Cognitive Behavioral Approaches in the Training Room

Although sports medicine physicians, physical therapists, and certified athletic trainers indicate that they encounter psychological issues that are both injury-related (e.g., fears of re-injury, lack of patience; Mann et al., 2007) and non-injury-related (e.g., stress, anxiety, and burnout; Mann et al., 2007) and also report that the role of psychological skills are valuable and effective in the rehabilitation process (Hamson-Utley et al., 2008), the majority of individuals associated with the physical recovery of an injury indicate that there is a lack of training regarding application of psychological skills that could be used in a sports medicine setting (Arvinen-Barrow et al., 2010). Both pre-injury models (e.g., Williams & Andersen, 1998) and post-injury models (e.g., Wiese-Bjornstal et al., 1998) suggest that cognitive processes are key factors that influence both the risk for a sport-related injury and the outcome or recovery from a sport-related injury. Therefore, given the reports of psychological issues reported in various sports medicine settings, teaching individuals associated with the physical recovery of injuries basic skills that address cognitive processes could be an effective way to enhance both physical and psychological outcomes of injuries.

For example, teaching individuals involved in the physical recovery process basic tenants of cognitive therapy (Beck, 1995) could help individuals challenge maladaptive automatic thinking patterns that may be influencing the recovery process. An individual practicing a new rehabilitation exercise may have the automatic thought that, “this is too hard and I’ll never be able to do it.” According to cognitive therapy, this thinking pattern may influence one’s emotions as well as behaviors. An injured athlete with this thought may experience feelings of sadness and, as a result, stop rehabilitation exercises. Teaching an individual associated with the recovery process basics skills and techniques to challenge maladaptive thoughts like these could not only increase the likelihood that an athlete has a positive psychological response to the injury, but also adheres to rehabilitation processes throughout the treatment leading to a positive and successful physical outcome. Although application of all the intricate details of cognitive therapy would be beyond the job-scope of an individual working in a sports medicine setting, learning basic components of this therapy could lead to better treatment outcomes, both physically and psychologically. Is it asking too much to encourage sports medicine physicians, physical therapists, and certified athletic trainers to attend seminars to learn basic components of various cognitive behavioral approaches?

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Integrated Model of Psychological Response to Sport Injury

The majority of research within the Sports Medicine Psychology Lab is based on the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., 1998). According to this model, pre-injury factors (e.g., personality, a history of stressors, coping resources; Williams & Andersen, 1998) as well as both personal and situational factors influence athletes’ cognitive appraisal (i.e., thoughts) of a sport-related injury. The model suggests that these “thoughts” of sport-related injuries then influence both emotional and behavioral responses in a reciprocal and ongoing process to, ultimately, impact (positively or negatively) physical and psychological recovery outcomes.

For example, a swimmer, who is a self-proclaimed perfectionist, incurs a fourth shoulder injury of her collegiate career. Her perfectionistic tendencies cause her to set extremely high standards for herself and, therefore, a thought related to the injury could include, “If I’m not 100% in a week, I will never be competitive again.” As a result of this thought, she feels frustrated and a sense of urgency. This emotional response causes her to approach rehabilitation with a high level of intensity (behavioral response) and do everything that her trainers asks her to do as well as additional activities outside of the training room that she believes with help her recovery. After a week of these behaviors, she has not noticed an improvement in her shoulder pain and thinks, “this isn’t getting better, I’ll never be a good swimmer again.” As a result of this thought, she gets depressed and begins to skip rehabilitation sessions. This process of interactions between cognitive appraisals, emotional responses, and behavioral responses continues over time and, as the example highlights, impacts both physical and psychological recovery outcomes.

For those interested, the document linked above provides a more detailed explanation of the integrated model of psychological response to sport injury. While a lot of the variables outlined in the model have been supported by research, some components still need to be tested. Our goal in the Sports Medicine Psychology Lab is to provide further support for the various components of the model.

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Welcome to the Sports Medicine Psychology Lab Blog

Welcome to the Sports Medicine Psychology Lab blog. Our lab is located within the Department of Kinesiology at the University of Minnesota, Twin Cities. The purpose of this blog is to provide information to readers on current research findings and activities within our lab as well as interests of members of the lab on topics related to sport and exercise psychology. Our goal is to provide useful and applicable information to individuals involved in or interested in sport and exercise.

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