Learning to Exhale

Alyssa Wohlfahrt, A13Tisch Scholar Alyssa Wohlfahrt, A13, is helping elementary school students with emotional and behavior disorders reduce their stress and anxiety, and succeed at school and at home.  Working with Dr. Naomi Steiner, a developmental-behavioral pediatrician at the Floating Hospital for Children and director of the Center for Mind-Body Pediatric Research at Tufts Medical Center, the Calm Breathing and Relaxation Project is helping to improve medical understanding and treatment of children with these difficulties.

Wohlfahrt and Steiner have partnered with the Josiah Quincy Elementary School in Boston’s Chinatown.  Twice each week Wohlfahrt and fellow Tisch Scholar Craig Cooper, A15, joined by Steiner’s head research assistant, Elizabeth Frenette, A09, MPH11, visit the school and work with groups of five students for thirty minutes.

“We’re teaching them how to breathe calmly,” said Wohlfahrt, “that means deep breaths in through the nose, and out slowly from the mouth.  There are a lot of issues around anger, so we work with the kids to get them stop and breathe before reacting when they start to feel upset.  We help them reflect about when it’s a good time to use these techniques in their daily lives, which can be anything from during a test to when they might feel themselves getting mad at a classmate or family member.”

The need for these kinds of interventions is growing according to Steiner.  There has been a dramatic rise in the number of children diagnosed with psychiatric conditions, which are exacerbated by stress and often include anxiety.  The corresponding increase in the use of medications has also generated concern, and mind/body techniques can be both an alternative to and supplement of pharmacology.

“We’re supporting kids who already have a lot of difficulties,” said Steiner.  “These are skills that can belong to them, and they can use whenever they need them in the long term.  Feeling knowledgeable and like they have some control is very powerful for children.”

“It’s also very powerful to have Scholars like Alyssa and Craig as models in the school,” Steiner continued.  “It’s a live demonstration that the community cares about these students, and the kids see that.  Working with Tisch Scholars is special, and this project is a great marriage of teaching and learning – the Tufts students are the guiding lights, but they are reflecting on and observing their own actions.  To me, that is active citizenship, and I see it in Alyssa all the time.  She’s made so many stellar suggestions.  It was her idea to increase the frequency of the sessions to twice a week, because she saw that the students would benefit from more time.  On an individual level too, she is tracking their trajectory, and making adjustments that are going to benefit these kids.”

Through this project, Wohlfahrt and Cooper are also learning innovative biofeedback techniques.  Wohlfahrt leads exercises, like having the students breathe into a balloon so they can see the volume of their breaths, and blow bubbles to practice slow and sustained exhales.  She also teaches the kids to use a handheld device for measuring pulse and breathing called a StressEraser.

“The StressEraser has a digital display, so you can see how your breathing and pulse rate are changing,” explained Wohlfahrt.  “It helps you figure out what your optimal exhale is, and it awards you points for long slow breaths and helps you adjust your breathing.  Students see this as a game, the more points you get the better you do; for us as researchers, it gives us a quantifiable way to track student progress over time.”

Stories play an important part in spurring discussions and helping the students feel connected.  Wohlfahrt says Alexander and the Terrible, Horrible, No Good, Very Bad Day by Judith Viorst is a favorite.  Students do activities that relate to the books, such as making a meditation jar like the one in Moody Cow Meditates by Kerry Lee MacLean.

“It’s sort of like a snow globe,” said Wohlfahrt.  “The angry thoughts are the sparkles, and no matter how much you stir them up, they will settle down – if you stop shaking them.”

Visualization exercises are also effective, like the one called Special Place.

“Students imagine a special place, where they feel calm, safe, happy, and relaxed,” explained Wohlfahrt.  “This can be anywhere they want: their room, the beach, even a made-up place. Candy Land is a favorite, and so are amusement parks. They picture this place in their mind and summon how they feel when they are there.  Then they tuck away those good calm feelings so they’ll be able to remember them whenever they want.”

A pre-med student, Wohlfahrt is preparing for a career as a physician and hopes to become a pediatric surgeon.  She credits the child development course Pediatric Psychology, one of the many courses on Tisch College’s Active Citizenship in the Curriculum course list, with helping her see the connection between the classroom and professional practice.

“I think medicine is a way to directly affect a person’s life,” she said, “and that one-on-one connection really appeals to me.  I see being a doctor as a way to be an active citizen, an involved and committed member of the community.”