Mental Health Exam 1 - Study Guide

Injury Pain

occurrence of pain that signals actual or potential tissue damage

Persistent Pain

pain that meets the time frame defined as chronic but is actually a symptom of a treatable condition

Chronic Pain

pain that persists beyond the normal time expected for healing (typically a minimum of 3-6 months)

Pain threshold

point at which *pain begins to be felt*; an entirely subjective phenomenon

Pain sensation

stimulus is received by the nervous system (via nociceptors)

Primary Appraisal

Initial assessment of a situation to evaluate it as a threat or challenge

Malingering

Intentionally pretending to have or exaggerating physical or psychological symptoms, especially to avoid work or a return to participation

Risk Assessment Grid

Locates the likelihood of future harm if the athlete plays through their pain/injury and the severity of such harm Ex. An olympic cross country skier falls and breaks her ribs during the semifinal but was able to qualify for the finals. If she competes, the likelihood of harm is very high and the severity of harm would also be high - the broken ribs could move and puncture organs in the area, etc.

Different Athletes have different expectations of their AT. How are these expectations different with regard to gender, prior experience with ATs, and injury history?

Male athletes expect less overall from the AT; however, first-time injured males expect to be educated by their AT on elements related to their injury and recovery. Males are often less forthcoming about their pain when the AT is a woman. Females expect more overall from their AT, regardless of their experience with AT services; they also tend to covet more hands-ons, companionship-like traits in the rehab setting

Coping Skills

Mechanisms that promote the ability to cope with a stressor or situation; built from experience or learned

Psychological Skills

Mental skills, techniques by which the individual can use the mind to control the body or to create an outcome

Acute Pain

Pain of recent and sudden onset; typically high-intensity pain localized at or near the site of injury

Pain-Spasm Cycle

Pain that causes vasoconstriction and muscle spasm, which, in turn, causes more pain, which causes more muscle spasm, which exacerbates the cycle. Sometimes called the "Pain-spasm-pain cycle"

Secondary Appraisal

Secondary assessment of a situation, including assessment of available coping resources.

What are some methods an AT can use to measure adherence to home based activities?

Self-report (but they could be lying) Injury progression (everyone's different, different healing at different rates) Objective measures (harder for us to use, maybe use a pedometer, check medication, etc)

Sport Socioculture

Social and cultural climates, contexts, and structures that surround sport Influences sport injury risk, how athletes respond to and recover from injury, and how athletes determine when to return to participation. Ex. Athletes are bombarded with common locker room slogans that send distinct messages about what is expected and what it takes to succeed in sports. These slogans clearly indicate that there will be some pain involved in achieving athletic success, but true athletes will not let that or anything else stand in their way.

How does social support impact an athlete's ability to cope with an injury?

Social support includes the feeling or sense of being supported by others, the act of supporting others, and social integration. There is a positive relationship between the amount of an satisfaction with social support that one receives and that person's well being. Social support is believed to influence injury risk and rehab through a number of mechanisms - it is believed to provide protection or a buffering effect on stressors; this effect is believed to *decrease the strength of the stress response*, thus decreasing the associated cognitive, emotional, and behavioral responses. It may also provide benefits through the reduction of uncertainty.

Sport Ethic

Socially defined criteria for consideration as an athlete in competitive sports

Underconformer

Someone who is intolerant of or unable to identify "normal" pain. They will overreport injuries to the medical staff, fake injury to avoid strenuous workouts, and depend too much on athletic trainers. They are athletes who reject or dismiss the norms of the sport ethic (don't believe in the "no pain no gain" idea, etc)

Overcomformer

Someone who throws out concern for long-term health consequences. They disregard or ignore medical advice to rest for healing, they hide or don't report injury to the medical staff. It is an athlete who unconditionally accepts the norms of the sport ethic and follows them without reservation. These athletes also overadhere to rehab protocols (try to do more reps at home, etc) They may misuse/abuse pain meds to play through pain.

Sport norms

Standards, beliefs, or models considered to be normal in a sport setting (ie enforcer in hockey)

Adherence

behaviors an athlete demonstrates by pursuing a course of action that coincides with the recommendations of the AT and is aimed at recovery from injury

Antecedent

A preceding event or condition, or a preexisting factor

Hardiness

A stable personality trait composed of three components: perceived control over the situation, view of the situation as a challenge as opposed to a threat, and commitment to changing the situation

Personality

A stable trait of an individual's general emotional, behavioral, and attitudinal response patterns

Psychosocial Strategies

A term typically used to describe a range of psychosocial skills and techniques athletes can use to control their thoughts, emotions, and behaviors

Message

A thought, feeling, or idea that is conveyed to another person

Overadherence

The athlete doing more than the rehab program calls for

Psychosocial Techniques

Methods athletes can use to rehearse, improve, and maintain their psychological skills

Nociceptors

Sensory neurons that respond to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.

Benign Pain

Temporary occurrence of discomfort that is not associated with new tissue damage; characterized as dull and generalized with no swelling or localized tenderness

Underadherence

The athlete doing less than the rehab program calls for

Noise

Internal and external barriers that prevent effective delivery or receipt of communicated messages -Internal = originate within the individuals trying to communicate -External = barriers that exist outside the individuals

Self-Talk

Internal/external statements to the self, multidimensional in nature, that have interpretive elements associated with their content; dynamic and serves as instructional and motivational

Matching Hypothesis

Involves matching the available social support to the social support needs of the athlete; the social support the athlete needs matches what is being given to them (both in type of social support and the person giving it)

Pain-Management Imagery

Focuses attention on the target visual stimulus to produce specific images to promote pain-management strategies

Healing Imagery

Focusing attention on a target visual stimulus to produce a specific physiological change that can promote healing

Rehabilitation-process Imagery

Focusing attention on a target visual stimulus to produce specific images of different aspects of the rehab process

Define the matching hypothesis and describe how it relates to an athlete's perception of social support.

For social support to be effective, the support needs of the recipient must coincide with the support the provider is willing and able to provide. Without this match, the satisfaction with and effects of social support will likely be impaired.

Normative Behavior

Someone who understands good versus bad pain; they report pain appropriately and adhere to advice from medical practitioners (the majority of athlete's we'll see)

What are the 5 conflict management styles and how are they related to assertiveness and cooperation?

*Avoidance*: avoid conflict until tensions are cooler; this may be good when an athlete is first injured or when a coach is really pissed after losing a play-off game *Accommodation*: accommodating an athlete who can only come in at certain times; can drain the AT out if they are bending over backwards all the time *Compromise*: compromising on different types of rehab; not the best conflict management style because each person is losing out a little bit *Competing*: bad; ex. when an athlete is really hurt and you need to be assertive and do what's best for them regardless of what the coach wants *Collaboration*: best scenario, both parties cooperate and both get what they want

Pain perception

*conscious interpretation* of nociceptive stimulus as pain

Pain tolerance

the ability of the patient to withstand pain or painful stimuli for a period of time

Listening

Perception and understanding of auditory signals

What are some common athlete stressors and positive coping strategies to match these stressors?

*Academic Examinations* - organize class materials, set aside time for studying, make study guides, study in groups, communicate with professors, be positive with self talk *Chronic or severe injury* - communicate to establish roadblocks, set goals for recovery, act with behaviors to achieve these goals, reward daily achievements, and stay positive *Personal Relationships* - use communication skills, ask friends and family for advice, eat right, get plenty of sleep *Teammate Relationships* - clear the air, address the problem, open communication lines and alert the coaching staff if the issue involves violence or danger *Coach Relationships* - meet with them to express concerns, communicate about possible ways to solve the problem *Financial Concerns* - communicate with financial aid office, seek help from a social worker, establish a budget and act within the lines

Proxemics

*Communication expressed through the space between people* as they interact (where I'm standing in relation to you; like a teacher standing in the front of the class while the students are sitting - she has the power) ^Can be measured by the space or distance between people or the arrangement of objects in a room (boss sits behind a desk - implies power over other employees)

Give examples of nonverbal messages and how those messages may be interpreted.

*Crossing arms over chest* - defensiveness, boredom, disagreement, cod *Firm, positive handshake* - confidence *Smile* - happiness, warmth, acceptance *Looking at watch* - impatience, tardiness *Leaning back in chair* - relaxation, fatigue, disinterest *Leaning forward in chair* - interest, excitement *Furrowed brow*: confusion, concentration, anger *Eye contact*: interest, concern *Glazed or unfocused eyes* - overwhelm, daydreaming, fatigue *Fast, high-pitched voice* - excitement, nervousness, joy, anger *Slow, low-pitched voice*: calmness, fatigue, uncertainty

What are some interventions to overconformity behaviors?

*Education* -Talk to them about the meaning of pain, potential long-term consequences of playing thru injury. Learn about their beliefs and attitudes regarding playing through pain and educate them on support networks. *Identify possible sources of secondary gain* *Assure athlete's motives for participation are intrinsic* (and it's not their parent/coach pushing them to play thru pain) *Communication* -Clarify participation limits with coaches and athlete -Explain rationale for restrictions *Goal setting with appreciation for time urgency* -Safe benchmarks for return to play -"Bulls-eye" approach to rehab -Negotiate surgical schedules -Make sure the athlete doesn't try to do too much rehab *Decrease media glorification of playing through injury*

Types of Social Support

*Emotional Support* (listening support, emotional support, emotional challenge) *Information Support* (reality confirmation, task appreciation, and task challenge) *Tangible Support* (material assistance and personal assistance)

Give Examples of Emotional and Behavioral responses to stress that can increase risk for injury.

*Emotional*: frustration, depression, anxiety *Behavioral*: poor choices, sleeping difficulties, self-medication, poor rehab adherence

Healthy vs Unhealthy Coping Strategies

*Healthy* = relaxation, journaling, social support networks, deep breathing, meditating, listening to music *Unhealthy*= using/abusing alcohol, isolation, smoking, compulsive spending, violent behavior, binge eating/purging

Immediately after injury and throughout the rehab process - describe the type of social support that is most commonly needed and who can provide that social support.

*Immediately After*: Social support may buffer the associated stress of an athlete's response to injury or serve it directly as a coping resource. When the athlete may have much fear of the unknown and concerns about the future, an AT can serve as an *emotional challenge*. As an athlete demonstrates their anger and frustration, the AT can provide *listening support* and *emotional support*. *Early Rehab*: When pain & swelling are at their peak, so too is an athlete's stress level. If the athlete is struggling with stress-management, the AT can provide *task challenge* and *emotional support* if the athlete is feeling isolated from their teammates. Also, the AT can provide *tangible/material support* in the form of crutches, ice, and wraps. If athletes feel like their injury and rehab are out of their control, the AT can assist by providing *emotional challenge* and *task challenge* to help the athlete identify areas they are in control. *Mid Rehab*: AT should provide *task support* in the form of goal setting, which is crucial for the athlete's maintenance of rehab adherence. *Emotional support* may be the most important for athletes who have a long rehab ahead. *Late Rehab*: If an athlete has not reached their desired outcomes, the AT should provide *listening support* (as the athlete talks about their situation), *emotional support* (as the athlete shares feelings of frustration), *emotional challenge* (when exploring the obstacles that may be facing the athlete), and *task support* (that includes goal setting to help the athlete refocus and stay motivated to complete rehab, and to enhance self-efficacy).

Give examples of specific factors that increase or decrease adherence to rehabilitation. What are some personal and cognitive factors that increase adherence to rehabilitation?

*Injury Severity* - if the injury isn't severe, the athlete might not feel that rehab is necessary, whereas a more severe injury would make them want to stick to the rehab plan *Location of Injury* - a soccer play may not care if they have a shoulder injury because it doesn't affect their play; but if they had a knee injury, they would be more worried about rehabbing and getting back to play *Age* - older, more experienced athletes may be fine with rehabbing an injury, even if it means they are missing a few games because they've likely experienced injuries before and aren't worried about keeping a spot on the team; younger , newer athletes may be more worried about proving themselves and are less likely to rehab/report an injury *Life Stress* - an athlete might be too busy with school, sport, personal issues to seek treatment *Personal Factors*: tolerant of pain, motivated by the desire to improve rather than beat others, self-motivated, task involved, and tough minded (increased adherence to rehab) *Cognitive Factors* - they believe the treatment is effective, value their rehab highly, perceive their level of exertion as high during rehab activities, report experiencing few threats to their self-esteem, consider themselves as motivated largely by self-determination, identify stable and personally controllable factors as responsible for their recovery, express confidence in their ability to cope with their injuries, and complete their rehab program; also, those who indicate that they use the cognitive strategies of goal setting, positive self-talk, and imagery tend to achieve higher levels of sport injury rehab adherence

Give examples of Internal and External barriers acting as noise in a conversation.

*Internal*: fatigue, poor listening skills, poor attitude towards the sender, poor attitude towards the information, lack of interest in the message, fear, mistrust of sender, past experience with communication in similar situations, negative attitude, problems at home, lack of common experiences with the sender, cultural expectations, and emotions. *External*: physical noise, distractions, email/phone/internet not working, bad phone/skype connection, time of day (too early, too late), and language that is too technical.

Identify the different types of social support and examples of how an athletic trainer can provide this type of support.

*Listening Support*: AT actively listens to the athlete without giving advice or being judgmental *Emotional Support*: AT comforts the athlete and indicates he or she is on the athlete's side and cares about the athlete *Emotional Challenge*: AT challenges the athlete to evaluate his/her attitudes, values, and feelings *Reality Confirmation*: AT who is similar to athlete, or sees things the way the athlete does, helps to confirm the athlete's perceptions about and perspectives on the world, and helps the athlete keep things in focus *Task Appreciation*: AT acknowledges the athlete's efforts and expresses appreciation for the work the athlete has done *Task Challenge*: AT challenges the athlete's way of thinking about his/her activity to stretch, motivate, and lead the athlete to greater creativity, excitement, and involvement in that activity *Tangible/Material Assistance*: AT provides the athlete with products or equipment *Personal Assistance*: AT provides the athlete with services or help

Give specific examples of factors that affect the cognitive appraisal after injury. How does the cognitive appraisal affect the emotional response to injury?

*Personal Differences* (ie personality, scholarship opportunities, etc), *Situational/Environmental Factors* (preseason vs post, freshman vs senior, etc), and *Injury history/context* (1st time injured or 10th time). -If an athlete sees their injury as a threat, they will have a negative reaction to it and the stress could put them at risk for harm. If the athlete sees it as a challenge, they may have a positive stress reaction which could aid them in their rehab and return to play. *Side note*: It helps to have the AT talk to the athlete and try to incorporate helpful additions into the athlete's rehab. For example, if the athlete really misses the competitive atmosphere of their sport, the AT could try to incorporate competitions/games into the rehab program as much as possible. Or, if the athlete misses being around their teammates/the camaraderie, the AT can try and get the teammates to help with rehab or encourage the athlete to help the team out "behind the scenes".

When given a stressful situation in sport, what affects the primary appraisal and the secondary appraisal? What interventions can an athletic trainer use to influence the cognitive appraisal of the situation?

*Primary Appraisal*: when individuals encounter a stressful situation, they cognitively appraise whether they perceive it as a threat or a challenge (what does this stressor and/or situation mean? How can it influence me?). If you perceive the situation as a threat, you view it as something that will cause future harm. If you look at the situation as a challenge, you develop a positive stress response because you expect to work your way beyond that situation. *Secondary Appraisal*: if individuals appraise the situation as a threat, they next evaluate whether they have adequate resources to deal with the situation. Involves feelings related to dealing with stressors or the stress they produce. If an athlete determines the situation is threatening and they are not capable of handling it, then they have an increased stress response leading to an increased risk for injury. *Interventions*: ATs can develop a relationship with the athletes to open the line of communication between them, they can educate athletes on coping skills with the overall goal of decreasing risk for injury. Psychosocial strategies can also be used.

What are some barriers to rehabilitation adherence and specific strategies/techniques to overcome these barriers?

*Severity of injury* - if the injury isn't severe, the athlete may not take it seriously; to overcome this, the AT would want to educate the athlete about their injury and why rehab is necessary *Injury Characteristics* (ie an athlete has to wear a brace for physical activity and return to play) - the AT would educate the athlete on the purpose of the brace and possibly do some performance imagery *Biological Factors* (ie. the athlete is having trouble sleeping) - AT would educate the athlete on stress related to sleep, engage them in stress-management and relaxation techniques *Personal Beliefs about Injury* (the athlete thinks they are done for the season, unwilling to try rehab and get back) - the AT would communicate the "why" of the rehab *Time/Convenient Hours* - the AT would try to be flexible and schedule a time that is convenient for the athlete to come and rehab *Social* (athlete is withheld from practice/games, no time with teammates, pressure from coaches) - AT would try to include teammates in rehab, modify their workouts, educate the coaches and communicate with them about the athlete/injury *Sociodemographic* - make rehab more convenient/accessible

What are the 5 domains of post-traumatic growth?

*Social*: sense of closeness with others, having compassion for others, enhanced social resources *Cognitive*: feeling stronger and more self-assured, a better self-concept, improved problem-solving abilities *Spiritual*: having a better understanding of life, not sweating the small stuff, a change in life's priorities, increased appreciation of life and one's family *Emotional*: more relaxed, less demanding, greater compassion for the pain of others, better capacity to accept and express a range of emotions, a feeling of self-reliance (if I got through this, I can get through anything) *Personal*: changed lifestyle, learning more about healthy diet and exercise ^These are the *silver-linings* after a traumatic injury

What are three types of nociceptors that transmit pain signals?

*Thermoreceptors*: respond to changes in temperature *Chemoreceptors*: respond to chemical changes - activated by the presence of proinflammatory mediators or neurotransmitters *Mechanoreceptors*: respond to pressure or stretch

Paralanguage

*Vocal characteristics* associated with communication (tone, speed, volume of speech) Ex. expressing a verbal message in a fast, high-pitched voice can convey a message of anxiety, fear, or excitement. Speaking slowly can mean that you are bored or uncertain.

What are some challenges an AT may encounter in preserving the primacy of the patient? (putting the athlete's best interests above all)

-They may have strong emotional ties to the athletes and the team -Outside pressures (from the coaches, teammates, athletes themselves) -They are understaffed to provide coverage to all -There's a desire to please coaches -Concerns over personal reputation -Concerns over job security

3 Expectations that Athletes have of their Athletic Trainer in terms of Psychosocial Strategies

1. *Communication/Education* (before and after injury): Developing good communication with athletes before injuries is associated with earlier reporting of injuries; then, post-injury, it is important to communicate and educate the athlete on *what they injured, their physical limitations, and what they can do to speed up recovery* 2. *Motivation*: this involves the physical presence of the athletic trainer and/or the athletic trainer performing rehab with the patient; the AT should also *provide feedback* and *engage the athlete* in conversation as well as *set short-term goals* to help motivate the athlete and ensure they adhere to the rehab plan 3. *Atmosphere/Social Support*: the AT should provide a *supportive and inviting atmosphere* and help *foster the development of support structures* - including pairing athletes up with other injured athletes who may share common challenges

List/Describe 4 Types of Normative Behavior Regarding Sport Ethic

1. *Makes sacrifices for "the game"* - athletes are expected to have a devoted love for the game and prove it by making the sport the top priority in life; they are expected to display "proper attitude," show unwavering commitment, and face sports demands without question. 2. *Accept no obstacles in the pursuit of success* - they are told that dreams are always attainable when you never give in to the obstacles that stand in your way. 3. *Strive for distinction* - athletes are supposed to have an irrepressible desire to be the best and achieve the highest honors and they need to push the limits and do what it takes to be the best. 4. *Accept risks and play through pain* - true athletes should be willing to accept the risks that come with playing sports and dismiss any fear of them.

Evidence Based Practice

A methodology that combines clinical expertise and the best available systematic research evidence when making decisions about patient care

Cortisol

A naturally occurring stress hormone in the human body associated with the fight-or-flight response

Cognitive Relaxation

A relaxation method that includes *verbal and visual cues*, which lead individuals to a relaxing time and place (in their mind)

Feedback

A verbal or nonverbal response or reaction to a message received -The receiver gives feedback to the sender after decoding their message

What are some methods to improve listening and attending skills?

Focus your attention, maintain good eye contact, paraphrase (restate message back to sender to ensure full understanding), ask questions, and use empathy.

Compliance

An individual completing a required behavior

How does athletic identity affect the emotional response to injury?

Athletic identity is the degree to which an individual identifies with the athletic role. Individuals with strong athletic identity are those whose self-worth is tied closely to their identity as an athlete. When athletic ability is taken away b/c of injury, individuals with strong athletic identity may be unable to adjust to being injured. These people need extra attention from their athletic trainer to help them maintain their identity because there is a high correlation between individuals with high athletic identity and psychosocial distress following injury. These athletes tend to interpret injury in terms of its implications for athletic functioning and are more likely to experience emotional difficulties.

Extrinsic Motivation

Behavior that is driven by a desire to attain a specific outcome; motivation from an outside source -Athletes who sustain an injury during the off-season may need additional motivation strategies to keep them motivated at a time when the ability to compete is not within the short-term realm

Intrinsic Motivation

Behavior that is driven by an interest or enjoyment in the task itself (ie personal best) -An athlete with a minor injury who will return to sport this season will likely be highly intrinsically motivated (desire to compete in upcoming games/matches will provide that)

Empathy

Being sensitive to and vicariously experiencing the feelings, thoughts, or motives of another person

What is complex regional pain syndrome (CRPS) and what are some special considerations an athletic trainer should keep in mind when dealing with this syndrome?

CRPS, also known as reflex sympathetic dystrophy syndrome (RSDS), may follow a major or minor nerve injury. The *sympathetic nervous system* seems to assume an abnormal function after an injury causing a number of signs/symptoms, such as: constant burning pain, pain that is disproportionate in intensity to the initial event, inflammation that may affect the appearance of the skin, swelling of the distal extremity, excessive sweating, changes in skin temp, muscle spasms of the extremities, abnormal hair/nail growth, insomnia, and cognitive problems. It is important to know that an AT would never use ice or cryotherapy on these patients because it would further compromise the nerves. Patients with CRPS may also need more help than ATs can give them so social support is key.

Active Listening

Communication technique that requires the listener to feed back what is heard by restating or paraphrasing; to confirm what was heard and to confirm the understanding of both parties

Describe the negative and potentially positive affect that stress can have on pain sensation and pain perception.

During acutely stressful situations (exercise/sports), the *fight-or-flight mechanisms may cause a decrease in the sensation of pain*. *Perception of pain may be decreased* because of an athlete's focus on factors other than pain (such as training or game components). The magnitude of the stressful situation may be linked to the decrease of the sensation/perception of pain (ie. a championship game may be more stressful for athletes, which decreases their pain perception and sensation allowing them to "play through pain" easier than if it were just a normal game).

Secondary Gain

Favorable consequences, such as increased attention from significant others and escape from stressful situations, or medication use, that occur in conjunction with a generally undesirable injury

What are some common psychological problems associated with injury?

Fear/anxiety, lack of confidence, identity issues, isolation, depression, and emotional distress

Anterior Cingulate Cortex

Frontal part of the cingulate cortex in the brain; plays a role in cognitive functions such as reward anticipation, decision making, empathy, and emotion. Responsible for *integrating information about pain perception*; alerts the individual to potential tissue damage and evaluates how serious the danger might be; helps learning to occur (remember and avoid pain in the future) and *associates memory to pain*; also *responsible for gauging the intensity of pain*.

How can previous experience with pain influence someone's current perception of pain?

If an athlete has previously suffered from a traumatic injury, their perception of pain may be drastically different than someone who is experiencing pain for the first time. If an athlete has never been really injured before, they may act like they are dying after spraining their ankle - because they have nothing to compare the feeling to. Whereas an athlete who has torn their ACL or shattered their tibia may not think a sprained ankle is bad at all.

Social Support

Includes the feeling or sense of being supported by others, the act of supporting others and social integration

Receiver

Person to whom a sender conveys a communicated message

What are some psychosocial strategies?

Positive self-talk/relaxation, imagery (self, healing, performance, life), nonpharmacological pain management, motivation and goal setting, education

Decoding

Process of interpreting meaning from the symbolic codes used to send a message -The receiver decodes a message from the sender

Encoding

Process of putting an intended message into symbolic code that can be observed -The sender encodes a message to the receiver

Paraphrasing

Process of restating what was understood in a message back to the sender

How can stress and anxiety increase the risk for injury? How can these antecedents be mediated?

Psychosocial antecedents influence how an individual interprets and responds to stress. This stress response then influences injury risks. *Three major categories of antecedents influence the interpretation of stressors and therefore the response to stress:* -*Personality* - includes constructs such as hardiness, optimism, and pessimism; generally considered to be a stable trait; intervention research does not generally focus on personality as a modifiable factor. -*History of stressors* - influences an individual's response to stress; includes overall life stress (major events like moving, financial issues, etc), daily hassles (being stuck in traffic, late for practice, etc) and previous injuries. -*Coping Resources* - tools that individuals have at their disposal to handle stressful situations; ex = social support and stress management techniques. These can buffer the influence of an individual's personality and history of stress on his or her stress response. ^These three antecedents influence an individual's cognitive appraisal of the situation.

Holistic

Related to healing; a holistic approach includes all parts of the healing systems - the mind and the body - in the healing process

Emotion Focused Coping

Strategies aimed at reducing the negative emotional response associated with stress; may be the only realistic option when the source of stress is outside of the person's control; involves using self-regulation to manage what is causing stress and can be proactive (relaxation, meditation) or potentially detrimental (withdrawal, self-blame). ^*The intention of emotion focused coping strategies is to soothe the individual and to increase his/her quality of life*

Instrumental Focused Coping

Strategies that target the cause of stress in practical ways that address the stress-produing problem or situation, consequently directly reducing the stress; examples include finding out specific information about the injury, attempting to alleviate sources of stress and discomfort by listening to the athlete and complying with advice from health-care providers, goal setting, and positive self-talk ^*Focuses on actively finding/implementing solutions to a stressful problem*

Nonadherence

The athlete working either too little or too much based on recommendations of the athletic trainer (ex. doing too many reps of rehab or not enough)

Performance Imagery

The creation or re-creation of an experience in the mind from memory or quasi-experience using a combination of the five sense with the goal of improving an aspect of a performance in sports or rehabilitation

Athletic Identity

The degree to which a person identifies the self as an athlete; athletes with strong athletic identity may have more difficulty coping with forced time away from their sport

Nonverbal communication

The expression of thoughts, feelings, or ideas without the use of words ^Touch, gestures, facial expressions and body language

Rapport

The harmonious or synchronous relationship of two or more people who relate well to each other

Biopsychosocial Perspective

The view that biological, psychological and social factors all play a significant role in human functioning in the context of disease or illness

How can ATs use psychosocial strategies to help prevent athletic injury?

They can *educate* coaches/staff about how stress can pre-dispose an athlete to injury. They can monitor an athlete's stress levels and seek education about signs that may indicate an athlete is stressed. They can also help athletes cope with stress by *providing social support*.

Cognitive Appraisal

Two-tiered personal interpretation of a situation (Made up of the Primary and Secondary appraisal)

Limbic System

a complex set of brain structures that lies on both sides of the thalamus; supports a variety of functions including emotion, behavior, and long-term memory