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) www.issponline.org

North American Society for the Psychology of Sport and Physical Activity (NASPSPA) www.naspspa.org

The Sport Psychology Academy (SPA) www.aahperd.org

Association for the Advancement of Applied Sport Psychology (AAASP) www.aaasponline.org

American Psychological Association Div. 47 (APA, Div. 47) www.psyc.unt.edu/apadiv47

American College of Sports Medicine (ACSM) www.acsm.org

The United States Olympic Committee (USOC) www.usoc.org

1. Performance Enhancement / Intervention: Focus is on performance

improvements in any any achievement settingachievement 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: AAASPRequired Coursework for becoming an AAASP certified consultantEITHER SPORT SCIENCE OR PSYCHOLOGY COURSES

Courses Description

1. Professional ethics 1 course

2. Sport psychology 3 courses in all subdisciplines

3. Research Design, Stats or 1 course in any of these areas

psychological assessment

4. Biological bases of behavior 1 course in comparative psychology; physio

psychology

5. Cognitive Affective bases Course in cognition, motor development or motor learning

6. Social Bases of behavior 1 course in social psychology

The Certification Issue: AAASPRequired Coursework for becoming an AAASP certified consultantPRIMARILY SPORT SCIENCE COURSES:Course Description1. Biomechanical / physiological bases 1 course in kinesio., Ex. Physio,

Biomechanics2. Historical, philosophy, sociology 1 course in this area of sport sci3. Skills, techniques, analysis 1 methods course in sport area

PRIMARILY PSYCH COURSES:1. Psychopathology 1 course in abnormal2. Counseling skills course work to foster basic

counseling skills3. Individual Behavior 1 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 others2. 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 1979-1988 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.