Shape Your Life: Final Report
Introduction
Shape Your Life (SYL) is a trauma-informed, non-contact boxing program for cis and trans women who have experienced gender-based violence. Since 2007, SYL has used trauma-informed approaches to reconfigure recreational boxing into a non-contact form, so that it plays an important role in the lives of women recovering from intimate partner and other forms of violence. In twelve years, over 1800 people have participated in SYL.
The goal of this project was to expand understanding of the mental and physical health outcomes for female survivors of domestic violence in the Shape Your Life project.
The following outcome-oriented research questions were assessed primarily through quantitative approaches, including self-report measures and objective indicators of program use:
- Does the SYL program lead to improvements in physical and mental health and quality of life (primary outcomes)?
- Does the SYL program lead to increases in measures of social support, self-esteem, resilience, physical self-efficacy, and personal and interpersonal agency (secondary outcomes)?
- Does the SYL program lead to decreases in financial strain (secondary outcome)?
- What is the implementation profile of participants in SYL (demographic information, # of sessions attended, referrals to community partners, and other indictors of program use)?
Additional process-oriented research questions were addressed through qualitative approaches, including interviews and focus groups. These included determining the acceptability of SYL for both the deliverers of the program (e.g., coach, assistant coaches, and project coordinator) and the participants. In other words, how did SYL staff and participants regard the suitability of the program including satisfaction, intention to continue, perceived positive or negative effects of SYL, safety, ability to complete measures, etc. We also asked participants, including those who discontinued attending, about any barriers to participation in SYL.
Funding for this project has been made possible through a contribution from the Public Health Agency of Canada, as well as in-kind contributions from Brock University and Opportunity For Advancement.
The Public Health Agency of Canada provided $420,536 from April 1, 2016 to March 31, 2019 through the Supporting the Health of Survivors of Family violence investment.
Background
Leading trauma researchers, Judith Herman (1997) and Bessel van der Kolk (2014), have documented that trauma is held in the body. Recovery from violence and trauma requires being able to feel in charge of your own body, in all its visceral dimensions. Too often women do not have access to physical, body-based experiences that directly contradict the immobilization, helplessness, collapse, or rage they experienced and continue to experience as part of their trauma (Van Der Kolk 2014). While there is no single approach to recover from trauma, women are most often directed towards talk-based therapy or pharmaceutical interventions, where they are medicated to address a range of physical and psychological symptoms (insomnia, anxiety, hyperarousal, depression, nightmares, etc.). Effective treatment and healing from violence and trauma has to engage with the whole person, including getting in touch with their (often dissociated) bodies. To recover from violence, abuse and trauma, the body has to be experienced as a source of pleasure and comfort (Van Der Kolk 2014).
Shape Your Life (SYL) is a unique program that is based on the premise that people who have experienced violence need to have physical experiences to help restore a visceral sense of control. SYL is trauma-informed, which means that we facilitate safety, and provide opportunities for participant control and choice. SYL coaches, and all SYL staff, received training in trauma-informed approaches, so they can better understand how trauma and violence can impact the lives of participants. Prior program evaluations and qualitative research with participants illustrated the beneficial impact of SYL in the lives of survivors of violence. The funding for this project enabled us to expand our program and measure the mental and physical health outcomes experienced by participants in Shape Your Life.
SYL participants join the program through self-referral (i.e., simply contacting the project coordinator on their own and registering for the program) or they were referred by an agency (for example, a community health centre, a social worker, addictions therapist, mental health worker, etc.).
Key activities and outputs
A total of six 14-week SYL sessions were offered over three years. All SYL classes were held on Sundays between 1:00 – 6:00 pm. The three year SYL program was delivered at a Toronto boxing gym to an audience of 225 participants, who ranged in age from 17 to 66 years old. The average age of a SYL participant was 35.3 years. SYL engaged a diverse group of participants, and ensured that participants of diverse ethno racial, dis/ability, sexual orientation, and economic backgrounds were included.
- To facilitate the delivery of the program, and to further train and support coaches and staff doing trauma-informed work, the first hour of programming (1:00 – 2:00 pm) was a weekly staff meeting. This also allowed us to meet with coaches and the SYL Project Coordinator to review programming for the session and to discuss if any further supports were needed for any participants (or coaches). It also gave us time to ensure that the gym was cleaned, organized, and ready for SYL programming.
- The SYL intervention took place Sundays 2:00 – 3:30 pm. In addition to boxing, participants had access to transit tokens, childcare (if needed), food and refreshments (which always were available for participants to help themselves to at any time during the session), and the support of a Project Coordinator, who could assist with coordinating additional social supports as needed. The very first class of each session was an introductory session where no boxing or physical activity took place. The initial class was used to familiarize participants with the space/gym, introduce the coaches and all the SYL staff, cover ground rules, and answer any questions about SYL and the intervention research. This also enabled us to obtain informed consent, followed by filling out the surveys/questionnaires that took, on average, 20-25 minutes to complete. In subsequent weeks, the specific boxing activities varied in each class. Classes began with a 5-10 minute warm up, led by one coach while another coach provided alternatives for anyone who choose different, self-guided or an adapted/modified warm up. This was followed by a progression of boxing activities done in small groups (for example, shadow boxing, pad work/punch mitts, heavy bags, and circuits). A group cool down was scheduled for the last 10 minutes of structured activity, followed by the sharing of refreshments and food.
- A SYL Grad Class ran each Sunday 3:45 – 5:00 pm. This provided SYL participants who had already been in the 14-week program with continued access to the gym, SYL resources, and enabled us to maintain engagement with participants on an on-going basis. Trauma-informed restorative yoga (for SYL grads who have already completed the intervention research) was held Sundays 5:00 – 6:00 pm. Participants in the SYL Grad Class could choose to attend the boxing session, or join yoga, or both. SYL Yoga was led by a certified instructor who was also trained in trauma-informed yoga.
SYL Partners: Brock University (the lead agency) partnered with a Toronto-based social service organization, Opportunity For Advancement, to deliver SYL. SYL also requires a physical setting/location to create a program perceived as safe and welcoming to survivors of violence. We rented space at a commercial boxing gym/fitness facility, Bloor Street Boxing and Fitness in Toronto, to deliver SYL programming. One key learning was to continually reflect on and improve service delivery to meet the changing needs of participants. For example, the boxing gym was located on the second floor of a commercial fitness facility. We hired a SYL staff person to “greet” participants as they entered the gym. This ensured participants were welcomed as soon as they entered a busy, and a potentially unfamiliar, space. This ‘greeting’ was particularly helpful for participants who were struggling with anxiety or depression. It also gave participants time to connect with program staff, further develop rapport, and gave them another opportunity to connect and ask for any supports, if they needed. It also enabled us to check in with participants as they left the program to ensure they were ‘grounded’ prior to leaving. In addition, having a SYL staff person at the entrance to the boxing facility also prevented non-SYL participants from walking into the space during programming, helping participants feel safe and protected while in SYL.
Several research and knowledge dissemination activities were undertaken, including conference presentations, research publications, trauma-informed coaching workshops, and teaching resources that are available through the SYL webpage: or through contacting the project lead, Dr. Cathy van Ingen [cathy.vaningen@brocku.ca]. In addition, a spoken word piece called “Shape Me” based on interviews with SYL participants and Dr. van Ingen, was written and performed by Nari (a SYL coach).
Project outcomes
The research results (qualitative and quantitative) documented improvements in participants mental and physical health over the 14-week SYL program. A single group, repeated measures design was implemented for the quantitative measures. Specifically, these measures were assessed at 3 time points during the SYL intervention: baseline (pre-intervention), at week 7-8 (mid-intervention) and at program end (post-intervention). Qualitative outcomes were assessed using focus groups (mid-intervention) and in-depth interviews (post-intervention). Below are the combined quantitative results from the six 14-week SYL sessions:
Shape Your Life – results combined (April 2016 – March 2019)
|
|
Time 1 Mean (SD) |
Time 2 Mean (SD) |
Time 3 |
|
Interpersonal relationships – support* |
44.58 (11.64) |
47.61 (10.47) |
49.47 (10.33) |
|
Financial strain |
31.86 (5.98) |
32.73 (6.17) |
32.90 (6.42) |
|
Personal agency* |
3.07 (.50) |
3.23 (.42) |
3.32 (.47) |
|
Interpersonal agency* |
2.84 (.56) |
3.04 (.59) |
3.06 (.56) |
|
Perceived physical ability* |
32.79 (9.18) |
36.09 (8.17) |
38.91 (7.55) |
|
Self-esteem* |
11.95 (6.07) |
14.64 (5.79) |
15.98 (5.49) |
|
Resilience* |
110.97 (23.31) |
122.35 (18.95) |
128.85 (18.43) |
|
SF12 – Physical health* |
44.53 (11.11) |
46.13 (9.91) |
48.52 (11.00) |
|
SF12 – Mental health* |
29.63 (10.32) |
37.38 (12.15) |
38.10 (12.28) |
|
QoL – physical health* |
11.91 (2.86) |
13.13 (2.54) |
13.52 (2.75) |
|
QoL – psychological health* |
10.08 (2.85) |
11.88 (2.92) |
12.25 (2.69) |
|
QoL – social relationships* |
10.12 (3.98) |
11.60 (3.82) |
12.09 (3.53) |
|
QoL – environmental* |
11.88 (3.09) |
13.32 (2.92) |
13.62 (2.83) |
|
Notes. N = 56 participants, *p < .05. It is also important to note that the participants who completed each of the three surveys over the 14-week program most often had completed either a college or university level education. Participants who had not completed high school or college were less likely to engage with the surveys. In addition, some participants found the questionnaires difficult or upsetting and declined to participate in that aspect of the research. |
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Overall, significant improvements were found in all mental and physical health indicators measured, except for financial strain. A reduction in financial strain was not a goal of SYL, and while the program did offer transit tokens, there was no other financial aid offered directly to members of the program.
The results demonstrate that social support significantly increased from the beginning to the end of the program. Program attendees may have found support by other program members and the staff, thereby explaining their perceived improvement in social support. Self-esteem, which is considered a component of self-concept and is understood as an individual’s set of thoughts and feelings about his or her own worth and importance, significantly increased from the beginning of the program to the midpoint, and from the beginning to the end of the program. This means in as little as 8 weeks, their attitudes about their own self-worth and importance improved and sustained to the end of the program. Another important finding was that resilience, understood as inner strength, competence, optimism, flexibility, and the ability to cope effectively when faced with adversity, and perceived physical ability, were both found to significantly improve throughout the 14-week program (i.e., from baseline to the midpoint, baseline to conclusion, and midpoint to conclusion). Thus, increases in both existed in as little as 8 weeks and continued to improve throughout the program. Personal agency, which is one’s perception that they can achieve a desired outcome through their own efforts, and interpersonal agency, which is the perception that they can achieve a desired outcome with help from others, both demonstrated significant improvements in 8 weeks. For both constructs, significant changes were found from baseline to the midpoint assessment and these improvements sustained by the end of the program. Furthermore, self-perceived physical health increased significantly from the beginning of the program to the end; moreover, self-perceived mental health (a more malleable construct than physical health) improved in as early as 8 weeks and this change sustained to the conclusion of the program. Lastly, for each domain of the quality of life scale (i.e., physical, psychological, social, and environmental), there were significant increases in each aspect in as little as 8 weeks. All domains demonstrated improvement from baseline to the midpoint, and these changes were sustained to the conclusion of the program.
The qualitative research (focus groups and individual interviews) involved asking participants to describe their experiences in SYL. Participants were never asked about their experiences with violence, rather the questions focused on SYL and the affect boxing had in their lives. Many participants reported that, because of their experiences with violence, they often felt chronically unsafe in their own bodies, but that boxing was a way for them to reconnect with themselves and other survivors, and to feel safety, pleasure, and strength in their bodies. This was an important aspect of the research and provided the necessary space for participants to articulate, in their own words, their experiences.
The SYL staff had several significant learnings about the use of trauma and violence informed approaches to support survivors of family violence. One key learning is that survivors of violence often experience extreme disconnection from the body. In fact, disconnection is “the essence of trauma” (Van Der Kolk, 2014). Yet, trauma survivors cannot recover until they become familiar with and befriend the sensations in their bodies. Dissociation can occur in a number of ways and is a process of being disconnected from the present. It can include feeling removed from one’s thoughts, feelings, memories, or a sense of identity. It can occur when someone “blanks out,” feels nothing, or has a blank stare. There were some SYL participants who had been diagnosed with dissociative identity disorder. Given this, and that physical self-awareness is an important way to recover from dissociation, it is increasingly important to train staff to recognize and respond to dissociation in participants.
Next steps
SYL has continued to offer weekly programming to cis and trans women in Toronto. We are now offering 10-week sessions, and continue to maintain a waiting list of individuals. We are also working to support other organizations who are wanting to develop new audiences for Shape Your Life. To that end, we are currently working with two public schools in Toronto (West Hill Public and Lester B. Pearson Collegiate Institute), and we have trained coaches and supported the development of Niagara’s first Shape Your Life program. We are also working with organizations in England, Scotland, and Australia to develop programs based on the SYL model. In the future, we will work to continue to expand SYL with new community partners to broader audiences in regions across Canada.
