psych exam 3 chp 20, 21, 22

Roles of Sport Psychology in Injury Rehabilitation

- A holistic approach is needed, emphasizing the healing of both the mind and the body. - Psychological factors play an important role in injury recovery (Ievleva & Orlick, 1991). - Injury treatment should include psychological techniques to enhance the healing and recovery process. Some 90% of certified athletic trainers reported that it is important or very important to treat the psychological aspects of injuries. - Athletes will not automatically transfer psychological skills used in athletics (e.g., imagery) to the injury rehabilitation situation. - Physical healing does not necessarily coincide with psychological readiness for return. - Psychological factors (e.g., self-talk, goal setting, self-motivation) also positively affect adherence to injury treatment protocols.

Psychological Factors in Athletic Injuries

- Americans sustain an average 8.6 million sport- and recreation-related injuries per year. - In children ages 5 through 14 years old, 2.78 million sport- and recreation-related injuries resulted in trips to the emergency room. - Data from Sweden also show that 75% of elite soccer players will sustain an injury sometime during a season. - After anterior cruciate ligament (ACL) reconstruction, return to play is disappointingly low, with one in three athletes failing to return. - Physical factors are the primary causes of injury, but psychological factors can also contribute.

Causes of Athletic Injury

- Physical factors: Factors include muscle imbalance, high-speed collisions, overtraining, and physical fatigue. - Social factors: Attitudes and norms such as the perception by performers that playing with pain and injury is seen as highly valued in our society. - Psychological factors: Personality factors, a history of stressors, and coping influence the onset of injuries, as does an athlete's psychological skills. - Personality factors: To date, a direct link between personality factors and athlete's injuries has not been consistently shown. Personality is thought to be involved with injuries in more complex ways, interacting with factors such as stress levels. - Stress levels: People with high levels of stress have more sport- and exercise-related injuries.

Physiological Components of Athletic Injury Stress

- Psychological stress increases catecholamines and glucocorticoids, 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 actions of insulin-like growth hormones that are critical during the rebuilding process. - Stress also causes sleep disturbance, another factor identified in interfering with physiological recovery.

How Athletes Use Imagery When Recovering From Injury

- Research shows that athletes use imagery during their rehabilitation from athletic injuries. - Athletes most often used imagery while observing practices, while driving, and at home in bed. - Athletes used imagery to rehearse rehabilitation exercises, improve performance of certain exercises, facilitate goal setting, facilitate relaxation, control anxiety, motivate themselves to engage in their rehabilitation exercises, maintain a positive attitude, and maintain concentration.

Concussion Research Findings

- When an athlete is suspected of a sport-related concussion, he should be immediately removed from play and not allowed to return until cleared by a licensed health care provider. - Second-impact syndrome ----An athlete experiences a concussion and does not completely recover before a second concussion. ----It often results in catastrophic consequences and permanent brain injury. - Females compared to males have a greater risk of concussion in comparable sports and are 1.5 times more likely to sustain a concussion. - Multiple concussions may cause short- and long-term impairments.

Injury Treatment and Rehabilitation three-phase process of rehabilitation and recovery

1. Injury or illness phase 2. Rehabilitation and recovery phase 3. Return to full activity phase

Major Categories of Performance-Enhancing Drugs

1. Stimulants 2. Narcotic analgesics 3. Anabolic steroids 4. Beta-blockers 5. Diuretics 6. Peptide hormones and analogues

Injury Treatment and Rehabilitation

Each phase dictates different approaches to the psychology of recovery. ---Injury or illness phase focuses on helping the athlete understand the injury. ---Rehabilitation or recovery phase focuses attention on helping sustain motivation and adherence to rehabilitation protocols through goal setting and maintaining a positive attitude. ---Return to full activity phase—although an athlete is physically cleared for participation, complete recovery does not happen until normal competitive functioning occurs. - Educate the injured person about the injury and recovery process. - Teach specific coping skills. - Teach how to cope with setbacks. - Identify athletes and exercisers who are at high risk for injury (high trait anxiety, high life stress, low psychological and coping skills, low social support, and high avoidance coping). - Teach specific coping skills: Discuss goal setting, positive self-talk, imagery, visualization, and relaxation training. - Assist the athlete in coping with setbacks: Remind them to use their mental skills to cope and provide social support. - Foster social support. - Ensure injured athletes are psychologically ready to return to play. - Learn from injured athletes.

Psychological Reactions to Exercise and Athletic Injuries

Emotional responses ---Grief responses (while cited in early work, injured athletes have not been found to move through these inflexible fixed stages) 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance and reorganization Three general categories of emotional reactions to being injured 1. Injury-relevant information processing 2. Emotional upheaval and reactive behaviors 4. Positive outlook, coping Keys - Most people experience a typical response to injury, but the speed and ease with which they progress through stages can vary widely. - The period immediately after injury is characterized by the greatest negative emotional reactions.

Concussion Signs and Symptoms

Headache, Dizziness, Fatigue, Drowsiness, Sensitivity to light and noise, Feeling slowed down, Mental fogginess, Difficulty remembering and concentrating, Sadness, Nervousness, feeling more emotional, Vomiting, Numbness and tingling, Trouble falling asleep, Sleeping disturbances

Recommendations for Coping With Injuries

Recommendations for other injured athletes ----Accept and positively deal with the situation. ----Focus on high-quality training ----.Set goals. Recommendations for coaches ----Foster coach-athlete contact and involvement. ----Demonstrate positive empathy and support. ----Don't repeatedly mention injury in training. Recommendations for sports medicine personnel ----Educate and inform athletes about injury and rehabilitation. ----Foster positive interaction and customize training. ----Demonstrate competence and confidence.

Concussion Treatment

Rest, Academic accommodations (e.g., more time on tests), Vestibular and ocular therapy, Cognitive behavior therapy, Medication Note: Most symptoms for 80-85% of concussions are resolved in 7 to 14 days, but some athletes remain symptomatic for much longer

Poor Adjustment to Injury: Getting Professional Help

When abnormal emotional reactions to injuries are identified, a referral to a sport psychologist or another qualified mental health provider should be made just as should be the case if an uninjured athlete exhibits general life problems (e.g., depression, severe generalized anxiety) of a clinical nature.

Injury

is defined as trauma to the body or its parts that results in at least temporary, but sometimes permanent, physical disability and inhibition of motor function. This may involve an individual participating while still feeling pain so that attention is needed due to the pain, there is a loss of or change in function due to the injury, and a decision process takes place about whether to continue participation.

Making Referrals

· A person who has a rapport with the affected individual should schedule a private meeting to discuss the matter. · Emphasize feelings rather than directly focusing on eating behaviors. · Be supportive of the athlete and treatment recommendations, and keep all information confidential. · Consistently show concern for the athlete as a person. · Avoid using the term eating disorder. · Make and have ready potential referrals to a specific clinic or person.

Prevalence of Eating Disorders and Disordered Eating in Sport

· Accurate assessment is difficult to achieve for a variety of reasons: · Fear of being dropped from program · Questionable accuracy of studies (assessment problem) so data must be viewed with caution

Prevalence of Substance Abuse in Sports

· Accurate assessment of substance abuse is difficult to achieve because of the sensitive and personal nature of the problem. · Most studies have focused on alcohol and steroid use: o Alcohol use: 55-92% of high school athletes; 87-88% of college athletes o Performance-enhancing drugs: Reported use by only 5% of high school and college athletes (40-60% among elite athletes) o A 2003 CDC study: 1 in 16 high school students used steroids

Parents of gamblers need to be aware of these things:

· An unexplained need for money, a sudden increase in credit card debt, displays of unexplained wealth · Money and valuables missing from home · Sudden dip in grades, poor attendance in class · Depression and anxiety; withdrawal from family, friends, and outside interests · Watching more TV sports, calls to 900 numbers for sports results and betting lines · Getting unduly emotional over sporting events

Understanding Anorexia Nervosa

· Anorexia is potentially deadly, with a mortality rate of 5%, the highest mortality rate of any psychiatric condition. It can lead to starvation and other medical complications such as heart disease. · The suicide risk of those affected is 50% higher than that of the general population. · Affected people don't see themselves as abnormal.

Anorexia Nervosa

· Anorexia nervosa is a psychological disease characterized by - an intense fear of becoming obese, - a disturbed body image, - significant weight loss, - the refusal to maintain normal body weight, and

Recognition and Referral of an Athlete With Eating Problems

· Be able to recognize the physical and psychological signs and symptoms of these conditions. · If you suspect an eating disorder, make a referral to a specialist in the area.

Detection of Substance Abuse

· Be aware of the warning signs of substance abuse: - Change in behavior (lack of motivation, tardiness, absenteeism) - Change in peer group - Major change in personality - Major change in performance (academic or athletic) - Apathetic or listless behavior - Impaired judgment - Poor coordination - Poor hygiene and grooming - Profuse sweating - Muscular twitches or tremors

Characteristics of Compulsive Gamblers

· Boastfulness · Arrogance · Optimism · External competitiveness · Intelligence

Bulimia

· Bulimia is an episodic eating pattern of uncontrollable food bingeing followed by purging and is characterized by · an awareness that the pattern is abnormal, · fear of being unable to stop eating voluntarily, · depressed mood, and · self-deprecation. · Condition is severe but less severe than anorexia. · Bulimia can lead to anorexia. · Bulimic people are aware that they have a problem.

COM-B Model to Reduce Doping Risk

· Capability: Psychological and physical capacity to reduce inadvertent doping · Opportunity: Factors lying outside the individual that make performance of the behavior possible or prompt it o Physical o Social · Motivation: Brain processes that energize and direct behavior o Reflective (e.g., foster collective responsibility for clean sport) o Automatic (e.g., continually reinforce inadvertent doping by developing a risk-reducing routine) · Behavior: Increase or decrease in inadvertent doping

Alcohol Use

· College athletes are more likely than nonathletes to abuse alcohol and experience alcohol-related problems. · Athletes are at higher risk for binge drinking because they are more likely to regard parties as an important part of their social life, spend at least two hours a day socializing, and possess binge-drinking friends. · It is estimated that about 80% of college athletes drink, a higher percentage than nonathletes. · Within a given two-week period, college athletes are more likely than nonathletes to binge drink and to do so more frequently. · More athletes than nonathletes are likely to experience negative consequences related to heavy drinking (e.g., regretting decisions that were made when drunk, becoming injured). · The use of alcohol by male athletes is higher than that of nonathletes, but no significant differences exist between the use of alcohol by female athletes and nonathletes.

Compulsive Gambling

· Compulsive gambling, despite its long history in competitive sport, is only now getting public attention. · Gambling on sporting events is widespread. o In 2008, 118 million Americans gambled in sports in some manner. o Seventy-two percent of NCAA Division I football and basketball athletes engage in some form of gambling. o Twelve percent of male and three percent of female college athletes have problematic or pathological gambling problems. o Six to eight percent of college students are compulsive gamblers. · A 2003 NCAA study showed that 35% of male athletes and 10% of female athletes bet on college sports, and approximately 60% of NCAA Division I and 40% of Division III athletes did not know the NCAA rules about gambling. · Gambling by high school students is thought to be widespread.

Disordered Eating

· Disordered eating covers a spectrum of exaggerated eating patterns involving increased health risks. · The extremes of disordered eating are anorexia and bulimia. · It is difficult to distinguish athletes with an eating disorder from those who have many of the psychological symptoms of an eating disorder but no official diagnosis of an eating disorder. · Eating disorders are often seen as a female affliction; however, males also experience disordered eating.

Dealing With Eating Disorders

· Do o Be supportive and empathetic o Emphasize the importance of nutrition o Make a referral for professional treatment for the person if possible · Don't o Hold team weigh-ins o Single out the individual in front of teammates o Discuss the problem with nonprofessionals

Defining Drug Addiction

· Drug addiction is a state in which either discontinuing or continual use of a drug creates an overwhelming desire, need, and craving for more of the substance.

Why Athletes and Exercisers Take Drugs Physical reasons

· Enhance performance · Rehabilitate injury · Look better · Control appetite and lose weight

Why Athletes and Exercisers Take Drugs Psychological reasons

· Escape from unpleasant emotions or stress · Build confidence or enhance self-esteem · Seek thrills · Gain extrinsic rewards · One is low in self-control

Addiction to Exercise

· Exercise addiction: A psychological or physiological dependence on a regular regimen of exercise that is characterized by withdrawal symptoms after 24 to 36 hours without exercise · Positive addiction to exercise: A condition in which exercise is viewed as important in one's life but is successfully integrated with other aspects of life (healthy habit) · Negative addiction to exercise: A condition in which life becomes structured around exercise to such an extent that home and work responsibilities suffer

Parental Reactions to Teenage Gambling

· Feel fear; imagine organized crime is involved · Think they can handle it (most common reaction) · Think, Thank God it's not drugs.

Research on the Prevalence of Eating Disorders in Sport

· Frequency rates of eating disorders in athletes range from as low as 1% to as high as 62% across a variety of sports. · Athletes appear to have a greater occurrence of eating-related problems (disordered eating) than does the general population. · Athletes and nonathletes have similar eating-related symptoms. · A significant percentage of athletes engage in pathogenic eating or weight loss behaviors (e.g., bingeing, fasting), although the behaviors are subclinical in intensity. · Eating disorders and pathogenic weight loss techniques tend to have a sport-specific prevalence (e.g., among wrestlers versus archers). · Female athletes in general report higher rates of eating disorders than male athletes, which is similar to rates for the general population. · Compared with nonathletes, it is primarily athletes in "thin build" sports that emphasize leanness (e.g., gymnastics and diving) who are at greater risk of developing eating disorders. · Up to 66% of female athletes may be amenorrheic as compared to 2% to 5% of nonathletes. · Although anorexia and bulimia are of special concern in sports emphasizing form (e.g., gymnastics, diving, and figure skating) or weight (e.g., wrestling), athletes with eating disorders have been found in a variety of sports. · Approximately 63% of all female athletes develop symptoms of an eating disorder between the 9th and 12th grades.

Signs of Compulsive Gambling

· Identification is next to impossible. · Use the Gamblers Anonymous 20 questions for self-identification. · Sport psychology professionals should make referrals when negative consequences appear.

Factors Contributing to the Onset of Eating Disorder Symptoms

· Internal Factors o Negative mood o Low self-esteem o Perfectionism in achievement o Desire for control · External Factors o Negative influences on self-esteem o Hurtful relationships o Hurtful role models o Sport performance

Preventing Eating Disorders in Athletes and Exercisers Recommendations for athletes

· Keep hope that recovery is possible. · Determine the underlying cause and triggers for the disorder. · Seek professional treatment. · Reach out to important others in your life for emotional support. · Focus on the benefits of recovery. · Put your life and eating disorder behaviors into perspective.

Facts About Disordered Eating

· Lifetime prevalence of bulimia is 1.5% in women and .5% in men. · Lifetime prevalence of binge eating disorder is 3.5% in women and 2.0% in men. · Binge eating is more common than anorexia or bulimia and is commonly associated with severe obesity. · Eating disorders have more than doubled since the 1960s. · Forty to sixty percent of high school girls diet. · Thirteen percent of high school girls purge. · Thirty to forty percent of junior high girls worry about weight. · Forty percent of nine-year-old girls have dieted. · Five-year-old girls are concerned about diet.

Signs of Compulsive Gambling In college students

· Missing classes because of gambling · Having trouble focusing in class because they are thinking about gambling · Buying books or otherwise educating themselves on becoming a more skillful better · Facing more debts than they can handle financially

Common Side Effects of Recreational Drugs

· Mood swings · Distorted vision · Decreased reaction time · Changes in blood pressure · See "Common Recreational Drugs and Their Side Effects" (p. 504 of text).

The Problem of Substance Abuse

· Ninety-eight percent of elite athletes said they would take a banned performance-enhancing substance with two guarantees—they would not be caught and they would win. · Sixty percent said they would do so even if it meant they would die from the side effects.

Steroid Use

· Of teens who use steroids, 4 out of 10 say that their decision to pursue the performance-enhancing drugs was inspired by professional athletes who take them. · Among high school boys, 11% say that they've tried using steroids at least once in order to gain an edge in their preferred sport. · Of athletes who decide to take steroids regularly, 80% show some form of biochemical abnormalities of the liver during medical testing. · Aggression and irritability are 56% more likely to happen when athletes are taking steroids compared to when they are not. · Among those who admit using steroids, 80% said they believed the drugs could help them achieve their athletic dreams. · When asked, 57% of users said they would use steroids even if it would shorten their lives. · Of people who use steroids, 60% believe that taking them is a right of the modern professional athlete.

Why Athletes and Exercisers Take Drugs Social reasons

· Peer pressure · False consensus effect (overestimate number of competitors doping) · Emulating athletic heroes

Primary Versus Secondary Exercise Dependence

· Primary exercise dependence o Exercise is an end in itself, although it may include altered eating behaviors for the purpose of enhancing performance. · Secondary exercise dependence o Exercise is a symptom of another primary pathological condition, such as an eating disorder.

Preventing Eating Disorders in Athletes and Exercisers Recommendations for coaches

· Promote proper nutritional practices. · Focus on fitness, not body weight. · Be sensitive to weight issues. · Promote healthy management of weight. · Teach mental skills.

Prevention and Control of Substance Abuse

· Provide a supportive environment; address the reasons that people take drugs. · Educate participants about the effects of drug use. · Inform participants that performance-enhancing drugs amount to cheating and unfair competition to enhance athletes' morality. · Set good examples. · Teach coping skills. · Use web-based programs to deliver personalized feedback. · Often those from suffering from substance abuse behave in irrational ways (ways that do not make any sense). On the other hand, the solutions provided in this lecture and chapter are rational. That is they are well thought out, make sense, and are logical.

Preventing Eating Disorders in Athletes and Exercisers Recommendations for parents

· Provide emotional support. · Encourage use of professional treatment. · Become educated about eating.

Characteristics of Bulimia

· Recurrent binge eating · A sense of lacking control over eating behavior during the binges · Engaging in regular self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain · Average minimum of two binge-eating episodes a week for three months · Persistent overconcern with body shape and weight

Preventing Negative Addiction to Exercise

· Schedule rest days. · Work out regularly with a slower partner. · If you're injured, stop exercising until healed. · Train hard-easy: Mix in low intensity and less distance with days of harder training. · If interested in the health aspect, exercise three or four times a week for 30 minutes. · Set realistic short- and long-term goals.

Sexual Harassment and Abuse in Sport

· Sexual harassment and abuse have increased in sport. · Sexual harassment refers to behavior toward an individual that involves sexualized verbal, nonverbal, or physical behavior, whether intended or unintended, that is based on an abuse of power and trust and is considered by the victim to be unwanted or coerced. · Data collected over a 16-year period showed that specific situational risk factors included going to the coach's house, getting massages from the coach, and being driven home by the coach. · In addition, athletes' low self-esteem, distant parent-athlete relationships, and devotion to the coach were personal risk factors. · All sport organizations should develop specific policies for the prevention of sexual harassment and abuse. · They should also monitor the implementation of these policies and procedures, foster strong partnerships with parents and caregivers, and develop an education and training program on sexual harassment and abuse in their sport. · Safe and healthy ways for negotiating the use of touch when coaches spot athletes should be understood and promoted. · Safe and healthy ways for negotiating the appropriate use of touch by sports medicine personnel is essential.

Defining Substance Abuse

· Substance abuse is a maladaptive pattern of psychoactive substance use indicated by one of two patterns of use: 1. Continued use despite knowledge of having a persistent or recurring social, occupational, psychological, or physical problem caused or exacerbated by use of the psychoactive substance. 2. Recurrent use in situations in which use is physically hazardous. Some symptoms of disturbance have persisted for at least one month or have occurred repeatedly over a longer period. · Persistence of some symptoms of the disturbance for at least one month, or repeated occurrence over a longer period of time.

Sport Deterrence Model of Drug Abuse

· The DSDM states that individuals conduct a cost-benefit analysis of the consequences of law-breaking behavior before deciding to break a law. · The DSDM consists of three components: 1. The costs of a decision to use 2. The benefits associated with using 3. Specific situational factors that may affect the cost-benefit analysis of using · Costs o Legal sanctions (fines, suspensions, jail time) o Social sanctions (disapproval, criticism by important others, material loss) o Self-imposed sanctions (guilt, reduced self-esteem) o Health concerns (negative side effects) · Benefits o Material (prize money, sponsorship, endorsements, contracts) o Social (prestige, glory, acknowledgment by important others) o Internalized (satisfaction of high achievement) · Situational variables o Perceptions of prevalence (how frequently others use this drug) o Experience with punishment and punishment avoidance o Professional status (how much money and status might be lost) o Perception of authority legitimacy (can the agency enforce the law?) o Type of drug (its effects and side effects)

Symptoms of Negative Addiction to Exercise

· Tolerance or need for increased amounts of exercise · Withdrawal symptoms such as anxiety and fatigue · Exercise often is in larger amounts than was intended (intention effect) · Loss of control · More and more time devoted to exercise · Conflict as exercise takes precedence over other activities · Exercise is continued despite knowledge of problems

Steroid Use by Females

· Traditionally, the use of performance-enhancing drugs such as steroids has been seen as predominantly a male domain. · However, research has revealed that young girls (some as young as nine years old) are using bodybuilding steroids—not necessarily to get an edge on the playing field but to get the toned, sculpted look of models and movie stars. · About 5% of high school girls and 7% of middle school girls admit to trying anabolic steroids at least once; use of the drugs has risen steadily since 1991. · In teenage girls, the side effects from taking male sex hormones can include severe acne, smaller breasts, deeper voice, excessive facial and body hair, irregular periods, depression, paranoia, and fits of anger dubbed "roid rage." · Steroids also carry higher risks of heart attack, stroke, and some forms of cancer.

Characteristics of Anorexia Nervosa

· Weight loss to 15% below normal · Intense fear of gaining weight or being fat, despite being underweight · Disturbance in one's experience of body weight, size, and shape · In females, the absence of at least three consecutive expected menstrual cycles

Predisposing Factors of Eating Disorders

· Weight restrictions and standards · Coach and peer pressure · Sociocultural factors · Performance demands · Judging criteria · Critical comments about body shape and weight · Genetic and biological factors · Mediating factors

Introduction to Addiction and Unhealthy Behaviors in Sport and Exercise

· While sport and physical activity involvement has numerous physical and psychological benefits, this does not mean participants do not engage in unhealthy behaviors or even become addicted to drugs and alcohol. · Such unhealthy behaviors include doping, substance abuse, eating disorders, and illegal gambling. · Examples of addiction and unhealthy behaviors o The Russian Olympic team was banned from the 2018 Winter Olympics because Russia was found to state-sponsor athlete doping. o S. figure skating champion and 2018 Olympian Adam Rippon openly discussed the eating issues in figure skating. o Mickey Mantle, the legendary center fielder for the New York Yankees, abused alcohol over much of his career and eventually died of resulting liver problems. o NBA referee Tim Donaghy admitted to betting on games, some of which he officiated, creating a crisis in confidence.

The Stress Injury Relationship

- Athletes with higher levels of life stress experience more injuries than do those with lower levels of life stress: 85% of the studies verify that this relationship. - The majority of studies link negative life event stress with injuries but in some studies positive life events can also cause stress and increase injuries. - A number of factors are involved in the stress-injury relationship. - Athletes at high risk of being injured had fewer injuries after stress management training interventions than their high-risk counterparts who did not take part in such training. - The greatest stress sources for injured athletes were not the physical aspects but the psychological ones (e.g., fear of reinjury, shattered hopes or dreams). - Research shows that teaching stress management techniques (see chapter 13) may help athletes and exercisers perform more effectively and may reduce their risk of injury and illness. - The stress-injury relationship is complex. -----In a classic study, Smith and colleagues (1990) found that life stress related to injuries only in at-risk athletes (those with few coping skills and low social support). -----Individuals with low self-esteem, are pessimistic and low in hardiness, have higher levels of trait anxiety, have a low mental toughness and low family social support, or have higher levels of daily hassles and decreases in daily uplift experience more injuries.

Explaining the Stress-Injury Relationship

- Attentional disruption: Stress disrupts an athlete's attention by reducing peripheral attention and causing distraction and task-irrelevant thoughts. - Increased muscle tension: High stress can cause muscle tension and coordination interference as well as generalized fatigue, muscle inefficiency, reduced flexibility, and motor coordination problems. - Other explanations for stress-injury relationship ---Overemphasis on acting tough and a "giving 110%" attitude ---Failure to distinguish between normal discomfort and pain of injury ---"You're injured, you're worthless" attitude ---Sport ethic norm, values, and environment in which "winners never quit and quitters never win" and "bravery, bravado, and machismo" lead to denial of pain and injury

Guidelines for Providing Social Support

- Build rapport with the injured party: Take the athlete's perspective, provide emotional support, and be realistic but positive and optimistic. - Provide social support to athletes. (Sources of support include coaches, significant others, and medical personnel.) - Athletes generally turn to coaches and medical professionals for informational support and to family and friends for social support. - Social support needs to vary across rehabilitation phases. - The need for social support is greatest when setbacks occur or when other life demands place additional stress on athletes. - While generally helpful, social support can have negative side effects (e.g., when the support provider does not have a good relationship or have credibility with the athlete, or when support is forced). - Learn from injured athletes by understanding the recommendations injured athletes have made about facilitating rehabilitation and injury recovery. - Ensure injured athletes are psychologically ready to return to play by ----having sports medicine professionals work in conjunction with coaches to make sure athletes are psychologically ready to return to play; ----systematically addressing both physical and psychological factors during rehabilitation; ----making assessments of psychological readiness to return to play by considering factors such as confidence, realistic expectations, motivation, and fear of reinjury.

Concussions: The Invisible Sport Injury

- Concussion has received increased attention in sport, the mainstream media, and scientific research communities because of devastating stories about professional football players who sustained concussions. - Nine percent of high school and 8% of college athlete injuries are concussions. - Concussion injuries are not just a problem in elite sports. Approximately 1.6 to 3.8 million concussion injuries occur in competitive and recreational athletes. - A concussionis "a complex pathophysiological process affecting the brain, induced by biomechanical forces" (McCrory et al., 2017). - A concussion may be caused by either a direct or indirect blow to the head, face, neck, or elsewhere on the body, with an impulsive force transmitted to the head.

Signs of Poor Adjustment to Athletic Injuries

- Feelings of anger and confusion - Obsession with the question of when one can return to play - Denial (e.g., "The injury is no big deal") - Repeatedly coming back too soon and experiencing reinjury - Exaggerated bragging about accomplishments - Dwelling on minor physical complaints - Guilt about letting the team down - Withdrawal from significant others - Rapid mood swings - Statements indicating that no matter what is done, recovery will not occur

Other Injury Reactions

- Identity loss: When athletes can no longer participate because of an injury, they may have a loss of personal identity. That is, an important part of themselves is lost, seriously affecting self-concept. - Fear and anxiety: When injured, athletes can have high levels of fear and anxiety. They worry whether they will recover, if reinjury will occur, and whether someone will replace them permanently in the lineup. Because the athletes cannot practice and compete, there's plenty of time for worry. - Lack of confidence: Given the inability to practice and compete and their deteriorated physical status, athletes can lose confidence after an injury. Lowered confidence can result in decreased motivation, inferior performance, or additional injury because the athletes overcompensate. - Performance decrements: Because of the lowered confidence and missed practice time, athletes may have post injury declines in performance. Many athletes who have difficulty lowering expectations after an injury expect to immediately return to a preinjury level of performance. - Group processes: Although injury is generally seen through the eyes of the injured athlete, injury to an athlete can affect group processes within a team either negatively or positively.

Predictors and Enhancement of Adherence to Sport Injury Rehabilitation

- Personal attributes: Pain tolerance, tough mindedness, self-motivation, and athletic identity - Environmental characteristics: Social support, practitioner expectations of adherence, comfortable clinical settings, convenient scheduling of appointments - Effective adherence interventions: Reinforcement, goal setting, education, multimodal interventions - Predictors of adherence: Rehabilitation self-efficacy, personal control over injury recovery, emotional distress, treatment efficacy, perceptions of injury severity