A Stress Management Curriculum for At-Risk Youth
Rollin, S. A., Arnold, A. R., Solomon, S., Rubin, R. I., Holland, J. L., Journal of Humanistic Counseling, Education and Development
Project KICK (Kids in Cooperation With Kids) is a delinquency prevention program for ut-risk youth that uses nontraditional approaches to stress management. Twelve African American children who were taught physical, cognitive, and experiential models of stress reduction and management reported that they enjoyed the program, and they demonstrated an increased ability to recognize and manage stress.
Children experience stress from numerous sources: self, others, and the environment. In this article, we discuss the need for stress reduction programs that are tailored to meet the needs of at-risk youth and provide an outline of a curriculum that can be implemented in a variety of settings. This curriculum provides youth with various methods for recognizing and moderating stress levels so that they become responsible agents for their own well-being. This proposed stress management curriculum is modeled after other stress management curricula that have been used with children (Rickard, 1994; Trotter, 1998). In particular, this program was developed for use with at-risk youth in a program called Project KICK (Kids In Cooperation With Kids).
Project KICK is a community-based drug prevention program that began in 1991 in a mid-sized southern city (Rollin, Rubin, Marcil, Ferullo, & Buncher, 1995). Youth who live in this area were considered to be at risk because, compared with youth in most other neighborhoods in the city where the research was conducted, they were overrepresented in the statistics dealing with involvement with law enforcement agencies because of violent crime, theft, and drug activity. Consequently, the majority of youth who participated in Project KICK had an increased risk of being influenced by these negative community forces.
Currently, Project KICK operates in public housing as an after school program. All of the youth and families being served through Project KICK are African American. The program uses a peer mentoring model to teach children the following Project Kick curricula units: Orientation and Rapport Building, Learning to Like Myself, Feelings, Drug Education/Awareness, Friendships, Trust, Peer Pressure, Basic Communication Skills, Anger Management, Conflict Resolution, and Problem Solving and Decision Making (Rollin et al., 2001). The Relaxation Unit was developed as an additional unit for the KICK curriculum as part of the health promotion emphasis. Its purpose was to provide the students with an array of preventive stress reduction techniques.
THE DAMAGING EFFECTS OF STRESS
How Stress Affects Youth
Stress affects people in a variety of ways, including emotionally, physically, and mentally. For children, excessive stress can interfere with their schoolwork and with peer, family, and interpersonal relationships (Paschall & Hubbard, 1998). During times of excessive and unmanageable stress, people, especially adolescents, respond with symptoms of anxiety, withdrawal, aggression, poor coping skills, drug and/or alcohol use and abuse, and physical illness (Rollin et al., 1995). In addition, obesity, cardiovascular problems, asthma, and hypertension are the most prevalent physical disorders for children and adolescents who deal with stress (Ewart & Kolodner, 1992; McQuaid et al., 2000).
African Americans and Stress
Project KICK operates at the Boys and Girls Club in a low-income public housing community and, therefore, serves a low socioeconomic status population. All of the members of the Boys and Girls Club, and subsequently the population used for the Stress Management program, are African American. Many of the stress-related diseases that have been found to affect children are endemic among disadvantaged individuals and certain racial subgroups, including African Americans. Social forces such as lack of resources, poverty, poor education, substandard housing, unemployment, racism, and environmental conditions diminish the quality of life in some African American communities (Bullard, 1992). These social forces place African Americans at a significant risk for poor health, higher incidence of mortality, and reduced life expectancy (Centers for Disease Control, 2001). Other risk factors prevalent in this population are the use of tobacco, alcohol, and nonprescribed psychotropics; poor nutrition; and susceptibility to sexually transmitted disease (Centers for Disease Control, 2000; Neighbors, Braithwaite, & Thompson, 1995; U.S. Department of Health and Human Services, 1998).
In particular, the African American population is at a high risk for many diseases, including diabetes, cardiovascular disease, hypertension, obesity, and asthma (Harris, 1990; Kirn, 1989; Persky et al., 1989). African Americans show a higher risk than other ethnic groups for many of these diseases. For example, the risk of African American adults developing Type 2 diabetes is twice that for their White counterparts. An ethnic disparity in the mortality rates attributed to cardiovascular disease has also been identified (Gillum, 1991).Moreover, childhood obesity is more prevalent among minority subgroups, such as African Americans, than it is in the general population.
Exercise as a Means of Reducing Stress
The Stress Management curriculum developed for Project KICK incorporates exercises from different disciplines, including Tai Chi and yoga. Tai Chi is a moderate form of exercise that has been shown to reduce tension, stress, depression, anger, fatigue, confusion and anxiety (Jin, 1989). Tai Chi decreases total mood disturbance and increases vigor, concentration, focus, and a sense of well-being (Sandlund & Norlander, 2000). Yoga has also been shown to have stress-reduction benefits. In particular, yoga has been shown to significantly reduce systolic blood pressure, hypertension, and stress and to increase well-being (Pandaya, Vyas, & Vyas, 1999; Scott, 1999). Tai Chi and yoga have also been used for the prevention of health-related problems.
All of the components of the Stress Management curriculum are similar to techniques that have been used in other stress-reduction programs for children, for example, Tai Chi, yoga, progressive muscle relaxation, creative visualization, guided imagery, cognitive skill development, and breathing methods (Angus, 1989; Koeppen, 1974; Smith & Womack, 1987; Trotter, 1998). Many stress-management programs use a single method or a combination of several methods. However, Project KICK is unique because it combines all of these stress-reducing techniques in a comprehensive program that is designed to target several aspects of stress management and well-being.
For this study, we hypothesized that when 7- to 15-year-old children are taught stress reduction skills, they will be able to apply the skills and concepts they learn to manage their own stress more effectively. This idea follows the model of childhood determination that states that physical activities and habits are learned early in the life cycle (Brady, 1998; Kenyon & McPherson, 1978). Furthermore, it was believed that, as research has shown for similar situations, the KICK participants would continue to implement the stress management skills later as adolescents and adults (Mihalik, O'Leary, McGuire, 1989). The program outlined in this article provides a paradigm that we have developed to enable the participants to recognize and control their stress and apply an appropriate skill that promotes well-being.
THE STRESS MANAGEMENT AND RELAXATION PROGRAM
The Stress Management unit was a 10-week program that was held for 1 hour twice a week. A pilot study explored the relationship between the stress management education program and the reported increases in awareness about stress and use of stress management techniques by the children.
These relaxation interventions were targeted to the children residing in the southeast neighborhood of a mid-sized southern city. Many of the participants were residing in or around the city's public housing. The primary method used to reach the children for this study was through their participation at the Boys and Girls Club located at the public housing facilities.
According to the Census Tracts 3, 10.01, and 10.02 (as cited in Rubin, 2001) regarding the Orange Avenue housing complex, 90% of heads of households were single parents, almost all were women. The racial make-up of this population was 99% African American, and the average income per household was $5,000 per year. Furthermore, there were 2.5 children per family unit (Rubin, 2001). This is in contrast to the rest of the county's demographics. Census reports showed that in the county surrounding the Boys and Girls Club, 29% of the population was African American, 8% of all families had only one parent in the household, and the average family income was $27,000 per year (U.S. Census Bureau, 2001).
The Stress Management and Relaxation Curriculum
The program has three main components: Part A, the Physical Approach; Part B, the Cognitive Approach; and Part C, the Experiential Approach. Because stress is multifaceted and can affect an individual physically, cognitively, and emotionally, these three approaches were chosen in an effort to present a holistic approach to stress management. The first component (Part A) emphasized a physical approach that combined movements from Tai Chi and Yoga. The second component (Part B) involved lectures and group discussions on cognitive--educational aspects of stress including recognition, application of physical techniques, and stress prevention. The third component (Part C) was experiential and used creative movement, guided visualization, and breathing techniques that are designed to lead the students toward a deeper state of mental and physical relaxation. Part A was taught twice a week for 30 minutes each session, and Part B and Part C were taught on alternating days of the week for 15 minutes each.
The physical component of the stress reduction program was designed to give the participants an array of movements that could be used to alleviate physical tension in most areas of the body and to increase body awareness. For Part A, a series of relaxing physical movements were taught to the children. Exercises were chosen to relieve muscular tension in each main body part. The areas of the body that were targeted were the head, neck, shoulders, chest, elbows, wrists, abdomen, spine, hips, knees, and ankles. Examples of these exercises are head and shoulder rolls, arm swings, headstands, leg stretches, and elements of a Tai Chi form. Each exercise was consistently repeated for each class session, with slight variations and increases in the level of difficulty of the exercises as the children gained proficiency in their practice. There were approximately 30 exercises used for this component that were modeled primarily after Chen style Tai Chi and Hatha yoga. For this program, exercises were performed more quickly than adults would perform them.
The cognitive component of the stress education program was designed to teach children the skills they need to understand, recognize, and manage stress and to build knowledge of how and when to use the stress-reduction skills. For Part B, a series of relaxation-related concepts were presented during each class. Different skills were targeted covering health, stress awareness, and stress reduction/prevention skill building.
Class introduction. For the first class, participants were provided with an introduction to abdominal breathing. The concept of lowering the breath to the abdomen, a practice vital for anxiety reduction, was introduced during the first class as an alternative to high, shallow chest breathing (Davis, Eshelman, & McKay, 2000; Fried, 2000). Abdominal breathing was reinforced frquently during the program.
Fruit day. The children affectionately referred to the second class as "fruit day." It included an introduction to a variety of different fruits, such as kiwi, red banana, papaya, mango, and blackberries. This exercise was designed to develop mental flexibility through the exploration of something that was new and unusual. Another aspect was the development of openness to healthy foods. The children appeared to be cautious when sampling the unusual foods. However, they found that they liked several of the fruits that seemed unappealing at first. The children would often ask for certain fruits as their incentive for that day.
Stress skit. The children performed the stress skit intervention on the third day as an introduction of the cognitive component of stress reduction. First, we asked the children, "What are some different forms of stress?" Responses were discussed, listed on a chalkboard, and divided into categories--physical, mental, or emotional. The children divided themselves into three groups, and each group brainstormed, developed, and acted out a skit related to their group's assigned form of stress. Each child in the group acted out a particular aspect of how they were affected by stress. For example, children in the "mental stress group" acted out a scenario in which one child was taking a test and the other children acted out the positive and negative self-talk of the test taker. In this way, rather than have all of the new information come from the teacher, older children who had a greater knowledge base and broader range of experience were able to teach the younger children. This interactive, nonpressured learning environment was frequently reproduced throughout the program.
Stress collage. In another activity, the children were asked to create a large "stress collage" by finding images in magazines that were either relaxing or stressful. The stressful and relaxing images were pasted on opposite sides of a large piece of construction paper to illustrate the contrast between the two states of being. The children chose images based on facial expressions, bodily postures, actions, and environments that they perceived as relaxing or stressful. Participants had an opportunity to view other's choices and discuss them as they worked.
Bodily responses to stress. As a way of discussing the physical aspect of stress, children were asked to share their knowledge of how the body responds to stress. The leaders then introduced the broad array of physical responses to stress that were not mentioned by the children. Some of the responses that were discussed included an upset stomach, rapid or shallow breathing, rapid heartbeat, feeling hot, headaches, increased or decreased appetite or sleep, insomnia, crying, and tightness in the throat or chest. On this day, the cognitive component, Part B, was taught before the physical component, Part A. Then, as each physical exercise was performed, the class discussed which physical stress symptoms a particular movement might help to alleviate. For example, when the class did the head-roll exercise, they were asked the question, "For what part of the body does this exercise work to release tension?"
Life events and stress. For the next class, participants completed the Coddington's Life Events Scale for Children (Coddington, 1984) as a means of understanding the variety of life events that cause stress. This measure examines changes in the life of the child and/or parent that have occurred within the past year that may cause distress or eustress (i.e., positive stress. Items cover issues such as the death of a parent, sibling, or grandparent; remarriage, divorce, or change in cohabitation of a parent; and personal achievements or setbacks. Each item is given a numerical weight depending on its severity.
The original questionnaire (Coddington, 1984) was retyped in a large format and handed out to the children. To protect the participants' privacy, they were asked to complete the measure but were told that it would not be scored or collected. The participants were encouraged not to share their answers with others. When they had completed the measure, children were told to follow the instructions given with the survey and to use the numbers to translate their experiences into a numeric value. This activity helped illustrate how different life events cause an increase in subjective levels of stress. Participants discussed the impact of multiple stressors as compared with the effect of a single stressful event. Each child was able to identify stressful events in his or her life.
Creative movement. As a means of developing an awareness of the mind--body connection, children were asked to simulate unique movements and expressions. Exercises required the participants to imagine as fully as posible that they were a variety of objects such as a hard rock, a sock, and a lava lamp. Various animals, such as a cat, dog, snake, and tiger, were acted out in different emotive states. The participants were asked to adopt postures, facial expressions, patterns of movement, and sounds to mentally and physically emulate the thing they were imagining. For example, when the children pretended that they were lava lamps, they moved around in a slow, flowing manner. These activities helped demonstrate that imagery and mental practice could be used to change physical levels of tension (Cratty, 1972; Humphrey, 1984).
Circle of emotions artwork. In another activity, children were introduced to "the circle of emotions" originated by Plutchik (1962). Plutchik described emotions as a complex sequence of events involving feelings, cognitions, impulse to actions, and overt behaviors designed to deal with the stimulus that causes change (Plutchik, 1962, 1997). The circle of emotions consists of primary emotions and secondary emotions.
Children were each given a pie-shaped piece of a circle on which one of the primary emotions had been written. Secondary emotions were distributed as pieces of a ring that fit around the circle created by the primary emotions. They were given watercolor paint and asked to paint on the pie piece, using whatever colors or patterns they thought represented their respective emotion. The pie pieces were then arranged and pasted on poster board with the pieces of the ring surrounding the circle, and the children discussed what they had done and why. This activity allowed participants to be exposed to and to recognize different feelings and emotions, to be aware that different people perceive each emotion differently, and to build experience practicing the skill of expressing one's emotions artistically.
The experiential component, Part C, of the stress-reduction program introduced the children to a number of techniques that were designed to guide the children into deeper states of relaxation. In these exercises, a leader described a process or a series of images to a group that was listening passively in a relaxed posture, usually lying down. There was a considerable evidence showing the effectiveness of using relaxation techniques, stress reduction techniques, and guided imagery to manage stress (Gibson & Heap, 1991; Hilgard & Hilgard, 1994; Yapko, 1990).
Basic progressive relaxation techniques were taught during the first class (Bernstein & Borkovec, 1973; Jacobson, 1938). These exercises required the person to become aware of various parts of his or her body, beginning with the head and working progressively through the body to the feet, with the intent of relaxing that body part. The students were also taught to focus their attention on their breathing and to relax different parts of their body (Hammond, 1990). The purpose of this was to show the students that they could use their breathing to put themselves in a relaxed and calm state.
During the next session of Part C, KICK staff adapted a script from Masters and Houston's (1972) self-exploration exercises. The script used guided imagery techniques that are appropriate for beginners. The script instructed the students to imagine going into a room that had no gravity, then to walk down the stairs that led to a cavern with a stream, where a boat was waiting. The students were told to imagine that the boat was taking them to the ocean where a ball of healing energy would appear and surround them. The students were next instructed to merge with the ball of energy that took them into outer space where they imagined merging with everything around them. Finally, the students were brought back into the boat where the ball of energy merged with the students.
The next relaxation session revolved around listening to music. Several music selections that represented different genres, such as New Age, classical, African, and jazz, were chosen to give participants a variety of experiences. Using the imagery explained earlier, the students were guided into a deep, meditative state. Once this was achieved, the music was played and the students were told to imagine different ways of experiencing the music. For example, they were asked to imagine what the music might taste like, smell like, look like, and feel like. They were asked to use all their senses, thereby exploring different ways to interpret and react to the music.
Throughout this program, these stress and relaxation techniques were used with the students in the hope that the students would realize that there are different ways of experiencing and dealing with stress. The students were taught that they had very powerful resources and ways of handling and dealing with stressful life events. Because it was understood that some of the participants might experience fear and anxiety in connection with some of these exercises, children were always given the opportunity to end their participation at any time.
The program consisted of 20 sessions. Of the 24 children who began the program and pretested, 12 completed the program and were posttested. Twelve Project KICK participants between the ages of 7 and 15 years, with a mean age of 11.08 years, consistently and voluntarily participated in the relaxation exercises twice a week following the regularly scheduled interventions. All of the participants were female. The average number of sessions the participants attended was 8.7. Approximately 30 more children participated transitionally, attending only a few classes; they were never preor posttested.
Twelve of the participants completed the pretesting and posttesting self-report qualitative measure. Two members of the Project KICK staff, both graduate students and coauthors of this article, administered pretests and posttests in a private testing room. The same members also scored and rated the results of the measures. Before testing, both raters conferred on what would be considered an appropriate response. The raters were trained in methods of nonbiased rating by university professors. Each rater scored the participants' responses independently and later came to a consensus on the participants' score.
The self-report measure consisted of four items: Item 1, "Please tell me what stress is"; Item 2, "How do you know if you are experiencing stress?"; Item 3, "What are some things that happen in your life that cause stress?"; and Item 4, "What kinds of things can you do if you are experiencing stress?" Posttest results indicated that there was an increase of correct responses to the questions. Of the 12 children posttested, 50% showed a positive increase of responses to Item 1, with answers such as when you are "angry," "when you put pressure on yourself," and "when you have a lot of stuff in your head." Item 2 showed a 33% positive increase of responses with typical answers such as "feel bad" or "feel weak," "can't concentrate," and you "get tired." Item 3 showed a 42% positive increase with responses such as "fights," when "someone dies," and when "taking a test." Item 4 also showed a 42% increase and had responses such as "talk to mom or friends," "lay down, close my eyes, and count to 10," "exercise," and "listen to music."
During the posttest self-report, the children were also asked which of the relaxation techniques they remembered. Responses included stretching, the headstand, the backbend, painting the pie chart of emotions, abdominal and deep breathing, and a facial massage. Overall, participants reported that they most enjoyed the experiential guided imagery, deep breathing, closing their eyes, and the headstand.
These comments indicated that the children were able to understand and retain some of the stress reduction techniques that had been taught. They were able to identify stressful situations and to give specific examples of how they would apply the techniques during a stressful situation. The students reported that they enjoyed these sessions and that they would come to future stress-reduction classes. Ten of the children reported that they had practiced the skills they had learned at home and that they had begun using and incorporating them in their everyday lives. In addition, after the relaxation program had been completed, 20 of the children expressed dissatisfaction that there was no class.
Because of changes within the Boys and Girls Club administrative structure, attendance at the Club, and, consequently, at the Relaxation program was dramatically reduced during the course of this curriculum. Although not all of the children who pretested were available for posttesting, there were many (18) participants who attended several classes but never participated in the pre- or posttesting. The environment at the Boys and Girls Club was not conducive to relaxation. There were occasional noise disturbances, and other children at the Club would walk in and out of the room. Ideally, we would have liked to hold the classes in a private room.
IMPLICATIONS FOR COUNSELORS
The exercises described here could easily be used in various settings, for example, schools, day care centers, and community-based programs. Because stress is a risk factor for a variety of disorders and disabilities that occur with children, adaptations of the program would be useful for children at most levels of physical, mental, and emotional ability. It is important for the participants to be able to identify sources of stress and then to have interventions to target the stress. These techniques could be added to current curriculums either as a complete unit by following the model presented here or by using individual exercises independently to target specific skill building.
Posttest results indicated that children ages 7 to 15 years are able to practice stress prevention skills and implement the stress reduction skills as needed. Posttesting shows that the program increased the children's understanding of stress and how it affected them. The children were able to identify events that caused stress and to cite examples of exercises and techniques that they could use to manage stress. For the posttest, children were able to give concrete answers that reflected the concepts that were taught in the stress management curriculum. The participants reported that they enjoyed the program and would attend the program again.
Project KICK staff noted that the children seemed to enjoy the program, and they also showed a great deal of enthusiasm for the opportunity to move in new ways. They struggled with their abundance of energy and with exercises that demanded that they cultivate slower movement, the use of new muscles, patience, and quietude. As the program progressed, participants seemed to be able to maintain increasing levels of focus and stamina and to reach deeper levels of relaxation. Children were aware of the date that the relaxation program would end because it was provided on the attendance board. In addition, verbal reminders were given for each class during the last 2 weeks of the program. After the class, the children asked if they could have a party to celebrate their achievements. Approximately 80% of the children approached the facilitators for weeks after the program ended, asking if they could do "yoga" again.
There is much opportunity for future research. Replication of this study with a large population is necessary to more accurately determine the program's efficacy. Longitudinal studies are necessary to investigate how well participants remember the skills they were taught, if they continue to apply them to real life situations after a program ends, and any long-term changes that resulted from the program.
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In life, no matter how tall your parents were, you still have to do your own growing.
--Henry Boye, Writer
S. A. Rollin, A. R. Arnold, S. Solomon, R. I. Rubin, and J. L. Holland, College of Education, Center for Educational Research and Policy Studies, Florida State University. Correspondence concerning this article should be addressed to S. A. Rollin, Florida State University, 236 Stone Building, Tallahassee, FL 32306 (e-mail: firstname.lastname@example.org).…
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Publication information: Article title: A Stress Management Curriculum for At-Risk Youth. Contributors: Rollin, S. A. - Author, Arnold, A. R. - Author, Solomon, S. - Author, Rubin, R. I. - Author, Holland, J. L. - Author. Journal title: Journal of Humanistic Counseling, Education and Development. Volume: 42. Issue: 1 Publication date: Spring 2003. Page number: 79+. © 2007 American Counseling Association. COPYRIGHT 2003 Gale Group.
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