Since the start of 2021, a special program launched by the English National Opera (ENO) has been attracting extensive international attention. Called “Breathe,” the program brings the techniques of proper breathing and singing techniques to recovering COVID-19 patients who experience breathlessness and anxiety. While some patients recover sooner, others suffer from long-term issues, often referred to as “Long COVID.” The first of its kind, the ENO Breathe program has already benefited numerous participants through significant improvements in breathing, reduction of anxiety, and an increase in overall well-being. Spearheaded by ENO Baylis (ENO’s learning and participation arm), the program offers weekly group online sessions and digital resources for the participants and focuses on retraining the breath through singing.
The participants also learn exercises to practice by themselves, assisted by customized online resources. Many have expressed their gratitude, enthusiasm, and desire to integrate these exercises into their lives even after their participation in the program has come to an end. One participant, Richard, said: “Having been a part of ENO Breathe, I now have the confidence to quietly undertake the singing and breathing exercises on my own—which can only be a good thing for my long-term personal health.” Another participant, Jen, added: “I definitely know that during my day-to-day life, I’m calling upon things that I have done in the course. I’ve no doubt that ENO has been one of the causes of my progress over the last six weeks.” Participant Ludmila commented: “I never before had an experience like this. I didn’t think things like singing could help me with my breathing and improve my recovery from COVID, and it has really helped me emotionally and physically.”
Director of Baylis Jenny Mollica has been leading ENO’s work on the strategic design and development of ENO Breathe in collaboration with Imperial College Healthcare Trust. As creative director of ENO Breathe, educator and singing specialist Suzi Zumpe designed session content and resources for the program and leads some of the groups. Ms. Mollica and Ms. Zumpe generously took time out of their busy schedules to offer our CS readers some insights into the program and their work.
Ms. Mollica, how did the idea for the ENO Breathe program come about?
Jenny Mollica: Last June, we were having conversations with doctors and medics about the type of role that the ENO could play to support the health and well-being of communities. At that same time, the phenomenon of Long COVID was really becoming recognized as a significant issue here in the UK. As we talked to doctors about some of those key symptoms associated with Long COVID—breathlessness and associated anxiety—it became clear to us very quickly that the ENO might have a useful skillset to offer to that problem.
Opera is rooted in breath. Breathing well is at the heart of good vocal production, and opera singers spend a lot of time training their bodies to serve their voices in order to fill a big building with their voice without amplification. So, we had a hypothesis that, potentially, we could utilize our skills and expertise as an opera company to help support COVID recovery.
It was at that juncture that we were introduced to Dr. Sarah Elkin, respiratory consultant at Imperial College Healthcare Trust in London, and we also approached vocal specialist Suzi Zumpe (who has a long-standing association with our learning and participation program at ENO as an educator and singing specialist). Bringing together the medical expertise of Sarah and her team of respiratory physios at Imperial and the musical and learning expertise of Suzi and the ENO, we collaborated to codesign and codevelop a six-week online program of breathing retraining through singing, called ENO Breathe.
Following a successful trial in autumn 2020, we moved to a national rollout of ENO Breathe in January 2021 and are currently working with 30 healthcare trusts across the country, with the aim to reach 1,000 patients by this autumn.
What are your responsibilities in overseeing the ENO Breathe program?
JM: I am responsible for leading the strategic design and development of the ENO Breathe program, in close collaboration with our partners, Imperial College Healthcare Trust. This includes developing our national partnerships, overseeing the research and evaluation of the program and its risk management, managing the program’s resources, leading the project delivery team, supporting with fundraising and advocacy, and ensuring that the ENO Breathe program remains true to its aims, purpose and objectives.
An integral part to your mission as director of the Baylis program is to make opera accessible to all. Would you say that the success of the Breathe program might contribute to that mission? If those who participate and those who hear about this program realize how therapeutic music and singing are and, as a result, they connect these discoveries to ENO, do you think that this might encourage them to see an opera, even if they know nothing about it and have never even thought of giving it a chance?
JM: In short…yes, absolutely! Whilst ENO Breathe’s primary objective is to support people back to wellness post COVID, we recognize that a beautiful secondary outcome of the program is that many of our participants develop a love of music and singing and, in many instances, participants feel a deep sense of connection to the ENO as a result of taking part in the program.
This is particularly important for our Learning and Participation work, which is rooted in a deeply held belief that opera is for everyone. Ultimately, we want the ENO to matter to people—and a program like ENO Breathe enables us to make a difference and build new connections with people. Connections that, we hope, are the beginning of a lifelong relationship with the ENO.
Ms. Zumpe, how do you get someone who never sang to understand and practice breathing and singing exercises?
Suzi Zumpe: Just like thinking about posture, it is so easy to get in a tangle with regards to breathing. Thinking about breathing is like trying to catch a butterfly: as soon as you bring your attention to it, it is very tempting to change what you are doing. For that reason, trying to catch yourself doing it well—or, indeed, trying to be aware of how you breathe at all—is tricky. We begin by thinking about and bringing an awareness to posture and by noticing and checking in about how breathing feels.
ENO Breathe is not about teaching a people a new way of breathing; rather, we bring awareness to what is currently happening and try to help participants to get rid of unhelpful habits. These are often things that were coping mechanisms when they were unwell, but that have stuck around even though they are no longer useful. And the trouble with habits is that once you have grown used to them, building awareness of them is not straightforward.
As imagery and emotional connections are essential in your work, how do you employ them here?
SZ: We use lots of different approaches, but our goal is broadly the same: to bring awareness to posture and breath, help promote diaphragmatic involvement, reduce accessory muscle involvement, elongate the exhale relative to the inhale, build sensory connection with good breathing, and essentially help people to get out of their own way. There are some specific tools and exercises that are especially helpful for managing moments of profound breathlessness, and panic associated with breathlessness, so those can feel like a real lifeline for people. But more generally, engaging with images and emotions gives you lots of physical benefits for free.
One of my favorite images to use is to imagine yourself standing at a shoreline and allow your breathing to follow the in and out of the waves, being aware that you are observing the waves rather than making them. This helps slow breathing down and makes one less tempted to “muscle” the air. The sea is always moving and doesn’t need our help to do so—this can be helpful in connection with breathing as it helps to get rid of extraneous effort.
What has surprised you the most in teaching breathing and singing techniques to the participants?
SZ: I am happy to report that although many people feel a strong conviction (in the abstract) that singing is not for them, the reality is often far less scary and a lot more fun than they anticipated. It is such a connecting thing to do—to come together with people facing similar difficulties and together to focus on breathing and to sing together. ENO Breathe is experiential rather than intellectual, and I am struck by the power of music to connect us and by the openness and willingness of our participants.
I feel enormously privileged to have the opportunity to build this program, to collaborate with an interdisciplinary team including respiratory experts, and to make a contribution to people’s ability to manage their symptoms. Hearing some of the positive changes reported by our cohort is just wonderful.
Why do you choose lullabies for the participants to sing? And do they have any favorites?
SZ: Lullabies are some of my most favorite music—it’s impossible to resist lullabies like “Gently, little boat” from The Rake’s Progress when a jewel-like oasis of calm is juxtaposed with tremendous turmoil.
Traditional lullabies are disarmingly simple and often blend our need for the calm tranquility of sleep with dreams and hopes for the future. They are the very music of safety and their purpose is to soothe.
Two lullabies that are particular participant favorites are “Summertime” from Gershwin’s Porgy and Bess and “The Slumber Boat” (aka “Baby’s Boat’s the Silver Moon”), a lullaby from the early 1900s by Jessie Gaynor and Alice Riley. It has a beautiful lilting tune and is about a baby sailing over the sea of sleep—but whilst enticing the baby to sleep, the singer also entreats the baby not to forget to sail home again.
There is a bargain of trust being made between singer and listener—a mother might dearly long for her baby to go to sleep, only to feel an overwhelming urge to wake them once they finally succumb to checking they are still breathing. All of this feels both soothing and poignant in the context of ENO Breathe.
For additional information about the ENO Breathe program, visit eno.org/eno-breathe/about-the-eno-breathe-programme