Athlete+response+to+stress+and+chronic+injury

=** ATHLETE RESPONSE TO STRESS AND CHRONIC INJURY **=

Head injuries (concussions) in American football (see also links to other articles about football head injuries) [|New York Times article]



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Types of stress: Physical stress – pain Psychological stress- anxiety and fear that dreams are shattere Social stress- social isolation – no longer part of the team (links to sociocultural level of analysis)

Grief response model. Stages: 1. denial 2. anger 3. bargaining 4. depression 5. acceptance and reorganization

Evaluation of the model: It is intuitive Lacks empirical support from sport Relies on retrospective evidence Some psychologists claim that not all athletes go through all stages (links to cognitive level of analysis)

Stress is most probably a reason for sports injuries and slow recoveries from injury. In understanding the role of different stressors on an athlete, psychologists will be able to prevent negative behaviours and help to rehabilitate athletes who have suffered from injury.
 * // Stress-based model for injury //**

According to Finch et al. (1998), 20-30 per cent of total injuries in a population are related to sport - in spite of knowledge of the factors that influence the risk of injury. A large number of people practising sport are forced into a period of rehabilitation (estimated that annually, 3.5 million US children under the age of 14 are injured playing sports or participating in recreational activities (National Safe Kids Campaign 2004)). The number of adults similarly injured ranges from 3 to 17 million, depending on the level of injury considered. The cost of injury to society is considerable.

Athletes with higher stress levels experience more injuries than those with less stress in their lives. Stressors include:
 * high expectations from coaches and parents
 * financial problems
 * managing an academic schedule because of scholarship demands
 * balancing family life with a heavy practice schedule


 * //__﻿Types of stress __//**:
 * Physical stress = pain (biopsych)
 * Psychological stress = anxiety and fear that dreams are shattered (cognitive)
 * Social stress- social isolation = no longer part of the team (sociocultural)

It has also been found that other factors play a role in sport injury. Smith et al. (1990) carried out a study of 452 male and female high-school athletes which addressed the relationship between a number of factors, such as stressful life events, social support, coping skills, and the number of days when the participants could not take part in their sport because of injury. No correlation was found between the number or intensity of stressors and injury, but there was a higher injury rate in participants with **//low levels of social support and low coping skills//**. Ford et al. (2000) found that individuals who have **//low self-esteem or are pessimistic//** have higher levels of injury, which indicates that **//personality factors may play a role//**. A significant body of evidence supports the notion that **//stress can cause increased muscular tension, which disrupts coordination and increases the risk of injury.//**

Williams et al. (1991) argue that **//stress disrupts an athlete's attention by reducing peripheral attention//** (when athletes are stressed, they are less able to pay attention to what happens around them). For example, an athlete preparing for a competition fails to warm up properly because he is having problems with his girlfriend and this disrupts concentration. This is particularly problematic in most team sports, in which athletes must have complete access to the full field of view, and focus their vision on this view to forestall unwanted collisions with other participants or equipment. Under high stress conditions, athletes pay too much attention to what is going on in their own heads, and not enough attention to what is happening on the field of play. They also show **//slowed reaction time//**. Andersen and Williams (1999) measured changes in anxiety, visual perception, and reaction time during stress among 196 collegiate athletes participating in 10 sports. The athletes also completed measures of life events and social support at the beginning of the season. Measures of life-events stress, social support, perceptual changes, and changes in reaction time during stress were used as predictors of the number of injuries. For the entire sample, the only significant predictor of injury was negative life-events stress. Correlations were performed for those with least social support. Among this group, those individuals with, more negative life events and greater peripheral narrowing during stress incurred more injuries than those with the opposite profile.

Smith et al. (2000) argue that **//muscle tension can interfere with normal coordination and thus increase the chance of injury//**. For example, a highly stressed figure skater who becomes stressed during a difficult movement may experience muscular tension and fall.

Stress may also have an effect on how an **//athlete recovers from injury//**. Cramer et al. (2000) suggest that the **//body's natural healing process can be disrupted by high levels of depression and stress//**. **//Psychological stress increases glucocorticoids (stress hormones), which impair the movement of healing immune cells to the site of the injury and interfere with the removal of damaged tissue//**. Prolonged stress may also **//decrease the action of growth hormones, which are essential during the rebuilding process//**. Perna et al. (2003) found that stress **//causes sleep disturbances, which may interfere with the protein synthesis necessary for physiological recovery.//**


 * // Athlete response to injury //**
 * //Note: much of the section below is taken in large part from YOUR IB Psych Course Companion!//**

Rehabilitation personnel must have an understanding of how athletes respond to injury and rehabilitation when treating injured athletes. Though **//stress may be part of the cause of injury, it is also a result//**. Athletes experience physical stress (e.g. pain or physical inactivity), psychological stress (e.g. fear that their dreams are shattered, anxiety about letting down the team), and social stress (e.g. social isolation because they are not able to take part in team activity). How an athlete copes with these stressors resulting from injury is crucial to their rehabilitation. Two key models which describe how athletes respond to injury: the **//grief response//** and **//cognitive appraisal models//**.

//**Grief response model (Hardy and Grace 1990) **// Based on a stage model created by Kübler-Ross (1969), which she applied to coping with terminal illness = argues that an athlete goes through a series of stages before reaching a stage of acceptance, which then allows rehabilitation to occur. The stages are:
 * 1) denial - individual's inability to accept that he or she is really injured (may result in continued play and an underestimation of the seriousness of the injury
 * 2) anger - after acknowledgment, athlete realizes what this means for the season, or potentially for his or her career
 * 3) bargaining - deals that the athlete makes with himself or herself or a higher power—for example, "I will make sure I never do this again, as long as I get to play in the finals"
 * 4) depression - athlete understands the limitations that the injury will put on his or her performance in the future
 * 5) acceptance and reorganization - where coping with the injury begins

The grief response model is commonly accepted among coaches as an explanation of athletes' responses to injury. However, it is **//criticized//** on many levels = argued that it is flawed (lacks internal validity), considering that Kiibler-Ross's model was not intended to be representative of athletes' experiences with an athletic injury. Also, the model lacks empirical support; most evidence for the model is descriptive and anecdotal. Many of the studies carried out are retrospective, asking athletes to discuss how they felt as they went from the incident that caused injury to the diagnosis and through rehabilitation. The reliability of these testimonies in light of the model is rather questionable.

Brewer (1994) argues that many athletes show aspects of this model, though they do not follow a set pattern and not all stages are shown, and not always in the same sequence. Udry et al. (1997) stated that there is only provide support for the stage of 'denial', and no support for the 'bargaining' stage as a response to athletic injury. It has been theorized that athletes do not deny the existence of an injury, but are more likely to be attempting to make sense of it and determine its severity.

Psychological **//reactions to injury include cognitive and emotional factors//**. Petitpas and Danish (1995) suggested that **//identity loss may be important//** = if an athlete cannot participate because of injury, it may be experienced as a loss of personal identity, especially if the athlete has invested a lot of his/her identity in the sport. This loss of identity **//may seriously affect the athlete's self-concept in a negative way//**. Since the injured person cannot participate in training and competitions, this **//may result in a general lack of confidence//**. Some athletes may feel this as a loss in personal status and lose confidence in themselves. The **//result is perhaps decreased motivation, bad performance, and sometimes additional injuries, if the athlete tries to compensate//**. Some athletes also have problems acknowledging that they cannot perform in the same way as before the injury. A **//general feeling of fear and anxiety may result from not knowing whether they will recover completely//**, or from seeing others taking their place.

Evaluation of the model:
 * It is intuitive
 * Lacks empirical support from sport
 * Relies on retrospective evidence
 * Some psychologists claim that not all athletes go through all stages (cognitive level of analysis)

**//Udry et al. (1997)//** theorizes an **//information-processing model of injury response//** = takes emotional reactions into consideration.
 * // Cognitive appraisal models (Udry 1997, Wiese-Bjornstal 1998) //**
 * First stage,= information regarding the injury is processed = athlete focuses on information related to the pain, of the injury, how it happened, the negative consequences of the injury, and what rehabilitation will entail
 * Second stage = emotional upheaval and reactive behaviour; possibly expressions of anger and frustration. Wiese-Bjornstal et al. (1995) reported evidence that some athletes are said to have expressed relief from external pressures when injured (e.g. parents, coaches, teammates, perfectionism, and commitment). Some athletes also report an immense sense of loss when injured. Studies have revealed that a number of injured athletes, approximately 10-20 per cent, experience extreme responses to injury, particularly depression, which surpass levels usually recommended for clinical referral (Brewer 1995)
 * Third stage = developing a positive outlook and coping with the injury


 * //Wiese-Bjornstal (1998)//** proposed an **//alternative model of cognitive appraisal//**. Cognitive appraisals are processes through which a potentially stressful situation is assessed as being stressful, along with the individual's evaluation of the extent of that stress. Appraisals influence the way in which an individual copes with a stressful situation. Coping is defined as an individual's ever-changing efforts to manage circumstances that are appraised as stressful. Coping varies between individuals, depending on the circumstances, individual differences, and the individual's cognitive appraisals.

Cognitive appraisals are said to occur in two forms, primary and secondary appraisals: The appraisal process shapes the degree of perceived stress, and the content and strength of the emotional and behavioural, responses. Wiese-Bjornstal's model suggests that, dispositional and situational factors determine how an athlete appraises his or her injury. The appraisals subsequently affect emotional responses (e.g., anger, depression) and further influence behavioural responses (e.g., adherence to rehabilitation).  []
 * Primary appraisals involve assessment of what is at stake, taking into account challenge, benefit, threat, and harm, or loss
 * Secondary appraisals mirror primary appraisals and involve assessment of the coping options available to manage the demand

** Wiese-Bjornstal's cognitive appraisal model of response to injury ** ** [] ** ** [] ** ** [] **  Hardy (1992) reviewed the literature on psychological stress in sport to determine **//effects of stress on performance, vulnerability to injury, and rehabilitation from injury//** = found that the major sources <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">of stress reported include: <span style="color: black; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Additionally, Hardy found that **//research on the// //link between psychological stress and injury was limited//**, but the available literature suggests that **//techniques such as goal setting, imagery, and relaxation skills, which are used to enhance performance, can be used to reduce the risk of injury and promote faster recovery from injury.//**
 * <span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 10pt; text-align: left;">fear of failure
 * concerns about social evaluation of others (especially the coach)
 * <span style="color: black; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">lack of readiness to perform, and loss of internal control


 * //<span style="background-color: #ffff00; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Depression in athletes //**
 * //Note: ALSO use the information YOU find in the 'Abnormal Psych' unit for this aspect of sports psych!//**

<span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Kenny McKinley (depression) case study [] Depression among athletes goes unreported article [] <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Surfacing from depression article []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Depression is a psychological disorder that interferes with the physical and psychological well-being of an individual. **//Athletes are at risk for depression//** = **//high pressure sporting events, personal and team expectations and individual disposition may increase bouts of depression in susceptible athletes//**. Identification and treatment of depression in athletes helps relieve symptoms and decrease the depression.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">One in ten Americans experience depression, according to the National Institute of Health. Genetics and external stresses are common causes of depression. Regardless of how physically fit an athlete is, genetics or chemical imbalances may influence the development of depression. Sports may create a high pressure environment that focuses on winning and achieving progress. Setbacks, whether because of a loss or an injury, may challenge an athlete's esteem and feelings of self worth and contribute to the development of depression.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">**//Symptoms of depression//** include emotional withdrawal from friends and usual activities, moodiness, crying, changes in appetite and weight, feelings of anxiety and sadness, a decrease in sex drive and feelings of anger. Indecision, fatigue and a lack of concentration are additional symptoms of depression.

//**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Sports Environment & Depression **//<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">= categorized by society as physically and mentally fit and tough, athletes are represented as pillars of health and well-being in culture. Societal projections and expectations make it challenging for athletes to seek mental health help. According to Russ Johnson (former infielder for the Tampa Bay Devil Rays), physical ailments are tolerated in professional sports, while athletes with depression face stigmatization.

__//**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Post-Competition Depression **//__ <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Many athletes spend years preparing for a narrow window of opportunity--a college career, the Olympics or professional sports limited to certain ages. Intense preparation, daily practice and adjusting life to meet the sport's needs may dominate an athlete's life. After the particular event, an athlete may lose his sense of purpose and have a hard time reintegrating into a routine that does not focus solely on the sport. An athlete may experience depression if he is unprepared for the transition.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">[|http://www.livestrong.com/article/84436-depression-athletes/#ixzz19jnm20ve]
 * //<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Treatment //**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">= Education and providing mental health resources to athletes is imperative in preventing and treating depression. Familiarizing coaches, athletes and athletic staff with symptoms of depression will help identify athletes struggling with the mental health condition. Persons suffering with symptoms of depression should contact their doctor to discuss treatment. **//Cognitive behavioral treatment (CBT)//** is a form of therapy that helps athletes challenge and change negative thoughts and behaviors that contribute to their feelings of depression. Sports psychologists are aware of the emotional and physical challenges of athletes and specialize in treating athletes. Some athletes benefit from treatment that includes antidepressants, medications that increase serotonin levels in the body and alleviate symptoms of depression.

You can learn to turn off the physiology of stress through instruction in relaxation techniques. Some relaxation techniques work directly with the physiology of stress, such as learning to relax the muscles or breathe more slowly and deeply.
 * //<span style="background-color: #ffff00; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Reaction response to injury = relaxation techniques //**
 * //Note: YOU will never have to describe an actual relaxation technique (there are MANY) - the below is just so YOU understand what is involved when using a relaxation technique.//**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Exercise can also reduce the physiology of stress. Since the body is geared up for vigorous physical effort, exercise is a natural way to reduce that tension.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Other relaxation techniques work on a cognitive (thought) level, since it is the thought about what is happening that triggers the physiology of stress. Techniques include those that quiet the mind, such as <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">meditation, and techniques that replace negative, worry thoughts or images with positive thoughts and images.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Interrupting the stress response at any of these levels will cause the body to go into the opposite response, the relaxation response, with corresponding positive physiological and emotional changes. Learning relaxation techniques is relatively simple. Mastering these techniques for optimum benefit requires commitment and practice, much like an exercise fitness program. Most of us have forgotten how to deeply relax, and we must relearn this skill. It can be helpful to get coaching in these techniques from a trained professional through individual counseling or a group stress management program. **//Biofeedback//**, which provides direct, immediate information about physiology during relaxation practice, can be of significant benefit in learning relaxation skills.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">You can get started on your own by trying the following relaxation technique whenever you are feeling stressed: <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">1. Take a deep breath and let it out in a sigh. This slows and deepens your breathing. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">2. Focus your attention on your breath. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">3. On the inhalation, think the word "relax". <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">4. On the exhalation, think the words "let go". <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">5. Continue to focus on your breathing, inhale "relax", exhale "let go", and if your mind wanders, bring it back to the breath. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">6. This can be done for any length of time. Five minutes can make a significant difference in your stress level. For best results, 20 minutes twice a day is recommended. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Note: your mind will wander--that is the nature of the mind. You are training your mind in this exercise, so just gently bring your attention back to the breath as soon as you notice your mind has wandered. Do not try to change the breath, which can create tension. Just watch the breath going in and out of your body. This technique can be done with the eyes open or closed, but is easiest when done with the eyes closed. []