigging, I don't know, four or five times a week, or even in a show eight times a week, their nutrition requirements and the timing of when they eat needs to be taken into consideration. But, once again you know, you could tell the nutritionist, this is what I do during the day, and this is how I use my energy. This is when I wake up, when I sleep, and that will help them with planning your nutrition. A psychologist, [00:08:00] or a variety of different therapies. Psychiatrist is someone who can,, prescribe medications. So generally that won't be in your arena anyway. You will probably find that if someone needs a psychiatrist, they , will get referred by their GP . So psychologists are more for counseling, and there's a variety of different types of psychology. There's, , somatic type treatments as well. maybe a hypnotherapist, Emotional Emotional Freedom Technique is something which I've been into more recently. CBT Cognitive Behavioural Therapist. It's going to be difficult for you to know the kind of consultants that you might need, but a gastroenterologist if someone's got reflux, a rheumatologist if someone's got joint problems like arthritis, a neurologist if there's some kind of nerve damage or issues,, [00:09:00] orthopedics, you know, if it's related to the bones. so there's a bunch of different consultants that you might need. And if you've got someone who has to use their hands, like they're a pianist or a guitarist, and they've got problems, then you need an orthopedic surgeon who's got a hand specialty. so that might be, you know, relevant there. BAPAM is very good with those kind of specialist

areas. An osteopath. A chiropractor might be useful, they're probably going to be enough there to get started.

Alexa Terry: You have a medical background as an ex nurse, so how did you transition from nursing to working with singers and with a particular Performing Arts Medicine niche, if you like?

Line Hilton: If I'm really honest, and I've told this story before, when I was transitioning over to become a singer, I honestly thought that I would leave nursing behind and would never ever connect with it or [00:10:00] need it ever again. And when I started teaching, one of my friends said to me, Oh, you're so lucky that you've got all that medical knowledge because that must be so useful when you're working with someone who, I don't know, has to have an operation or is on medications. And I looked at them and just went, Oh, this little light bulb went off in my brain going, Oh, I can combine these two things that had just never occurred to me to do that. I saw it as separate occupations and never the twain. And so It wasn't till that happened that I started to think about, well, how can I incorporate what I know and understand as a nurse? And then later, very fortunately, I met somebody who was involved in the masters at UCL, setting up the Performing Arts Medicine masters. And he said to me, I think he'd be a really good candidate for this course with your medical background and performance background. And I felt like they'd created the course just for [00:11:00] me. That's how I put those two together more formally. The other thing was that somehow, I don't know if it was just because of the kind of advice I would give or nature, but I would often attract into my studio people who were quite complicated in terms of their health and their requirements for singing and performing. I really relished and enjoyed the challenge of working with those kind of clients. To help them navigate the health well-being aspect as, well as the performance and singing.

Alexa Terry: What does your work target under the umbrella of Performing Arts Medicine and what's driving that as you move forwards?

Line Hilton: Well, I take a very holistic approach to my students and clients. So when somebody comes to see me, and more often than not, , I see people who do have complicated health issues. health issues that are interfering with their [00:12:00] singing or performance, I will take a very thorough audit, which will encompass everything, you know, medical history,, medications,, psychological, nutrition, sleeping, as well as finding out from an occupational point of view, what they have to do, how it's been going, what issues they've been finding.

And so I take this very in depth audit and think about how does that impact that person's ability to go and do their job or to go and do, you know, whatever it is they want to do as a performer.

One of the things that I noticed and attracted me to figuring a new line of approach was that I would be working with singers who had perfectly good voices. who had the ability to go out and perform and apply for gigs and jobs and auditions. But what was stopping them was what was going on between the ears. It was [00:13:00] all the stuff that was going on in their mind. And it wouldn't matter how good their technique got or how much encouragement I was giving them. There would be something stopping them. And so I started to realize that it was a lot more to do with what was going on in the mind. During my master's, we did a module in psychology and I loved it. So I started to pursue that a little bit further and look into, well, what's going on in the mind when that happens? And what can I do? So I started doing some training, eliminating limiting beliefs with Morty Lefkoe. Then I eventually became a clinical hypnotherapist and now I've just started doing my practitioner training for Emotional Freedom Technique. So I work still from that point of view of taking it holistically.

So for instance, recently, somebody rang me and said, I encountered you, talking about Performing Arts Medicine during a course, and I really [00:14:00] love. that approach and I have this issue and I know a lot of it's to do with my mindset and some blocks that I have, but also want to work on my voice and add in a little bit more, variation in my vocal qualities and I'm sitting there going, you are the perfect client for me because I love working with all of those things and I love the fact that I have permission to be able to do all of them. because obviously if someone comes to you for a straight ahead singing lesson, they may not understand why you're talking about these other things, or trying to encourage them to get some kind of therapy or counselling. But it's definitely made a huge difference to some of the clients and students that I've worked with. Whether I did it or whether I sent them off to someone else, I can remember one particular student when ever she was performing, even if she didn't necessarily feel that way, she looked like the scared rabbit in the headlights with the eyes literally open wide like that whenever she was performing. And she ended up going and seeing [00:15:00] a clinical hypnotherapist and doing some work with her. And then I think she also did some talk therapy. And within about three to five months, there was a huge change in the way that she looked when she was performing. She was really relaxed. She was engaging with the audience. She looked like she was comfortable and confident. And so I could see even back then, you know, before I started my journey down this pathway, that it could make a huge difference. And I think we both knew that she was very capable as a singer and performer, but there was just something going on that was holding her back. And this anxiety that she had that was sort of underlying her mindset had this impact of making her performance or not only, you know, with these wide scared looking eyes, but lack of ability to engage with the audience and to relax

and enjoy her performance. So it's been, you know, a gradual thing, but also just totally made [00:16:00] sense to me to be going in this direction.

The other thing is that there's been a general increase in anxiety and depression in the population, the general population. Something like one in six people experience anxiety and depression. But in the performing arts world, it's even more frequent. So it's something like three times more than the general population. And I've certainly noticed that with my students. And so having an understanding of that whether or not I'm the person that ends up helping them means that when I'm working with my students, I can help advise them and direct them, encourage them to get that attended to, and also to help them realize that they're not the only one. And of course, during the pandemic, there was a very , big spike in anxiety amongst everyone and that's dropped back down, but it's still higher than pre pandemic. And of course, if you're working with people who, for whom this is a [00:17:00] profession, it's such an unstable career. You never know when your next gig's coming. And even if you've got a gig or a show, you don't know whether you're going to have it for more than six months or a year or whatever the contract is. And there's always someone else coming up behind you, to get the job. As well, it's not well paid. The work conditions aren't always great. You might rehearse in a small room without any kind of ear protection, or you might not be able to access, the actual place where you're going to perform. So you're literally walking on to perform and you've never actually been on that stage or set before. It's very unsure and of course being creative also probably attracts certain neurodivergent types and so you're, if that's not you or even if that's you, you know, you may be dealing with other people who are experiencing a lot of anxiety and that can be infectious. there's all sorts of [00:18:00] things that make this job really difficult and It's going to put us at higher risk of things like anxiety and depression. And I feel like as singing teachers, we need to be aware of it. We're not going to necessarily treat it or be the therapist unless, of course, you're trained in that way. But if you're aware of it, you can be encouraging and, help the student to go and get the right kind of help. And that could be as simple as just starting with their GP.

Alexa Terry: As you've just explained there, singing teachers and vocal coaches, they often describe singing lessons as being akin to a therapist's work. And I've recently received a lovely card from a student who said that our sessions were like free therapy for them. But we are limited in what we can do, as you say, we aren't all necessarily trained to be able to help in particular ways.

We've spoken before in the past on this podcast about [00:19:00] reframing and using facts and looking at things that may be written in like the Chimp Paradox, for example, but what would be your advice on what we can actually do in a session to help someone when they, they come in feeling anxious or upset?

Line Hilton: think active listening is very important. You know, if you do ask somebody, how are they, you know, actually listen to what they say and, and also be checking out their body language. Sometimes someone will say I'm all right, but their body is telling you otherwise. Without prying, you can also say, is there anything you think I should know, you about how your day's going or your week has been going? If the student doesn't want to reveal anything, then there's not much we can do other than just to say, look, I'm here, if you want to talk about something, obviously I'm not a professional in terms of being a therapist or doctor, but maybe I can help give you some guidelines or advice or [00:20:00] support, you know, in other ways. I think it's about not being scared about that. Though also being cognisant of your lane and recognizing that if it's getting to the point where you feel uncomfortable or if it's out of your realms, then that's okay. One of the easiest things, especially if someone's experiencing anxiety or depression is to advise them to see their GP, that's always a good starting point. And certainly to find out, is there anyone else that they can talk to? If they're young it might be that there's somebody at school, like a counselor, someone that they can turn to, maybe a teacher who's got more experience the other thing is that you yourself could get better educated. So mental health first aid courses are very affordable and certainly in the UK, I'm pretty sure they've got them in Australia as well and they might have something [00:21:00] like that in other countries. It's a good way of just getting to understand a lot more about mental health issues and what the resources are out there.

Alexa Terry: Something that I found quite useful, I took this from Sarah Joyce, who we've had on the podcast talking about pregnancy, actually, and she mentioned how she started her lessons with checking in with how many chips somebody has.

How many chips they're down or how many chips they're up. So I took that myself and now say to students, you know, out of 10, if 10 is bouncing off the walls and one is not feeling so great, where would you say you are? And sometimes they'll say I'm a three and then you'll know that, okay, the session maybe needs to be adapted.

We might just do a little bit more breathing in the warmup. We might not explore too many things. We'll just focus on one thing, so that you can. have an idea of where they're at without them feeling like they have to elaborate. And I feel that can kind of work very [00:22:00] well for someone who isn't a therapist and isn't trained in anything else like counseling or hypnotherapy or anything like that.

Line Hilton: That's great advice. Yeah. The breathing thing is very easy for anyone to do. And if anyone's into yoga or any of the mindfulness, there's also a

variety of apps out there. I often recommend inside timer. There's also Calm, there's lots of websites where you can go., to get advice and it might even be that say someone's in a very acute situation, maybe they need to call the Samaritans. Cause they're obviously well trained and will be able to direct the person on. If it's just a matter of haven't had a really good week, there's been some kind of event that's occurred that's maybe thrown them off for that week, but it's not anything serious , finding things that they enjoy doing. It might be just sitting and listening to certain music or sitting and [00:23:00] watching their favourite artists performing together. Or it might be actually doing rhythm work instead of singing. If they're not feeling like singing or , maybe there's a lot of tension around their throat. There's lots of different things that you can be doing. And I love the one that you're talking about where you do breathing exercises. You might do various physical stretches as well to help release tension.

Alexa Terry: The work we do as singing teachers is kind of keeping us on the cusp of performing arts medicine anyway, with our questioning and all of the considerations that we make with mental health, nutrition, whilst keeping in our lane. But for those who are interested in pursuing a path, in Performing Arts Medicine a little bit more exclusively. You've mentioned BAPAM, but where else could they look?

Line Hilton: Well, I know that UCL have developed some other postgrad courses for people who might be interested in it, but may not have qualifications or clinical experience. So when I did my master's, you had to [00:24:00] either be in clinical practice or have had some kind of health professional training.

And so I was with physios, doctors, osteopaths,, et cetera. But then they realized that there were other people out there who just have an interest in it. And so. If you wanted to do something more formal, then, UCL is a place to go to and see what they've got available. There are some courses cropping up in the U. S. as well, but I would say that it's probably mainly the U. K. and the U. S. that have, specific performing arts medicine courses. Other than that, put in performing arts medicine in my country and just see what comes up. And it might be that you just encounter one person and I would connect with them and say, can I take you out for lunch? And can we have a chat about, what you do? So I better understand it, and see what kind of relationships you can form as a result, because it's quite [00:25:00] a niche field, and so if someone approaches you who's interested in what you're doing, most people will be very grateful for that.

PAMA also do conferences and do free educational videos and courses and webinars. So get onto their list. And beyond that, obviously BAST training because of me, you know, we'll always bring in people from outside that's one of the reasons that this podcast has such a wide variety of different guests,

because we're recognizing that all these people. are contributing to the health and well being of the singer.

Alexa Terry: You recently attended the Performing Arts Medicine Association event in London, so what emerging ideas in this field excite you?

Line Hilton: Well, it was exciting, first of all, to see 350 people in this one place who are interested in helping performers with their health and well being. A couple of [00:26:00] things came out, the recognition of hypermobility, and there's still a little bit more dance orientated, but there's starting to, be hints that maybe, you know, it's having an impact on the singer as well. it's a very difficult area to study in particular for voices, but at least it's getting acknowledged. The other thing which I found really quite enlightening was hearing medical people take a much more biopsychosocial approach to working with their performers and recognizing that, if you're wanting to do some kind of manual therapy or massage on the throat, and you have a very strong negative reaction from the patient, that there may be some sort of psychological, reason for that, and that needs to get attended to. Otherwise, maybe we're not going to be able to resolve or help that patient resolve their issue. Also the need for this multidisciplinary approach to the singer. And there were people [00:27:00] who were agreeing, you know, that this is necessary, that we can't just look at the singer In isolation of their voice , but everything else matters and counts. So there's definitely a stronger biopsychosocial approach, you know, pervading, I suppose, the field. It's still early days and I would like to see a lot more medical people attending, as in doctors. And I also would like to see a lot more performers coming out and talking about their experience, how they managed with whatever their medical conditions were, whether that was, you know, something they acquired or something that was genetic or, that they were born with. So that it can raise awareness amongst performers that These are very valid issues, and we need to think about how that impacts the singer and the [00:28:00] performer, but also to help the medical field understand better what's going on with the performer. So there's still work to be done, but it's definitely heading in the right direction. And there were many talks that I couldn't go to. Tended not to go to the ones related to dance or instrumentalists, but obviously singers will dance and will play an instrument, and so they're relevant. So maybe next time I'll be able to catch up on those things.

Alexa Terry: And somebody you connected with at the event is Genevieve Tawiah, a physiotherapist, who is actually coming onto the podcast next week. So keep your eyes peeled for that one. Line, thank you so much. What are the BAST updates? Anything to share with us?

Line Hilton: Well, the Foundation course has now successfully been transferred into an online self paced course, which is available for anybody who

would like to do the course either with or without a mentor. Also we've got [00:29:00] our new cohort starting in September. Of, teachers who want to do the level five course. So that's very exciting to know that there are people out there who really want to, to do that course. Yeah. So that's what we're focused on at the moment.

Alexa Terry: And where can people get signed up for the Foundation or for the Level 5?

Line Hilton: Well, if you haven't figured it out yet, listening to this podcast, we're BAST B A S T training.com and info@basttraining.com. If you've got any queries, sign up to our newsletter and we'll keep you updated with any special offers or changes or exciting news. And certainly with the weekly podcast. You can find us on social media. on YouTube and join our list.

Alexa Terry: Well Line, as always, it's been a pleasure.

Line Hilton: Thank you very much.