Mental Health Conditions in the Athlete Chapter 15 Medical Considerations

What is Sport Psychology? 2 main objectives: 1. To understand how psychological factors affect in individual’s performance 2. To understand how participation in sport and exercise affects one’s psychological development, health, and well- being.

What Sport and Exercise Psychologists Do: Research role Teaching role Consulting role Policy Making / advocating role

Global Sport Psychology Specialties: 1. Clinical Sport Psychology  Have training in PSYCHOLOGY to learn about diagnose and treat emotional disorders  Licensed by state boards to treat clinical conditions Have additional training in sports & exercise sciences 2. Educational Sport Psychology:  Extensive training in sport sciences – have large background in psychology  Serves as mental coach / mental trainer – works through individual/group sessions and teaches the development of psychological skills

Sport and Exercise Psychology Orientations: 1. Psychophysiological Orientation:  Best way to study behavior during sport / exercise is by examining physiological processes in the brain; brain- body connections  EX: using biofeedback to train biathletes to shoot between heartbeats; examining changes in serotonin as explanation for psychological benefit of exercise

Sport and Exercise Psychology Orientations: 2. Social Psychological Orientation  Assumption is behavior is determined by interchange between person and their environment  EX: How does leader behavior influence team cohesion; Are people with high Sports Personality Assessment (SPA) more comfortable in same- gender exercise settings?

Sport and Exercise Psychology Orientations: 3. Cognitive-Behavioral Orientation:  Emphasis is on athlete’s / exercisers thoughts and behaviors  EX: Is there a self-fulfilling prophecy linking self-talk and batting slumps?

Main Organizations involved in Sport and Exercise Psychology: International Society of Sport Psychology (ISSP)  North American Society for the Psychology of Sport and Physical Activity (NASPSPA)  The Sport Psychology Academy (SPA)  Association for the Advancement of Applied Sport Psychology (AAASP)  American Psychological Association Div. 47 (APA, Div. 47)  American College of Sports Medicine (ACSM)  The United States Olympic Committee (USOC) 

1. Performance Enhancement / Intervention: any achievement setting Focus is on performance improvements in any achievement setting Also concerned with effects of interventions on well- being of sport / exercise participants Examples:  Stress Inoculation Training (SIT) with athletes  Attentional Training effectiveness  Flow experiences in sport

2. Social Psychology Emphasis Uses theory / research to focus on group processes in sport & exercise settings Social factors are examined as they relate to athletes, coach, team, and spectators Examples of special interests:  Achievement motivation (Achievement Goal Theory)  Moral development through sport  Peer relationships in physical activity and sport  Youth sports (The reverse- dependency trap)  Social Physique Anxiety in Sport and Exercise Settings (A problem at both ends of the spectrum)

3. Health and Exercise: Focuses on role of psych. Factors in exercise; as they pertain to resistance to disease development & remediation, coping with stress, and health promotion Primary interest is link between mental and physical health. Examples of special interest areas:  Problem-focused vs. emotion focused coping and health  Hardiness and disease risk (Control, Challenge, Commitment)  Exercise and Psychoneuroimmunology  Psychological benefits of exercise

Major Splits in Recent Years within the Field: Sport Psychology Health Psychology Exercise Psychology Sport Psychology

Why the Need for Exercise Psychology?

Behaviors are easier to maintain in environments that are supportive of that behavior- for better ….. Or worse…

Sample Interest Areas within Exercise Psychology: Designing exercise programs to maximize psych. Benefits Exercise addictions Exercise adoption, maintenance, and adherence Exercise as a stress management technique Gender / Sex-role influences on exercise Overuse injuries in exercise settings The runners/exercisers’ high Psychotherapeutic influences of exercise for depression Psychological benefits for specific populations

The Certification Issue: AAASP Required Coursework for becoming an AAASP certified consultant EITHER SPORT SCIENCE OR PSYCHOLOGY COURSES CoursesDescription 1. Professional ethics1 course 2. Sport psychology3 courses in all subdisciplines 3. Research Design, Stats or1 course in any of these areas psychological assessment 4. Biological bases of behavior1 course in comparative psychology; physio psychology 5. Cognitive Affective basesCourse in cognition, motor development or motor learning 6. Social Bases of behavior1 course in social psychology

The Certification Issue: AAASP Required Coursework for becoming an AAASP certified consultant PRIMARILY SPORT SCIENCE COURSES: CourseDescription 1. Biomechanical / physiological bases1 course in kinesio., Ex. Physio, Biomechanics 2. Historical, philosophy, sociology1 course in this area of sport sci 3. Skills, techniques, analysis1 methods course in sport area PRIMARILY PSYCH COURSES: 1. Psychopathology1 course in abnormal 2. Counseling skillscourse work to foster basic counseling skills 3. Individual Behavior1 course in developmental, personality theory, individual differences Supervised Consulting Experience: Verification of at least 400 hours of supervised experience in exercise and sport psychology

Achievement Goal Theory: 3 major factors in determining the motivation levels of children in youth sport settings: 1. Goal Orientation Task-orientation – success is defined as self-referent improvement Ego-orientation – success is defined by social comparison and out-doing others 2. Motivational Climate  Mastery climate – focus is on learning, effort, cooperative strategies, and skill development  Performance climate – competitive, beating teammates, demonstrating superiority over others 3. Perceived ability High – greater competence Low – less competence

Ego-oriented children seek competence through comparison

Ego orientation may undermine the value attached to fairness and justice in sport settings

Who would you most want to have as a patient? Hi task/hi ego? Hi task/low ego? Low task/High ego? Low task/Low ego?

Body Image & Eating Disorder Mental or Physical Disorder?

Messages about Food What messages have you received (from parents, peers, media, etc.) about food? How are messages about food different for women and men?

Some statistics Eating disorders have increased threefold in the last 50 years 10% of the population is afflicted with an eating disorder 90% of the cases are young women and adolescent girls Up to 21% of college women show sub-threshold symptoms 61% of college women show some sort of eating pathology

Three Types of Eating Disorders Anorexia nervosa- characterized by a pursuit of thinness that leads to self-starvation Bulimia nervosa- characterized by a cycle of bingeing followed by extreme behaviors to prevent weight gain, such as purging. Binge-eating disorder- characterized by regular bingeing, but do not engage in purging behaviors.

Anorexia Nervosa Begins with individuals restricting certain foods, not unlike someone who is dieting  Restrict high-fat foods first  Food intake becomes severely limited

More on anorexia nervosa May exhibit unusual behaviors with regards to food.  preoccupied with thoughts of food, and may show obsessive-compulsive tendencies related to food may adopt ritualistic behaviors at mealtime. may collect recipes or prepare elaborate meals for others.

Bulimia Nervosa Qualitatively distinct from anorexia  characterized by binge eating A binge may or may not be planned  marked by a feeling of being out of control The binge generally lasts until the individual is uncomfortably or painfully full

Bulimia Nervosa Common triggers for a binge  dysphoric mood  interpersonal stressors  Intense hunger after a period of intense dieting or fasting  feelings related to weight, body shape, and food are common triggers to binge eating

Bulimia Nervosa Feelings of being ashamed after a binge are common  behavior is kept a secret Tend to adhere to a pattern of restricted caloric intake  usually prefer low-calorie foods during times between binges

More on bulimia nervosa Later age at the onset of the disorder Are able to maintain a normal weight Will not seek treatment until they are ready Most deal with the burden of hiding their problem for many years, sometimes well into their 30’s

Two subtypes purging type  self-induced vomiting and laxatives as a way to get rid of the extra calories they have taken in non-purging type  use a period of fasting and excessive exercise to make up for the binge

Anorexia Risk of Death: The Deadliest of all Psychological Disorders

Risk Factors for developing an eating disorder  Personality/psychological factors  Family influence  Media  Subcultures existing within our society

Personality/Psychological Factors Sense of self worth based on weight Use food as a means to feel in control Dichotomous & rigid thinking Perfectionism Poor impulse control Inadequate coping skills

Protective personality Factors Nonconformity Having a feminist ideology High self-esteem Belief that body weight and shape are out of one’s control Self-perception of being thin

Media and Cultural Factors Culture bound syndrome Belief that being thin is the answer to all problems is prevalent in western culture

Media and Cultural Factors Bulimia can be influenced by social norms  It can be seen as a behavior, which is learned through modeling Women who are seen as being attractive by societies standards can be very susceptible to eating disorders as well

Media and Cultural Factors Media images are inescapable  devastating when we see idealized images in the media and feel they do not meet the expectations of our society Frequent readers of fashion magazines are two to three times more likely than infrequent readers to be dieting

Historical Beauty Ideals

The Celebrity Thin Ideal

The Thin-Ideal The avg. model weighs 23% less than the avg. American woman Longitudinal study from showed that 69% of playboy models and 60% of Miss America contestants met weight criteria for anorexia Women’s bodies in the media have become increasingly thinner

The Impact on Women One study showed that 55% of college women thought that they were overweight though only 6% were 94% of one sample of women wanted to be smaller than they currently were 96% thought that they were larger than the current societal ideal Half the women in a study said they would rather be hit by a truck than be fat

Challenges to treatment Lack of motivation to change  intrinsically reinforced by the weight loss, because it feels good to them  may deny the existence of the problem, or the severity of it Lack of insight  Not really about food.