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Stress Management in Sport

Stress  management  refers  to  the  environmental, physiological, cognitive, and behavioral techniques employed by an individual to manage the factors and  components  that  underlie  the  stress  process or  experience  of  stress.  A  primary  goal  of  stress management  in  sport  is  to  allow  the  athlete  to effectively  regulate  competition  related  demands to  facilitate  optimal  performance  as  well  as  to enhance  psychological  well-being  (PWB).  There are  numerous  stress  management  techniques  that can be classified into various heuristic categories. Many of these are covered in this entry. However, to  understand  why  these  techniques  are  effective under  specific  conditions,  it  is  important  first  to understand the stress and emotion process.

Contemporary  thinking  in  sport  psychology (SP)  conceptualizes  stress  as  a  complex  dynamic transaction between environmental demands, such as  those  associated  with  high-level  competition, and  the  athlete.  Stress  occurs  when  the  demands tax or exceed the resources, such as skills or support,  that  the  athlete  has  at  his  or  her  disposal. Since  competitive  sport  is  by  nature  demanding, how athletes evaluate and cope with the demands they  encounter  has  a  large  impact  on  the  stress process.  The  environmental  demands,  as  well as  internally  generated  demands  from  personal expectations and goals, are typically called stressors.  Stressors  can  be  acute,  chronic,  or  intermittent, and they can also be expected or unexpected.

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The  stress  process  is  highly  influenced  by  how athletes evaluate the personal and social meaning of  stressors.  Such  evaluation,  typically  called  an appraisal  process ,  can  be  rapid  and  automatic  or reflective and is shaped by social learning, culture, and  memories.  In  many  cases,  emotional  feelings  and  patterns  of  thought  and  behaviors  are activated,  with  corresponding  physiological  and neurological activation, action impulses, cognitive plans,  and  actions.  Thus,  the  stress  response  can include  changes  in  emotion,  feelings,  cognitions, behavior,  and  autonomic  physiological  systems. Stress responses differ from athlete to athlete, and, for any given athlete, stress responses can take different forms in varying situations. Thus, effective stress management can target the actual demands and/or enhance the athlete’s ability to regulate the factors that are associated with the appraisal, emotion, and cognitive behavioral response.

Stress  management  techniques  in  sport  typically  target  somatic,  behavioral,  and/or  cognitive affective  symptoms  of  stress.  Somatic  responses involve the athlete’s physiological reactions, such as changes in heart rate (HR), respiration (R), sweating,  gastrointestinal  functioning,  muscular  tension and control, pupil dilation, urinary system, and salivation. Behavioral responses are the direct actions taken  because  of  the  stress,  including  engagement or disengagement in certain strategies or activities, as  well  as  distraction.  Finally,  cognitive  affective responses include the thoughts associated with the stress,  including  worries,  beliefs,  apprehensions, and  negative  expectations  about  performance  as well as action plans to manage stress. Distinguishing between and being aware of each of these aspects is important for the athlete, coach, and SP consultant, as this knowledge helps to ensure the appropriate stress management skills are applied.

Effective   stress   management   also   needs   to recognize  the  temporal  aspect  of  the  stress  process.  Stressful  transactions  in  sport  often  involve anticipation,  confrontation  (engagement),  and post-engagement  stages  and  can  result  in  an  athlete feeling overwhelmed. Stress management techniques can target specific stages or combination of stages.

Types of Stress Management Programs and Techniques

There   are   a   number   of   stress   management approaches   in   sport   to   deal   with   various components  of  the  stress  process.  Some  practitioners  advocate  a  multimodal  approach,  which involves using different tactics thought to be more effective  in  combination.  Others  suggest  focusing  on  the  dominant  stressor  with  a  unimodal approach, which uses a singular, focused intervention  strategy.  Multimodal  approaches  tend  to  be favored  because  of  their  effectiveness  on  a  wide range  of  factors  related  to  different  elements  of the  stress  process  (i.e.,  actual  stressor,  emotional feeling,  cognition,  behavior,  and  physiological responses).  However,  there  is  evidence  that  situations dominated by one particular stressor may be more efficiently treated with a unimodal approach. The effectiveness of any type of stress management ranges  depends  on  variables  such  as  the  athlete’s situation,  his  or  her  coping  resources,  and  the appropriateness of the approach for the stressor. It is best to create individualized stress management skills  programs  designed  to  meet  each  athlete’s specific needs. Common stress management interventions  are  briefly  outlined  next,  in  alphabetical  order.  These  approaches  can  been  seen  as  an application  of  theoretical  and  clinical  knowledge to  produce  a  more  practical  approach,  and  each of  the  approaches  has  varied  levels  of  empirical support,  depending  on  important  factors  such  as context and person variables.

Anxiety Management Training

Anxiety   management   training   involves   an athlete’s  learning  to  employ  relaxation  strategies under  stressful  or  arousing  situations,  including  those  producing  emotions  such  as  anger  and anxiety.  During  anxiety  management  training, the  athlete  visualizes  the  stressful  situation  and allows the accompanying physiological arousal to be generated within himself or herself. Relaxation techniques, such as applied relaxation, progressive muscle relaxation, breath control or deep breathing, or meditation (outlined later), are then used by the athlete to reduce the symptoms of physiological  arousal,  such  as  increased  HR,  R,  and  blood pressure (BP). This may also promote management of  behavioral  responses  such  as  loss  of  coordination, acts of aggression or frustration, “choking,” or withdrawing from sport.

Applied Relaxation

The aim of applied relaxation is to learn the skill of  relaxation  and  develop  the  ability  to  apply  it rapidly where needed, in any situation. Connected to  this  approach  are  six  stages.  The  first  stage  is progressive  muscle  relaxation,  a  technique  where muscles are contracted or tensed and subsequently relaxed, which is used to help facilitate relaxation and help the athlete reduce somatic anxiety symptoms.  As  the  athlete  becomes  proficient  in  this skill and moves to stage two, muscle relaxation is promoted by relaxing the muscles without tensing them first. In stage three, the term relax is conditioned  to  bring  on  a  relaxed  state  when  spoken or  thought  by  the  athlete.  A  focus  on  breathing is  also  promoted  in  this  stage,  as  well  as  a  focus on  passive  concentration,  which  is  an  effortless, automatic,  yet  focused  state  of  mind,  similar  to mindfulness.  Stage  four  requires  the  athlete  to learn  to  use  the  skill  in  real-life  settings,  relaxing appropriate  muscles  while  engaging  ones  needed for activity. Stage five focuses on having an athlete relax  while  in  a  naturally  occurring,  nonstressful situation.  Breathing  is  the  trigger  of  relaxation in  this  stage  and  is  practiced  15  to  20  times  per day. The sixth and final stage is called application training. The relaxation technique is implemented in a practice or training session and then in a low-stakes competition. The more frequently and completely  it  is  implemented,  the  easier  it  will  be  for the athlete to use the strategy in a higher level of competition.

Arousal or Energizing Techniques

Some  research  suggests  that  athletes  differ  on the level of activation needed to produce optimal performance.  Various  levels  of  arousal  are  often conducive  to  high  performance,  and  it  is  paramount that the athlete perceives the arousal as beneficial (see Cognitive Control later in this section). While  many  stress  management  approaches  take an  arousal  reduction  focus,  strategies  to  increase arousal include imagery, self-talk, goal setting, and cognitions  or  thoughts  focused  on  heightening stimulation.

Autogenic Training

Autogenic training, first introduced in psychiatry by Johannes Heinrich Schultz, involves a series of  exercises  designed  to  produce  sensations  such as  warmth  or  heaviness,  to  help  promote  relaxation.  The  program  is  based  on  six  stages,  each with  a  separate  goal.  The  stages  are  learned  and practiced  in  the  following  order:  heaviness  in  the extremities,  warmth  in  the  extremities,  regulation  of  cardiac  activity,  regulation  of  breathing, abdominal  warmth,  and  cooling  of  the  forehead. Verbal  cues  to  the  athlete  can  be  used  to  aid  in prompting the sensations.

Biofeedback

Biofeedback  training  (BFBT)  can  help  control autonomic  physiological  stress  responses,  such  as increased HR and BP. It also has been used to control anxiety disorders as well as anxiety connected to particular environments or contexts. The premise behind biofeedback (BFB) is for the athlete to become aware of how stress is manifested physiologically, such as changes in BP, HR, breathing, or muscle  tightness,  using  different  modes  of  objective feedback and monitoring. With this increased awareness, athletes are better equipped to control their  actions.  With  training,  athletes  become  less reliant  on  the  feedback,  learning  to  control  their physiological responses on their own.

Breath Control and Deep Breathing

Breath  control  is  a  relaxation  technique  using the  physical  strategy  of  breathing.  It  is  an  effective  and  relatively  easy  stress  management  technique to apply. Irregularities in breathing, such as holding one’s breath, hyperventilating, or random shallow  breaths,  can  affect  performance,  potentially  influencing  coordination,  focus,  or  rhythm, or can cause the athlete to feel unsettled, causing further  stress.  Breath  control  can  be  practiced  by taking  a  slow,  complete  breath.  Often,  the  lungs are conceptualized in three parts to aid in proper instruction of a slow, complete breath. The lower lungs  are  filled  by  pushing  the  diaphragm  down and forcing the abdomen out. The middle portion of  the  lungs  is  then  filled  by  expanding  the  chest cavity, expanding the rib cage. The upper lungs are then  filled  by  raising  the  chest  and  rib  cage.  The breath is held for several seconds, and then a slow exhalation  is  made,  taking  approximately  double the  time  taken  for  the  inhalation  process.  Breath control  is  commonly  used  before  a  competition or during a natural break during the competition, as  it  is  most  practically  applied  during  nonactive times.

Cognitive Affective Stress Management Training

Cognitive  affective  stress  management  training is one of the most comprehensive multimodal stress   management   programs   used   in   sport. Originally  designed  by  Ronald  Smith,  the  program  is  designed  to  teach  the  athlete  relaxation and  cognitive  skills  that  can  aid  in  controlling physiological  reactions  and  cognitive  thought patterns.  Intervention  consists  of  both  cognitive and  physiological  strategies,  including  relaxation skills, cognitive restructuring, and training that is self-instructed and targets the physical and mental reactions to stress. The premise behind the combination of physical and mental coping strategies is the development of an integrated coping response. The program, which has some empirical support, is  educational  rather  than  psychotherapeutic  in nature  and  is  designed  to  help  athletes  increase their self-control.

The   cognitive   affective   stress   management program  consists  of  four  distinct  phases.  In  the first  phase,  the  pretreatment  assessment,   the consultant uses an interview approach as well as questionnaires  to  assess  the  athlete’s  issues  with stress—namely,  what  situations  tend  to  produce stress, how the athlete responds to stress, and how the resultant stress affects performance and other behaviors.  The  athlete’s  cognitive  and  behavioral skills are assessed to determine existing resources. This stage is integral in understanding the unique aspects  and  situation  of  the  particular  athlete  in question,  allowing  for  a  personalized  program to  be  tailored  for  the  athlete.  The  next  phase  is the  treatment  rationale  phase,  the  aim  of  which is  to  help  the  athlete  better  understand  his  or her  stress  responses  through  analysis  of  personal stress  reactions  and  experiences.  Next,  in  the skill  acquisition  phase,  athletes  receive  training in  muscular  relaxation,  cognitive  restructuring, and self-instruction. Muscular relaxation is taught under  the  guidelines  of  progressive  relaxation, described earlier in this section. Cognitive restructuring,  as  described  in  more  detail  later  in  this section,  involves  the  identification  of  irrational and  destructive  thoughts  and  the  subsequent refocusing  into  more  positive  thoughts.  Self-instruction training aims to teach athletes to provide themselves with specific instructions designed to  improve  concentration  and  promote  problem solving.  The  final  stage  is  skill  rehearsal.  In  this stage,  different  levels  of  stress  are  induced  by the  consultant  using  mediums  such  as  videos  or imagery. The athlete is required to apply, and thus practice, the coping skills he or she has learned in the program.

Cognitive Control

Cognitive  control  involves  changes  to  cognitions that trigger, maintain, exacerbate, or reduce the  stress  and  emotion  response  process.  Many cognitive  control  strategies  were  developed  for cognitive  therapy  and  help  athletes  understand how thought processes are involved in the experience  of  stress.  Strategies  to  control  unwanted  or maladaptive  thoughts  include  cognitive  restructuring,  positive  thought  control,  and  attentional refocusing.   Cognitive   restructuring   involves helping  an  athlete  to  recognize  and  challenge irrational  thoughts  and  to  change  these  thoughts so  that  they  become  more  adaptive.  There  are several  steps  in  cognitive  restructuring  including identifying  automatic  thoughts  or  beliefs  that are irrational and negative, challenging or debating  the  rationality  of  these  thoughts,  and  then replacing  these  automatic  thoughts  with  more positive  and  rational  thoughts.  Positive  thought control  involves  self-awareness  to  identify  negative  thoughts  and  replace  them  with  more  adaptive  ones.  Positive  thought  control  involves  three elements:  using  negative  thoughts  in  a  positive way,  controlling  negative  thoughts,  and  training positive  thoughts.  The  aim  is  to  have  the  athlete take  a  more  positive  orientation  regarding  the situation. Attentional refocusing involves shifting attention  or  focus  from  a  stressful  issue  to  one with  fewer  negative  connotations  attached  to  it. Some  athletes  may  become  too  focused  on  their thoughts  and  stress  reactions,  causing  them  to become  more  anxious.  To  a  large  extent,  attention refocusing attempts to shift attention from a self-focus to more of a focus on the features of the sporting environment.

Hypnosis  involves  getting  the  athlete  to  an altered  state  of  consciousness  in  which  he  or she  is  relaxed  and  where  perceptions,  feelings, thoughts, or actions can be changed through suggestion.  Although  still  somewhat  controversial and misunderstood, hypnosis has been employed with  athletes  to  help  reduce  anxiety  and  manage stress, as well as enhance other mental skills, focus  attention,  and  increase  confidence.  Other stress  management  techniques  such  as  relaxation and  imagery  or  visualization  are  often  used  in conjunction with hypnosis, but the athlete is in a hypnotic  state  before  they  are  applied.  Typically, hypnosis is applied in four phases. The induction phase involves putting the athlete in a relaxed state and  then  inducing  hypnosis  using  imagery  and/ or  attention-focusing  techniques.  In  the  hypnotic phase,  athletes  are  given  suggestions  designed  to target the issue at hand, most of which will be carried out once out of hypnosis. The waking phase consists of the athlete coming back to a conscious state,  and  the  posthypnotic  phase  involves  the athlete carrying out the suggestions given to him or  her  while  in  a  hypnotized  state.  Athletes  will benefit from hypnosis only to the extent to which they are able to be influenced on a subconscious level.

Meditation  is  another  method  of  raising  self-awareness,  allowing  an  athlete  to  better  manage stress.  Through  meditation,  the  athlete  becomes more attuned to physical sensations and builds an understanding  of  the  connection  between  physiological  functions  (e.g.,  increased  HR,  nausea) and psychological state (e.g., anxiety, confidence). There  are  a  variety  of  approaches  to  meditation, all directed toward increasing awareness of internal  physical  and  psychological  triggers  that  have potential to prompt certain outcomes. This knowledge  can  help  to  promote  relaxation  or  direct other  stress  management  approaches,  depending on the situation.

Performance and Competition Planning

Preperformance  and  competition  as  well  as performance  and  competition  plans  can  help the  athlete  manage  the  stress  that  is  inherent in  competition.  Such  plans  allow  the  athlete to  take  a  proactive  stance  on  stress,  identifying ahead  of  time  triggers  of  stress,  and  formulating  a  plan  to  counteract  those  issues.  Planning allows  many  athletes  to  feel  more  in  control  of the situation and the self, thereby often decreasing further  experiences  of  stress.  It  also  provides a  structure  for  them  to  incorporate  other  stress management  and  psychological  skills  into  their preperformance   and   performance   routines. Preperformance and performance plans have been suggested to promote proper focus and attention toward task relevant issues and help to attain the proper  level  of  activation  for  performance,  promoting  both  physical  and  mental  readiness  to perform.

Self-Compassion

Self-compassion  interventions  can  help  prevent athletes  from  becoming  overly  self-critical.  Based on  the  work  of  psychologist  Kristin  Neff,  self-compassion   has three key components. Self-kindness involves being understanding and accepting toward oneself  in  instances  of  adversity  as  opposed  to being overly self-critical. Common humanity is the acknowledgment that one’s experiences are not isolating, as others also have these experiences. Finally, mindfulness involves a balanced perspective, keeping thoughts and feelings in a state of equilibrium, as opposed to over identifying with them. Strategies to promote self-compassion include writing, imagery, and  psychoeducational  components.  Interventions are currently being adapted for sport.

Stress Inoculation Training

Stress  inoculation  training  (SIT),  developed  by Donald Meichenbaum, is based on the idea that if an athlete is exposed to stress and learns to cope or deal with that stress in amounts that increase incrementally,  an  increased  tolerance  to  stress  will  be obtained. It is a multimodal approach using coping skills  that  include  creating  productive  and  adaptive thoughts, images, and self-statements designed to benefit the athlete’s psychological state, as well as  performance.  It  has  been  found  to  be  effective in  reducing  anxiety  and  enhancing  sport  performance. SIT involves three stages. The conceptualization  stage  aims  to  raise  the  athlete’s  awareness on  the  effects  of  positive  and  negative  thoughts, self-talk, and imagery. The rehearsal stage involves the  athlete’s  learning  to  use  a  number  of  specific coping  skills  such  as  arousal  control,  imagery, and self-talk, which creates coping resources. The actual  skills  will  depend  on  the  specific  needs  of the  athlete.  Finally,  the  application  stage  involves the  athlete’s  practicing  the  skills  in  increasingly stressful situations. A key feature of SIT is the gradual exposure to stress such that the athlete becomes “inoculated”  and  is  less  affected.  The  application begins  with  low-stress  situations  and  gradually builds  toward  higher  stress  situations  as  coping skills become more advanced. Specific application procedures involve imagery, role-playing, and simulations of increasing perceived stressfulness.

Other Associated Psychological Skills

There  are  a  number  of  other  psychological skills,  such  as  imagery,  identifying  strengths,  and goal  setting,  that  can  be  incorporated  into  stress management programs. Calming imagery, such as visualizing oneself in a safe, relaxing place, can be used to help reduce cognitive anxiety and arousal and  to  bring  on  physical  relaxation.  Conversely, imagery  can  be  used  to  energize  and  motivate by  visualizing  more  stimulating,  exciting  places or  scenarios.  Imagery  is  often  incorporated  into athletes’  preperformance  and  performance  plans and  routines.  Identifying  strengths  can  help  refocus  athletes’  thought  processes  toward  what  they can  do  rather  than  what  they  cannot  do  and assist  in  developing  competition  plans  that  maximize assets. Goal setting can help the athlete stay focused  on  the  task  at  hand  and  keep  attention on  relevant  issues.  Setting  reasonable  goals— ones  that  are  measureable  and  challenging,  yet attainable—can also help keep stress from becoming  overwhelming.  This  is  most  commonly  incorporated  into  preperformance  and  performance plans and routines.

Stress  management  techniques  can  include  any intervention  that  can  modify  one  or  more  components  of  the  stress  process .  Stress  management techniques need to be directed at individual needs and the issue at hand, as well as take into account the coping resources the athlete has available. As with  the  acquisition  of  any  skill,  application  of stress  management  techniques  requires  training, time, and practice. Knowledge is not sufficient, as it does not guarantee an athlete can apply the necessary skills or program to his or her specific issue. Application and practice are necessary, and effort is needed on the part of the athlete to make gains in stress management ability.

References:

  • Crocker, P. R. E., Kowalski, K. C., & Graham, T. R. (2002). Emotional control intervention for sport. In J. Silva & D. Stevens (Eds.), Psychological foundations of sport (pp. 155–176). Boston: Allyn & Bacon.
  • Lehrer, P. M., Woolfolk, R. L., & Sime, W. E. (2007). Principle and practices of stress management (3rd ed.). New York: Guilford Press.
  • Owen, T., Mellalieau, S. D., & Hanton, S. (2009). Stress management in applied sport psychology. In S. D. Mellalieu & S. Hanton (Eds.), Advances in applied sport psychology (pp. 124–161). New York: Routledge.
  • Suinn, R. M. (2005). Behavioral intervention for stress management in sports. International Journal of Stress Management, 12, 343–362.
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Exercise and stress: Get moving to manage stress

Exercise in almost any form can act as a stress reliever. Being active can boost your feel-good endorphins and distract you from daily worries.

You know that exercise does your body good, but you're too busy and stressed to fit it into your routine. Hold on a second — there's good news when it comes to exercise and stress.

Virtually any form of exercise, from aerobics to yoga, can act as a stress reliever. If you're not an athlete or even if you're out of shape, you can still make a little exercise go a long way toward stress management. Discover the connection between exercise and stress relief — and why exercise should be part of your stress management plan.

Exercise and stress relief

Exercise increases your overall health and your sense of well-being, which puts more pep in your step every day. But exercise also has some direct stress-busting benefits.

  • It pumps up your endorphins. Physical activity may help bump up the production of your brain's feel-good neurotransmitters, called endorphins. Although this function is often referred to as a runner's high, any aerobic activity, such as a rousing game of tennis or a nature hike, can contribute to this same feeling.
  • It reduces negative effects of stress. Exercise can provide stress relief for your body while imitating effects of stress, such as the flight or fight response, and helping your body and its systems practice working together through those effects. This can also lead to positive effects in your body — including your cardiovascular, digestive and immune systems — by helping protect your body from harmful effects of stress.

It's meditation in motion. After a fast-paced game of racquetball, a long walk or run, or several laps in the pool, you may often find that you've forgotten the day's irritations and concentrated only on your body's movements.

As you begin to regularly shed your daily tensions through movement and physical activity, you may find that this focus on a single task, and the resulting energy and optimism, can help you stay calm, clear and focused in everything you do.

  • It improves your mood. Regular exercise can increase self-confidence, improve your mood, help you relax, and lower symptoms of mild depression and anxiety. Exercise can also improve your sleep, which is often disrupted by stress, depression and anxiety. All of these exercise benefits can ease your stress levels and give you a sense of command over your body and your life.

Put exercise and stress relief to work for you

A successful exercise program begins with a few simple steps.

  • Consult with your doctor. If you haven't exercised for some time or you have health concerns, you may want to talk to your doctor before starting a new exercise routine.

Walk before you run. Build up your fitness level gradually. Excitement about a new program can lead to overdoing it and possibly even injury.

For most healthy adults, the Department of Health and Human Services recommends getting at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. Examples of moderate aerobic activity include brisk walking or swimming, and vigorous aerobic activity can include running or biking. Greater amounts of exercise will provide even greater health benefits.

Also, aim to do strength training exercises for all major muscle groups at least two times a week.

Do what you love. Almost any form of exercise or movement can increase your fitness level while decreasing your stress. The most important thing is to pick an activity that you enjoy. Examples include walking, stair climbing, jogging, dancing, bicycling, yoga, tai chi, gardening, weightlifting and swimming.

And remember, you don't need to join a gym to get moving. Take a walk with the dog, try body-weight exercises or do a yoga video at home.

  • Pencil it in. In your schedule, you may need to do a morning workout one day and an evening activity the next. But carving out some time to move every day helps you make your exercise program an ongoing priority. Aim to include exercise in your schedule throughout your week.

Stick with it

Starting an exercise program is just the first step. Here are some tips for sticking with a new routine or refreshing a tired workout:

Set SMART goals. Write down SMART goals — specific, measurable, attainable, relevant and time-limited goals.

If your primary goal is to reduce stress in your life, your specific goals might include committing to walking during your lunch hour three times a week. Or try online fitness videos at home. Or, if needed, find a babysitter to watch your children so that you can slip away to attend a cycling class.

  • Find a friend. Knowing that someone is waiting for you to show up at the gym or the park can be a powerful incentive. Try making plans to meet friends for walks or workouts. Working out with a friend, co-worker or family member often brings a new level of motivation and commitment to your workouts. And friends can make exercising more fun!
  • Change up your routine. If you've always been a competitive runner, take a look at other, less competitive options that may help with stress reduction, such as Pilates or yoga classes. As an added bonus, these kinder, gentler workouts may enhance your running while also decreasing your stress.

Exercise in short bursts. Even brief bouts of physical activity offer benefits. For instance, if you can't fit in one 30-minute walk, try a few 10-minute walks instead. Being active throughout the day can add up to provide health benefits. Take a mid-morning or afternoon break to move and stretch, go for a walk, or do some squats or pushups.

Interval training, which entails brief (60 to 90 seconds) bursts of intense activity at almost full effort, can be a safe, effective and efficient way of gaining many of the benefits of longer duration exercise. What's most important is making regular physical activity part of your lifestyle.

Whatever you do, don't think of exercise as just one more thing on your to-do list. Find an activity you enjoy — whether it's an active tennis match or a meditative meander down to a local park and back — and make it part of your regular routine. Any form of physical activity can help you unwind and become an important part of your approach to easing stress.

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  • Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed Aug. 10, 2020.
  • AskMayoExpert. Physical activity (adult). Mayo Clinic; 2020.
  • Working out boosts brain health. American Psychological Association. https://www.apa.org/topics/exercise-stress. Accessed Aug. 10, 2020.
  • Seaward BL. Physical exercise: Flushing out the stress hormones. In: Essentials of Managing Stress. 4th ed. Jones & Bartlett Publishers; 2017.
  • Bodenheimer T, et al. Goal-setting for behavior change in primary care: An exploration and status report. Patient Education and Counseling. 2009; doi:10.1016/j.pec.2009.06.001.
  • Locke E, et al. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist. 2002; doi:10.1037//0003-066x.57.9.705.
  • Olpin M, et al. Healthy lifestyles. In: Stress Management for Life. 4th ed. Cengage Learning; 2016.
  • Laskwoski ER (expert opinion). Mayo Clinic. Aug. 12, 2020.
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The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model

  • Narelle Eather   ORCID: orcid.org/0000-0002-6320-4540 1 , 2 ,
  • Levi Wade   ORCID: orcid.org/0000-0002-4007-5336 1 , 3 ,
  • Aurélie Pankowiak   ORCID: orcid.org/0000-0003-0178-513X 4 &
  • Rochelle Eime   ORCID: orcid.org/0000-0002-8614-2813 4 , 5  

Systematic Reviews volume  12 , Article number:  102 ( 2023 ) Cite this article

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Sport is a subset of physical activity that can be particularly beneficial for short-and-long-term physical and mental health, and social outcomes in adults. This study presents the results of an updated systematic review of the mental health and social outcomes of community and elite-level sport participation for adults. The findings have informed the development of the ‘Mental Health through Sport’ conceptual model for adults.

Nine electronic databases were searched, with studies published between 2012 and March 2020 screened for inclusion. Eligible qualitative and quantitative studies reported on the relationship between sport participation and mental health and/or social outcomes in adult populations. Risk of bias (ROB) was determined using the Quality Assessment Tool (quantitative studies) or Critical Appraisal Skills Programme (qualitative studies).

The search strategy located 8528 articles, of which, 29 involving adults 18–84 years were included for analysis. Data was extracted for demographics, methodology, and study outcomes, and results presented according to study design. The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of belonging). Overall, adults participating in team sport had more favorable health outcomes than those participating in individual sport, and those participating in sports more often generally report the greatest benefits; however, some evidence suggests that adults in elite sport may experience higher levels of psychological distress. Low ROB was observed for qualitative studies, but quantitative studies demonstrated inconsistencies in methodological quality.

Conclusions

The findings of this review confirm that participation in sport of any form (team or individual) is beneficial for improving mental health and social outcomes amongst adults. Team sports, however, may provide more potent and additional benefits for mental and social outcomes across adulthood. This review also provides preliminary evidence for the Mental Health through Sport model, though further experimental and longitudinal evidence is needed to establish the mechanisms responsible for sports effect on mental health and moderators of intervention effects. Additional qualitative work is also required to gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants.

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Introduction

The organizational structure of sport and the performance demands characteristic of sport training and competition provide a unique opportunity for participants to engage in health-enhancing physical activity of varied intensity, duration, and mode; and the opportunity to do so with other people as part of a team and/or club. Participation in individual and team sports have shown to be beneficial to physical, social, psychological, and cognitive health outcomes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Often, the social and mental health benefits facilitated through participation in sport exceed those achieved through participation in other leisure-time or recreational activities [ 8 , 9 , 10 ]. Notably, these benefits are observed across different sports and sub-populations (including youth, adults, older adults, males, and females) [ 11 ]. However, the evidence regarding sports participation at the elite level is limited, with available research indicating that elite athletes may be more susceptible to mental health problems, potentially due to the intense mental and physical demands placed on elite athletes [ 12 ].

Participation in sport varies across the lifespan, with children representing the largest cohort to engage in organized community sport [ 13 ]. Across adolescence and into young adulthood, dropout from organized sport is common, and especially for females [ 14 , 15 , 16 ], and adults are shifting from organized sports towards leisure and fitness activities, where individual activities (including swimming, walking, and cycling) are the most popular [ 13 , 17 , 18 , 19 ]. Despite the general decline in sport participation with age [ 13 ], the most recent (pre-COVID) global data highlights that a range of organized team sports (such as, basketball, netball volleyball, and tennis) continue to rank highly amongst adult sport participants, with soccer remaining a popular choice across all regions of the world [ 13 ]. It is encouraging many adults continue to participate in sport and physical activities throughout their lives; however, high rates of dropout in youth sport and non-participation amongst adults means that many individuals may be missing the opportunity to reap the potential health benefits associated with participation in sport.

According to the World Health Organization, mental health refers to a state of well-being and effective functioning in which an individual realizes his or her own abilities, is resilient to the stresses of life, and is able to make a positive contribution to his or her community [ 20 ]. Mental health covers three main components, including psychological, emotional and social health [ 21 ]. Further, psychological health has two distinct indicators, psychological well-being (e.g., self-esteem and quality of life) and psychological ill-being (e.g., pre-clinical psychological states such as psychological difficulties and high levels of stress) [ 22 ]. Emotional well-being describes how an individual feels about themselves (including life satisfaction, interest in life, loneliness, and happiness); and social well–being includes an individual’s contribution to, and integration in society [ 23 ].

Mental illnesses are common among adults and incidence rates have remained consistently high over the past 25 years (~ 10% of people affected globally) [ 24 ]. Recent statistics released by the World Health Organization indicate that depression and anxiety are the most common mental disorders, affecting an estimated 264 million people, ranking as one of the main causes of disability worldwide [ 25 , 26 ]. Specific elements of social health, including high levels of isolation and loneliness among adults, are now also considered a serious public health concern due to the strong connections with ill-health [ 27 ]. Participation in sport has shown to positively impact mental and social health status, with a previous systematic review by Eime et al. (2013) indicated that sports participation was associated with lower levels of perceived stress, and improved vitality, social functioning, mental health, and life satisfaction [ 1 ]. Based on their findings, the authors developed a conceptual model (health through sport) depicting the relationship between determinants of adult sports participation and physical, psychological, and social health benefits of participation. In support of Eime’s review findings, Malm and colleagues (2019) recently described how sport aids in preventing or alleviating mental illness, including depressive symptoms and anxiety or stress-related disease [ 7 ]. Andersen (2019) also highlighted that team sports participation is associated with decreased rates of depression and anxiety [ 11 ]. In general, these reviews report stronger effects for sports participation compared to other types of physical activity, and a dose–response relationship between sports participation and mental health outcomes (i.e., higher volume and/or intensity of participation being associated with greater health benefits) when adults participate in sports they enjoy and choose [ 1 , 7 ]. Sport is typically more social than other forms of physical activity, including enhanced social connectedness, social support, peer bonding, and club support, which may provide some explanation as to why sport appears to be especially beneficial to mental and social health [ 28 ].

Thoits (2011) proposed several potential mechanisms through which social relationships and social support improve physical and psychological well-being [ 29 ]; however, these mechanisms have yet to be explored in the context of sports participation at any level in adults. The identification of the mechanisms responsible for such effects may direct future research in this area and help inform future policy and practice in the delivery of sport to enhance mental health and social outcomes amongst adult participants. Therefore, the primary objective of this review was to examine and synthesize all research findings regarding the relationship between sports participation, mental health and social outcomes at the community and elite level in adults. Based on the review findings, the secondary objective was to develop the ‘Mental Health through Sport’ conceptual model.

This review has been registered in the PROSPERO systematic review database and assigned the identifier: CRD42020185412. The conduct and reporting of this systematic review also follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 30 ] (PRISMA flow diagram and PRISMA Checklist available in supplementary files ). This review is an update of a previous review of the same topic [ 31 ], published in 2012.

Identification of studies

Nine electronic databases (CINAHL, Cochrane Library, Google Scholar, Informit, Medline, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, and SPORTDiscus) were systematically searched for relevant records published from 2012 to March 10, 2020. The following key terms were developed by all members of the research team (and guided by previous reviews) and entered into these databases by author LW: sport* AND health AND value OR benefit* OR effect* OR outcome* OR impact* AND psych* OR depress* OR stress OR anxiety OR happiness OR mood OR ‘quality of life’ OR ‘social health’ OR ‘social relation*’ OR well* OR ‘social connect*’ OR ‘social functioning’ OR ‘life satisfac*’ OR ‘mental health’ OR social OR sociolog* OR affect* OR enjoy* OR fun. Where possible, Medical Subject Headings (MeSH) were also used.

Criteria for inclusion/exclusion

The titles of studies identified using this method were screened by LW. Abstract and full text of the articles were reviewed independently by LW and NE. To be included in the current review, each study needed to meet each of the following criteria: (1) published in English from 2012 to 2020; (2) full-text available online; (3) original research or report published in a peer-reviewed journal; (4) provides data on the psychological or social effects of participation in sport (with sport defined as a subset of exercise that can be undertaken individually or as a part of a team, where participants adhere to a common set of rules or expectations, and a defined goal exists); (5) the population of interest were adults (18 years and older) and were apparently healthy. All papers retrieved in the initial search were assessed for eligibility by title and abstract. In cases where a study could not be included or excluded via their title and abstract, the full text of the article was reviewed independently by two of the authors.

Data extraction

For the included studies, the following data was extracted independently by LW and checked by NE using a customized Google Docs spreadsheet: author name, year of publication, country, study design, aim, type of sport (e.g., tennis, hockey, team, individual), study conditions/comparisons, sample size, where participants were recruited from, mean age of participants, measure of sports participation, measure of physical activity, psychological and/or social outcome/s, measure of psychological and/or social outcome/s, statistical method of analysis, changes in physical activity or sports participation, and the psychological and/or social results.

Risk of bias (ROB) assessment

A risk of bias was performed by LW and AP independently using the ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’ OR the ‘Quality Assessment of Controlled Intervention Studies’ for the included quantitative studies, and the ‘Critical Appraisal Skills Programme (CASP) Checklist for the included qualitative studies [ 32 , 33 ]. Any discrepancies in the ROB assessments were discussed between the two reviewers, and a consensus reached.

The search yielded 8528 studies, with a total of 29 studies included in the systematic review (Fig.  1 ). Tables  1 and 2 provide a summary of the included studies. The research included adults from 18 to 84 years old, with most of the evidence coming from studies targeting young adults (18–25 years). Study samples ranged from 14 to 131, 962, with the most reported psychological outcomes being self-rated mental health ( n  = 5) and depression ( n  = 5). Most studies did not investigate or report the link between a particular sport and a specific mental health or social outcome; instead, the authors’ focused on comparing the impact of sport to physical activity, and/or individual sports compared to team sports. The results of this review are summarized in the following section, with findings presented by study design (cross-sectional, experimental, and longitudinal).

figure 1

Flow of studies through the review process

Effects of sports participation on psychological well-being, ill-being, and social outcomes

Cross-sectional evidence.

This review included 14 studies reporting on the cross-sectional relationship between sports participation and psychological and/or social outcomes. Sample sizes range from n  = 414 to n  = 131,962 with a total of n  = 239,394 adults included across the cross-sectional studies.

The cross-sectional evidence generally supports that participation in sport, and especially team sports, is associated with greater mental health and psychological wellbeing in adults compared to non-participants [ 36 , 59 ]; and that higher frequency of sports participation and/or sport played at a higher level of competition, are also linked to lower levels of mental distress in adults . This was not the case for one specific study involving ice hockey players aged 35 and over, with Kitchen and Chowhan (2016) Kitchen and Chowhan (2016) reporting no relationship between participation in ice hockey and either mental health, or perceived life stress [ 54 ]. There is also some evidence to support that previous participation in sports (e.g., during childhood or young adulthood) is linked to better mental health outcomes later in life, including improved mental well-being and lower mental distress [ 59 ], even after controlling for age and current physical activity.

Compared to published community data for adults, elite or high-performance adult athletes demonstrated higher levels of body satisfaction, self-esteem, and overall life satisfaction [ 39 ]; and reported reduced tendency to respond to distress with anger and depression. However, rates of psychological distress were higher in the elite sport cohort (compared to community norms), with nearly 1 in 5 athletes reporting ‘high to very high’ distress, and 1 in 3 reporting poor mental health symptoms at a level warranting treatment by a health professional in one study ( n  = 749) [ 39 ].

Four studies focused on the associations between physical activity and sports participation and mental health outcomes in older adults. Physical activity was associated with greater quality of life [ 56 ], with the relationship strongest for those participating in sport in middle age, and for those who cycled in later life (> 65) [ 56 ]. Group physical activities (e.g., walking groups) and sports (e.g., golf) were also significantly related to excellent self-rated health, low depressive symptoms, high health-related quality of life (HRQoL) and a high frequency of laughter in males and females [ 60 , 61 ]. No participation or irregular participation in sport was associated with symptoms of mild to severe depression in older adults [ 62 ].

Several cross-sectional studies examined whether the effects of physical activity varied by type (e.g., total physical activity vs. sports participation). In an analysis of 1446 young adults (mean age = 18), total physical activity, moderate-to-vigorous physical activity, and team sport were independently associated with mental health [ 46 ]. Relative to individual physical activity, after adjusting for covariates and moderate-to-vigorous physical activity (MVPA), only team sport was significantly associated with improved mental health. Similarly, in a cross-sectional analysis of Australian women, Eime, Harvey, Payne (2014) reported that women who engaged in club and team-based sports (tennis or netball) reported better mental health and life satisfaction than those who engaged in individual types of physical activity [ 47 ]. Interestingly, there was no relationship between the amount of physical activity and either of these outcomes, suggesting that other qualities of sports participation contribute to its relationship to mental health and life satisfaction. There was also some evidence to support a relationship between exercise type (ball sports, aerobic activity, weightlifting, and dancing), and mental health amongst young adults (mean age 22 years) [ 48 ], with ball sports and dancing related to fewer symptoms of depression in students with high stress; and weightlifting related to fewer depressive symptoms in weightlifters exhibiting low stress.

Longitudinal evidence

Eight studies examined the longitudinal relationship between sports participation and either mental health and/or social outcomes. Sample sizes range from n  = 113 to n  = 1679 with a total of n  = 7022 adults included across the longitudinal studies.

Five of the included longitudinal studies focused on the relationship between sports participation in childhood or adolescence and mental health in young adulthood. There is evidence that participation in sport in high-school is protective of future symptoms of anxiety (including panic disorder, generalised anxiety disorder, social phobia, and agoraphobia) [ 42 ]. Specifically, after controlling for covariates (including current physical activity), the number of years of sports participation in high school was shown to be protective of symptoms of panic and agoraphobia in young adulthood, but not protective of symptoms of social phobia or generalized anxiety disorder [ 42 ]. A comparison of individual or team sports participation also revealed that participation in either context was protective of panic disorder symptoms, while only team sport was protective of agoraphobia symptoms, and only individual sport was protective of social phobia symptoms. Furthermore, current and past sports team participation was shown to negatively relate to adult depressive symptoms [ 43 ]; drop out of sport was linked to higher depressive symptoms in adulthood compared to those with maintained participation [ 9 , 22 , 63 ]; and consistent participation in team sports (but not individual sport) in adolescence was linked to higher self-rated mental health, lower perceived stress and depressive symptoms, and lower depression scores in early adulthood [ 53 , 58 ].

Two longitudinal studies [ 35 , 55 ], also investigated the association between team and individual playing context and mental health. Dore and colleagues [ 35 ] reported that compared to individual activities, being active in informal groups (e.g., yoga, running groups) or team sports was associated with better mental health, fewer depressive symptoms and higher social connectedness – and that involvement in team sports was related to better mental health regardless of physical activity volume. Kim and James [ 55 ] discovered that sports participation led to both short and long-term improvements in positive affect and life satisfaction.

A study on social outcomes related to mixed martial-arts (MMA) and Brazilian jiu-jitsu (BJJ) showed that both sports improved practitioners’ self-control and pro-social behavior, with greater improvements seen in the BJJ group [ 62 ]. Notably, while BJJ reduced participants’ reported aggression, there was a slight increase in MMA practitioners, though it is worth mentioning that individuals who sought out MMA had higher levels of baseline aggression.

Experimental evidence

Six of the included studies were experimental or quasi-experimental. Sample sizes ranged from n  = 28 to n  = 55 with a total of n  = 239 adults included across six longitudinal studies. Three studies involved a form of martial arts (such as judo and karate) [ 45 , 51 , 52 ], one involved a variety of team sports (such as netball, soccer, and cricket) [ 34 ], and the remaining two focused on badminton [ 57 ] and handball [ 49 ].

Brinkley and colleagues [ 34 ] reported significant effects on interpersonal communication (but not vitality, social cohesion, quality of life, stress, or interpersonal relationships) for participants ( n  = 40) engaging in a 12-week workplace team sports intervention. Also using a 12-week intervention, Hornstrup et al. [ 49 ] reported a significant improvement in mental energy (but not well-being or anxiety) in young women (mean age = 24; n  = 28) playing in a handball program. Patterns et al. [ 57 ] showed that in comparison to no exercise, participation in an 8-week badminton or running program had no significant improvement on self-esteem, despite improvements in perceived and actual fitness levels.

Three studies examined the effect of martial arts on the mental health of older adults (mean ages 79 [ 52 ], 64 [ 51 ], and 70 [ 45 ] years). Participation in Karate-Do had positive effects on overall mental health, emotional wellbeing, depression and anxiety when compared to other activities (physical, cognitive, mindfulness) and a control group [ 51 , 52 ]. Ciaccioni et al. [ 45 ] found that a Judo program did not affect either the participants’ mental health or their body satisfaction, citing a small sample size, and the limited length of the intervention as possible contributors to the findings.

Qualitative evidence

Three studies interviewed current or former sports players regarding their experiences with sport. Chinkov and Holt [ 41 ] reported that jiu-jitsu practitioners (mean age 35 years) were more self-confident in their lives outside of the gym, including improved self-confidence in their interactions with others because of their training. McGraw and colleagues [ 37 ] interviewed former and current National Football League (NFL) players and their families about its impact on the emotional and mental health of the players. Most of the players reported that their NFL career provided them with social and emotional benefits, as well as improvements to their self-esteem even after retiring. Though, despite these benefits, almost all the players experienced at least one mental health challenge during their career, including depression, anxiety, or difficulty controlling their temper. Some of the players and their families reported that they felt socially isolated from people outside of the national football league.

Through a series of semi-structured interviews and focus groups, Thorpe, Anders [ 40 ] investigated the impact of an Aboriginal male community sporting team on the health of its players. The players reported they felt a sense of belonging when playing in the team, further noting that the social and community aspects were as important as the physical health benefits. Participating in the club strengthened the cultural identity of the players, enhancing their well-being. The players further noted that participation provided them with enjoyment, stress relief, a sense of purpose, peer support, and improved self-esteem. Though they also noted challenges, including the presence of racism, community conflict, and peer-pressure.

Quality of studies

Full details of our risk of bias (ROB) results are provided in Supplementary Material A . Of the three qualitative studies assessed using the Critical Appraisal Skills Program (CASP), all three were deemed to have utilised and reported appropriate methodological standards on at least 8 of the 10 criteria. Twenty studies were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with all studies clearly reporting the research question/s or objective/s and study population. However, only four studies provided a justification for sample size, and less than half of the studies met quality criteria for items 6, 7, 9, or 10 (and items 12 and 13 were largely not applicable). Of concern, only four of the observational or cohort studies were deemed to have used clearly defined, valid, and reliable exposure measures (independent variables) and implemented them consistently across all study participants. Six studies were assessed using the Quality Assessment of Controlled Intervention Studies, with three studies described as a randomized trial (but none of the three reported a suitable method of randomization, concealment of treatment allocation, or blinding to treatment group assignment). Three studies showed evidence that study groups were similar at baseline for important characteristics and an overall drop-out rate from the study < 20%. Four studies reported high adherence to intervention protocols (with two not reporting) and five demonstrated that.study outcomes were assessed using valid and reliable measures and implemented consistently across all study participants. Importantly, researchers did not report or have access to validated instruments for assessing sport participation or physical activity amongst adults, though most studies provided psychometrics for their mental health outcome measure/s. Only one study reported that the sample size was sufficiently powered to detect a difference in the main outcome between groups (with ≥ 80% power) and that all participants were included in the analysis of results (intention-to-treat analysis). In general, the methodological quality of the six randomised studies was deemed low.

Initially, our discussion will focus on the review findings regarding sports participation and well-being, ill-being, and psychological health. However, the heterogeneity and methodological quality of the included research (especially controlled trials) should be considered during the interpretation of our results. Considering our findings, the Mental Health through Sport conceptual model for adults will then be presented and discussed and study limitations outlined.

Sports participation and psychological well-being

In summary, the evidence presented here indicates that for adults, sports participation is associated with better overall mental health [ 36 , 46 , 47 , 59 ], mood [ 56 ], higher life satisfaction [ 39 , 47 ], self-esteem [ 39 ], body satisfaction [ 39 ], HRQoL [ 60 ], self-rated health [ 61 ], and frequency of laughter [ 61 ]. Sports participation has also shown to be predictive of better psychological wellbeing over time [ 35 , 53 ], higher positive affect [ 55 ], and greater life satisfaction [ 55 ]. Furthermore, higher frequency of sports participation and/or sport played at a higher level of competition, have been linked to lower levels of mental distress, higher levels of body satisfaction, self-esteem, and overall life satisfaction in adults [ 39 ].

Despite considerable heterogeneity of sports type, cross-sectional and experimental research indicate that team-based sports participation, compared to individual sports and informal group physical activity, has a more positive effect on mental energy [ 49 ], physical self-perception [ 57 ], and overall psychological health and well-being in adults, regardless of physical activity volume [ 35 , 46 , 47 ]. And, karate-do benefits the subjective well-being of elderly practitioners [ 51 , 52 ]. Qualitative research in this area has queried participants’ experiences of jiu-jitsu, Australian football, and former and current American footballers. Participants in these sports reported that their participation was beneficial for psychological well-being [ 37 , 40 , 41 ], improved self-esteem [ 37 , 40 , 41 ], and enjoyment [ 37 ].

Sports participation and psychological ill-being

Of the included studies, n  = 19 examined the relationship between participating in sport and psychological ill-being. In summary, there is consistent evidence that sports participation is related to lower depression scores [ 43 , 48 , 61 , 62 ]. There were mixed findings regarding psychological stress, where participation in childhood (retrospectively assessed) was related to lower stress in young adulthood [ 41 ], but no relationship was identified between recreational hockey in adulthood and stress [ 54 ]. Concerning the potential impact of competing at an elite level, there is evidence of higher stress in elite athletes compared to community norms [ 39 ]. Further, there is qualitative evidence that many current or former national football league players experienced at least one mental health challenge, including depression, anxiety, difficulty controlling their temper, during their career [ 37 ].

Evidence from longitudinal research provided consistent evidence that participating in sport in adolescence is protective of symptoms of depression in young adulthood [ 43 , 53 , 58 , 63 ], and further evidence that participating in young adulthood is related to lower depressive symptoms over time (6 months) [ 35 ]. Participation in adolescence was also protective of manifestations of anxiety (panic disorder and agoraphobia) and stress in young adulthood [ 42 ], though participation in young adulthood was not related to a more general measure of anxiety [ 35 ] nor to changes in negative affect [ 55 ]). The findings from experimental research were mixed. Two studies examined the effect of karate-do on markers of psychological ill-being, demonstrating its capacity to reduce anxiety [ 52 ], with some evidence of its effectiveness on depression [ 51 ]. The other studies examined small-sided team-based games but showed no effect on stress or anxiety [ 34 , 49 ]. Most studies did not differentiate between team and individual sports, though one study found that adolescents who participated in team sports (not individual sports) in secondary school has lower depression scores in young adulthood [ 58 ].

Sports participation and social outcomes

Seven of the included studies examined the relationship between sports participation and social outcomes. However, very few studies examined social outcomes or tested a social outcome as a potential mediator of the relationship between sport and mental health. It should also be noted that this body of evidence comes from a wide range of sport types, including martial arts, professional football, and workplace team-sport, as well as different methodologies. Taken as a whole, the evidence shows that participating in sport is beneficial for several social outcomes, including self-control [ 50 ], pro-social behavior [ 50 ], interpersonal communication [ 34 ], and fostering a sense of belonging [ 40 ]. Further, there is evidence that group activity, for example team sport or informal group activity, is related to higher social connectedness over time, though analyses showed that social connectedness was not a mediator for mental health [ 35 ].

There were conflicting findings regarding social effects at the elite level, with current and former NFL players reporting that they felt socially isolated during their career [ 37 ], whilst another study reported no relationship between participation at the elite level and social dysfunction [ 39 ]. Conversely, interviews with a group of indigenous men revealed that they felt as though participating in an all-indigenous Australian football team provided them with a sense of purpose, and they felt as though the social aspect of the game was as important as the physical benefits it provides [ 40 ].

Mental health through sport conceptual model for adults

The ‘Health through Sport’ model provides a depiction of the determinants and benefits of sports participation [ 31 ]. The model recognises that the physical, mental, and social benefits of sports participation vary by the context of sport (e.g., individual vs. team, organized vs. informal). To identify the elements of sport which contribute to its effect on mental health outcomes, we describe the ‘Mental Health through Sport’ model (Fig.  2 ). The model proposes that the social and physical elements of sport each provide independent, and likely synergistic contributions to its overall influence on mental health.

figure 2

The Mental Health through Sport conceptual model

The model describes two key pathways through which sport may influence mental health: physical activity, and social relationships and support. Several likely moderators of this effect are also provided, including sport type, intensity, frequency, context (team vs. individual), environment (e.g., indoor vs. outdoor), as well as the level of competition (e.g., elite vs. amateur).

The means by which the physical activity component of sport may influence mental health stems from the work of Lubans et al., who propose three key groups of mechanisms: neurobiological, psychosocial, and behavioral [ 64 ]. Processes whereby physical activity may enhance psychological outcomes via changes in the structural and functional composition of the brain are referred to as neurobiological mechanisms [ 65 , 66 ]. Processes whereby physical activity provides opportunities for the development of self-efficacy, opportunity for mastery, changes in self-perceptions, the development of independence, and for interaction with the environment are considered psychosocial mechanisms. Lastly, processes by which physical activity may influence behaviors which ultimately affect psychological health, including changes in sleep duration, self-regulation, and coping skills, are described as behavioral mechanisms.

Playing sport offers the opportunity to form relationships and to develop a social support network, both of which are likely to influence mental health. Thoits [ 29 ] describes 7 key mechanisms by which social relationships and support may influence mental health: social influence/social comparison; social control; role-based purpose and meaning (mattering); self-esteem; sense of control; belonging and companionship; and perceived support availability [ 29 ]. These mechanisms and their presence within a sporting context are elaborated below.

Subjective to the attitudes and behaviors of individuals in a group, social influence and comparison may facilitate protective or harmful effects on mental health. Participants in individual or team sport will be influenced and perhaps steered by the behaviors, expectations, and norms of other players and teams. When individual’s compare their capabilities, attitudes, and values to those of other participants, their own behaviors and subsequent health outcomes may be affected. When others attempt to encourage or discourage an individual to adopt or reject certain health practices, social control is displayed [ 29 ]. This may evolve as strategies between players (or between players and coach) are discussion and implemented. Likewise, teammates may try to motivate each another during a match to work harder, or to engage in specific events or routines off-field (fitness programs, after game celebrations, attending club events) which may impact current and future physical and mental health.

Sport may also provide behavioral guidance, purpose, and meaning to its participants. Role identities (positions within a social structure that come with reciprocal obligations), often formed as a consequence of social ties formed through sport. Particularly in team sports, participants come to understand they form an integral part of the larger whole, and consequently, they hold certain responsibility in ensuring the team’s success. They have a commitment to the team to, train and play, communicate with the team and a potential responsibility to maintain a high level of health, perform to their capacity, and support other players. As a source of behavioral guidance and of purpose and meaning in life, these identities are likely to influence mental health outcomes amongst sport participants.

An individual’s level of self-esteem may be affected by the social relationships and social support provided through sport; with improved perceptions of capability (or value within a team) in the sporting domain likely to have positive impact on global self-esteem and sense of worth [ 64 ]. The unique opportunities provided through participation in sport, also allow individuals to develop new skills, overcome challenges, and develop their sense of self-control or mastery . Working towards and finding creative solutions to challenges in sport facilitates a sense of mastery in participants. This sense of mastery may translate to other areas of life, with individual’s developing the confidence to cope with varied life challenges. For example, developing a sense of mastery regarding capacity to formulate new / creative solutions when taking on an opponent in sport may result in greater confidence to be creative at work. Social relationships and social support provided through sport may also provide participants with a source of belonging and companionship. The development of connections (on and off the field) to others who share common interests, can build a sense of belonging that may mediate improvements in mental health outcomes. Social support is often provided emotionally during expressions of trust and care; instrumentally via tangible assistance; through information such as advice and suggestions; or as appraisal such feedback. All forms of social support provided on and off the field contribute to a more generalised sense of perceived support that may mediate the effect of social interaction on mental health outcomes.

Participation in sport may influence mental health via some combination of the social mechanisms identified by Thoits, and the neurobiological, psychosocial, and behavioral mechanisms stemming from physical activity identified by Lubans [ 29 , 64 ]. The exact mechanisms through which sport may confer psychological benefit is likely to vary between sports, as each sport varies in its physical and social requirements. One must also consider the social effects of sports participation both on and off the field. For instance, membership of a sporting team and/or club may provide a sense of identity and belonging—an effect that persists beyond the immediacy of playing the sport and may have a persistent effect on their psychological health. Furthermore, the potential for team-based activity to provide additional benefit to psychological outcomes may not just be attributable to the differences in social interactions, there are also physiological differences in the requirements for sport both within (team vs. team) and between (team vs. individual) categories that may elicit additional improvements in psychological outcomes. For example, evidence supports that exercise intensity moderates the relationship between physical activity and several psychological outcomes—supporting that sports performed at higher intensity will be more beneficial for psychological health.

Limitations and recommendations

There are several limitations of this review worthy of consideration. Firstly, amongst the included studies there was considerable heterogeneity in study outcomes and study methodology, and self-selection bias (especially in non-experimental studies) is likely to influence study findings and reduce the likelihood that study participants and results are representative of the overall population. Secondly, the predominately observational evidence included in this and Eime’s prior review enabled us to identify the positive relationship between sports participation and social and psychological health (and examine directionality)—but more experimental and longitudinal research is required to determine causality and explore potential mechanisms responsible for the effect of sports participation on participant outcomes. Additional qualitative work would also help researchers gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants. Thirdly, there were no studies identified in the literature where sports participation involved animals (such as equestrian sports) or guns (such as shooting sports). Such studies may present novel and important variables in the assessment of mental health benefits for participants when compared to non-participants or participants in sports not involving animals/guns—further research is needed in this area. Our proposed conceptual model also identifies several pathways through which sport may lead to improvements in mental health—but excludes some potentially negative influences (such as poor coaching behaviors and injury). And our model is not designed to capture all possible mechanisms, creating the likelihood that other mechanisms exist but are not included in this review. Additionally, an interrelationship exits between physical activity, mental health, and social relationships, whereby changes in one area may facilitate changes in the other/s; but for the purpose of this study, we have focused on how the physical and social elements of sport may mediate improvements in psychological outcomes. Consequently, our conceptual model is not all-encompassing, but designed to inform and guide future research investigating the impact of sport participation on mental health.

The findings of this review endorse that participation in sport is beneficial for psychological well-being, indicators of psychological ill-being, and social outcomes in adults. Furthermore, participation in team sports is associated with better psychological and social outcomes compared to individual sports or other physical activities. Our findings support and add to previous review findings [ 1 ]; and have informed the development of our ‘Mental Health through Sport’ conceptual model for adults which presents the potential mechanisms by which participation in sport may affect mental health.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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We would like to acknowledge the work of the original systematic review conducted by Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., and Payne, W. R. (2013).

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Eather, N., Wade, L., Pankowiak, A. et al. The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model. Syst Rev 12 , 102 (2023). https://doi.org/10.1186/s13643-023-02264-8

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Review article, stress in academic and athletic performance in collegiate athletes: a narrative review of sources and monitoring strategies.

stress management through sports essay

  • 1 School of Kinesiology, Applied Health and Recreation, Oklahoma State University, Stillwater, OK, United States
  • 2 Department of Kinesiology, California State University, Fullerton, CA, United States
  • 3 Department of Kinesiology, Point Loma Nazarene University, San Diego, CA, United States
  • 4 Department of Kinesiology and Sport Sciences, University of Miami, Miami, FL, United States

College students are required to manage a variety of stressors related to academic, social, and financial commitments. In addition to the burdens facing most college students, collegiate athletes must devote a substantial amount of time to improving their sporting abilities. The strength and conditioning professional sees the athlete on nearly a daily basis and is able to recognize the changes in performance and behavior an athlete may exhibit as a result of these stressors. As such, the strength and conditioning professional may serve an integral role in the monitoring of these stressors and may be able to alter training programs to improve both performance and wellness. The purpose of this paper is to discuss stressors experienced by collegiate athletes, developing an early detection system through monitoring techniques that identify the detrimental effects of stress, and discuss appropriate stress management strategies for this population.

Introduction

The college years are a period of time when young adults experience a significant amount of change and a variety of novel challenges. Academic performance, social demands, adjusting to life away from home, and financial challenges are just a few of the burdens college students must confront ( Humphrey et al., 2000 ; Paule and Gilson, 2010 ; Aquilina, 2013 ). In addition to these stressors, collegiate athletes are required to spend a substantial amount of time participating in activities related to their sport, such as attending practices and training sessions, team meetings, travel, and competitions ( Humphrey et al., 2000 ; López de Subijana et al., 2015 ; Davis et al., 2019 ; Hyatt and Kavazis, 2019 ). These commitments, in addition to the normal stress associated with college life, may increase a collegiate-athlete's risk of experiencing both physical and mental issues ( Li et al., 2017 ; Moreland et al., 2018 ) that may affect their overall health and wellness. For these reasons, it is essential that coaches understand the types of stressors collegiate athletes face in order to help them manage the potentially deleterious effects stress may have on athletic and academic performance.

Strength and conditioning coaches are allied health care professionals whose primary job is to enhance fitness of individuals for the purpose of improving athletic performance ( Massey et al., 2002 , 2004 , 2009 ). As such, many universities and colleges hire strength and conditioning coaches as part of their athletic staff to help athletes maximize their physical potential ( Massey et al., 2002 , 2004 , 2009 ). Strength and conditioning coaches strive to increase athletic performance by the systematic application of physical stress to the body via resistance training, and other forms of exercise, to yield a positive adaptation response ( Massey et al., 2002 , 2004 , 2009 ). For this reason, they need to understand and to learn how to manage athletes' stress. Additionally, based on the cumulative nature of stress, it is important that both mental and emotional stressors are also considered in programming. It is imperative that strength and conditioning coaches are aware of the multitude of stressors collegiate athletes encounter, in order to incorporate illness and injury risk management education into their training programs ( Radcliffe et al., 2015 ; Ivarsson et al., 2017 ).

Based on the large number of contact hours strength and conditioning coaches spend with their athletes, they are in an optimal position to assist athletes with developing effective coping strategies to manage stress. By doing so, strength and conditioning coaches may be able to help reach the overarching goal of improving the health, wellness, fitness, and performance of the athletes they coach. The purpose of this review article is to provide the strength and conditioning professional with a foundational understanding of the types of stressors collegiate athletes may experience, and how these stressors may impact mental health and athletic performance. Suggestions for assisting athletes with developing effective coping strategies to reduce potential physiological and psychological impacts of stress will also be provided.

Stress and the Stress Response

In its most simplistic definition, stress can be described as a state of physical and psychological activation in response to external demands that exceed one's ability to cope and requires a person to adapt or change behavior. As such, both cognitive or environmental events that trigger stress are called stressors ( Statler and DuBois, 2016 ). Stressors can be acute or chronic based on the duration of activation. Acute stressors may be defined as a stressful situation that occurs suddenly and results in physiological arousal (e.g., increase in hormonal levels, blood flow, cardiac output, blood sugar levels, pupil and airway dilation, etc.) ( Selye, 1976 ). Once the situation is normalized, a cascade of hormonal reactions occurs to help the body return to a resting state (i.e., homeostasis). However, when acute stressors become chronic in nature, they may increase an individual's risk of developing anxiety, depression, or metabolic disorders ( Selye, 1976 ). Moreover, the literature has shown that cumulative stress is correlated with an increased susceptibility to illness and injury ( Szivak and Kraemer, 2015 ; Mann et al., 2016 ; Hamlin et al., 2019 ). The impact of stress is individualistic and subjective by nature ( Williams and Andersen, 1998 ; Ivarsson et al., 2017 ). Additionally, the manner in which athletes respond to a situational or environmental stressor is often determined by their individual perception of the event ( Gould and Udry, 1994 ; Williams and Andersen, 1998 ; Ivarsson et al., 2017 ). In this regard, the athlete's perception can either be positive (eustress) or negative (distress). Even though they both cause physiological arousal, eustress also generates positive mental energy whereas distress generates anxiety ( Statler and DuBois, 2016 ). Therefore, it is essential that an athlete has the tools and ability to cope with these stressors in order to have the capacity to manage both acute and chronic stress. As such, it is important to understand the types of stressors collegiate athletes are confronted with and how these stressors impact an athlete's performance, both athletically and academically.

Literature Search/Data Collection

The articles included in this review were identified via online databases PubMed, MEDLINE, and ISI Web of Knowledge from October 15th 2019 through January 15th 2020. The search strategy combined the keywords “academic stress,” “athletic stress,” “stress,” “stressor,” “college athletes,” “student athletes,” “collegiate athletes,” “injury,” “training,” “monitoring.” Duplicated articles were then removed. After reading the titles and abstracts, all articles that met the inclusion criteria were considered eligible for inclusion in the review. Subsequently, all eligible articles were read in their entirety and were either included or removed from the present review.

Inclusion Criteria

The studies included met all the following criteria: (i) published in English-language journals; (ii) targeted college athletes; (iii) publication was either an original research paper or a literature review; (iv) allowed the extraction of data for analysis.

Data Analysis

Relevant data regarding participant characteristics (i.e., gender, academic status, sports) and study characteristics were extracted. Articles were analyzed and divided into two separate sections based on their specific topics: Academic Stress and Athletic Stress. Then, strategies for monitoring and workload management are discussed in the final section.

Academic Stress

Fundamentally, collegiate athletes have two major roles they must balance as part of their commitment to a university: being a college student and an athlete. Academic performance is a significant source of stress for most college students ( Aquilina, 2013 ; López de Subijana et al., 2015 ; de Brandt et al., 2018 ; Davis et al., 2019 ). This stress may be further compounded among collegiate athletes based on their need to be successful in the classroom, while simultaneously excelling in their respective sport ( Aquilina, 2013 ; López de Subijana et al., 2015 ; Huml et al., 2016 ; Hamlin et al., 2019 ). Davis et al. (2019) conducted surveys on 173 elite junior alpine skiers and reported significant moderate to strong correlations between perceived stress and several variables including depressed mood ( r = 0.591), sleep disturbance ( r = 0.459), fatigue ( r = 0.457), performance demands ( r = 0.523), and goals and development ( r = 0.544). Academic requirements were the highest scoring source of stress of all variables and was most strongly correlated with perceived stress ( r = 0.467). Interestingly, it was not academic rigor that was viewed by the athletes as the largest source of direct stress; rather, the athletes surveyed reported time management as being their biggest challenge related to academic performance ( Davis et al., 2019 ). This further corroborates the findings of Hamlin et al. (2019) . The investigators reported that during periods of the academic year in which levels of perceived academic stress were at their highest, students had trouble managing sport practices and studying. These stressors were also associated with a decrease in energy levels and overall sleep quality. These factors may significantly increase the collegiate athlete's susceptibility to illness and injury ( Hamlin et al., 2019 ). For this reason, coaches should be aware of and sensitive to the stressors athletes experience as part of the cyclical nature of the academic year and attempt to help athletes find solutions to balancing athletic and academic demands.

According to Aquilina (2013) , collegiate athletes tend to be more committed to sports development and may view their academic career as a contingency plan to their athletic career, rather than a source of personal development. As a result, collegiate athletes often, but certainly not always, prioritize athletic participation over their academic responsibilities ( Miller and Kerr, 2002 ; Cosh and Tully, 2014 , 2015 ). Nonetheless, scholarships are usually predicated on both athletic and academic performance. For instance, the National Collegiate Athletic Association (NCAA) requires collegiate athletes to achieve and maintain a certain grade point average (GPA). Furthermore, they are also often required to also uphold a certain GPA to maintain an athletic scholarship. The pressure to maintain both high levels of academic and athletic performance may increase the likelihood of triggering mental health issues (i.e., anxiety and depression) ( Li et al., 2017 ; Moreland et al., 2018 ).

Mental health issues are a significant concern among college students. There has been an increased emphasis placed on the mental health of collegiate athletes in recent years ( Petrie et al., 2014 ; Li et al., 2017 , 2019 ; Reardon et al., 2019 ). Based on the 2019 National College Health Assessment survey from the American College Health Association (ACHA) consisting of 67,972 participants, 27.8% of college students reported anxiety, and 20.2% reported experiencing depression which negatively affected their academic performance ( American College Health Association American College Health Association-National College Health Assessment II, 2019 ). Approximately 65.7% (50.7% males and 71.8% females) reported feeling overwhelming anxiety in the past 12 months, and 45.1% (37.1% males and 47.6% females) reported feeling so depressed that it was difficult for them to function. However, only 24.3% (13% males and 28.4% females) reported being diagnosed and treated by a professional in the past 12 months. Collegiate athletes are not immune to these types of issues. According to information presented by the NCAA, many certified athletic trainers anecdotally state that anxiety is an issue affecting the collegiate-athlete population ( NCAA, 2014 ). However, despite the fact that collegiate athletes are exposed to numerous stressors, they are less likely to seek help at a university counseling center than non-athletes ( NCAA, 2014 ), which could be related to stigmas that surround mental health services ( NCAA, 2014 ; Kaier et al., 2015 ; Egan, 2019 ). This not only has significant implications related to their psychological well-being, but also their physiological health, and consequently their performance. For instance, in a study by Li et al. (2017) it was found that NCAA Division I athletes who reported preseason anxiety symptoms had a 2.3 times greater injury incidence rate compared to athletes who did not report. This same study discovered that male athletes who reported preseason anxiety and depression had a 2.1 times greater injury incidence, compared to male athletes who did not report symptoms of anxiety and depression. ( Lavallée and Flint, 1996 ) also reported a correlation between anxiety and both injury frequency and severity among college football players ( r = 0.43 and r = 0.44, respectively). In their study, athletes reporting high tension/anxiety had a higher rate of injury. It has been suggested that the occurrence of stress and anxiety may cause physiological responses, such as an increase in muscle tension, physical fatigue, and a decrease in neurocognitive and perception processes that can lead to physical injuries ( Ivarsson et al., 2017 ). For this reason, it is reasonable to consider that academic stressors may potentiate effects of stress and result in injury and illness in collegiate athletes.

Periods of more intense academic stress increase the susceptibility to illness or injury ( Mann et al., 2016 ; Hamlin et al., 2019 ; Li et al., 2019 ). For example, Hamlin et al. (2019) investigated levels of perceived stress, training loads, injury, and illness incidence in 182 collegiate athletes for the period of one academic year. The highest levels of stress and incidence of illness arise during the examination weeks occurring within the competitive season. In addition, the authors also reported the odds ratio, which is the occurrence of the outcome of interest (i.e., injury), based off the given exposure to the variables of interest (i.e., perceived mood, sleep duration, increased academic stress, and energy levels). Based on a logistic regression, they found that each of the four variables (i.e., mood, energy, sleep duration, and academic stress) was related to the collegiate athletes' likelihood to incur injuries. In summary, decreased levels of perceived mood (odds ratio of 0.89, 0.85–0.0.94 CI) and sleep duration (odds ratio of 0.94, 0.91–0.97 CI), and increased academic stress (odds ratio of 0.91, 0.88–0.94 CI) and energy levels (odds ratio of 1.07, 1.01–1.14 CI), were able to predict injury in these athletes. This corroborates Mann et al. (2016) who found NCAA Division I football athletes at a Bowl Championship Subdivision university were more likely to become ill or injured during an academically stressful period (i.e., midterm exams or other common test weeks) than during a non-testing week (odds ratio of 1.78 for high academic stress). The athletes were also less likely to get injured during training camp (odds ratio of 3.65 for training camp). Freshmen collegiate athletes may be especially more susceptible to mental health issues than older students. Their transition includes not only the academic environment with its requirements and expectations, but also the adaptation to working with a new coach and teammates. In this regard, Yang et al. (2007) found an increase in the likelihood of depression that freshmen athletes experienced, as these freshmen were 3.27 times more likely to experience depression than their older teammates. While some stressors are recurrent and inherent in academic life (e.g., attending classes, homework, etc.), others are more situational (e.g., exams, midterms, projects) and may be anticipated by the strength and conditioning coach.

Athletic Stress

The domain of athletics can expose collegiate athletes to additional stressors that are specific to their cohort (e.g., sport-specific, team vs. individual sport) ( Aquilina, 2013 ). Time spent training (e.g., physical conditioning and sports practice), competition schedules (e.g., travel time, missing class), dealing with injuries (e.g., physical therapy/rehabilitation, etc.), sport-specific social support (e.g., teammates, coaches) and playing status (e.g., starting, non-starter, being benched, etc.) are just a few of the additional challenges collegiate athletes must confront relative to their dual role of being a student and an athlete ( Maloney and McCormick, 1993 ; Scott et al., 2008 ; Etzel, 2009 ; Fogaca, 2019 ). Collegiate athletes who view the demands of stressors from academics and sports as a positive challenge (i.e., an individual's self-confidence or belief in oneself to accomplish the task outweighs any anxiety or emotional worry that is felt) may potentially increase learning capacity and competency ( NCAA, 2014 ). However, when these demands are perceived as exceeding the athlete's capacity, this stress can be detrimental to the student's mental and physical health as well as to sport performance ( Ivarsson et al., 2017 ; Li et al., 2017 ).

As previously stated, time management has been shown to be a challenge to collegiate athletes. The NCAA rules state that collegiate athletes may only engage in required athletic activities for 4 h per day and 20 h/week during in-season and 8 h/week during off-season throughout the academic year. Although these rules have been clearly outlined, the most recent NCAA GOALS (2016) study reported alarming numbers regarding time commitment to athletic-related activities. Data from over 21,000 collegiate athletes from 600 schools across Divisions I, II, and III were included in this study. Although a breakdown of time commitments was not provided, collegiate athletes reported dedicating up to 34 h per week to athletics (e.g., practices, weight training, meetings with coaches, tactical training, competitions, etc.), in addition to spending between 38.5 and 40 h per week working on academic-related tasks. This report also showed a notable trend related to athletes spending an increase of ~2 more athletics-related hours per week compared to the 2010 GOALS study, along with a decrease of 2 h of personal time (from 19.5 h per week in 2010 to 17.1 in 2015). Furthermore, ~66% of Division I and II and 50% of Division III athletes reported spending as much or more time in their practices during the off-season as during the competitive season ( DTHOMAS, 2013 ). These numbers show how important it is for collegiate athletes to develop time management skills to be successful in both academics and athletics. Overall, most collegiate athletes have expressed a need to find time to enjoy their college experience outside of athletic obligations ( Paule and Gilson, 2010 ). Despite that, because of the increasing demand for excellence in academics and athletics, collegiate athletes' free time with family and friends is often scarce ( Paule and Gilson, 2010 ). Consequently, trainers, coaches, and teammates will likely be the primary source of their weekly social interactivity.

Social interactions within their sport have also been found to relate to factors that may impact an athlete's perceived stress. Interactions with coaches and trainers can be effective or deleterious to an athlete. Effective coaching includes a coaching style that allows for a boost of the athlete's motivation, self-esteem, and efficacy in addition to mitigating the effects of anxiety. On the other hand, poor coaching (i.e., the opposite of effective coaching) can have detrimental psychological effects on an athlete ( Gearity and Murray, 2011 ). In a closer examination of the concept of poor coaching practices, Gearity and Murray (2011) interviewed athletes about their experiences of receiving poor coaching. Following analysis of the interviews, the authors identified the main themes of the “coach being uncaring and unfair,” “practicing poor teaching inhibiting athlete's mental skills,” and “athlete coping.” They stated that inhibition of an athlete's mental skills and coping are associated with the psychological well-being of an athlete. Also, poor coaching may result in mental skills inhibition, distraction, insecurity, and ultimately team division ( Gearity and Murray, 2011 ). This combination of factors may compound the negative impacts of stress in athletes and might be especially important for in injured athletes.

Injured athletes have previously been reported to have elevated stress as a result of heightened worry about returning to pre-competition status ( Crossman, 1997 ), isolation from teammates if the injury is over a long period of time ( Podlog and Eklund, 2007 ) and/or reduced mood or depressive symptoms ( Daly et al., 1995 ). In addition, athletes who experience prolonged negative thoughts may be more likely to have decreased rehabilitation attendance or adherence, worse functional outcomes from rehabilitation (e.g., on measures of proprioception, muscular endurance, and agility), and worse post-injury performance ( Brewer, 2012 ).

Monitoring Considerations

In addition to poor coaching, insufficient workload management can hinder an athlete's ability to recover and adapt to training, leading to fatigue accumulation ( Gabbett et al., 2017 ). Excessive fatigue can impair decision-making ability, coordination and neuromuscular control, and ultimately result in overtraining and injury ( Soligard et al., 2016 ). For instance, central fatigue was found to be a direct contributor to anterior cruciate ligament injuries in soccer players ( Mclean and Samorezov, 2009 ). Introducing monitoring tools may serve as a means to reduce the detrimental effects of stress in collegiate athletes. Recent research on relationships between athlete workloads, injury, and performance has highlighted the benefits of athlete monitoring ( Drew and Finch, 2016 ; Jaspers et al., 2017 ).

Athlete monitoring is often assessed with the measuring and management of workload associated with a combination of sport-related and non-sport-related stressors ( Soligard et al., 2016 ). An effective workload management program should aim to detect excessive fatigue, identify its causes, and constantly adapt rest, recovery, training, and competition loads respectively ( Soligard et al., 2016 ). The workload for each athlete is based off their current levels of physical and psychological fatigue, wellness, fitness, health, and recovery ( Soligard et al., 2016 ). Accumulation of situational or physical stressors will likely result in day-to-day fluctuations in the ability to move external loads and strength train effectively ( Fry and Kraemer, 1997 ). Periods of increased academic stress may cause increased levels of fatigue, which can be identified by using these monitoring tools, thereby assisting the coaches with modulating the workload during these specific periods. Coaches who plan to incorporate monitoring and management strategies must have a clear understanding of what they want to achieve from athlete monitoring ( Gabbett et al., 2017 ; Thornton et al., 2019 ).

Monitoring External Loads

External load refers to the physical work (e.g., number of sprints, weight lifted, distance traveled, etc.) completed by the athlete during competition, training, and activities of daily living ( Soligard et al., 2016 ). This type of load is independent of the athlete's individual characteristics ( Wallace et al., 2009 ). Monitoring external loading can aid in the designing of training programs which mimic the external load demands of an athlete's sport, guide rehabilitation programs, and aid in the detection of spikes in external load that may increase the risk of injury ( Clubb and McGuigan, 2018 ).

The means of quantifying external load can involve metrics as simple as pitch counts in baseball and softball ( Fleisig and Andrews, 2012 ; Shanley et al., 2012 ) or quantifying lifting session training loads (e.g., sum value of weight lifted during an exercise x number of repetitions × the number of sets). Neuromuscular function testing is another more common way of analyzing external load. This is typically done using such measures such as the counter movement jump, squat jump, or drop jump. A force platform can be used to measure a myriad of outcomes (e.g., peak power, ground contact time, time to take-off, reactive strength index, and jump height), or simply measure jump height in a more traditional manner. Jumping protocols, such as the countermovement jump, have been adopted to examine the recovery of neuromuscular function after athletic competition with significant decreases for up to 72 h commonly reported ( Andersson et al., 2008 ; Magalhães et al., 2010 ; Twist and Highton, 2013 ). ( Gathercole et al., 2015 ) found reductions in 18 different neuromuscular variables in collegiate athletes following a fatiguing protocol. The variables of eccentric duration, concentric duration, total duration, time to peak force/power, and flight time:contraction time ratio, derived from a countermovement jump were deemed suitable for detecting neuromuscular fatigue with the rise in the use of technology for monitoring, certain sports have adopted specific software that can aid in the monitoring of stress. For example, power output can be measured using devices such as SRM™ or PowerTap™ in cycling ( Jobson et al., 2009 ). This data can be analyzed to provide information such as average power or normalized power. The power output can then be converted into a Training Stress Score™ via commercially available software ( Marino, 2011 ). More sophisticated measures of external load may involve the use of wearable technology devices such as Global Positioning System (GPS) devices, accelerometers, magnetometer, and gyroscope inertial sensors ( Akenhead and Nassis, 2016 ). These devices can quantify external load in several ways, such as duration of movement, total distance covered, speed of movement, acceleration, and decelerations, as well as sport specific movement such as number and height of jumps, number of tackles, or breakaways, etc. ( Akenhead and Nassis, 2016 ). The expansion of marketing of wearable devices has been substantial; however, there are questions of validity and reliability related to external load tracking limitations related to proprietary metrics, as well as the overall cost that should be considered when considering the adoption of such devices ( Aughey et al., 2016 ; Torres-Ronda and Schelling, 2017 ).

Monitoring Internal Loads

While external load may provide information about an athlete's performance capacity and work completed, it does not provide clear evidence of how athletes are coping with and adapting to the external load ( Halson, 2014 ). This type of information comes from the monitoring of internal loads. The term internal load refers to the individual physiological and psychological response to the external stress or load imposed ( Wallace et al., 2009 ). Internal load is influenced by a number of factors such as daily life stressors, the environment around the athlete, and coping ability ( Soligard et al., 2016 ). Indirect measures, such as the use of heart rate (HR) monitoring, and subjective measurements, such as perceived effort (i.e., ratings of perceived exertion), are examples of internal load monitoring. Using subjective measurement systems is a simple and practical method when dealing with large numbers of athletes ( Saw et al., 2016 ; Nässi et al., 2017 ). Subjective reporting of training load (Rating of Perceived Exertion—RPE) ( Coyne et al., 2018 ), Session Rating of Perceived Exertion—sRPE) ( Coyne et al., 2018 ), perceived stress and recovery (Recovery Stress Questionnaire for Athletes—RESTQ-S), and psychological mood states (Profile of Mood States—POMS) have all been found to be a reliable indicator of training load ( Robson-Ansley et al., 2009 ; Saw et al., 2016 ) and only take a few moments to complete. In addition, subjective measures can be more responsive to tracking changes or training responses in athletes than objective measures ( Saw et al., 2016 ).

Heart rate (HR) monitoring is a common intrinsic measure of how the body is responding to stress. With training, the reduction of resting HR is typically a clear indication of the heart becoming more efficient and not having to beat as frequently. Alternately, increases of resting HR over time with a continuation of training may be an indicator of too much stress. Improper nutrition, such as regular or ongoing suboptimal intakes of vitamins or minerals, may result in increased ventilation and/or increased heart rate ( Lukaski, 2004 ). It has been suggested that the additional stress may lead to parasympathetic hyperactivity, leading to an increase in resting HR ( Statler and DuBois, 2016 ). This largely stems from research examining the sensitivity of various HR derived metrics, such as resting HR, HR variability (HRV), and HR recovery (HRR) to fluctuations in training load ( Borresen and Ian Lambert, 2009 ). HRR in athlete monitoring is the rate of HR decline after the cessation of exercise. A common measure of HHR is the use of a 2 min step test followed by a 60 s HR measurement. The combination of the exercise (stress) on the cardiovascular system and then its subsequent return toward baseline has been used as an indicator of autonomic function and training status in athletes ( Daanen et al., 2012 ). In collegiate athletes it was found that hydration status impacted HRR following moderate to hard straining sessions ( Ayotte and Corcoran, 2018 ). Athletes who followed a prescription hydration plan performed better in the standing long jump, tracked objects faster, and showed faster HRR vs. athletes who followed their normal self-selected hydration plan ( Ayotte and Corcoran, 2018 ). To date, HR monitoring and the various derivatives have mainly been successful in detecting changes in training load and performance in endurance athletes ( Borresen and Ian Lambert, 2009 ; Lamberts et al., 2009 ; Thorpe et al., 2017 ). Although heart rate monitoring can provide additional physiological insight for aerobic sessions or events, it thus far has not been found to be an accurate measurement for quantifying internal load during many explosive, short duration anaerobic activities ( Bosquet et al., 2008 ).

A multitude of studies have reported the reliability and validity of using RPE and sRPE across a range of training modalities ( Foster, 1998 ; Impellizzeri et al., 2004 ; Sweet et al., 2004 ). This measure can be used to create a number of metrics such as session load (sRPE × duration in minutes), daily load (sum of all session loads for that day), weekly training load (sum of all daily training loads for entire week), monotony (standard deviation of weekly training load), and strain (daily or weekly training load × monotony) ( Foster, 1998 ). Qualitative questionnaires that monitor stress and fatigue have been well-established as tools to use with athletes (see Table 1 for examples of commonly used questionnaires in research). Using short daily wellness questionnaires may allow coaches to generate a wellness score which then can be adjusted based off of the stress the athlete may be feeling to meet the daily load target ( Foster, 1998 ; Robson-Ansley et al., 2009 ). However, strength and conditioning coaches need to be mindful that these questionnaires may require sports psychologist or other licensed professional to examine and provide the results. An alternative that may be better suited for strength and conditioning professionals to use could be to incorporate some of the themes of those questionnaires into programing.

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Table 1 . Overview of common tool/measures used by researchers to monitor training load.

A Multifaceted Approach

Dissociation between external and internal load units may be indicative of the state of fatigue of an athlete. Utilizing a monitoring system in which the athlete is able to make adjustments to their training loads in accordance with how they are feeling in that moment can be a useful tool for assisting the athlete in managing stress. Auto-regulation is a method of programming that allows for adjustments based on the results of one or more readiness tests. When implemented properly, auto regulation enables the coach or athlete to optimize training based on the athlete's given readiness for training on a particular day, thereby aiming to avoid potential overtraining ( Kraemer and Fleck, 2018 ). Several studies have found that using movement velocity to designate resistance training intensities can result in significant improvements in maximal strength and athletic performance ( Pareja-Blanco et al., 2014 , 2017 ; Mann et al., 2015 ). Velocity based training allows the coach and athlete to view real time feedback for the given lifts, thereby allowing them to observe how the athlete is performing in that moment. If the athlete is failing to meet the prescribed velocity or the velocity drops greater than a predetermined amount between sets, then this should signal the coach to investigate. If there is a higher than normal amount of stress on that athlete for the day, that could be a potential reason. This type of combination style program of using a quantitative or objective measurement (s) and a subjective measure of wellness (qualitative questionnaire) has recently been reported to be an effective tool in monitoring individuals apart of a team ( Starling et al., 2019 ). The subjective measure in this study was the readiness to train questionnaire (RTT-Q) and the objective measures were the HRR 6min test (specifically the HRR 60s = recorded as decrease in HR in the 60 s after termination of the test) to assess autonomic function and the standing long jump (SLJ) to measure neuromuscular function. The findings found that, based on the absolute typical error of measurement, the HRR 60s and SLJ could detect medium and large changes in fatigue and readiness. The test took roughly 8 min for the entire team, which included a group consisting of 24 college-age athletes. There are many other combinations of monitoring variables and strategies that coaches and athletes may utilize.

Data Analysis – How to Utilize the Measures

Regardless of what type of monitoring tool a coach or athlete may incorporate, it is essential to understand how to analyze this data. There are excellent resources available which discuss this topic in great detail ( Gabbett et al., 2017 ; Clubb and McGuigan, 2018 ; Thornton et al., 2019 ). This section will highlight two main conclusions from these sources and briefly describe two of the main statistical practices and concepts discussed. The use of z-scores or modified z-scores has been proposed as a method of detecting meaningful change in athlete data ( Clubb and McGuigan, 2018 ; Thornton et al., 2019 ). For different monitoring tools listed in Table 1 , the following formula would be an example of how to assess changes: (Athlete daily score—Baseline score)/Standard deviation of baseline. The baseline would likely be based off an appropriate period such as the scores across 2 weeks during the preseason.

In sports and sports science, the use of a magnitude-based inference (MBI) has been suggested as more appropriate and easier to understand when examining meaningful changes in athletic data, than null-hypothesis significance testing (NHST) ( Buchheit, 2014 ). Additional methods to assess meaningful change that are similar to MBI are using standard deviation, typical error, effect sizes, smallest worthwhile change (SWC), and coefficient of variation ( Thornton et al., 2019 ). It should be noted that all of these methods have faced criticism from sources such as statisticians. It is important to understand that the testing methods, measurements, and analysis should be based on the resources and intended goals from use, which will differ from every group and individual. Once identified, it is up to the practitioner to keep this system the same, in order to collect data that can then be examined to understand meaningful information for each setting ( Thornton et al., 2019 ).

Managing and Coping Strategies

Once the collegiate-athlete has been able to identify the need to balance their stress levels, the athlete may then need to seek out options for managing their stress. Coaches are be able to assist them by sharing information on health and wellness resources available for the students, both on and off campus. Another way a coach can potentially support their athletes is by establishing an open-door policy, wherein the team members feel comfortable approaching a member of the strength and conditioning staff in order to seek out resources for coping with challenges related to stress.

There are some basic skills that strength and conditioning coaches can teach (while staying within their scope of practice). Coaches can introduce their athletes to basic lifestyle concepts, such as practicing deep breathing techniques, positive self-talk, and developing healthy sleep habits (i.e., turning off their mobile devices 1 h before bed and aiming for 8 h of sleep each night, etc.). A survey of strength and conditioning practitioners by Radcliffe et al. (2015) found that strategies used by practitioners included a mix of cognitive and behavioral strategies, which was used as justification for recommending practitioners find opportunities to guide professional development toward awareness strategies. Practitioners reported using a wide variety of psychological skills and strategies, which following survey analysis, highlighted a significant emphasis on strategies that may influence athlete self-confidence and goal setting. Themes identified by Radcliffe et al. (2015) included confidence building, arousal management, and skill acquisition. Additionally, similar lower level themes that are connected (i.e., goal setting, increasing, or decreasing arousal intensities, self-talk, mental imagery) are all discussed in the 4th edition of the NSCA Essentials of Strength and Conditioning book ( Haff et al., 2016 ). When the interventions aiming to improve mental health expand from basic concepts to mental training beyond a coach's scope, it would be pertinent for the coach to refer the collegiate-athlete to a sport psychology or other mental health consultant ( Fogaca, 2019 ). Moreover, strength and conditioning coaches may find themselves in a position to become key players in facilitating management strategies for collegiate athletes, thereby guiding the athlete in their quest to learn how to best manage the mental and physical energy levels required in the quest for overall optimal performance ( Statler and DuBois, 2016 ).

Conclusion and Future Directions

This review article has summarized some of the ways that strength and conditioning professionals may be able to gain a better understanding of the types of stressors encountered by collegiate athletes, the impact these stressors may have on athletic performance, and suggestions for assisting athletes with developing effective coping strategies to reduce the potential negative physiological and psychological impacts of stress. It has been suggested that strategies learned in the context of training may have a carry-over effect into other areas such as competition. More education is needed in order for strength and conditioning professionals to gain a greater understanding of how to support their athletes with stress-management techniques and resources. Some ways to disseminate further education on stress-management tools for coaches to share with their athletes may include professional development events, such as conferences and clinics.

Author Contributions

All of the authors have contributed to the development of the manuscript both in writing and conceptual development.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The handling editor declared a past collaboration with one of the authors RL.

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Keywords: stress, load management, academic stress, stress management, injury

Citation: Lopes Dos Santos M, Uftring M, Stahl CA, Lockie RG, Alvar B, Mann JB and Dawes JJ (2020) Stress in Academic and Athletic Performance in Collegiate Athletes: A Narrative Review of Sources and Monitoring Strategies. Front. Sports Act. Living 2:42. doi: 10.3389/fspor.2020.00042

Received: 05 October 2019; Accepted: 30 March 2020; Published: 08 May 2020.

Reviewed by:

Copyright © 2020 Lopes Dos Santos, Uftring, Stahl, Lockie, Alvar, Mann and Dawes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: J. Bryan Mann, Bmann@miami.edu

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Editorial: Adaptation to Psychological Stress in Sport

Martin j. turner.

1 Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom

Marc V. Jones

Anna c. whittaker.

2 Faculty of Health Sciences, Sport University of Stirling, Stirling, United Kingdom

3 School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom

Sylvain Laborde

4 Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany

Sarah Williams

Carla meijen.

5 Faculty of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom

Katherine A. Tamminen

6 Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada

Psychological stress is ubiquitous in sport. Unsurprisingly then, research that examines the antecedents, correlates, consequences, and interventions pertaining to psychological stress in sport is sizable and broad. With this Research Topic we aimed to capture the breadth and depth of work taking place around the theme of adaptation to psychological stress in sport. Pleasingly, 111 authors responded to our call for papers, contributing 25 papers between them. In this Editorial we undertake the difficult task of synthesizing these contributions, and highlight important implications that could influence future research and practice.

One thing that is clear from this Research Topic, is that adaptation to psychological stress is truly a biopsychosocial phenomenon. Whether papers explore biological (bio), psychological (psycho), or social constructs, or a combination of the three, any collective conclusions drawn from the contributions here must involve an appreciation of all three facets. The multiple ways in which these facets interact to predict and impact upon affective and behavioral outcomes within a sport setting is complex, which is one of the reasons we do not have a single unified way of understanding adaptation to psychological stress. In this Research Topic we have some useful theories that capture this biopsychosocial perspective, including two revised theories of challenge and threat states in sport. Indeed, numerous papers within this Research Topic align with and draw upon challenge and threat theory.

Britton et al. provide an important piece of work that speaks to the complex interaction of constructs that are implicated within challenge and threat theory. They recruited adolescent athletes who completed self-reported stress reactivity and cognitive appraisals on approach to competition and a retrospective assessment of emotions, coping strategies, and subjective performance. The path analysis revealed that perceived stress reactivity had direct and indirect effects on the appraisal of higher stressor intensity, lower perceived control, higher perceived threat, negative emotions, and maladaptive coping. Increased threat, positive and negative emotions, and maladaptive coping were associated with performance satisfaction. The complex interaction of cognitive appraisal constructs and affect is also captured by Harwood et al. in their study of stress among parents of competitive British tennis players, in which they consider the primary appraisals, emotions, and coping strategies associated with self-disclosed stressors. The mixed methods analyses showed that a range of organizational, competitive, and developmental stressors were predominantly appraised as harm or challenge, and that anxiety and anger were the most prominent emotions experienced by parents. In particular, parents experienced greater anger in relation to competition (compared to organizational and developmental) stressors, harm appraisal increased negative emotions, and challenge appraisal increased positive emotions.

Where most challenge and threat research has focused on singular events, Moore et al. focused on examining the generalizability of challenge (adaptive) and threat (maladaptive) by examining the consistency of challenge and threat evaluations across potentially stressful situations. In their sample of roller derby players, they found some idiosyncrasies in the athletes' tendency to view particular stressors as more of a challenge or threat. A key take away message from this paper is that there is an interaction between the person and the situation in determining challenge and threat, a notion at the heart of transactional stress theories such as cognitive appraisal theory (Lazarus and Folkman, 1984 ), and rational emotive behavior therapy (REBT)—also featured in this Research Topic.

The interacting constructs and the personal-situational variability of cognitive appraisals, and by extension challenge and threat, provides an exciting task for researchers to conceptualize challenge and threat in testable theories. This Research Topic contains two pieces of work that seek to adjust and extend theory, that of Uphill et al. and Meijen et al. . Both reflect a re-conceptualization of challenge and threat theory applied to sport. Uphill et al. provide a critical review of challenge and threat literature, and propose a new theory, Evaluative Space Approach to Challenge and Threat (ESACT). The ESACT reconciles some of the ambiguities found in the extant research and draws upon the Evaluative Space Model (ESM). One of Uphill's suggestions is that rather than seeing challenge and threat as opposite ends of a single bipolar continuum, it might be better to consider that individuals could be (1) challenged, (2) threatened, (3) challenged and threatened, or (4) neither challenged or threatened by a particular stimulus. The article by Meijen et al. also offers a rethink of the dichotomous nature of challenge and threat but is more conservative than the suggestions of Uphill et al. Meijen et al. provide a review and revision of the Theory of Challenge and Threat States in Athletes (TCTSA), with a specific focus on the predictions made in the TCTSA and inclusion of Lazarusian cognitive appraisal constructs. The revised TCTSA (TCTSA-R) considers additional biomarkers of challenge and threat, includes more specific predispositional factors that influence challenge and threat, and offers a more parsimonious integration of Lazarusian ideas of cognitive appraisal and challenge and threat. Most notably, Meijen et al. propose a 2 × 2 bifurcation theory of challenge and threat, which reflects a polychotomy of four states: high challenge, low challenge, low threat, and high threat. For example, in low threat, an athlete can evince a threat state but still perform well so long as they perceive high resources. We urge the research community to test the hypotheses posited by Uphill et al. and Meijen et al. to progress this area.

The TCTSA-R places a greater emphasis on dispositional factors compared to the original TCTSA, but this aspect of challenge and threat theory is somewhat underdeveloped. One factor that may predispose athletes to threat is the extent to which they hold irrational beliefs, a notion examined in Chadha et al. , in which path analyses across two study phases revealed how cognitive appraisals, irrational beliefs, and challenge and threat co-occur to predict affective states among golfers, such that golfers who reported more negative cognitive appraisals and higher irrational beliefs, were more likely to report greater threat, and subsequent higher anxiety and negative affect, and a less facilitative interpretation of their anxiety symptoms for performance. This offered some theoretical advancement to both theories of challenge and threat, and Rational Emotive Behavior Therapy. Similarly, exploring dispositional traits that could affect performance under pressure, Clarke et al. examined personality traits in predicting yips and choking susceptibility in a group of golfers and archers. They found that 11 variables correctly classified 71% of choking and non-choking participants and that a combination of four variables correctly classified 69% of the yips and non-yips affected participants. Notably, conscientiousness and private self-consciousness were the largest contributors to the choking model, whilst conscientiousness and perfectionistic self-promotion were the largest contributors to the yips model. Another dispositional trait relevant to challenge and threat is rumination which is addressed by Kröhler and Berti who used data from 157 competitive athletes from different sports to demonstrate that sports and competition-related ruminative mechanism exists and further that ruminative cognitions are related to the cognitive basis of state orientation. In another study of personality traits, Frenkel, Brokelmann et al. set out to identify protective factors in stressful situations in risk sports. Specifically, the authors experimentally examined the role of sensation seeking and dispositional mindfulness on the stress response to a risk sport-specific stressor; the Heidelberg Risk Sport-Specific Stress Test (HRSST–evaluated in the Research Topic in an additional paper by Frenkel, Laborde et al. ). Their results indicate that high sensation seekers perceived the stressor as less stressful, but dispositional mindfulness did not predict anxiety.

Where irrational beliefs and rumination can predispose one to threat, one construct that could be an important protective factor from the negative impact of psychological stress is resilience. Hrozanova et al. reason that stress can deleteriously affect sleep, and that potentially mental resilience may protect individuals against the detrimental effects of stress on sleep. In their study, the authors investigated the effects of mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, on the sleep quality of junior athletes. Results revealed that sleep quality was predicted by greater mental resilience sub-components Social Resources and Structured Style, and lower worry and perceived stress. Hrozanova et al. suggest that close attention should be paid to athletes' abilities to manage worry and perceived stress, and that mental resilience could act as a protective factor preventing sleep deterioration. Relevant to the notion of protective factors, some researchers have suggested that individual's histories of adversity may influence stress reactivity, an idea examined by Wadey et al. in their multi-study paper. The authors draw upon prominent sport injury, and challenge and threat theory to examine whether preinjury adversity affects postinjury responses over a 5-year period. They found that injured athletes with moderate preinjury adversity experienced less negative psychological responses and used more problem- and emotion-focused coping strategies compared to low or high preinjury adversity groups. In a follow-up study, Wadey et al. found that athletes with high preinjury adversities were excessively overwhelmed to the point that they were unable to cope with injury, while those with low preinjury adversities had not developed the coping abilities and resources needed to cope postinjury.

As previously stated in this editorial, adaptation to psychological stress is a biopsychosocial phenomenon, and thus, it is pleasing to see works included in the Research Topic that take a psychophysiological perspective on psychological stress. MacDonald and Wetherell assessed competitive anxiety and salivary diurnal cortisol in elite rowers during two training and two competition weekends. They found that anxiety levels were significantly greater during the competition phase compared with training, and specifically that cognitive anxiety was greater on the day of competition compared with the preparation day. They also found that the cortisol awakening response (CAR) magnitude was significantly reduced during the competition phase compared with training, with no differences between preparation and event days. Importantly, the findings indicate maladaptive responding during a period where maximized functioning is critical, whereby reduced or blunted CARs are typical in chronically stressed populations. Similarly examining acute psychophysiological responses, Guo et al. examined the impact of high and low coping self-efficacy (CSE) on the neural activity of athletes' cerebral cortex under acute psychological stress. Results indicate that high CSE athletes were better able to cope with the acute stressor, adjust their behaviors in a timely manner according to the results of their coping, and focus more on processing positive information, demonstrating significantly lower N1 amplitude and significantly shorter N1 latency, compared to low CSE athletes. In contrast to MacDonald and Wetherell , and Guo et al. , Roberts et al. studied the longitudinal patterns of change in stress variables in the lead up to, during, and following the Invictus Games, in a cohort of wounded, injured, and sick military veterans. In addition, the interactions between psychosocial variables and salivary biomarkers of stress, and how these relate to veterans' health, well-being, illness, and performance, was investigated. Multilevel growth curve analyses revealed significant changes in growth trajectories of stress-related variables, with for example, anger and dejection emotions increasing, whilst challenge appraisals and excitement and happiness emotions decreased over the same timeframe. Alongside additional self-report effects (e.g., threat appraisals were found to negatively relate to performance, well-being, and mental health), the authors also found that organizational stressor intensity was positively related to cortisol exposure at competition. Collectively, the papers by MacDonald and Wetherell , Guo et al. , and Roberts et al. , lend additional support for the transactional nature of psychological stress.

There are a number of papers in the Research Topic that have significant theoretical and practical implications for adaptation to psychological stress in sport. In addition, there are number of papers included in the Research Topic that expressly posit potential interventions for successful adaptation. In one study, Quinton et al. examined whether mastery imagery ability was associated with stress response changes to a competitive car racing stress task following an imagery intervention. They also assessed the effects of different guided imagery content on pre-task cognitive and emotional responses. Based on the study results, the authors suggest that positive mastery imagery ability may act as a buffer against the stress effects of negative images. Imagery featured as part of the intervention tested in the Olmedilla et al. paper, whereby a program based on cognitive-behavioral therapy was applied with youth soccer players. Pre to post-test data demonstrated that athletes improved their stress management, and enhanced the use of psychological resources and techniques. One psychological intervention that has particular efficacy in endurance sports is action monitoring and this was explored by Vitali et al. . That is, to deal with discomfort, fatigue, and pain associated with endurance performance under pressure, athletes tend to direct attention to both internal (e.g., bodily) sensations and external (e.g., environmental) stimuli. Thirty-two male participants completed a time-to-exhaustion running task on a treadmill. There was no difference in performance regardless of the type or level of action monitoring employed.

One technique for which research evidence has been growing is mindfulness, which is at the center of the study by Shannon et al. . The authors posit that mindfulness training could be beneficial for athlete well-being, reducing stress, and increasing competence in mental health self-management. Indeed, their findings demonstrate that mindfulness training was directly related to positive changes in competence, resulting in indirect effects on mindfulness awareness, stress, and well-being, bringing into focus self-determination theory in athlete adaptation to psychological stress. Controlled breathing is often an important part of mindfulness and Laborde et al. explored slow-paced breathing (SPB) in two experiments. Both experiments involved SPB done either before (experiment 1) or after (experiment 2) 5 min of physical exercise (burpees). In both experiments, adaptation to psychological stress was investigated with a Stroop task, a measure of inhibition, which followed physical exercise. The results suggest that SPB realized before or after physical exercise has a positive effect regarding adaptation to psychological stress and specifically inhibition, however, the underlying mechanisms require further investigation. Another burgeoning literature within sport is the research concerning self-compassion. Ceccarelli et al. investigated the influence of self-compassion on athletes' psychological and physiological responses when recalling a sport failure. Athletes imagined past performance failure whilst a range of psychophysiological data were collected. Self-compassion positively predicted HRV reactivity and behavioral reactions, and negatively predicted maladaptive thoughts and negative affect. The finding that self-compassion promoted adaptive physiological and psychological responses relative to a recalled sport failure may have implications for performance enhancement, recovery, and health outcomes.

As well as positing and testing the imbuement of athletes with psychological skills in order to manage stress, some papers provide practical considerations for environmental factors that could aid adaptation to psychological stress. Hartley and Coffee test perceived availability of support and received support in regard to the main and stress-buffering effects of social dimensions of burnout. Data indicated that athletes who report greater levels of stress also reported higher burnout, and that higher levels of perceived availability of support was associated with lower levels of the burnout dimensions reduced sense of accomplishment and devaluation. Further, perceived availability of emotional support buffered the negative effects of high stress upon devaluation. The important role of support, and who provides it, is also illustrated in the work by Campo et al. on emotional intelligence (EI) training with the French u18 rugby union national. The aim of this study was to investigate the effectiveness of EI training programs provided by three different EI trainers, each of which has a support or leadership role in the team: the team's coach, the team's physiotherapist, and an expert in sport psychology. Linear mixed-effects models showed that the intervention helped the players to increase some emotional competences at the trait level highlighting the suitability of a group-based approach in the training-week structure and EI improvement in a short period of time. In terms of the broader environment Davis et al. examined the student-athlete experience of the dual career pathway. Surveys from 173 elite junior alpine skiers and interviews with six coaches also illustrated that optimizing support mechanisms across domains can promote positive adaptations to potential sources of stress.

As well as creating an environment in which athletes perceive high levels of availability of support, creating an adaptive motivational climate is also important. Ruiz et al. employed a two-wave approach to investigate the temporal interplay between motivation and the intensity and reported impact of athletes' emotions in training settings. They found that a higher task involving climate was related to decreased dysfunctional anxiety and dysfunctional anger, and in contrast, that a higher ego-involving climate was related to an increase in the intensity and reported impact of dysfunctional anger. The authors make clear the importance of a coach-created motivational climate and the importance of identifying high levels of controlled motivation to help athletes better adapt to psychological stress.

Conclusions and the Way Forward

Clearly, the topic of adaptation to psychological stress in sport remains a vibrant, progressive, and multi-perspective area of study. This makes conducting research in this area challenging, and bringing together the threads of this research is complicated and requires nuance. What is evident, is that the papers included here are of high-quality and reflect great diversity across theoretical approaches, methodologies, analytic strategies, and scope. The topic of adaptation to psychological stress in sport has an exciting future, and we implore researchers to build on these works to develop and refine theory. We hope that practitioners make use of this work to inform their practice. A key step for this area is to ensure that research findings leap out of the laboratory into the hands of practitioners who can test theory at the coalface. To facilitate this process, we urge researchers to engage with practitioners in the designing and dissemination of their work, and to test theory at the elite level of sport.

Author Contributions

MT created an early draft of Editorial which was then expanded upon by MJ and final edits and approval was given by the remainder of the authors. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We wish to acknowledge the contribution of all reviewers and paper editors of the 25 original contributions to this Topic, the authors of research, reviews, and commentaries, and to all the participants across the relevant studies.

  • Lazarus R.S., Folkman S. (1984). Stress, Appraisal, and Coping . New York, NY: Springer. [ Google Scholar ]

Sports psychology: stress management in sport

Athletics coaches are constantly experimenting on their athletes, whether consciously or not, by seeing how much training they can take. Up to a certain level the athlete improves in performance, to a measurable extent, but there eventually comes a point when the training is too much.

How athletes can avoid emotional burnout in sport

Athletics coaches are constantly experimenting on their athletes, whether consciously or not, by seeing how much training they can take. Up to a certain level the athlete improves in performance, to a measurable extent, but there eventually comes a point when the training is too much. The athlete becomes more and more tired and eventually breaks down. This breakdown is often seen in the form of listlessness, loss of appetite, poor sleep pattern, accompanied by a susceptibility to infections. Conversely, the athlete who has the right training load seems full of energy and is hardly ever ill.

Stress is non-specific

To understand the reasons behind this one must go back to Dr Hans Selye, the Canadian who pioneered the investigation of stress in a holistic way. His book, ’Stress Without Distress’ (published by J. H. Lippincott, New York, 1974) had a great effect on my approach to training. His concept is simple and yet all-embracing - that stress is non-specific. When the body is placed under any kind of stress it alters its hormone balance. Not only adrenaline, but substances like testosterone, human growth hormone, the glucocorticoids and mineralocorticoids show an increased output, while the production of others falls. It doesn’t matter what the stress is - it may be problems of moving house, working for exams, playing too many games of football, or simply worrying about something.

Up to a certain point stress is beneficial. We perform with greater energy and increased awareness. However, if the stress increases still further, the output of anti-stress hormones will eventually start to fall. This has an effect on the entire metabolism, including the rate at which our cells grow and are repaired as well as the production of the cells in the immune system.

The Total Stress Load

The concept we have to bear in mind is the Total Stress Load. For the athlete the formula is: Lifestyle Stress + Emotional Stress + Training Stress + Competition Stress = Total Stress Load. The fit athlete should be able to withstand stress better than the ordinary person because he or she is trained to perform well under pressure. However, if the athlete is training too hard or competing too much, a slight increase in the total stress can push them over the top. It is a sad fact that fitness is not the same as health; the highly tuned athlete may be less healthy than the club athlete who maintains a high degree of fitness without going over his physical limits. Being aware of the ’total stress load’ concept enables the individual to maintain equilibrium and avoid succumbing to the effects of over-stress. Remembering that a moderate amount of stress is good for us, we must balance an increase of stress in one area with a decrease in another. Top-class athletes must bear in mind that they need a stable emotional and economic background if they are going to train and compete at the highest level. I remember the case of a brilliant athlete who was competing at international level during his final year at university. He was regarded as a certainty for the British team to take part in a major Games meeting in August. He continued to train hard and compete at a high level right up to the week of his final exams. After the exams he had nowhere to live and no job lined up, so he tried to continue training and competition while living a nomadic life. His performances became more and more erratic. He failed to qualify for the Games and later developed injuries which kept him out of international competition - all of which could have been avoided by proper stress management. As Ian Stewart recently said about training: ’It is really what I would call commonsense - except it doesn’t seem to be very common’

Lifestyle stress

The sportsman needs an economically stable base. He should not be adding to his stress by worrying about mounting debts. Thus a part-time job which pays enough for basic living but allows time for training is better than a well-paid but demanding job - and better than having no job at all and growing financial worries. Other factors such as where you live and how much travelling you have to do must also be considered. The college-based athlete in America, the state-supported athlete in the old East Germany or the heavily sponsored athlete in Western Europe have all had this stress removed from their lives.

Emotional stress

This is something we can rarely control, but we can adjust other aspects of our lives so as to diminish the total stress load. During times of great stress, one should use training as a form of therapy. As Kipling said: ’If you can fill the unforgiving minute with 60 seconds worth of distance run...’. I would have recommended 40 minutes worth, myself. One should avoid serious competition when under great stress, though non-serious competition is fine.

Training stress

Training must be progressive, and very gradually progressive at that. The increase in volume and the introduction of new training methods must all be done gradually, with one phase merging into the next (as I described in the December PP). There must be regular pauses to make sure that the body can adapt to the extra load before increasing it further. Each hard session must be followed with recovery time before the next one is attempted. It is a mistake to try to improve quality and quantity at the same time. Train first for the distance, then improve the quality.

Competition stress

Since competition is at the heart of sport, one would never say ’avoid competition’, but I would say ’select competition’, and the selection must take into account the other stresses in your life. One can train to cope with competition stress and the thinking athlete - or the thinking coach - will plan out a competitive series in which the challenge gradually increases. As each challenge is successfully met, the athlete’s confidence grows, until he is ready for the highest level. One must realise that going into this level carries with it the strong possibility of failure - something which the up-and-coming young athlete may never have met. Being able to handle failure and come back again is the most valuable lesson sport can teach you.

Everyday stress

On a more ordinary level, one can use the concept of ’total stress load’ to control one’ s day-to-day health and fitness. There are a few simple guidelines. When lifestyle stress or emotional stress increase, competition stress should be avoided, and training should take the form of therapy - hard or easy, according to how you feel.

However great the pressures on you, some time should be set aside every day for physical exercise. Thirty minutes a day, five days a week, is the minimum.

Even when not taking part in sport, you should monitor yourself as though you were an athlete in training. Your eating and sleeping pattems should be as regular as possible. A daily check on your resting pulse and a weekly check on your weight will tell you if anything is going wrong.

It is good to be an athlete when you are 30, but when you are 50 it is essential. Bruce Tulloh

Andrew Hamilton

Andrew Hamilton

Andrew Hamilton BSc Hons, MRSC, ACSM, is the editor of Sports Performance Bulletin and a member of the American College of Sports Medicine. Andy is a sports science writer and researcher, specializing in sports nutrition and has worked in the field of fitness and sports performance for over 30 years, helping athletes to reach their true potential. He is also a contributor to our sister publication, Sports Injury Bulletin.

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Sport and Exercise Psychology pp 679–706 Cite as

Sports, Stress, and Health

  • Markus Gerber 5 &
  • Flora Colledge 5  
  • First Online: 26 February 2023

2198 Accesses

The topic of stress regulation and sports can be viewed from two differing perspectives. From the point of view of sports as a health-promoting activity, the focus is on sports as a means to stress regulation. The central question is the degree to which sports, exercise, and physical activity can help us to cope with daily challenges, so that the negative health effects of these stressors can be avoided or reduced. From the point of view of performance sports, on the other hand, the central focus is stress regulation during sporting activity. In other words, how can athletes cope with high levels of training and psychological pressure, without suffering a drop in physical performance or psychological complaints? From this perspective, important factors are those which allow high-performance and elite athletes to perform at the highest level under pressure. The first section of this chapter presents the theoretical foundations of stress regulation and sports; in the second section, the two perspectives presented here will be discussed in detail.

  • Allostatic load
  • Autonomic nervous system
  • Cognitive transaction
  • Critical life-events
  • Cross-stressor adaptation hypothesis
  • Distress/eustress
  • Exercise addiction
  • Post-traumatic stress disorder
  • Stress-buffering effects
  • Stress-management training

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Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

  • Rosemary Purcell 1 , 2 ,
  • Kate Gwyther 1 , 2 &
  • Simon M. Rice   ORCID: orcid.org/0000-0003-4045-8553 1 , 2  

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The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Currently, there is no comprehensive framework or model of care to support and respond to the mental health needs of elite athletes.

We propose a framework that recognises the impact of general and athlete-specific risk factors, and engages key individuals that may identify and promote athlete mental health.

The framework is adaptable and responsive to varied career stages and mental health states.

There has been a rapid increase in research examining the mental health of elite athletes culminating with the International Olympic Committee’s (IOC’s) recent Expert Consensus Statement on mental health in elite athletes [ 1 ]. This statement provides a comprehensive analysis of, and recommendations for, the treatment of both high prevalence (e.g. anxiety and mood symptoms) and more complex mental health disorders (e.g. eating and bipolar disorders) in the elite sporting context. This is a timely resource which will help guide and ultimately improve the clinical management of athletes by sports medicine, mental health, and allied health professionals. The primary focus of the consensus statement, along with much of the extant literature, is on managing the individual athlete affected by mental ill-health. There has been little scholarly and service-level attention to more comprehensive frameworks that (a) recognise the role of the broader elite sports ecology as both a contributor to athlete mental health difficulties and a facilitator of their remediation, and (b) approaches that emphasise the prevention of mental health symptoms, along with early detection and intervention to restore athlete wellbeing (and ideally optimise performance).

Risk Factors for Mental Ill-health in Elite Athletes

Meta-analytic reviews indicate that elite athletes experience broadly comparable rates of mental ill-health relative to the general population in relation to anxiety, depression, post-traumatic stress and sleep disorders [ 2 , 3 ]. This should not be unexpected given the considerable overlap in the years of active elite competition and the primary ages of onset for most mental disorders [ 4 , 5 , 6 ].

Increasing evidence points to a range of both athlete-specific and general risk factors associated with mental ill-health in elite athletes. Athlete-specific risk indicators include sports-related injury and concussion [ 3 , 7 , 8 , 9 ], performance failure [ 10 ], overtraining (and overtraining syndrome) [ 11 ] and sport type (e.g. individual sports conferring a higher risk that team sports) [ 12 ]. General risk indicators include major negative life events [ 13 , 14 ], low social support [ 15 , 16 ] and impaired sleep [ 17 , 18 ]. These risk factors may impact the severity and onset of particular mental health symptoms, but can also guide appropriate response strategies.

The salience of particular risk factors may vary across career phases. For example, in junior development years, supportive relationships with parents and coaches are imperative to athlete wellbeing [ 19 , 20 ]. During the high performance and elite phase, in addition to the coaching relationship, environmental and training demands become more relevant to mental health and wellbeing [ 21 ], including extended travel away from home and exposure to unfamiliar (training) environments [ 22 ]. Environmental conditions and travel may be especially salient for the mental health of para-athletes, who often encounter disruptive logistical issues associated with travel, such as a lack of adaptive sport facilities and sleeping conditions [ 23 ]. Prominent risk factors during the transition out of sport include involuntary or unplanned retirement and lack of a non-athletic identity, both of which are associated with a range of psychological challenges [ 24 ]. For para-athletes, involuntary retirement due to declassification (i.e. no longer meeting the required criteria to be classified as a para-athlete) is a unique burden [ 25 ].

Optimising the Mental Health and Wellbeing of Elite Athletes: Barriers and Facilitators

A comprehensive framework for mental health in elite athletes needs to consider the range of relevant risk factors across key career phases, as well as factors that inhibit or facilitate the ability to effectively respond to athletes’ needs. Key barriers include more negative attitudes towards help-seeking amongst athletes than the general population [ 26 ], as well as greater stigma and poorer mental health literacy. Fear of the consequences of seeking help (e.g. loss of selection) and lack of time are also influential [ 26 , 27 , 28 ]. Facilitative factors include support and acknowledgment from coaches [ 27 ] who can help to create a non-stigmatised environment where help-seeking can be normalised [ 28 ]. Approaches that seek to optimise athletic performance while simultaneously providing intervention for mental health symptoms may also facilitate engagement [ 29 , 30 ]. Brief anti-stigma interventions and mental health literacy programs that seek to increase knowledge of mental health symptoms have been shown to improve help-seeking intentions in elite athletes [ 31 , 32 , 33 ], although the impact of such programs on help-seeking behaviours is not known.

Are there Existing Frameworks or Models of Care for Mental Health in Elite Sport?

To date there are no published frameworks regarding how best to support the mental health needs of elite athletes. In addition to the IOC Consensus Statement, recent position statements have emphasised the need to build awareness of mental health problems and increase help-seeking behaviours [ 34 , 35 , 36 ]. These initiatives are unquestionably warranted; however, improving awareness and help-seeking behaviours are at best pointless, and at worst unsafe, if systems of care to respond to athlete’s need are not available. A whole of system approach needs to be developed simultaneously.

Beyond the peer-reviewed literature, useful guidelines exist within selected sporting associations regarding supporting athlete wellbeing [ 37 , 38 , 39 ]. These resources highlight a number of critical factors in managing athlete mental health in the sporting context including (i) the sports’ responsibility for managing the athlete’s care and support (e.g. duty of care issues); (ii) the need for regular screening or monitoring of athletes to detect changes in mental state or behaviour; (iii) privacy and confidentiality regarding mental health as key ethical issues and challenges; (iv) athlete preferences for help-seeking (how and from whom); (v) the need to refer out to or engage external mental health professionals where expertise does not exist within the sporting environment; and (vi) the value of trained peer workers (former athletes/players) to provide support and guidance to athletes and to coordinate activities related to professional development needs (such as public speaking or financial planning) and individual goal-setting (e.g. around educational or post-sport vocational interests). However, no single framework incorporates all of these factors nor is there a framework that focuses on the spectrum of athlete/player mental health needs, from symptom prevention to specialist mental health care. There has been some progress in developing mental health guidelines in collegiate-level athletes [ 40 , 41 , 42 ], which highlight the need to provide specific and targeted support, while noting that few comprehensive or targeted models of care for mental health have been developed for this population.

Developing a Comprehensive Mental Health Framework to Support Elite Athletes

Many of the general and athlete-specific risk factors for mental ill-health are potentially modifiable (e.g. coping strategies, coaching style, training demands) and require intervention at the individual athlete, the sporting or environmental and/or organisational levels. A comprehensive framework for athlete mental health that is conceptualised within the broader ‘ecology’ of elite sporting environments will be best able to respond to the range of risk indicators in this context (see Fig. 1 ). Ecological systems help to explain the relationship between the aspects or experiences of an individual (termed ‘ontogenetic’ factors, such as coping or substance use) and the broader social and cultural contexts in which they exist [ 43 ]. In the case of elite athletes, this includes the ‘microsystem’ of coach(es), teammates (where appropriate) and family/loved ones. The wider sporting environment (e.g. the athlete’s sport, its rules and governing body) forms the exosystem, while the role of national and international sporting bodies and the media and broader society form the macrosystem.

figure 1

An ecological systems model for elite athlete mental health

Any mental health framework that ignores wider ecological factors runs the risk of focusing exclusively on, and potentially pathologising the individual athlete, when other factors may be more influential in contributing to, or perpetuating poor mental health. Such factors may include maladaptive relationships with coaches or parents, social media abuse and/or financial pressures.

In addition to ecological factors, a comprehensive framework for mental health should encompass both prevention and early intervention, consistent with established models that are influential in public health and social policy (e.g. Haggerty and Mrazek’s mental health promotion spectrum [ 44 ]; see Fig. 2 ). An early intervention framework can optimise athlete mental wellbeing and respond rapidly to mental health symptoms and disorders as they emerge to best maintain the athlete’s overall function.

figure 2

The mental health promotion spectrum

Within this framework, the prevention stages aim to reduce the risk of mental health symptoms developing or to minimise their potential impact and severity; the treatment and early intervention stages seek to identify and halt the progression of emerging mental health difficulties; and the continuing care stages help an individual to recover and prevent relapse, typically through ongoing clinical care with a mental health professional [ 44 ].

Based on the extant literature regarding risk factors for mental ill-health in elite athletes, along with existing sporting guidelines or statements regarding athlete wellbeing, and our experience developing and implementing early intervention services and system reform for young people’s mental health [ 45 , 46 , 47 ], we propose the following framework to respond to the mental health of elite athletes (see Fig. 3 ).

figure 3

Elite athlete mental health and wellbeing framework

Preventative or ‘Foundational’ Components

Core foundational components should include (i) mental health literacy to improve understanding, reduce stigma and promote early help-seeking; (ii) a focus on athlete development (both career and personal development goals) and skill acquisition to help attain these goals; and (iii) mental health screening of, and feedback to, athletes. The purpose of these foundational components is to enhance awareness of the importance of athlete wellbeing across the elite sport ‘ecology’. This in turn addresses workplace duty of care and occupational health and safety responsibilities towards athletes’ overall wellbeing in the context of sport-related stressors.

Mental Health Literacy

Mental health literacy programs should be provided to athletes, coaches and high-performance support staff to help to create a culture that values enhancing the mental health and wellbeing of all stakeholders. Programs should also be offered to the athlete’s family or friends to build their capacity to identify symptoms and encourage help-seeking, particularly as these are the individuals from whom athletes will initially seek help and support [ 48 , 49 ]. Engaging an array of individuals, including organisational staff, in these programs broadens the reach of mental health literacy within an athlete’s (or sport’s) ecology (see Fig. 1 ). Gulliver and colleagues effectively trialled the delivery of a mental health literacy program to elite athletes via team-based workshops facilitated by mental health professionals [ 26 ]. This delivery method is preferred given the opportunity for qualified facilitators to discuss and explore athlete questions or concerns (especially regarding confidentiality and the implications of help-seeking for selection) and to potentially problem-solve together. The content of such training should be customised to address the specific aspects of the sport (e.g. team-based versus individual sport) and developmental stages (e.g. junior versus retiring athletes). Basic program content should cover (i) athlete-specific and general risk factors that can increase susceptibility to mental ill-health; (ii) key signs or symptoms of impaired wellbeing; (iii) how and from whom to seek help, both within and outside the sport; and (iv) basic techniques for athletes to self-manage transient mood states or psychological distress, such as relaxation techniques, adaptive coping strategies, self-compassion and mindfulness.

Individually Focused Development Programs

Individually focused development programs can assist athletes to identify personal/vocational goals and acquire the skills necessary to achieve them. This is necessary to help develop a parallel non-athletic identity, the skills to manage life-sport balance and to prepare for the eventual end of competitive sport. The latter may be challenging in younger athletes who often lack the longer-term perspective or life experience to perceive the need for such planning. However, a focus on developing a non-athletic identity must occur at all phases of the sporting career and not be confined to the transition out of sport phase, since building such skills takes time (and athletes are prone to unplanned retirement due to injury). These activities are ideally facilitated by a skilled, well-trained ‘peer workforce’. These are individuals who have a lived experience of mental ill-health and sufficient training to share their knowledge to help support others in similar situations [ 50 ]. In the sporting context, a peer workforce could include former athletes or coaches who work with current athletes to discuss and normalise experiences of mental health symptoms or their risk factors. Former athletes can assist with athlete development programs and mobilise athletes to the importance of actively participating with such programs, based on their own experiences [ 39 ].

Mental Health Screening

Mental health screening should be included alongside routine physical health checks by medical staff as part of a comprehensive framework. Screening items should be sensitive to the elite context [ 50 , 51 ] and should be designed to provide feedback to athletes to help promote improved self-awareness, such as their mental state and triggers for symptoms. Critical times to screen are following severe injury (including concussion) and during the transition into, and out of sport [ 1 ], and the lead-up to and post major competitions may also be periods of higher risk. It is important to note that there is currently a lack of widely validated athlete-specific screening tools, though one elite athlete sensitised screening measure—the Athlete Psychological Strain Questionnaire—has been validated in a large sample of male elite athletes reporting strong psychometric properties [ 52 ], and is under further validation with female and junior athletes. Research potential exists to not only develop further athlete-specific measures, but to determine who is best suited to conduct screening, and what credentials or training may be required to ensure safety and integrity in this process (e.g. that appropriate help or referral is provided to athletes who screen positive).

Indicated (‘at-risk’) Prevention Programs

The second phase is indicated prevention programs for those considered or assessed as being ‘at-risk’ of impaired mental health and wellbeing. This phase aims to mitigate the likelihood of deterioration in mental health by detecting symptoms as early as possible and facilitating referral to appropriate health professionals. Key staff within the sports system can be assisted to develop skills in early symptom identification and to promote professional help-seeking. This includes coaches, athletic trainers and teammates (where appropriate) who are in a position to notice ‘micro’ changes in an athlete over days or weeks, and sports medicine staff, such as physiotherapists who may detect other non-observable signs, such as changes in energy or body tension. We term these individuals ‘navigators’ in the mental health framework, as they have a crucial role in observing the athlete’s behaviour or mental state and being able to link them to professional care. These navigators can be provided with additional training (adjunctive to mental health literacy) to better recognise and interpret the athlete’s behaviour in relation to their overall wellbeing, understand athlete privacy concerns that inhibit the disclosure of mental health symptoms and build self-efficacy to be able to raise their concerns safely with the affected athlete or medical/mental health staff.

Sport administrators should also consider developing guides on ‘what to do if concerned about an athlete’s mental wellbeing’ and make these available to all relevant staff. These should include information regarding appropriate referral sources, responses (e.g. prevention program vs. early intervention) and facilitators to engage athletes, such as support and encouragement [ 27 , 28 ] and/or linking mental wellbeing with athletic performance [ 29 , 30 ]. Protocols or guides for responding to mental health concerns become less stigmatised when wellbeing needs are already routinely promoted via foundational programs.

Early Intervention

Early intervention is necessary in instances where the performance and life demands placed on an athlete exceed their ability to cope (i.e. major career-threatening injury or significant life stress). Structured clinical interventions for mild to moderate mental ill-health are typically indicated at this phase and should ideally be provided ‘in-house’ by mental health clinicians, such as sports or clinical psychologists or psychiatrists, or medical staff where appropriate (e.g. pharmacotherapy). The use of in-house professionals helps to counter the low levels of service use associated with referring athletes out to external service providers and the stigma that is associated with the athlete needing expert ‘outside help’ [ 53 ]. Where requisite in-house expertise does not exist, this can be managed by the use of qualified consultants, but ideally these professionals should be ‘embedded’ to some extent within the sporting environment to ensure that athletes and other staff understand ‘who they are and what their role is’, even if their presence is infrequent [ 54 ]. When referral out is necessary, or preferred by the athlete, ideally this should be to a mental health professional with appropriate sport sensitised training, knowledge and experience assisting elite athletes.

Early interventions need not always be face-to-face, but can be augmented by telephone or web-enabled consultations, the latter particularly relevant given the frequency with which elite athletes travel unaccompanied by the sporting entourage. All interventions, regardless of the mode of delivery, should use an individualised care approach that is based on assessment and conceptualisation of the individual athlete’s presenting problem(s). The intervention should target the psychological processes of the athlete that are impeding mental health [ 55 ] and take account of the specific familial, sporting and organisational issues that may be impacting on the athlete’s wellbeing.

An example of an early intervention model of care is the Australian Institute of Sport (AIS) mental health referral network [ 56 ]. Athletes are assessed by an AIS mental health advisor, who can make a referral, if necessary, to a qualified mental health practitioner who has been credentialed to work within the network. This practitioner then works individually with the athlete to address their needs and ideally restore their mental health and functioning [ 57 ].

Specialist Mental Health Care

Despite best efforts to prevent or intervene early, some athletes will nonetheless experience severe or complex psychopathology requiring specialist mental health care, particularly where there is a risk of harm to self or others. In some cases, this may include hospitalisation or specialist inpatient or day programs. The IOC Expert Consensus Statement provides a summary of recommended clinical interventions for a range of mental disorders, including bipolar, psychotic, eating and depressive disorders, and suicidality [ 1 ]. Developing and implementing a mental health emergency plan may also be required, particularly in cases where an athlete presents with an acute disturbance in their mental state, for instance agitation/paranoia, or suicidal ideation [ 58 ]. The IOC Expert Consensus Statement recommends that structured plans should acknowledge and define what constitutes a mental health emergency, identify which personnel (or local emergency services) are contacted and when, and consider relevant mental health legislation [ 1 ].

There is also arguably a need for ‘return to sport or training’ guidance for athletes who have been unable to compete or train for their sport due to mental illness, akin to guidelines for managing concussion [ 59 ]. Such guidance could potentially provide a graduated, step-by-step protocol that prepares not only the athlete for a successful return to sport, but also the microsystem that supports them.

Conclusions

We have proposed a comprehensive framework for elite athlete mental health. More research is needed to bolster the efficacy of the approaches discussed here in the elite sports context, as well as other factors that are under-researched in the literature, such as gender-specific considerations in mental health [ 60 ] and considerations for para-athletes [ 23 ]. We are mindful that coaches and other high-performance staff are vulnerable to mental health problems [ 61 ] and the needs of these individuals need to be incorporated into a more inclusive model of care. Further, we recognise the scope of this framework does not cover the needs of non-elite athletes. Elements of this framework may be tailored in the future to be applicable and contextualised for non-elite environments where there may be limited resources, less professional staffing and greater limitations in athlete schedules.

Despite the exponential increase in research interest related to athlete mental wellbeing, major service delivery and treatment gaps remain. Evaluating the efficacy of mental health prevention and intervention programs via controlled trials or other high-quality designs is urgently needed. Program evaluation should ideally adopt an ecological systems approach to account for competition-related, individual-vulnerability and organisational factors on mental health outcomes, for example by seeking to measure system-level variables (e.g. the degree of perceived psychological safety within the sporting organisation [ 62 , 63 ]) and individual athlete-level variables (e.g. coping skills, relationship with coach, injury history). As initiatives are evaluated and enhanced or adapted, developers should consult with elite sport organisations and individuals to ensure the relevance and sport sensitivity of their programs. Increased resources and research funding to support the evaluation and implementation of athlete mental health programs is needed, such as currently exists for managing athletes’ physical health (e.g. musculoskeletal injuries, concussion).

Finally, we are acutely aware that a framework such as that articulated here requires substantial investment and that such funding is scant even in high income settings. The foundational and at-risk components lend themselves, we believe, to be adaptable to low resource settings, given the emphasis on athlete self-management and a trained peer workforce. Adaptations to providing early intervention in low resource settings will be needed, and innovations in general mental health can act as a blueprint [ 64 ]. Regardless of settings or resources, investment in a comprehensive response to athlete mental health needs attention if it is to ever gain parity with physical health.

Availability of Data and Materials

Not applicable.

Abbreviations

International Olympic Committee

Australian Institute of Sport

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Purcell, R., Gwyther, K. & Rice, S.M. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Med - Open 5 , 46 (2019). https://doi.org/10.1186/s40798-019-0220-1

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Sports injury and stressor-related disorder in competitive athletes: a systematic review and a new framework

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Sophie Xin Yang, Siyu Cheng, Diana Linyi Su, Sports injury and stressor-related disorder in competitive athletes: a systematic review and a new framework, Burns & Trauma , Volume 10, 2022, tkac017, https://doi.org/10.1093/burnst/tkac017

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For professional athletes, sports injury has been considered one of the most influential factors determining their athletic careers' duration and quality. High-intensity training and competitiveness of the sports competition are perhaps critical causes of sports-related stress. This article reviews the relevant research on sports injuries and stressor-related disorders. Further, it explores the following three issues in depth: (1) Do physical injuries caused by competitive sports lead to acute or posttraumatic stress disorder for athletes? What are the abnormal stress responses? (2) What diagnoses are currently available for sports injury related traumatic stress disorder? (3) What kinds of psychological rehabilitation are available for trauma-related symptoms in sports injury? How efficient are they in alleviating these symptoms?

The study searched electronic databases, including PubMed, MEDLINE, CINAHL, etc. And reference lists of included papers were also screened. Two researchers selected the literature strictly according to the inclusion criteria and sorted them out. Based on the proved conclusions, the study established a new framework to manage traumatic stress disorders after the injury occurred.

16 articles were included in the study. (Q1: N = 10; Q2: N = 3; Q3: N = 3 ) The findings of this review suggested that athletes who suffer from sports injuries are more likely to experience abnormal physiological or psychological stress responses, which may become a massive challenge for athletes to continue their sports careers at a competitive level. However, there is a minimal understanding of addressing sports injury-related traumatic stress disorder from a biological perspective. Thus, it is challenging to build a scientific basis for diagnosis, screening, and treatment. In addition, the current diagnostic tool for athletes stress disorder still heavily relies on subjective measurement, and the treatment plan is not different from that of the general population.

It highlighted that sports-related stress disorder could be the greatest challenge to return to competition for injured athletes. The present study indicated the importance of systematically identifying the symptoms of sports-related stress disorder and improving the current diagnosis and treatment system.

Athletes who suffered from sports injury are more likely to experience abnormal physiological or psychological stress responses, and the severity may be related to the individual characteristics and injury events' characteristics.

The treatments for stress disorders in injured athletes is no different from those in the general population, and the effectiveness of the current therapy remains to be further explored.

The present study attempted to develop a new management framework for the traumatic stress disorders after injury, suggesting that personal files should be established to identify high-risk groups. After injury, abnormal symptoms can be detected early through a comprehensive screening management process. Then, according to types of sports, types of sports injuries and injury event characters, targeted interventions should be taken.

Injury is the biggest enemy for professional athletes. No matter how talented athletes are, they cannot avoid the occurrence of injuries. Consequently, injury can end their athletic career. Furthermore, physical as well as mental injuries, such as traumatic psychological disorders, may accompany them lifelong. Athletes who had to retire at their peak performance level because of injuries described the injury experience as a nightmare surrounding their daily lives [ 1 ]. Research on athletes who suffered from knee anterior cruciate ligament (ACL) injury also described overcoming the psychological barriers as being as complex as the physical function recovery during rehabilitation [ 2 ].

Traumatic stress disorder is seen as a severe psychological disorder, and research has indicated that athletes have a much higher possibility of suffering from stress disorders than the general population [ 3 ]. This is due to the frequency of experiencing physical injuries in sports [ 4 ]. The most common symptoms of sports injury-related stress disorder include attention distraction and uncontrolled body movements in specific scenarios [ 5 ], which become an obstacle preventing the athletes from returning to competitive sports. Furthermore, even when they are able to continue training and competition, the probability of re-injury may also increase [ 6 ].

Stress is a complex psychological process that includes the dynamics between the individual and environmental factors. For example, a soccer player who experienced medial collateral ligament (MCL) and ACL rupture constantly recalled the incident of injury while watching soccer games [ 7 ]. When individuals encounter a stimulus event that interferes with their internal balance or exceeds their ability to cope with it, they are more likely to experience a specific reaction process, including stress stimulus, perceptual evaluation of threat and stress response. Athletes with a history of injury tend to exhibit extreme cognitive judgment and a series of abnormal stress responses when facing a situation similar to the injury scenario (stressors) [ 8 ]. If this kind of reaction is severe and lasts for a long time, it may meet the diagnostic criteria of trauma- and stressor-related disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptoms of trauma and stressor-related disorder, including acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and adjustment stress disorder (AD), are intrusion, avoidance, dissociation and alterations in reactivity. ASD refers to the abnormal stress symptoms that people show within 2 days to 4 weeks after witnessing or experiencing traumatic events with death threats or severe injuries, such as natural disasters, traffic accidents and major diseases [ 9 ]. PTSD is a delayed and long-lasting stress disorder stimulated by similar events. The onset time is primarily within 1 month to 6 months after the event [ 10 ]. Empirical studies suggested that ASD has a specific predictive effect on PTSD—indicating that early detection of ASD symptoms may reduce the incidence of PTSD [ 11 ]. AD is a sort of mental illness that does not take the source of stress into account. Psycho-social stress and life changes are generally the leading causes of ASD [ 12 ], such as job changes or parental divorce. The present research targeted the scope of ASD and PTSD, since sports injury is similar to a catastrophic event for professional athletes [ 13 ].

To enhance the understanding of the relationship between sports injuries and stress disorders and establish more effective clinical guideline, this article will use the terminology of stress disorder to describe sports injury-related psychological disorders. The article is structured as follows. First, we examine the following specific issues. Do physical injuries caused by competitive sports lead to ASD or PTSD? What types of abnormal stress responses may appear? Second, we review and discuss the current diagnostic tools for sports injury-related traumatic stress disorder. Third, we focus on the type of rehabilitation that has proved efficient for trauma-related symptoms in sports injury. Finally, based on the results, we present a new traumatic stress disorder management framework for injured athletes.

Literature searches

This study searched electronic databases, including PubMed, MEDLINE, CINAHL, Sportdicus, Scopus, Psyinfo, CNKI and Wanfang; the reference lists of included papers were also searched.

The research question is divided into keywords: athlete, athletic injury, stress disorders, and diagnosis and psychological therapy. On this basis, the search terms were extended to sport(s) injury, sport(s) injuries, athletic injuries, traumatic, posttraumatic, posttraumatic stress disorder, PTSD, acute, acute stress disorder, ASD, stress disorder(s), measurement, instrument, psychological treatment, psychological remedy, and psychological therapeutics. Combinations of these search terms were used when conducting online searches.

Selection criteria

We selected the publications according to the following criteria.

(1) Participants: competitive athletes, no age limits.

(2) Definition: sports were defined as competitive sports, including professional competitive sports, winning competitive sports. Sports injury refers to the physical injury caused by competitive sports.

(3) Method: the research related to question 1 (Q1) below requires that the phenomenon’s existence be proved quantitatively. The research related to questions 2 and 3 (Q2 and Q3) can be accepted by qualitative or quantitative methods.

(4) Contents: literature related to at least one research question. It is necessary to indicate sports injury, which is the only source of stress, and discuss different types of stress reaction or anxiety disorder shown by the athlete population. This study will attempt to avoid analysing mental health problems in general. Furthermore, psychological treatments (Q3) must be carried out in injured athletes.

Screening and quality assessment

The primary literature search was completed in March 2021. Two researchers conducted literature screening and quality assessment according to the inclusion criteria ( Figure 1 ). First, we browsed the titles and abstracts of articles for preliminary screening. Then, if the article met the group criteria, we further browsed the full text to judge the correlation. The literature was only incorporated when both researchers unanimously agreed to accept. If two researchers’ decisions are inconsistent, a third researcher will be asked to review and decide. In January 2022, we conducted a literature search again to supplement the relevant research in 2021, and the process was consistent. The criteria of literature quality evaluation followed mature protocols [ 14 ].

Screening flow chart

Screening flow chart

Summary of included papers

Searches identified 1764 articles after removing duplicates. After preliminary screening of topics and abstracts, 93 articles were put forward for full-text screening. Of these, 77 were excluded for the following reasons: the sports injury was not explicitly discussed ( n  = 12), the stress disorder was not expressly discussed ( n  = 55), the phenomenon could not be proved quantitatively ( n  = 4) and treatment has not been carried out ( n  = 6).

Finally, 16 articles were included in the study. They were divided into three groups according to the research questions: the study to verify the relationship between sports injury and stress disorder ( n  = 10), research on the diagnosis of stress disorders in athletes ( n  = 3) and research related to treatment ( n  = 3).

Of the 16 papers included, 13 scored in the middle and upper level based on the quality evaluation scale. The scoring details are provided in the supplementary material , available online.

Researches related to question 1

IES Impact of Event Scale, IES-R Impact of Event Scale – Revised, PANAS Positive and Negative Affent Schedule, PTSD post-traumatic stress disorders, TSI traumatic stress inventory, PCL-C PTSD Checklist-Civilian Version, mTBI mild traumatic brain injury, NSI neurobehavioural symptom inventory, IPQ-R Revised Illness Perception Questionnaire, SCSQ Simplified Coping Style Questionnaire, PC-TSS post-concussion total symptom scores, DSM-V diagnostic and statistical manual of mental disorders, AIMS Athletic Identity Measurement Scale, GSES General Self-Efficacy Scale, HR heart rate, EDA Electrodermal Activity, SCL skin conductance level, SCR skin conductance response, BAM brief assessment of mood, SUDS Subjective Units of Distress Scale, POMS profile of mood states, LESCA Life-event Scale for Collegiate Athletes

Q1. Does physical injury caused by competitive sports lead to ASD or PTSD? What types of abnormal stress responses may appear?

A multi-dimensional systematic analysis that included 10 quantitative studies was conducted to establish the link between the the stress response and diffculties after a sports injury. The total number of participants in the study was 1653 aged between 13 and 30 years, including youth athletes and high-level athletes, involving multiple types of sports, such as skiing, swimming, volleyball, soccer and basketball.

PTSD symptoms

As shown in Table 1 , nine quantitative studies indicated that psychological symptoms related to traumatic stress disorders might include avoidance, hyper-arousal, sleep disorder and fear after injury. Psychological imbalance is often accompanied by physiological problems [ 15 ]. One study monitored athletes’ stress response through physiological indexes. The comparison between the athletes with or without injury history was made based on their heart rate (HR), skin conductivity level (SCL) and skin conductivity response (SCR). Results indicated that, when watching the related video of the injury, the SCR of athletes with a history of injury was significantly higher than that of healthy athletes [ 16 ]. Thus, the literature supported the conclusion that athletes would experience abnormal physiological or psychological stress responses after injury. While the presence of symptoms did not diagnose stress disorder in athletes, it suggested a possibility that needs to be paid attention to and managed. Research has shown that the effects of sports injury-related stress disorders were equivalent to those of earthquakes and fires. For instance, chronic sports injury may cause athletes to experience more severe avoidance symptoms than fire and earthquake victims. Athletes with intrusion symptoms tend to have similar experiences to fire victims [ 13 ].

Factors determining PTSD: individual characteristics

Factors affecting the severity and symptoms of stress disorder can be divided into individual and injury events characteristics. Previous studies mainly discussed individual characteristics from demographic and psychological perspectives. However, research in the general population suggested that the morbidity and severity of PTSD are related to age, indicating that older adults may develop more vital emotional regulation skills than young people. Specifically, they could cope with negative emotions better [ 17 ].

Meanwhile, the researchers believed that child or adolescent athletes (13–18 years old) were more sensitive to trauma events and could experience more pain than adults. For instance, injured adolescent athletes expressed more intrusive thoughts and avoidance behaviours than those without a recent injury history. It is also reported that the impact of event (IES) score of these athletes increased by 35–49% before and after the injury [ 18 ]. However, a review was put forward that contradicted this conclusion to some extent. Findings showed that athletes aged between 15 and 21 years had more severe symptoms of PTSD than those under the age of 14 years, as older athletes may be more sensitive to the costs of surgery and the implications of missing a competitive season [ 19 ]. Regarding sex, women always tended to experience more severe symptoms than men in some major PTSD domains [ 20 ]. Empirical studies reported that stress disorder incidence in women was 2–3 times higher than in men [ 21 ]. Further, female athletes tended to have higher emotional fluctuations and trauma than male athletes in the same situation [ 22 ]. Oxytocin may be responsible for this difference [ 21 ]. More recently, researchers attempted to identify the psychological factors that influence the relationship between sports injuries and stress disorder, e.g. self-efficacy [ 23 ] and coping style, in which negative coping style showed a full mediation effect between the degree of sports injury and post-injury stress disorder [ 24 ]. Another study revealed contradictory findings, showing that coping styles were not related to the intensity of traumatic symptoms [ 25 ].

Additionally, athletic identity plays an important role. The stronger of the sense of athlete identity, the severer of the impact of injury, and the emotional effects may extend to PTSD [ 19 ]. In addition to the factors mentioned above, many other psychological characteristics predict traumatic stress disorders. The mechanism of the effect of sports injury on traumatic stress disorder still needs to be confirmed.

Factors determining PTSD: injury events’ characteristics

Other studies focused on the characteristics of injury events. For instance, different physical injuries may contribute to various stress disorder symptoms. Researchers conducted a study on concussion injury caused by sports. They found a significant difference in the level of stress disorder between the concussion group and the healthy group. Moreover, the trauma-related scale score of athletes after the injury was significantly higher than that before the injury [ 26 ]. ACL rupture of the knee is one of the most common sports injuries for athletes [ 27 ], especially in female athletes. An empirical study of high-level juvenile athletes showed that >87.5% had avoidance symptoms after ACL rupture, 83.3% admitted to intrusion symptoms and 75% had hyperarousal symptoms [ 19 ]. The two studies discussed above indicate the differences in athletes’ clinical symptoms of stress disorder. For example, the results showed that the most severe symptom of ACL rupture was avoidance-related [ 19 ], while the most troublesome problem for athletes who had concussions was sleep disorder [ 26 ]. The study showed that concussions could lead to neurobiological changes related to sleep–wake mechanisms. Sleep disorder has been proved to be one of the main symptoms described by injured patients after a concussion diagnosis [ 28 ]. This may also be considered an early sign of traumatic stress disorders.

Additionally, researchers need to be aware that injury events may not necessarily impact athletes’ psychological well-being. However, research shows that witnessing, or even imaging, an injury event could be very influential. The real impact is of the process and athletes’ perceptions of the event, which they experienced, witnessed or heard of, rather than the diagnosis from medical professionals.

Experimental research was conducted by recruiting a group of healthy athletes. They were asked to read about the scenario of an injury situation. Further, the participants were given a psychical diagnosis randomly at the end of the reading, followed by an assessment of stress disorder. Findings indicated that athletes who predicted injuries for themselves were very likely to experience PTSD in approximately the next 6 months after reading the scenario. However, there were no significant differences between the groups labelled with different diagnoses, such as concussion, mTBI and no diagnosis [ 29 ]. Thus, this line of research implies that the injury experience itself may be more influential than the level of physical dysfunction to athletes’ psychological and physical well-being. Specifically, some sports injuries may not affect the recovery of physical function, but the psychological trauma caused by them is not negligible.

In addition to the injured athletes, those who witnessed or heard of injuries from others may also show stress disorder symptoms. Therefore, research has focused on perceived injury infection in team sports. One study selected same-age teammates who suffered injuries as the target sample. The research showed that, when trauma events occur in a team (e.g. if teammates were injured), they may cause abnormal emotional and stress reactions in other uninjured athletes [ 22 ].

Q2. What diagnoses are currently available for sports injury-related traumatic stress disorder?

After screening, three qualitative studies discussed stress disorder diagnosis in athletes ( Table 2 ). Aron et al . suggested that it is difficult to diagnose stress disorder in this specific population due to the distinct characteristics of professional athletes [ 30 ]. They may be using compartmentalization and dissociation to mask trauma-related symptoms. Specifically, they are more willing to believe that their bodies do not belong to them and ignore the pain to complete the skill requirements [ 31 ]. Moreover, they generally perceived that seeking psychological support indicates disgrace and low self-esteem. Kaier et al . [ 32 ] found that athletes have a stronger sense of shame than ordinary people. They treat emotional problems as a sign of cowardice and conceal their negative symptoms [ 33 ]. Therefore, athletes can cover up their symptoms unconsciously after injury.

Researches related to question 2

DSM-V diagnostic and statistical manual of mental disorders

The DSM-5 and International Classification of Diseases (ICD-11) are the most recognised assessments in the clinic. Within those scales, the main diagnostic tools for ASD include Brief Interview for Posttraumatic Disorder (BIPD), Acute Stress Disorder Interview (ASDI), Acute Stress Disorder Scale (ASDS) and Stanford Acute Stress Reaction Questionnaire (SASRQ) [ 34 ]. Additionally, the assessment tools for PTSD are divided into the self-reported questionnaire and structured diagnostic scale. According to the measured aspects, the self-reported questionnaire is constructed. Further, the subjects are required to answer the questions in order, based on their actual feelings, e.g. using the Revised Impact of Event Scale (IES-R). The structured diagnostic scale includes the Structured Clinical Interview Table (SCID) and Clinician-Administered PTSD Scale (CAPS) [ 10 ].

The three selected qualitative studies mentioned here also adopted other subjective scales, such as the review of traumatic stress disorders mentioned the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Trauma Screening Questionnaire (TSQ), the Startle, Physically Upset by Reminders, Anger and Numbness (SPAN) and the Short Posttraumatic Stress Rating Interview (SPRINT) [ 35 ].

The International Olympic Committee (IOC) developed an early identification tool for mental disorders for athletes, the Sport Mental Health Assessment Tool 1 (SMHAT-1), which includes items for PTSD. It can be used for early screening [ 36 ]. The previous study suggested that PTSD is a highly heterogeneous condition. It means that the diagnosis criteria of DSM-5 cannot accurately capture all trauma-related symptoms. Meanwhile, athletes live in conditions of high-intensity exercise and pressure in both training and competition, making it harder to recognise the specific symptoms of stress disorder related to sports injuries. Therefore, the self-reported scale cannot be used as the evidence or instrument in diagnosis, and clinical experience from practitioners is vital in ameliorating this problem [ 37 ].

Q3. What kinds of rehabilitations are available for trauma-related symptoms in sports injury? How efficient are they in alleviating these symptoms?

Three articles on the rehabilitation of traumatic symptoms were included in the group ( Table 3 ). Two of them are quantitative studies and the other was a case study.

Psychological rehabilitation treatment

IES Impact of Event Scale, A-POMS Abbreviated Profile of Mood States, CD-RISC Connor-Davidson Resilience Scale, SASRQ Stanford Acute Stress Response Questionnaire

The common types of psychotherapies for stress-related disorders include cognitive behavioural therapy (CBT), cognitive processing therapy (CPT), prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) [ 38 ]. Treatments for injured athletes are also developed from these therapies. For example, one study attempted to verify the effect of prolonged exposure on athletes’ stress disorder symptoms. The experiment required the injured athletes to participate in a 3-day writing intervention. Each writing task consisted of two steps. Participants were first asked to recall their traumatic memories and pay attention to their feelings for 5 min. Then, they need to write their negative thoughts and feelings associated with the injury experience continuously for 20 min. The results showed that writing emotional disclosure can accelerate the decline of intrusion and avoidance [ 39 ]. Another empirical study implemented a comprehensive psychological intervention, including preoperative management, postoperative support, and other measures, which resulted in a significant decrease in the scores of athletes with acute stress disorders [ 40 ]. Additionally, another case study incorporated a variety of CBTs to help an 18-year-old male soccer player, including dysfunctional thoughts and images being disputed by systematically questioning the reality of the thought and image. The goal was to make them believe that full recovery is possible. First, the player was asked to think about or talk to other athletes and soccer players who had successfully returned to the sport after ACL reconstruction. Next, the athletes were asked to develop a fear hierarchy in order to cure the fear of re-injury and posttraumatic stress. Finally, the anxiety of re-injury and traumatic symptoms were addressed through self-desensitization. After 4 months of treatment, the athletes reported relief from posttraumatic stress [ 7 ].

Additionally, some researchers indicated that EMDR is the best treatment for PTSD related to athletic injury [ 5 ]. This guides the patients to constantly recall traumatic events, activate individual inherent information processing systems, accelerate nerve conduction activity, make the posttraumatic experience be repeatedly processed many times and adaptively reduce stress disorder symptoms [ 41 ]. In sports psychology, EDMR is considered an effective method for coping with negative emotions [ 42 ], relieving stress and restoring exercise levels. However, the therapeutic effect on stress disorder after sports injury still needs to be verified.

Specific treatment guidelines for stress disorder in the injured athletes’ population have not yet been formed. The current treatments are no different from those in the general population. Further, verification of the treatment effect of universal treatment for athletes is still minimal. Therefore, the effectiveness of interventions cannot be judged.

New management model

Based on the existing findings, the present study attempted to develop a new framework ( Figure 2 ) for traumatic stress disorders after injury. Further, it explored a new in-depth direction in the field.

Traumatic stress disorder management framework after a sports injury. SMHAT Sport Mental Health Assessment Tool 1, APSQ Athlete Psychological Strain Questionnaire, PTSD post-traumatic stress disorder

Traumatic stress disorder management framework after a sports injury. SMHAT Sport Mental Health Assessment Tool 1, APSQ Athlete Psychological Strain Questionnaire, PTSD post-traumatic stress disorder

The literature related to Q1 proved that abnormal physical and psychological stress responses could occur after a sports injury. The severity and symptoms can be influenced by different factors, such as age, gender and psychological adjustment, found consistently across various studies. Conversely, a meta-analysis found that prior trauma experience is one of the critical predictors for PTSD, which should also be included in the assessment [ 43 ]. Therefore, identifying the potential risk of PTSD can be achieved by establishing a personal profile considering the factors mentioned above and providing guidelines for subsequent screening and diagnosis.

After a sports injury, primary screening and diagnosis are crucial. The timing of the treatment is key to the effectiveness of recovery. Furthermore, previous research highlighted that people diagnosed with ASD are more likely to develop PTSD [ 44 ]. Most patients with ASD have a good prognosis after prompt treatment, whereas patients with PTSD can suffer from these symptoms lifelong. Therefore, early screening should be carried out immediately after a sports injury to reduce the incidence of trauma-related stress disorder in athletes.

Both witnessing and experiencing traumatic events can lead to stress disorders; therefore, screening should not be limited to injured athletes. The negative emotion caused by sports injury may also affect other uninjured athletes. All the athletes aware of the incident should be considered [ 22 ].

The validity and reliability of the model developed by the Internal Olympic Committee, SMHAT-1, has been supported and used as an initial screening tool for mental disorders [ 36 ]. However, to reduce the influence of athletes’ hidden symptoms, subjective measurement is insufficient, and the clinical diagnoses of medical professionals and coaches are also necessary. For example, some athletes may avoid a particular motor skill in movement or exhibit a long-term mismatch between sports performance and physical state (dissociation). Therefore, both the self-report scale and observation should be considered in the diagnosis.

The currently available treatment tools are mainly drawn from drug therapy and psychotherapy. Considering the potential risk of drug therapy violating anti-doping policies, athletes should be cautious in their choice of drug treatment. For example, lamotrigine, an anticonvulsant drug aimed at intrusive symptoms and avoidance symptoms [ 45 ], is not prohibited by the World Anti-doping Code (WADC). However, the relevant regulations that allow international sports federations to ban specific drugs, may mean that anticonvulsant drugs are likely to violate the anti-doping regulations put forward by the World Archery Federation (WAF) [ 46 ].

Researchers suggested that psychological treatment should be the first choice for athletes with stress disorder and emphasised the effects of psychotherapy intervention on performance recovery [ 47 ]. A meta-analysis also confirmed this view, showing that psychotherapy was significantly superior to drug therapy in the follow-up study of PTSD. There were subtle nuances between psychopharmacological combined therapy and psychotherapy alone [ 48 ]. However, if the symptoms require pharmacological treatment, a combination of drugs can also be used. For instance, some medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) can be prescribed to relieve symptoms related to stress disorders, and are allowed to be used by WADC and sports federations [ 37 ].

Figure 3 highlights future research by developing a ‘tailored’ treatment guideline for sports injury-related PTSD. Athletes from different sports may have the same type of injury, but the impacts on their performance are different. For instance, ACL rupture (knee injury) may not be a career terminator for a rower, but it could be for a footballer. It implies that treatment must consider the sports type in which the injured athletes participated, the specific motor skills required by their sports and the characteristics of the injury event. A ‘tailored’ treatment means a guideline can be more specific to tackle issues unique to sports injury-related PTSD. For example, a volleyball player who suffered from an ankle sprain after blocking their symptoms of PTSD is different from a runner who twisted his ankle during routine jogging. The former injury is caused by inappropriate physical contact with others; the latter is caused by themselves. However, this line of research and practical guidelines have not been well developed, but the need for progress is urgent.

Proprietary treatment guidelines

Proprietary treatment guidelines

A more effective communication system between the coach and the medical team should be established to improve athletes’ stress disorder diagnosis and treatment [ 49 ]. Timely synchronization of information can ensure that both sides can better understand the physiological and psychological conditions of the athlete’s sports performance and improve the accuracy of judgment and decision-making. Additionally, it is necessary to provide an environment where athletes can express their psychological problems with coaching and medical team support.

Review of the present research

The literature review of sports injury and stress disorder uncovered a considerable research gap in athletes’ stress disorder diagnosis and treatment systems. Therefore, researchers from diverse disciplines such as sports psychology, physiology and medical-related aspects, need to investigate this field further. Simultaneously, the depth and breadth of the existing research also need to be strengthened.

The research on stress disorder for injured athletes has the following problems. First, the pertinence is weak in that the majority of the literature does not analyse and evaluate stress disorder as an independent dimension but chooses to discuss it with other psychological problems. Thus, the accuracy of the evaluation cannot be guaranteed. Second, most research designs did not strictly control the impact of the related variables. For example, in addition to sex, age and other essential characteristics, the type of sport, injury category and other factors would also affect the relationship between sports injury and stress disorder. Finally, only very few studies paid attention to the physiological indicators of the abnormal stress response. Therefore, the results of the studies were generally lacking scientific support.

Stress disorder after a sports injury is a tremendous challenge to the continuation of an athletic career. However, research on the diagnosis and treatment strategies for athletes’ stress disorder is very scarce. The diagnosis of traumatic stress disorder is still based on a subjective scale without considering the psychological characteristics. Moreover, there is a lack of quantitative research to verify the effect of a treatment plan. Thus, it is hard to determine the most suitable therapy for athletes.

Future research direction

The injury of competitive athletes occurs from time to time, especially in sports with high physical function. For example, research showed that the injury rate of 13–16 years old male sprinters and hurdlers is as high as 94.7% over 4 years [ 50 ]. During the recovery period after injury, athletes are prone to adverse emotional reactions. If they cannot cope with the negative emotions effectively, it may lead to the emergence of a stress disorder.

To better manage traumatic stress disorders in athletes and help them return to competition, it is essential to explore the stress disorder of competitive athletes more systematically and scientifically, mainly by including more physiological variables in the investigation. This study suggests that future research might investigate the following issues.

First, when the sports function is fully recovered, what changes have occurred in the sports performance compared with that before injury? What role does stress disorder play in changing the performance? There is a lack of comprehensive understanding of the stress disorder caused by sports injury in scientific research. Practitioners often ignore that the poor level of performance demonstrated by those injured athletes who return to the competition is the explicit manifestation of stress disorder after injury.

Second, what are the varied symptoms of stress disorder from different sports injuries? Would the type of sport affect the level of stress disorder facing the same injury events? Stress disorder may be affected by various factors, but in the process of literature retrieval it was found that there was no research that had addressed the issues mentioned above. It is a topic worth exploring, as the results of related research can provide a theoretical and empirical basis for establishing screening, diagnosis and grading criteria for stress disorder of athletes.

Third, what abnormal physiological indexes indicate stress disorder? How can the severity of stress disorder be evaluated through physiological indicators? In the long run, to solve the problem of deviation in the subjective evaluation of stress disorder, research in this field needs to understand the relationship between sports injury and stress disorder from the perspective of biological mechanism and to provide more objective and scientific support for the construction of the diagnosis and treatment system.

Often, athletes tend to cover up their abnormal stress reactions, which increases the difficulty of diagnosing and screening stress disorder. However, after in-depth consideration of various factors and characteristics of injured athletes, it is believed that the current diagnosis and treatment can be improved. Simultaneously, the traditional psychological intervention treatments often focus on the recovery of sports performance. However, there is a lack of illness perception toward PTSD, particularly as the evaluation of an athlete’s recovery relies heavily on their sports performance rather than the non-sports-related symptoms of PTSD, such as sleep disorder and fear of re-injury.

The related study on sports injury and stress disorder is the direction to be further explored. It is necessary further to refine the performance of athletes with stress disorders and improve the diagnostic and therapeutic guidelines. The researchers should consider whether the ultimate reason for athletes to retire earlier is the damage of sports function from the injury or the lack of self-efficacy caused by stress disorder, thus holding them back from reaching the peak performance level again. Notably, this is a problem that should be addressed with more scientific support.

SXY conceived the idea for the research. SC and DLS completed literature search and analysis. SXY and SC drafted the initial manuscript and all authors contributed to revision prior to submission.

The authors declare that they have no Conflicts of interest.

ACL: Anterior cruciate ligament; AD: Adjustment stress disorder; ASD: Acute stress disorder; CBT: Cognitive behavioural therapy; EMDR: Eye movement desensitization and reprocessing; IES: Impact of event; PTSD: Post-traumatic stress disorder; SCR: Skin conductivity response; SMHAT-1: Sport Mental Health Assessment Tool 1; WADC: World Anti-doping Code.

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Sports Demands and Stress Management in Athletics Essay

Introduction, causes of stress for athletes, effects of demands (stress) to an athlete, importance of stress management.

The demands of an athlete both professional and family life causes stress and anxiety. Therefore, we can not talk of the effects of demands without stress and it is effect. Mental health can also be another issue to be looked at while defining the cause’s demands. we can define stress in many ways. Stress is a harmful physical and emotional response that occur to and individual when the requirements of an activity exceed the capabilities and needs of the individual. ( www.ilo.org).As a matter of fact every individual is affected by anxiety, which is the reaction of an individual when he encounters stress. A great amount of stress can affect the performance of an athlete because he lacks concentration in what he is doing. Pre-competition anxiety has been the great important focus when researching about athletics.

It can also be defined as “the emotional, cognitive, behavioral and physiological reaction to aversive and noxious aspects of work, work environments and work organizations. It is a state characterized by high levels of arousal and distress and often by feelings of not coping.” (www.tcd.ie). from this definition demands can be related with

In relation to sports and specifically athletics it can be defined as a physiological reaction to aversive and noxious aspects of athletics and environments i.e. excessive pressures or the demands placed on them.

It is clear to everyone that you have to be mentally fit for you to be an athletic performer, you must be stress free, you must be a positive thinker, you must be aiming high at all times and even setup goals that you must achieve in life. All this attribute to mental health that one must bear. Therefore, when you see this, alongside other factors then you should be to point out that one could be optimistic athletic performer because this is the major requirements.

A good performing athlete has higher mental resistance and his performance is not affected by his mind. He is resistant to any change, when his mind is disturbed, he continues with his activities well up to the end. He is frank and does not hide anything, even if he realizes any point of weakness; he points it out and tries to improve it.

The athlete must be in good health, he should be free from diseases all the time, he should have a good physical composition and be physically fit because the activities he is involved in are demanding and requires someone to be strong enough to be able to succeed.

There are different types of stress that affect different athletes from different lifestyles. This can be subdivided into two that is personal and situational.

  • Cognitive anxiety, which includes worry, and uncertainty,
  • Somatic anxiety this includes movement changes in the perceived physiological stimulation
  • Behavioral anxiety this involves peoples behaviors.
  • Situational is related to the events and uncertainty. An athlete may feel burdened when entering into real action

The physiological reaction athletes to threats or pressure prepare them for intense physical activity of athletic. This can be observed through changes of the heartbeat and inhalation pace. In the body, there will be diversion of more blood to the muscles than to other organs. The result is the release of adrenaline raising levels of glucose and free fatty acids in the blood stream to provide greater energy (www.personal.psu.edu )

Stress can be positive or negative. Under normal circumstances, athletes should be able to find new balances and responses in their reactions to events. Such a stress cannot be said to be negative, as it will act as a motivational factor. “A moderate level of stress can be an important motivational factor and can be instrumental in achieving a dynamic adaptation to new situations. If health is considered as a dynamic equilibrium, stress is part of it. There is no health without interaction with other people and with the environment. Only excesses of stress are pathological.” (International labor organization)

In athletics, therefore stress normal and necessary. What should be avoided is intense, continuous or repeated which a person is unable to cope with, or if support is lacking, stress then becomes a negative phenomenon, which can lead to physical illness and psychological disorders. In a work context, it often results in inadequate adaptation to situations, people, and failure to perform at an optimal level. (International labor organization)

Dik B. (2004); measures of career interest; John Willey.

Doraten B. (1999); cross country runners and track and field athletes.

International labor organization (2007). Web.

Pendergrass L. (1999); Examination of the concurrent validity of scores from the CISS for student-athlete college major selection; counseling and development.

Penn state, stress management. Web.

Summers J. (2004); sports psychology: theory application and issues; Chichester.

Weinberg R.S (2003/2007); foundations of sports and exercise psychology.

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Bibliography

IvyPanda . "Sports Demands and Stress Management in Athletics." August 28, 2021. https://ivypanda.com/essays/sports-demands-and-stress-management-in-athletics/.

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Stress and Anxiety in Sports Essay Example

In order for psychologists to thoroughly understand anxiety and stress within sport it is important for the sources of stress to be identified which can be split into three: organisational, competitive and personal (Sarkar and Fletcher, 2014). Organisational stressors are commonly defined as the “environmental demands (i.e. stimuli) associated primarily and directly with the organization within which an individual is operating” (Fletcher and Mellalieu, 2006), this can include the individuals role within the sport. Competitive stressors are known to be those issues that are specifically linked to athletic success for instance, opponents and social evaluation (Hanton et al., 2005). Personal stressors are those that are associated with nonsporting life events, which can include family issues or work-life balance (Sarkar and Fletcher, 2014). Knowing these sources of stress can allow psychologists to work with the athlete to minimise the effects they have on them and to allow them to perform at an optimum when competing.

It is important to know the consequence of stress as an athlete and coach as you will want to avoid these as much as possible as they can have a negative impact on an individuals performance, mental and physical health (Stevens et al., 2013). A stress overload can have a negative effect on an individual’s mental health as it can lead to increased anxiety, panic attacks and depression (Morris et al., 2010). Indicating that regulation of the levels of stress is important for optimum mental health (Shankar and Park, 2016) as it is important to maintain a good level of mental health in elite athletes to prevent any knock on effects. Stress can also lead to negative effects on the physical health of an individual as high levels of stress can impact the quality and amount of sleep (Fortunato and Harsh, 2006). A negative impact on performance can be linked to increased muscle tension due to excessive stress (Schneider, 1978) and being overanxious before or during athletic performance (Stevens et al., 2013). 

In elite level sport a lot of demands are put on the performer in regards to physical, emotional and cognitive as well as the increasing importance of recovery (Balk et al., 2017). These demands increase the amount of stress placed on the individual which can cause a decrease in their performance. Competition can trigger a stress response, which can be looked at though Evans (1950) general adaptation syndrome (GAS) which is split into three stages: alarm stage, resistance stage and recovery stage (Tanguy et al., 2018). The body’s natural response to stress can have physiological effects such as increased heart rate and excessive sweating, as well as psychological effects such as increased anxiety (Leino, 1989) which can have a negative effect on an individual’s performance.

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    Sports help you manage stress. Exercise causes your body to release endorphins, the chemicals in your brain that relieve pain and stress. It also reduces the levels of stress hormones,...

  2. Stress Management in Sport

    Stress Management in Sport Stress management refers to the environmental, physiological, cognitive, and behavioral techniques employed by an individual to manage the factors and components that underlie the stress process or experience of stress.

  3. (Pdf) Stress Management Technique for Athletes During Sports: a

    ... There can be a worse effect on the athlete exists, especially for the physical and mental aspects of the athlete that such effects may further transform into physical and mental disorders due...

  4. The Effects of Stress on Physical Activity and Exercise

    1.2 Understanding Stress. There is no universal agreement on the definition of stress. McEwen [] simply states that "Stress is a word used to describe experiences that are challenging emotionally and physiologically."These stressors may be acute (e.g., hassles) or chronic (e.g., bereavement), small in magnitude (e.g., standing in a long line), or traumatic (e.g., violent attack) [].

  5. Exercise and stress: Get moving to manage stress

    Regular exercise can increase self-confidence, improve your mood, help you relax, and lower symptoms of mild depression and anxiety. Exercise can also improve your sleep, which is often disrupted by stress, depression and anxiety.

  6. The impact of sports participation on mental health and social outcomes

    The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for exam...

  7. A Systematic Review of Stress Management Interventions With Sport

    Kevin Daniels. University of East Anglia. The purpose of this review was to systematically identify and evaluate the psychosocial interventions used to manage a component of the stress process in ...

  8. Behavioral Intervention for Stress Management in Sports

    Psychology. Anxiety in Sports. This article covers stress management for athletes beginning with a brief behavioral conceptualization of athletic performance and analysis of stress. Examples of external and internal stressors are offered, as well as of stress responses from autonomic, somatic, and cognitive domains.

  9. Frontiers

    Strength and conditioning coaches strive to increase athletic performance by the systematic application of physical stress to the body via resistance training, and other forms of exercise, to yield a positive adaptation response ( Massey et al., 2002, 2004, 2009 ).

  10. Editorial: Adaptation to Psychological Stress in Sport

    With this Research Topic we aimed to capture the breadth and depth of work taking place around the theme of adaptation to psychological stress in sport. Pleasingly, 111 authors responded to our call for papers, contributing 25 papers between them. In this Editorial we undertake the difficult task of synthesizing these contributions, and ...

  11. Sports psychology: stress management in sport

    The Total Stress Load. The concept we have to bear in mind is the Total Stress Load. For the athlete the formula is: Lifestyle Stress + Emotional Stress + Training Stress + Competition Stress = Total Stress Load. The fit athlete should be able to withstand stress better than the ordinary person because he or she is trained to perform well under ...

  12. Sports, Stress, and Health

    First Online: 26 February 2023 2156 Accesses Abstract The topic of stress regulation and sports can be viewed from two differing perspectives. From the point of view of sports as a health-promoting activity, the focus is on sports as a means to stress regulation.

  13. Mental Health In Elite Athletes: Increased Awareness ...

    The current 'state of play' in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a ...

  14. How exercise can help manage stress, anxiety, and depression

    Summary. Researchers theorize that exercise can reduce stress levels and improve depression and anxiety symptoms by promoting resilience and giving people a break from stress. People can try short ...

  15. (PDF) Organizational stress and well-being in competitive sport: A

    Through critical exploration, evaluation, and synthesis ... and stress management in sport (Rumbold et al., 2012), and. were deemed appropriate due to the volume of relevant papers that were returned.

  16. Psychological stress and psychological well-being among sports coaches

    Introduction. Sports coaching is a potentially stressful occupation (*Frey, Citation 2007; *Levy et al., Citation 2009) not least because coaches are required to maintain their own psychological and physical health and performance whilst supporting the athletes with whom they work (Kelley et al., Citation 1999).Psychological stress is defined as 'a particular relationship between the person ...

  17. The Effect of Physical Activity on the Stress Management, Interpersonal

    The aim of this study was to assess the changes of health behaviors in college students as they transition through their freshman year. The author surveyed 167 freshmen, ages 18 to 25, to examine the effects of physical activity on the stress management, interpersonal relationships, and alcohol consumption in college freshmen.

  18. Management of Competitive Stress in Elite Sport

    This chapter contains sections titled: Introduction. Clarification and contextualization of key terms. Competition stressors and athletes' responses. The relationship between anxiety and sport performance. How to assess anxiety symptoms. A reduction approach to stress management intervention. A restructuring approach to stress management ...

  19. Sports injury and stressor-related disorder in competitive athletes: a

    High-intensity training and competitiveness of the sports competition are perhaps critical causes of sports-related stress. This article reviews the relevant research on sports injuries and stressor-related disorders. ... abnormal symptoms can be detected early through a comprehensive screening management process. Then, according to types of ...

  20. Sports Demands and Stress Management in Athletics Essay

    Importance of stress management. Stress can be positive or negative. Under normal circumstances, athletes should be able to find new balances and responses in their reactions to events. Such a stress cannot be said to be negative, as it will act as a motivational factor. "A moderate level of stress can be an important motivational factor and ...

  21. Stressors, coping, and well-being among sports coaches: A systematic

    Collectively, the quantitative studies that have discussed stressors and burnout suggest that increased levels of stressors can lead to burnout among sports coaches. A total of 13 papers studied the coping strategies that are used by coaches to reduce the negative outcomes of stressors.

  22. Stress and Anxiety in Sports Essay Example

    2. 📌Published: 20 May 2021. Get sample for $1. In order for psychologists to thoroughly understand anxiety and stress within sport it is important for the sources of stress to be identified which can be split into three: organisational, competitive and personal (Sarkar and Fletcher, 2014). Organisational stressors are commonly defined as the ...

  23. Stress Research Within Sport Psychology Psychology Essay

    2.1 Anxiety Research Anxiety is well-studied construct in a range of psychological research areas, including sports, and has over the years undergone considerable refinements with regard to conceptualisations and inventories used.

  24. (PDF) The Relationship between Sports, Physical ...

    Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. All individuals are all prone to the risk of being affected mentally, especially ...