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Boxing and Mindfulness Therapy (BAM-T)

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Summary

 

While just beginning, the BAM-T program could be a highly useful mechanism toward freeing clients troubled by anxiety and trauma. Because it is self-regulated in terms of accessing difficult feelings or memories, and empowering in a manifestly physical and assertive way, it might be more palatable to some client populations that feel challenged to express emotions, those that have deeply disempowering and traumatic experiences that bear reprocessing and those that have a negative impression of more conventional ‘talk’ or group therapies.

 

Boxing and Mindfulness Therapy (BAM-T) was developed by Paul Stubbs, LCSW as a method of trauma processing. With his previous career as an infantry officer in the Marine Corps, he saw the difficulty that many combat Veterans had in allowing expression of emotions. In finding a mechanism to access and discharge uncomfortable memories in a way that reinforces, not erodes, ego and sense of self-efficacy and identity, a novel trauma reprocessing approach emerged. 

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How BAM-T Began

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In October 2020, Stubbs initiated a movement-based, mindfulness-based, trauma-resolution and processing-focused therapy program at a residential addiction recovery facility. This was based on graduate school studies of Peter Levine’s Somatic Experiencing and Stephen Porges’ Polyvagal Theory. This program also draws from the writings of interpersonal neurobiology author Louis Cozolino, emotional processing theory, inhibitory learning models, and narrative therapy.

 

Academic References 

 

Ross Deuchar, Thomas Friis Søgaard, Torsten Kolind, Birgi@e Thylstrup & Liam Wells (2016) ‘When you're boxing you don't think so much’: pugilism, transitional masculinities and criminal desistance among young Danish gang members, Journal of Youth
Studies, 19:6, 725-742, DOI: 10.1080/13676261.2015.1098770

Tiredness, Negative Arousal, Relaxation, and Perceived Stress 

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Breedlove, S., Watson, N. (2013). Biological Psychology (Seventh Edition): An Introduction to Behavioral, Cognitive and Clinical Neuroscience. Sinauer Associates, Inc: Sunderland, MA.

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Colletti, M., (2019). “The Creation of Emotion: The Journey from Interoception to Embodied Self-Awareness.” Greenhouse Therapy Center: Pasadena, CA.

Cozolino, L., (2014). The Neuroscience of Human Relationships: Attachment and
Developing Social Brain; Second Edition. W.W. Norton & Company: New York.

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Porges, S. (2004). Neuroception: A Subconscious System for Detecting Threats and Safety Zero to Three, May, p. 19-24.

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Porges, S. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachement, Communication, Self-Regulation. W.W. Norton & Company: New York.
hophysiology.Self-Awareness.” 
Precursor Program to BAM-T

 

Participants at the residential addiction facility were presented with the option of joining a 6:00 AM workout. This workout consisted of an audio program focusing on boxing and kickboxing. Participants executed an audio program of throwing punches and knees with the instructor rotating among them with focus mitts to give them a live target and further demanding their attention. Each participant was provided mixed martial arts gloves to protect their hands. Through the course of approximately eight 3-minute rounds, with one minute rest, participants were asked to throw the combination indicated by the audio program. This equates to about 300 strikes per three minutes. After an initial warm-up, stretch and safety brief, clients received instruction on athletic breathing techniques. Over the course of 45-50 minutes, they performed the exercises, followed by a cool down and check out.

 

Prior to initiating the exercise, the program was explained and basic technique reviewed, with an emphasis on pacing and breathing. Group size varied from as few as two, to as many as twenty-one, with an optimal class size being approximately six to nine. This allowed for ample individual instruction with each participant. 

 

Participants had a wide gradient of age, fitness and experience with throwing punches. Some who had substantial injuries and limited range of motion could complete the workout with modifications, or even seated. For clients with a boxing background, more emphasis was placed on technique, such as rotation and retraction. If the client was sufficiently technical, the instructor either backed up or advanced toward the client to make them move their feet during and between combinations. This was intended to occupy as much of their awareness as possible. For participants with no boxing background, basic fundamentals were emphasized to include heel rotation, and clean lines within their punches, to both convey force and protect their hands. 

 

Benefits observed during the pilot program

 

Over the initial course of approximately 15 months, or 60 workouts, with an interim during which training was suspended because of considerations due to COVID-19, a number of trends emerged. While these are anecdotal reports and were not specifically measured, their occurrence across time with varied participant populations was consistent enough to indicate the possibility of a replicable positive effect.

 

Documentation took place in the form of attendance reports sent to the clinical director, and remarkable reactions were conveyed to the client’s individual therapist via email. Additionally, at weekly staff meetings, the clinical staff provided feedback if the client expressed an impression positive or negative about the workout.

 

The first and perhaps most obvious benefit of the pre-BAM-T program was the value of the workout itself. Because it is not steady-state cardiovascular exercise where the participant falls into a regular breathing rhythm and either pushes or does not push toward a higher percentage of maximum, close attention is required throughout. One participant who was an NCAA 10K runner on scholarship found the workout exceedingly difficult because she had no background in boxing, and tended to hold her breath during combinations. Exercise is a common component of addiction recovery, oxygenating the brain, and connecting the participants back into their body. With the bilateral movements required, very few participants completed the entire workout at a high intensity. Instead, they were required to attune and pace their efforts to improve physical regulation.

 

The second benefit of the pre-BAM-T program was related to the effects on participants of their relationship to their personal trauma experiences. Trauma experiences of participants were identified by the instructor in two ways: 1) by working with the participant individually; 2) by asking the participant’s therapist about their background. A signed Release of Information was secured before consulting with a participant’s therapist. One participant stated “You can’t think about anything else while you’re doing this.” Another said “That is the first time in years that I’ve been out of my own head.” Participant reports indicated catharsis, decreased somatic symptoms, and increased elevation of mood throughout the days on which the training was conducted, and often for days afterwards. Occasionally, but regularly, female and male clients that had survived sexual traumas directly displayed catharsis in the form of breaking down crying after the workout was complete. When this occurred, the instructor, also a licensed therapist, sat with them to ensure that they were stable and safe. Follow-up emails were sent to the participant’s primary therapist, with copies given to the Clinical Director. During these debriefs, one female client stated “You knocked something loose.” Upon exploration with this participant, she stated that “I finally feel like I’m fighting back.” Another female participant that had been sexually trafficked also broke down after the workout and stated to the therapist/instructor “Nobody’s ever going to treat me that way again.”

 

After substantial refinements, this became the basis for the BAM-T program. It now incorporates a deliberate check-in accessing an anxiety-producing memory before and after the exercise. While the initial program used by Stubbs was more geared toward the workout aspect and did not emphasize defensive moves, the BAM-T program now incorporates defensive moves and is less cardiovascularly demanding. 

 

Results

 

Results, so far, have been consistent reports of significantly diminished anxiety, stress, reactivity, and depression, and improved emotional regulation and sense of calm. There have been no reports of adverse effects, re-triggering or distress. As this is a new program, no claim is made that the results are definitive or more than anecdotal due to a limited sample size (~300+ participants). The usual progression is 7-10 boxing classes before moving to the intermediate level which incorporates kickboxing and 7-10 classes at that level before doing work on the advanced level using a force-measuring striking pad. At this level, the clients are challenged to physically and emotionally regulate by hitting the striking pad at a consistent force, further challenging their attunement and mindfulness. 

 

Similar to Eye Movement Desensitization and Reprocessing (EMDR) therapy, participants in BAM-T choose the memory or feeling with which to engage prior to the program and can choose whether they want to verbalize it. The treatment goal is to render a difficult or uncomfortable memory less intrusive or non-intrusive with the participant regulating the extent to which they engage with the memory to their tolerance.

 

This program can be conducted for macro benefit or targeted toward specific resolutions, such as for generalized anxiety or individual traumatic memories, one by one until the re-empowerment pathways outweigh the disempowering ones.

 

Safety Considerations

 

It is incumbent on the instructor to ensure that the participant is within both their physical limitations and individual window of affect tolerance during the workout and is not being re-traumatized. Even if they insist that they are not agitated, if their presentation indicates distress, the program is either modified or ceased for that participant. Participants are asked directly after the nature of the therapy is understood, if it is too uncomfortably similar to a traumatic event to be therapeutic for them. For example, if part of the participant’s trauma involves an attack coming from a particular side, that is incorporated into the workout itself to avoid re-traumatization. 

Difficult memories are then re-shaped with engaging and empowering exercises.

 

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