Boabom: A Feasible and Acceptable Approach to Helping College Students Manage Stress

Abstract

Objective:

College students in the United States report high rates of psychological health concerns. Psychological and physical complementary health approaches have been found to be protective for college students. The aims of this study were to assess the feasibility and acceptability of Boabom, a martial art, with college students and to explore any changes in psychosocial outcomes.

Participants:

Twenty-six college students (25 females; mean age 21.73 years) participated in an 8-week Boabom intervention.

Methods:

Feasibility measures were attendance and retention of participants; acceptability was based on participants' cognitive and emotional responses to Boabom and was determined through analysis of focus group data. Psychosocial outcomes were assessed through analyses of pre- and postintervention measures of mindfulness, perceived stress, anxiety, depression, resilience, perceived health, and life satisfaction.

Results:

The Boabom intervention was feasible as 23 of 26 participants attended at least six of eight classes, and 22 participants attended the last class. Students found the intervention acceptable, with three themes emerging from the focus group data to describe the participants' experience with Boabom: (1) disengaging from constant, daily stress and breathing and moving as a group leads to sense of calm, (2) empowerment through incremental mastery of skills, and (3) recognition of the value of health benefits to be gained. Participants reported positive changes in mindfulness, perceived stress, anxiety, depression, resilience, perceived health, and life satisfaction from pre- to postintervention.

Conclusions:

Boabom may be a feasible and acceptable offering for college students; still, further piloting with other college student populations is recommended.

Introduction

College is a period of growing independence for young adults in the United states, and a phase in which future patterns of adult health are established.¹ Unfortunately, many young adults find it difficult to adjust to this phase in their lives.² Psychological distress is common, with 35% of U.S. college students reporting that anxiety impacts their academic performance and 25% reporting that depression impacts their ability to perform well.² These psychological health concerns may be exacerbated by lack of social support, as over half of U.S. college students report feeling lonely, and around a third report feeling that they do not belong at their college.² Activities that can reduce stress and increase connection to others are needed to increase wellbeing and lay the groundwork for future health behaviors.

Psychological and physical complementary health approaches³ such as meditation, yoga, Tai Chi, and physical exercise are protective for college students. For example, mindfulness meditation teaches students how to spend less time worrying about the future and ruminating about the past by learning to focus on the present moment,⁴ and when students participate in mindfulness meditation programs, they experience less stress,⁵ anxiety,⁶ and depression.⁷ Meditative approaches that incorporate movement, such as yoga, Tai Chi, and qigong are also effective ways for managing symptoms of depression and anxiety,^8
–10 and practicing martial arts, in particular, have also been found to increase confidence.¹¹ Systematic reviews suggest that exercise alone increases wellbeing,¹² with exercising as part of a group being especially protective as experiencing movement together fosters a sense of connection.¹³ Taken together, meditation and movement-based complementary approaches, particularly when practiced as a group, can help students overwhelmed by stress, who are feeling isolated, anxious, and depressed.

Boabom is a relatively unknown martial art that may be well-suited to college students as it includes meditation and vigorous movement and is practiced in a group. Boabom originated in Ancient Tibet.¹⁴ The group practice incorporates breathwork, meditation, movement, and noncontact, noncompetitive self-defense. In 2000, the first formal school of Boabom was founded, the same year that the first book about Boabom was published (in Spanish, translated into English in 2003).¹⁴ Other books about Boabom have since been published.^15,16 Schools dedicated to the practice of Boabom are in the United States and in Chile, and students from around the world participate in Boabom classes offered online.¹⁷

Boabom has similarities to yoga and Tai Chi, but its combination of components makes it unique. Like yoga and Tai Chi, there is a focus on meditative breathing. Like Tai Chi, noncontact, noncompetitive self-defense is an important part of the practice. However, Boabom incorporates fast-paced physical activity, unlike the slower movement characteristic of Tai Chi and yoga. A more subtle but important differentiating factor is the focus on progressing as a group. While yoga and Tai Chi are often taught in groups, students start learning Boabom with other beginners, and a strong emphasis is put on incremental mastery of skills as a group.

Given the popularity¹⁸ and effectiveness^{4

–13} of other complementary psychological and physical health practices, there is reason to believe that Boabom's combination of features may also appeal to U.S. undergraduate students. The aim of this study was to evaluate Boabom for the first time. Specifically, the goals were (1) to assess the feasibility of offering Boabom to students on a college campus, and (2) to understand, from the perspective of college students, their experience of Boabom and whether it is acceptable, and (3) to explore changes in psychosocial outcomes from pre- to postintervention.

Method

Design

The study used a single-group design, as recommended by the National Center for Complementary and Integrative Health,¹⁹ and, as with other pilot tests of mind–body interventions,^20
–22 a mixed methods approach. Quantitative data (attendance, retention, and psychosocial measures) were used to assess feasibility and changes in psychosocial outcomes. Qualitative data, collected through two focus groups, were used to assess acceptability of Boabom and to explore students' experience of the practice. Any adverse events were recorded and handled in keeping with IRB procedures.

Participants

Twenty-six college students (25 females; mean [M] age 21.73) enrolled in the 8-week Boabom intervention. To be eligible to participate, students needed to be (1) 18–25 years old, (2) fulltime college students, and (3) available to attend one of two prescheduled weekly meeting times. Thirty-six students completed screening questionnaires. Twenty-six of these students were eligible, returned a signed consent form, and attended the first Boabom session. Three of these students did not attend the last session and complete the posttests so were not included in the analyses. (See Table 1 for descriptive information about the participants).

Table 1.

Participant Characteristics

Characteristic	Frequency	%
Gender
Male	1	3.8
Female	25	96.2
Race
Asian/Pacific Islander	4	15.4
Black/African American	2	7.7
White/Caucasian	18	69.2
Other	2	7.7
Ethnicity
Hispanic	4	15.4
Age (years)
M: 21.7
SD: 3.2

M, mean; SD, standard deviation.

The university Institutional Review Board approved the study.

Procedure

Students recruited for the study attended a college in the northeast of the United States that had a women's undergraduate program and a coed graduate program. The four methods used for recruitment were class announcements, emails, social media posts, and flyers distributed on campus.

Interested students emailed a study researcher who responded with screening questions and consent forms for those who screened in. Students completed psychosocial assessments immediately before and after the intervention. After the intervention, students were invited to attend one of two 60-min focus groups held on the college campus and led by a female investigator (E.D.). The focus groups were audiorecorded; two research assistants took notes and later transcribed the recordings. Participants received gift cards for completing the preintervention questionnaire ($20), postintervention questionnaire ($30), and for participating in a focus group ($50). The 8-week Boabom sessions ran from September 2019 to November 2019.

Intervention

The Boabom intervention consisted of eight, 1-h sessions created by a senior teacher of Boabom, and Director of a School of Boabom in Boston, MA. The Boabom teacher has taught courses and seminars throughout the United States, as well as in Europe, Asia, and South America and is the cotranslator and editor of books about Boabom.^14
–16 The goal of the intervention was to introduce students to the core components of Boabom practice (Table 2).

Table 2.

Description of 8-Week Boabom Curriculum

Week	Description
1	Introduction to BoabomBasic breathing techniqueIntroduction to warm-upsFundamental hand positionsFirst defense movements—armsFirst meditation technique
2	Continued development of warm-upsProgress with defense movements—armsFirst defense movements—steps and legsSecond meditation technique
3	Complete development of warm-upsProgress with defense movements—armsIntroduce basic coordinations: arms and steps
4	Progress with defense movements—arms and legsFurther development of coordinations: arms and steps
5	Progress with defense movements—arms and legsFurther development of coordinations: arms and stepsBasic defense coordination/reaction to being taken
6	Progress with defense movements—arms and legsFurther development of coordinations: arms and stepsPractice basic defense coordination/reaction to being takenBasic defense coordination/reaction to strike
7	Final progress with defense movements—arms and legsPractice basic defense coordination/reaction to being takenPractice defense coordination/reaction to strike
8	Review of defense techniques and coordinationsCompletion meditation and ceremony

Measures

As with other pilot studies of mind–body interventions to reduce stress, 75% attendance and 80% retention was established as a measure of feasibility.^20,22

The qualitative measure of acceptability was whether themes from the focus groups indicated acceptability of Boabom using Sekhon's definition of acceptability²³ (i.e., is Boabom appropriate for college students, based on anticipated or experienced cognitive and emotional responses?) Focus group guides were developed by Author E.D., informed by Sekhon's²³ definition of acceptability (Table 3).

Table 3.

Focus Group Questions to Assess Acceptability of Boabom

IntroductionWhy did you decide to participate in the program?What did you expect Boabom to be like? Were you surprised by anything? Was it what you expected?Why did you stay with the program?Describing BoabomHow would you describe Boabom? What is it? How is it similar or different to other activities you have tried?How does the program compare to yoga?How does the program compare to Tai Chi?How does the program compare to a mindfulness/meditation class?How is it similar to other activities you have tried?What benefits (if any) does Boabom offer as compared to some of these other activities?Experience with BoabomTell me more about your experience in the program.What did you like best about the program?What did you like least about the program?Tell me about any benefits, if any, you gained from doing Boabom? Stress reduction? Mood? Energy? Physical fitness?What was the most valuable thing (if anything) that you learned from the program?What do you think could be improved?Is there anything else I should know?Offering Boabom in the futureIf boabom was offered at no cost on the campus, would you go? Why or why not?One of the goals of this study was to determine whether this program is a good fit for college students. Tell me about whether you think the program should be offered to other students? Why or why not? Are there any particular groups that could benefit? Are there some groups for whom boabom might be a better fit than yoga or tai chi or mindfulness? Are there some people that might be less likely to boabom this than yoga or tai chi or mindfulness?[If yes]Who should the program be offered to?When should the program be offered?Should the program be changed in any way?How should the program be offered?For credit?How should boabom be described to give a good understanding of what to expect?[If no]Why not?Overall, how could the program be improved?

Any pre- to postintervention changes in mindfulness, perceived stress, anxiety, depression, resilience, perceived health, and life satisfaction were assessed using the following measures:

Mindfulness

The Cognitive and Affective Mindfulness Scale—Revised²⁴ is a 12-item measure designed to capture a broad conceptualization of mindfulness. Participants respond on a Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). An example item is “I can accept things I cannot change.” Internal consistency is reported as acceptable (α = 0.76).²³ Cronbach's alpha was 0.81 in the current sample.

Perceived stress

Perceived stress was measured using the 10-item Perceived Stress Scale²⁵ where responses are indicated on a Likert scale ranging from 0 (Never) to 4 (Often). An example item is “In the last month, how often have you felt that things were going your way?” Reported reliability is 0.91 in community samples²⁴ and 0.89 in a college student sample.²⁶ Cronbach's alpha was 0.82 in the current sample.

Depression

The Short Mood and Feelings Questionnaire²⁷ is a self-report 13-item scale that assesses childhood and adolescent depression experienced in the past 2 weeks. Items are rated on a 3-point Likert scale (not true = 0; sometimes true = 1; true = 2). An example item is ‘I cried a lot’. Reliability has been reported as 0.85.²⁶ Cronbach's alpha was 0.85 in the current sample.

Anxiety

The Spielberger State-Trait Anxiety Inventory (STAI) short form²⁸ of the state scale of the Spielberger STAI²⁹ was used to measure anxiety. This short form has six items (e.g., “I am tense”) scored on a 1 (not at all) to 4 (very much) scale. Summary scores range from 6 to 24 with higher scores indicating higher anxiety. For the current sample, Cronbach's alpha was 0.89.

Resilience

The Brief Resilience Scale³⁰ is a self-report 6-item scale that assesses ability to recover from stress (e.g., “It is hard for me to snap back when something bad happens”). Items are scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Summary scores range from 6 to 30 with higher scores indicating higher resilience.³² Cronbach's alpha was 0.86 in the current sample.

Health

The 10-item PROMIS Global Health Scale v1.2³¹ measures an individual's generic rather than a disease-specific assessment of perceived health. Items are scored on a 1 (always/poor) to 5 (never/excellent) scales. Summary scores range from 5 to 25 with higher scores indicating better physical and mental health. Example items include (“In general, how would you rate your physical health?” and “How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?”). Cronbach's alpha was 0.88 in the current sample.

Life satisfaction

General Life Satisfaction³² was measured with the five-item, PROMIS General Life Satisfaction Short Form v1.0, self-report cognitive evaluation of life experiences and whether one likes his/her life or not. Items are scored on a 1 (strongly disagree) to 7 (strongly agree) scale. Summary scores range from 1 to 35 with higher scores indicating greater satisfaction with life. Example items include (“So far I have gotten the important things I want in life”). Cronbach's alpha was 0.83 in the current sample.

Data analysis

To assess feasibility, descriptive statistics (Ms, standard deviations [SDs], and frequencies) were used to calculate attendance and retention. To assess acceptability, three research team members (E.D., H.S., and B.E.) conducted qualitative analysis with focus group data, incorporating principles of the immersion–crystallization.³³ This inductive method involved independently reviewing the focus group transcripts, then discussing impressions together as a group to determine a broad set of codes which were then applied to the focus group transcripts in duplicate. The three members of the research team independently studied the quotes associated with each code, noting potential themes, and discussed their ideas over the course of several team meetings. Once the research team had agreed on the three main themes, they also came to consensus on subthemes. During group meetings, any discrepancies were resolved through discussion. To assess changes in psychosocial outcomes, paired-samples t-tests were conducted.

Results

Feasibility

According to the criteria (75% of participants attending six classes and 80% of participants attending the last class),^20,22 the program was considered feasible as 23 of 26 participants (88%) attended at least six of eight classes (M = 7.192, SD = 1.855), and 22 students (85%) attended the last class. Most participants (n = 19) attended every class, with only three students attending less than seven classes. Please see Figure 1 for individual attendance data.

FIG. 1.

Individual participants' attendance at weekly Boabom sessions.

No adverse events were recorded during the study period.

Acceptability

Three main themes emerged from the focus groups to describe the students' experience and acceptance of Boabom: (1) disengaging from constant, daily stress, and breathing and moving as a group leads to sense of calm, (2) empowerment through incremental mastery of skills, and (3) recognition of the value of health benefits to be gained.

Disengaging from constant, daily stress, and breathing and moving as a group leads to sense of calm

Most students welcomed the change in mood and energy that they experienced after practicing Boabom. Almost every participant described their lives as relentlessly stressful, and students commonly reported their appreciation for having a place where they focused so purposefully on their breath, and doing so while moving together as a group left them feeling calmer and more energized, qualitatively different from when they had entered the room.

Relentless stress

Almost every student described feeling under tremendous stress, for example,

I'm just in a stressful program at this school, and I had a lot of trouble last semester with stress and mental health stuff, and I figured it would probably carry over, and I'm also a senior this year, and just the stress.—Participant 06 Group 1

Attention to breathing during physical activity

When asked to describe the experience of Boabom, many participants emphasized the focus on breathing.

I didn't realize how key breathing was in the process…it helped me recenter myself and reground when I was feeling really overwhelmed.—Participant 12 Group 1

Many participants described that attention to breathing during physical activity suited them better than a still meditative practice.

Yoga is really hard for me, but I found that I was being physically active, breathing through that, I was able to kind of shut things off better.—Participant 10 Group 1

Synchrony with other students

Some participants described the positive, calming effect that resulted from creating a flow of movements in synchrony with other group members, for example:

We all did the motions as one; there would be ones where we were grounded and we were punching or kicking and it was all in unison, but even if we were moving forward, backwards, side to side it was all in sync with each other.—Participant 1 Group 2

Another student described:

There was something about doing the coordinated movements as a group that centered you—Participant 03 Group 2

Empowerment through incremental mastery of skills

A second, main theme was the sense of empowerment resulting from the combination of incremental mastery of skills and focus on self-defense.

Incremental building of skills

Many participants described a sense of accomplishment from mastering a complex sequence of movements over time, as one participant commented:

The way that he [Instructor] did it, moving from okay first this then do this, made people think like, okay I can do it, I believe that I can do it, and made getting the more synchronized and more advanced movements more doable—Participant 1 Group 2

Confidence through learning self-defense skills

Some participants described peace of mind and growing confidence from understanding more about how to defend oneself, as one person described:

I feel safer in a sense. I'm not saying that I could beat someone up or if someone tried to attack me that I'd completely get away but I think it is good to know in case you do ever get caught in like a bad situation, so I think it's empowering in the sense that you feel good that you or you feel confident that you could potentially protect yourself.—Participant 5 Group 1

Recognition of value of health benefits to be gained

Most students said that their motivation for participating in the study was to reduce stress as they felt overwhelmed by the demands of competitive, academic programs. Students described the positive health benefits they experienced, including feeling more relaxed and sleeping better, and they emphasized the need for more opportunities for mind–body activities on campus.

Relaxation

I was so much calmer by the end of the class. I have class for four hours before it. I would go in super stressed feeling like this isn't going to work and then by the end of it, I felt a lot better and kind of forgot everything that was happening with school and the outside world.—Participant 7 Group 1

Sleep quality

A few students described experiencing better sleep. As one student described:

It would help me fall asleep when I would do the thing that focused on the parts of our body [body scan]. If I couldn't fall asleep, I would be like I'm just going to lay here and do that and then I would go to sleep.—Participant 11 Group 1

Encouragement to offer mind–body activities on campus

One student described the need for colleges to address high levels of stress among college students:

I feel like that stress management isn't really talked about in a lot of classes, and not everyone knows how to regulate that and take care of themselves, and that aspect of life and I think [offering Boabom] could be helpful especially in college where you have to learn how to balance everything.—Participant 07 Group 2

Other students echoed the general need for stress management support, with one student describing one possible approach:

Even if this is one class that's offered as an elective or something like every few weeks it's a new topic so one or two weeks it's Boabom, two weeks after that it's yoga, so you get a taste of everything and ay the end you can be like “this is what I want to try doing in my own time—Participant 09 Group 2

Psychosocial outcomes

To assess any changes in psychosocial outcomes, paired-sample t-tests were used to compare perceived stress, anxiety, depression, mindfulness, resilience, perceived health status, and life satisfaction before and after the Boabom intervention. The t-tests were conducted with data collected from the 23 students who took both the pre- and posttests (three participants did not take the posttest). For all outcomes, students reported changes that were positive. As can be seen in Table 4, there was a significant decrease in perceived stress, anxiety, and depression, from pre to post 8-week Boabom intervention. Moreover, students also reported increased mindfulness, resilience, perceived health, and life satisfaction in pre/post changes over the 8-week intervention period. These improvements had a range of effect sizes. The effect size for perceived health and depression was small, whereas there were medium effect sizes for perceived stress, mindfulness, resilience, and life satisfaction. The effect size for the change in anxiety from pre to post 8-week intervention was large.

Table 4.

Psychosocial Outcomes Before and After the 8-Week Boabom Intervention

Psychosocial outcome	Pretest		Posttest		t(22)	p	Cohen's d
Psychosocial outcome	M	SD	M	SD	t(22)	p	Cohen's d
Perceived stress	20.044	4.676	17.261	5.496	4.667	0.000	0.547
Anxiety	13.696	3.831	9.348	3.069	6.546	0.000	1.260
Depression	7.435	5.044	5.739	4.535	2.500	0.020	0.354
Mindfulness	26.261	6.496	29.696	6.003	−3.409	0.003	0.550
Resilience	18.478	4.935	21.000	4.232	−3.695	0.001	0.550
Perceived health	35.130	5.763	36.696	6.190	−2.294	0.032	0.262
Life satisfaction	23.870	4.596	26.044	4.685	−2.926	0.008	0.468

M, mean; SD, standard deviation.

Discussion

For this first evaluation of Boabom, the main goal was to assess the feasibility and acceptability of offering the practice to U.S. college students, as they experience high rates of psychological health challenges, and other psychological and physical complementary approaches have been found to be helpful.^{4

–13} Boabom holds promise as a feasible and acceptable approach that may appeal to students to learn new skills to manage stress.

Students responded positively to Boabom. Importantly, most students attended all eight classes, which is encouraging given students' demanding schedules. As this was the first evaluation of Boabom, it is important to learn about students' impressions of the practice. Participants described the experience of incrementally mastering breathing-centered, physically complex routines, along with self-defense skills, to be calming but also empowering. This theme of increased self-confidence is consistent with findings from some Tai Chi interventions delivered to college students¹¹ and may be particularly relevant and important to further explore as, for most students,³⁴ the college years occur during emerging adulthood, and involve many changes, including navigating a new environment and developing independence from families.³⁵

During the focus groups, some students commented on the joy and satisfaction they derived from practicing together as a group. Indeed, a distinguishing feature of Boabom is not only performing movements in synchrony but also incrementally learning the sequence of movements as a group. The experience of increased mood while moving in synchrony with others has been described as collective joy³⁶ and is associated with social connectivity as well as other positive psychological outcomes.^37,38 Given the loneliness and isolation that college students report,² the potential for Boabom to build social connections is meaningful. When students feel more connected to their peers, and more supported by the people around them, their risk of anxiety and depression decreases.³⁹ Future evaluations of Boabom may include social connectedness or social support as an outcome measure to explore this theme further.

Results from the psychosocial assessments included in this study indicated that students felt less stress, anxiety, and symptoms of depression after the intervention and more mindful, resilient, healthy, and happy, contributing to the existing body of research on group exercise as a way to support college students.¹³

Limitations

The study has limitations. The small sample size and single-group design are fitting to address the goals of learning whether students would attend classes and believe the intervention to be suitable for college students.¹⁹ However, given that the sample size was mostly White, female, and the students were attending a college located in a city in the northeast of the United States, the findings cannot be generalized to students attending colleges in other parts of the United States. Without a control group, there is no way to know whether practicing Boabom for 8 weeks caused the improvements in psychosocial outcomes, or whether these findings are due to other factors. The positive changes from pre- to posttest can be understood only as a sign, and an efficacy study with a control group will provide a clearer understanding of any benefits of Boabom.

Implications

Given the mental health crises on U.S. college campuses,² the potential for Boabom to offer another approach to increase resilience and wellbeing is important. Regarding students, practicing Boabom may have the potential to help them learn valuable coping skills and feel connected to their peers; while from an administrative perspective, offering a range of psychological and physical complementary group practices that are low cost may reduce demand on college counseling centers and help to address students' concerns that health and wellbeing are not a priority at their college² and contribute to larger efforts to improve retention.⁴⁰

Future directions

In the shorter term, future directions for research may involve replicating the current study and refining the Boabom intervention. Understanding more about the appropriate number of sessions, frequency, and duration of a Boabom intervention; the ideal method of delivery (in person vs. online); and the participant population that is most responsive to Boabom will help to strengthen the knowledge base around Boabom.¹⁹

Conclusions

This is the first scientific evaluation of Boabom, and there is more to learn about potential benefits of the practice; however, results from this first study of feasibility and acceptability suggest that Boabom holds promise as an approach to reduce stress and increase wellbeing in U.S. college students.

Footnotes

Acknowledgment

The authors wish to thank Ben Kelley for his time and commitment to the study.

Authors' Contributions

E.D.: conceptualization, formal analysis, investigation, methodology, project administration, supervision, and writing—original draft. H.S.: data curation, formal analysis, investigation, and writing—review and editing. B.E.: data curation, formal analysis, investigation, and writing—review and editing.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was funded by startup funds provided by Simmons University to E.D.

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