Sport Psychology: Aids to Injury Rehabilitation Ohio Athletic Trainers Association 2012 Annual Symposium

Transcription

1 Sport Psychology: Aids to Injury Rehabilitation Ohio Athletic Trainers Association 2012 Annual Symposium By Robert E. Stadulis, Ed.D. Exercise and Sport Science Kent State University

2 Acknowledgements Daniel Smith, Nanyang Technological University (2002) Duane Millslagle, University of Minnesota Duluth (2003) David Pargman, Florida State University, Psychological Bases of Sport Injuries (1993)

3 Recovery or Delay in Recovery Length and degree of complete recovery in reentry into the sport is dependent upon: Severity and type of injury Athlete s cognitive appraisal and emotional response to the injury Athlete s coping resources Interventions both psychologically and physiological

4 Perspectives to Injury Tendency by medical and paramedical personnel to dwell upon an injury s physical dimensions Behavioral, cognitive and emotional psychological dimensions are often overlooked or minimized

5 Presentation Goals 1 To provide an overview of some of the psychological processes involved after injury and during rehabilitation 2 To share some strategies and interventions that aid the recovery process

6 Outline Psychological Processes after Athletic Injury Psychological Responses to Injury The Cognitive Appraisal Model The Emotional Response & Behavioral Consequences The Way to Recovery Situational Factors, Goal Setting, Imagery, Social Support & Positive Outcomes Recommendations

7 Psychological Process and Recovery Timeline Elizabeth Kubler-Ross (1969) On Death and Dying Her stage theory has been applied to athletic injury; however, research has failed to demonstrate that injured athletes move in a predictable fashion through a series of stages on route to recovery (Brewer, 1994)

8 Stage Model Based on death and dying literature Relates to career ending injuries Most important aspects is individuals react differently across the stages. Many AT reject the stage model because each injured athlete act differently.

9 Stage Model & Catastrophic Injury Denial Anger Grief Depression Reintegration

10 The Affective Cycle of Injury Distress (e.g. anxiety and depression) Denial (unacknowledged distress) Determined Coping (vigorous, proactive, goal driven) The goal is to help the athlete to progress from distress and denial to determined coping

11 Response to Injury The athlete s cognitive appraisal of the injury interacts with the personality of athlete and the situational factors surrounding the injury. Perceived severity History of Injury Ability to Cope

12 Cognitive Appraisal Model Identified 5 components relevant to psychological responses to athletic injury Based on stress and coping process to athletic injury Advantage of this model is it accounts for individual differences in response to athletic injury

13

14 Emotional Response After cognitive appraisal by athlete about their injury, an emotional response will follow If perceived as threat the athlete will emotional vent, become angry, and most likely experience high anxiety, denial, disengagement, and depression.

15 Emotional Response Cont. If pessimistic the athlete will often engage in negative self-talk and selfblame. If neurotic the athlete will likely engage in loss of self, withdraw, and display changes in their personality. If an over-estimator, the athlete may become irrational about the severity of injury.

16 Behavioral Consequences After the emotional response the athlete will engage in positive or negative coping responses.

17 Behavioral Consequences + Adopt healthy coping responses physically, emotionally or psychologically Learn new psychological skills and physiological exercises Use injury as personal growth

18 Behavioral Consequences - Adopt maladaptive coping responses Career over Learned helplessness Blame others Use other as the excuses Non-compliance of rehab

19 Recovery or Delay in Recovery Length and degree of complete recovery and reentry into the sport is dependent upon: Severity and type of injury Athlete s emotional response to the injury Athlete s coping resources Interventions both psychologically and physiological

20 The Way to Recovery Education About 50% of injured athletes felt their physicians were impersonal and did not provide enough information about their injury (Macchi & Crossman, 1996).

21 Situational Factors Post injury emotional adjustment is positively related to situational variables and social support. AT needs to manipulate the situational factors and enhance social support.

22 Manipulating the Situational Factors Flexibility in rehab scheduling Communicate with the athlete about the seriousness of the injury Provide a rehab center so it accessible, safe, and friendly Explain the purpose of each protocol and goals of each rehab session

23 Goal-Setting 5 Guidelines 1. Help develop management skills that are transferable between rehabilitation situations. 2. Help athletes establish rehabilitation schedules. 3. Provide opportunities for self-evaluation and recording. 4. Involve athletes in decision making. 5. Ensure individual progress is self-referenced.

24 Goal Setting Principles Set specific, not general goals Emphasize short-term goals Set realistic, but challenging, goals Goals ought to be measureable Emphasize positive/approach goals

25 Mental Training Imagery Rehabilitation that includes imagery yields more effective healing than physical rehabilitation alone (numerous references). It represents a natural transfer of sport skills to rehab.

26 Rehabilitation Imagery Visualize internal healing Visualize effective movement the put the most demand on the injured area Imagine best performance Call up feelings associated with best performances See the return to competition at one s best

27 Self-Directed Healing Relax mentally and physically Maintain a positive attitude Mentally connect with the injured body part and imagine healing taking place Seeing Feeling Experiencing All in great detail

28 Self-Directed Healing Cont. See and feel the body exactly as it ought to be ideally Imagining the body fully functioning and performing well in the sport Reminding oneself that you are feeling good and improving more and more each day

29 Social Support Athletes lives are often intertwined with sport, with injury separating them from their teammates and coaches, thus they feel isolated. Connections with other injured athletes, particularly those with similar injuries seems to be helpful (Granito, 2001).

30 Social Support Athletes expect, but do not receive, sufficient social support and information from sports medicine professionals (Mainwaring, 1999). Emotional support was especially important when the rehab process was slow, setbacks were experienced, or other life demands placed additional pressure on the athlete (Evans et al., 2000).

31 Recommendations for Enhanced Recovery (Ievleva & Orlick, 1991) Maintain contact and involvement Show compassion while encouraging and supporting progress Speak of possibilities, not limitations Use modeling (athletes with similar injuries who are at the top of their game again)

32 Recommendations Cont. Reinforce the fact that the athlete has the capacity to directly influence healing Encourage athlete setting daily goals Mental skills that enabled excelling in the sport can be used to excel at healing Listen closely to the athlete s concerns Be flexible and adapt

33 Positive Aspects of Injury Psychological Momentum Injury boosts negative emotion, demanding a corresponding increase in positive affect to maintain emotion balance. Maintaining positive affect as negative emotions diminish with recovery creates positive psychological momentum.

34 Positive Aspects of Injury Revaluing of Sport When injury deprives the athlete of the opportunity to compete, it may have a paradoxical benefit calling to mind all the good things that sport brings.

35 Paradox of Injuries The injury made me a lot more mature. I have a better grasp of reality in life I m so much stronger emotionally. (Lieber, 1991, p.44) Are there ways to facilitate these positive consequences with athlete injuries?

36 Stress & Positive Consequences Little research on how athletes come to view there injuries in a positive manner. One study by Udry et al (1997) of 21 elite athletes on US Ski Team 95% of the athletes reported more positive consequences from their injuries 80% reported personal growth, psychological skill enhancement,& physical-technical enhancement from being injured

37 Recommendation Recognize that deriving positive consequences takes effort Injured athletes must not passively assume positive consequence will occur Recognize different problem-solving strategies can be used Use reversal strategies Avoid Secondary victimization AT should not trivialize the experiences of the injured athlete

38 Dispositional Optimism Investigations are consistent Cardiovascular and, Immunological function is associated with optimism(peterson et.al, 1991;Scheiver & Carver, 1987) Optimism mitigates the stress-illness relationship Link between optimism and recovery

39 Summary -- 1 Rehabilitation involves physical and mental aspects Athletes response to injuries reflect the stage model Cognitive appraisal model provide AT why some athlete behave differently when injured. AT should assess the athlete cognitive appraisal of injury via emotional responses and behavioral consequences.

40 Summary -- 2 Rehabilitation aided by employing: Situational awareness Goal Setting Imagery (& Modeling) Social Support Positive Outlook

41 Thank you! More information? U of Akron Sport Psychology Workshops Psychological Skills Training July 25-30

42

43 Personal Factors Self-esteem Neuroticism Pessimism Anxiety Extroversion Injury History Sense of self

44 Personality Correlates During Neuroticism Injury Rehabilitation Explanatory Style Dispositional optimism Hardiness

45 Neuroticism Abundant evidence that injuries produce generalized negative affect, especially in severe injury. Typical responses in athletes are: Disappointment Frustration Confusion and, Depression

46 There was pain because I had surgery; pain because I knew my career was over. It was probably the moment I suffered the most in my life. It was pain all over.

47 Maladaptive Behavior & Neuroticism Selective attention to the negative emotions to injury Anger is exhibited ( I was not a nice person when I was injured ) Tendency to rely on inefficient coping strategies Denial, withdrawal, selfblame, emotional venting, disengagement

48 Explanatory Style Pessimistic explanatory style Personality caused: It my own fault Stable over time: I m never going to play Global: the rest of my life Health effects Immune system function Poorer health

49 Hardiness Constellation of personality characteristics that function as a resistance resource in the encountering of stressful life events -Kobass, et. al P. 169 Components are Commitment-strong beliefs in one own value Challenge-views difficulties to over come Control-sense of personal power

50 Hardiness Link Kobasa (1979) linked hardiness to physical health. Mechanism underlying hardiness seems to be cognitive appraisal and coping processes(florian et al, 1995; Gentry & Kobasa, 1984)

51 Studies with Athletes Athletes who are high in neuroticism and pessimistic explanatory style display maladaptive behavior which results in longer rehab or incomplete recovery ( Grove, Stewart & Gordon (1990) with athletes with ACL damage Grove & Bahnsen (1997) with 72 injured athletes

52 Neuroticism Formal Assessment Procedures Eysenck Personality Questionnaire (EPQ-N)- Eysenck & Eysenck, 1975 Explanatory Style Attributional Style Questionnaire (ASQ)- Peterson et al., 1982)

53 Informal Assessment One-to-one visit & pay attention to the athlete comments Fear, sadness, embarrassment, guilt & anger, feelings of being over whelmed by the demands of rehab signs of neuroticism Ask the why statement. Insight into athlete s explanatory style

54 Implications the person that I wanted to talk to the most was the person that was going to help me get better..we had the best relationship. He/she knew what I was thinking; he/she knew what I was going through. He/she was my athletic trainer. (Quoted from elite skier, injured athlete)

55 Implication Personality information helps AT to provide a more complete service Highly neurotic athletes are prone to overreact, denial, disengagement, and emotional venting. AT need to: model rational behavior well planned treatments Maintain records of progress Develop psychological skills of cognitive appraisal, coping, and stress management.

56 Implications Injured Pessimistic Athletes feel helplessness and depressed. These athlete fail to follow recommended treatment programs(especially unsupervised aspects). Demonstrate a lack of persistence in the face of poor or slow progress. AT trainer should offer advise in how to cope, prevent athletic isolation, & provide emotional support.

57 Implications Injured athlete low in hardiness worry, experienced depressed moods,& overgeneralize negative aspects of their character. AT need to communicate clearly with the athlete about the severity of injury, get them actively involved in setting rehab goals, use feedback of progress through charts or graphs, and provide self-monitoring strategies such as logs.

58 The Way to Failed Rehabilitation Denial Functional when it protects the athlete from being overwhelmed by negative emotions, Problematic when failure to recognize the severity of the injury results in low level of motivation for rehabilitation.

59 Pain Pain is a whole brain experience derived from a summation of inputs from multiple brain centers including those that serve emotion and memory (Merskey,1986). Catastrophizing contributes to heightened pain (Sullivan et al., 2000). Cognitive Restructuring is necessary (attention diversion, rational emotive therapy, stress inoculation training).

60 Fear A type of competitive anxiety related to injury risk. Fear can contribute to a respect for dangerous conditions and limit reckless behavior or undermine concentration and interfere with skill execution. Fear of re-injury was common in those rehabilitating severe knee injuries, with the fear inhibiting the recovery process in some cases (Mainwaring, 1999). Cognitive restructuring needed.

61 Culpability When complications arise in rehabilitation, culpability may be directed to treatment providers (who may in turn, redirect blame to the athlete for failing to recover as anticipated). If the athlete assumes responsibility for injury, feelings of guilt may follow, especially if he or she feels the team or significant others have been let down. Attributing recovery to personal control (internal attributions) has been associated with greater rehabilitation adherence.