Can a classroom program that teaches kids to be resilient and equips them with skills such as mindfulness help them feel better, do better and ultimately experience better health? Even at a young age?
That's a question Catherine Knier is aiming to answer through a research study with third graders in Rochester.
Knier received her Ph.D. in the Medical Scientist Training Program at Mayo Clinic Graduate School of Biomedical Sciences and is continuing her M.D. training. She is among several researchers across Mayo Clinic who are studying the connection between resiliency and overall health and well-being.
"I approach this concept as a well-being to wellness continuum," Knier says. "Well-being involves practicing skills to manage emotions and treat ourselves kindly. Wellness is our health and our health outcomes, involving clinical measures like depressive symptoms. It's not like we're going to eliminate mental illness by teaching kids resilience, but maybe if we provide them with certain skills, we'll prevent clinical disease from emerging or reduce the severity of symptoms."
Clinicians agree that well-being affects all types of health, but little is known about how the areas are interconnected.
"It's a much-needed area of research that's still largely undefined at this point," says Christopher Pierret, Ph.D., a Mayo Clinic molecular biologist and Knier's mentor.
The idea to bring well-being training to classrooms stretches back more than a decade.
Since 2009, Mayo's educational outreach program InSciEd Out, launched in partnership with the Center for Clinical and Translational Sciences, has focused on increasing science literacy in underserved schools by offering authentic science experiences in K-12 classrooms.
The program began in Rochester, Minnesota, and now reaches classrooms in Florida, Illinois, Puerto Rico, Ghana and India.
InSciEd Out organizers also were interested in addressing health equity, says Dr. Pierret, who coordinates the program.
Working with Mayo pediatricians, the team drafted a list of health topics that could be woven into a classroom lesson. Several elementary classroom teachers were particularly interested in addressing students' mental health needs. Working with Amit Sood, M.D., who, at that time was a Mayo physician developing a mindfulness and resilience program for children, the team began to offer schools an optional resilience program in tandem with the science program.
But the team also committed to studying resilience training.
Amid the stress of the pandemic, Dr. Pierret's research team found resilience training improved students' perceived happiness and anxiety levels, and decreased stress. Students also showed improved scientific skills, as measured by a scale known as the Capacities and Research Appraisal Inventory, Dr. Pierret says.
Knier's research builds on Dr. Pierret's previous work.
When she approached a Rochester school with her proposal, she received enthusiastic responses from third-grade teachers. Four teachers joined her pilot study and were trained to teach resilience techniques.
"They'd seen behavioral issues among students and thought a program might be helpful," Knier says.
Teaching children mindfulness is one component of resilience training.
"Mindfulness is a way of building positive emotions to respond to a stressful event," she explains.
One lesson focuses on breathing. Students trace the shape of a star, inhaling and exhaling all during the exercise. Another lesson addresses feelings. Students learn to reframe negative events — for example, rethinking why they got a bad grade on a test instead of blaming themselves for personal flaws.
"The exercises develop the skill of self-compassion, speaking kindly to yourself, which is associated with decreased depression and anxiety," Knier says.
The teachers were receptive to the idea of studying the effects of resilience training on the students, she says.
Surveys in the pilot study showed strong improvement in students' self-compassion and positive emotions. Knier and a research team are now conducting a controlled trial with four schools and 14 classrooms. The team includes another graduate student interested in well-being research and a Mayo staff member with a background in epidemiology and data analysis. Eventually, they aim to add studies of health metrics such as cortisol levels and brain patterns, creating links from well-being to signs of wellness.
Other studies are showing that resilience training may help kids make smart health decisions.
As part of her graduate research in Clinical and Translational Sciences, Joanna Yang Yowler, Ph.D., studied the addition of a mental health module in a Rochester alternative middle school where truancy, trauma in students, and other issues were prevalent.
"We aimed to encourage students to discuss mental health, combating the stigma and changing their conversations with adults and with each other," Dr. Yang Yowler says.
She found the students receptive and that the module increased their knowledge about mental health, as well as their willingness to seek help when needed.
As a Mayo postdoctoral research fellow, Dr. Yang Yowler introduced the InSciEd Out program to underserved area schools near Mayo Clinic in Florida. In a second-grade class exploring habitats, students observed zebrafish in a tank and participated in discussions about the difference between "surviving" and "thriving."
As students brainstormed how a zebrafish's life could be enhanced, they discussed their own lives and what could help them succeed.
"That's a creative way of approaching well-being inside the classroom," says Dr. Yang Yowler, who now works with a nonprofit, advancing science, technology, engineering and mathematics (STEM) education. "A student who deeply considers these issues may feel empowered to make healthier choices in their life."
Dr. Pierret says initial data suggest that the programs have increased teachers' health literacy and understanding of mental health issues.
Learning resilience skills also may help students' academic achievement.
In Arizona, another Mayo team — including Camila de Avila, Ph.D., who was recently a postdoctoral fellow in neuroscience, and others — thought well-being might be a helpful addition to Mayo's ongoing work with undergraduates at Diné College in Tsaile, Arizona. The faculty at Diné College, which serves a predominantly Navajo student population, aimed to expand the undergraduate cancer biology curriculum. But they also were interested in providing a mental health component, particularly to help students at risk of dropping out.
The collaborative plan was to offer undergraduate students a summer program where they could do research with Mayo scientists and learn mindfulness strategies such as transcendental meditation, a technique practiced in the Navajo Nation.
Students reported that the program helped students handle emotions such as anxiety that can be disruptive to their ability to focus on their education. It also helped them feel supported as they considered career goals in medicine and the sciences.
The team will continue to evaluate the program, including dropout rates, reported sleep patterns and the students' perception of stress.
"The impact of COVID-19 on children's health, particularly mental health, is not going away anytime soon," Dr. Schimmenti says. "Studies that address the impact and investigate well-being will follow this generation for the rest of their lives."
The field also can have positive effects on researchers.
"Through this work, I've definitely learned skills to be kinder to myself and to understand setbacks differently," Knier says.
The Graduate School of Biomedical Sciences is considering incorporating a resilience component into a foundational course for first-year Ph.D. students.
Dr. Pierret says future steps would involve gathering data on any new resilience component to understand its effectiveness and to determine whether it's the right addition to help set students up for successful careers.
A version of this article was originally published on the Mayo Clinic College of Medicine and Science news blog.
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