injury risk and rehabilitation: psychological considerations jean m. williams and carrie b. scherzer...
TRANSCRIPT
Injury Risk and Rehabilitation: Psychological
Considerations
Jean M. Williams and Carrie B. Scherzer
“I knew I was in trouble when I heard snap, crackle and pop, and I wasn’t having a bowl of cereal.”
Nick Kypreos, ice hockey, Toronto Maple Leafs
Chapter 22
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consent of McGraw-Hill Education.
Thinking about Injury
• Although many of the causes for injury are physical (e.g., level of conditioning, equipment failure, poor playing surface, faulty biomechanics) or just plain bad luck, psychosocial factors also play a role
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McGraw-Hill Education.
How Psychosocial Factors Influence Injury
• Certain psychosocial factors predispose individuals to injury – other psychosocial factors help protect from injury• The difference = stress and a resulting stress response
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McGraw-Hill Education.
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
• Individuals with a history of many stressors, personality characteristics that exacerbate the stress response, and few coping resources will, when placed in a stressful situation such as a demanding practice or crucial competition, be more likely to appraise the situation as stressful and exhibit greater physiological activation and attentional disruptions.• Severity of the resulting stress response is what predisposes
the individual to injury
Stress-Injury Model Hypothesis
Personality History of Stressors
Coping Resources
Potentially Stressful Athletic Situation Injury
Interventions
Stress ResponseCognitive Appraisals
Physiological /Attentional
Changes
Stress-Injury Model
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consent of McGraw-Hill Education.
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
• “Good” stress = stress• Occurs when athlete views a
competitive situation as challenging, exciting, and fun• Helps the athlete stay
focused and his/her play to successfully “flow”
• “Bad” stress = distress • Occurs when athletes
perceive they lack resources to meet the demands of the situation and it is important to succeed because dire consequences if fail• Manifests physiologically,
attentionally, and anxiety
Stress Response
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Stress Response (cont.)
• Stress-injury model proposes that primary culprits in injury risk are increased muscle tension, narrowing of the auditory and visual field, and increased distractibility• SO when high-risk psychosocial profile performs
under stress, they experience higher anxiety and greater peripheral narrowing and delayed or missed responding to central vision cues compared to low-risk individuals
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History of Stressors
• Major life events – from a breakup, change in residence, death of a loved one to eligibility difficulties, trouble with coaches, and change in playing status• Daily hassles - minor daily problems, irritations, or changes
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Personality and Coping Resources• Trait anxiety• A general disposition or tendency to perceive situations as
threatening and to react with an anxiety response• Dispositional optimism and hardiness • Mood states • Quantity and quality of relationships with supportive people
(family, friends, coaches, etc.)
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• It is possible to reduce sports injuries through psychological skills training• Must strengthen coping skills and control emotional states
• Two-pronged approach• Change cognitive appraisal• Decrease physiological arousal and enhance attention
control
Interventions to Reduce Injury Vulnerability
Reducing Injury Cognitive Appraisal
• Negative self-talk• Foster realistic
expectations• Develop a sense of
belonging• Optimal coach-athlete
communication
Physiological/Attention
• Relaxation skills• Distractibility• Keep an appropriate
attention focus
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prior written consent of McGraw-Hill Education.
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Implications for Coaches, Sport Psychologists, and
ATs • Implement interventions with athletes predisposed to
injury due to psychosocial factors• Target specific interventions to those most likely to
benefit from them• Reduce exposure to high-risk activities if the athlete has
recently experienced many stressors or appears to be in a high-stress or distracted state
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Athletes Psychological Reactions to Injury
• View as disaster• Opportunity to display courage• Uncertainty regarding recovery• Negative mood states• Identity loss• Treatment compliance problems• Relief from practice drudgery and/or poor
performance• Opportunity to focus on other aspects of life
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Athletes Psychological Reactions to Injury (cont.)
• Following concussion, some athletes experience depression, confusion, and total mood disturbance• Mood changes might be due to the injury itself and not just
the removal from sport• Some athlete’s experience resembles the stages of grief• Postinjury emotions (tension, depression, anger) improve as
rehabilitation progresses
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Cognitive Appraisal Models • Cognitive Appraisal Models• Derived from stress and coping theory• Accounts for individual differences in response to
athletic injury• How does the athlete perceive the injury?• Cognitive appraisal determines the emotional response,
which determines the behavioral response to injury rehabilitation
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Cognitive Appraisal Models
Personal Factors
Cognitive Appraisal
Emotional Response
Behavioral Response
SituationalFactors
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Grief Stage Model
• Incorporated when an injured athlete is facing termination of participation in sport• Injury constitutes a loss of self, and that psychological
responses to injury follow a predictable sequence• Denial• Anger• Bargaining• Depression• Acceptance and resignation
• Minimal support within area of injury due to variability across individuals & situations
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Self-Regulation Theory
• People form a representation of their injury on the basis of 1. General information available about the injury2. Information obtained from expert sources (e.g., athletic
trainer, physician)3. Current and past experiences with injury
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• Act Tough and Always Give 110%• Giving 110% is impossible• Creating image of invulnerability to injury• Trying to give 110% can lead to performing at 50% of
optimal ability• Injured Athletes are Worthless• Coaches may isolate, cease communication, or criticize
injured athletes• Communicates that athlete is only useful as a performer
Potentially Dangerous Attitudes
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Whole-Person Philosophy• Respond to athletes as people, not just injuries• They need social support• Critical in the rehabilitation phase• Help ensure that normal contacts are maintained and be as
optimistically reassuring as possible• Teammates, coaches, sport psychologists, and athletic
trainers • As soon as athletes can rejoin a team—even if on crutches or
bandaged—they should• Peer mentors and injury support groups
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Double-Edged Crutch• Social support and the reintegration of the injured athlete are
important parts of the rehabilitation process, there are two problems:
1. An injured athlete may present a conscious or unconscious threat to others
2. An athlete’s injury may present an opportunity to another person
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• Important to learn about the injury itself and the rehabilitation process - knowledge is power!
• Results in faster recovery and reduction in pain, state anxiety, and fear of re-injury• Thought stoppage• Cognitive restructuring• Imagery• Goal-setting• Relaxation
Teaching Psychological Rehabilitation Strategies