Psychology Chapter 5: Wellbeing and Emotions

Stress, Mental Health, and Wellbeing in Sport and Exercise Psychology

• Stress is a physical and mental response to a stressor.
• A stressor is a force that acts on a biological system.
• Distress is a psychological reaction to stressors which can be emotional, cognitive, or behavioral.
• Part of the stress response includes biological and physiological reactions to stressors.
• Stress is an imbalance in physiological systems that activates physiological and behavioral responses to restore balance.

Psychosocial Disorders in Athletes

• One in three athletes are affected by a psychosocial illness.
• Higher rates of anxiety and depression for athletes compared to general population
• Higher rates of bipolar disorders in the 16-34 year old athlete population compared to general population.
• Higher rates of self-harm, substance abuse, and suicidal ideation in athletes compared to general population.
• Greater risk of issues such as anxiety and depression in athletes compared to the general population during and after competition, particularly, in individual sports.

Defining Wellbeing

• Psychological wellbeing is about lives going well, a combination of feeling good and functioning effectively.
• Wellbeing is more than feeling good all the time, (happiness and contentment, interest, engagement, confidence, affection)
• Wellbeing involves functioning effectively, development of one's potential, having some control over one's life, having a sense of purpose (e.g. towards valued goals), and experiencing positive relationships.

Drivers of Wellbeing

• Personality is the strongest predictor of usual emotional style.
• Extraversion is related to positive characteristics and neuroticism is related to negative mood and common mental disorders
• Higher income and education are generally viewed as having a protective function against poor mental health, though this is controversial
• Income inequality is associated with poorer wellbeing and more psychological disorders
• Unemployment is associated with mental health problems.

Theories and Models of Stress and Coping

• Stimulus-oriented approaches: The accumulation of life changes leads to health changes, regardless of whether the change is positive or negative. Social Readjustment Rating Scale (SRRS).
• Reaction-oriented approaches: Stress is the nonspecific physiological response of the body to any demand, characterized by three stages: alarm, resistance, exhaustion. General Adaption Syndrome (GAS)
• Cognitive approaches: Stress is a relationship between the person and the environment appraised by the person as taxing or exceeding his/her resources and endangering well-being. Transactional Model of Stress. Conservation of Resources (COR)

Coping strategies of athletes

• Sex differences: female athletes use more emotion-focused coping but experience more stress from coaches, and more likely to use support strategies.
• Performance level differences: elite male athletes tend toward an approach coping style, while non-elite males use more avoidance. Elite female athletes use more avoidance, while non-elite females tend toward approach.

Classification systems of diseases and mental disorders

• WHO's ICD-10: This is an international classification system of diseases and related health problems.
• APA's DSM-5: This is the diagnostic and statistical manual of mental disorders. This is an American classification system of diseases and related health problems.

Difficulties with Stress-Related Research

• Different definitions of stress.
• Different measures (eg., Perceived Stress Questionnaire or salivary free cortisol levels) to study stress levels.

Physical activity and wellbeing

• Higher levels of physical activity are associated with positive mood and affect.
• Aerobic exercise has positive effects on mood, but can cause fatigue, confusion, lack of concentration, depression, anger, and tension.
• Exercise interventions work well, but results become less effective over time.
• Physical activity is associated with benefits for psychological wellbeing

Physical activity and depression

• Accumulating 2.5 hours of brisk walking/week is associated with a 25% lower risk for depression.
• Physical activity reduces depression symptoms by regulating the monoamine system and HPA axis.

Physical activity and anxiety

• Regular exercise may reduce stress-induced anxiety by increasing the production of relevant neurotransmitters.
• Anxiety can be positively impacted by exercise but negative effects can emerge if the training focus is on appearance metrics.

Psychological antecedents of sport injury

• Physical factors are often the main cause of sport injuries, but psychological factors also contribute.
• Stress-related injuries often manifest as increased muscle tension and attention difficulties.
• Factors such as personality, history of stress, and coping resources contribute to the athlete's risk of injury
• Psychological states, like feeling in a bad mood, lack of perceived physical energy, and feeling unsociable, are commonly associated with increased risk of injury.

Psychological responses to sport injury

• Stages of grief or disbelief, denial and isolation, anger (inward or outward), bargaining, depression, and acceptance after an injury are common responses.
• Athletes do not always follow these stages sequentially and may exhibit several emotions and thoughts at once, or cycle back through some stages often.
• The common reported response categories after injury are injury-related information processing, emotional upheaval and reactive behavior, and a positive outlook and coping approach

Sports as a risk factor for substance use

• Participation in competitive sports may increase the risk for developing substance use issues (particularly in team sports or team environments)
• The type of sport may play a role: team sports may pose greater risk compared to individual sports
• Social and cultural factors, such as peer pressure, easy access to substances, and particular expectations of performance and/or body image, may all exacerbate risk.

Treatments for Substance Use Disorders

• A detailed history of the patient's past and present use and effects
• General medical and psychiatric history and examination
• History of psychiatric treatments & outcomes
• Family and social history
• Screenings of blood, breath, urine
• Additional laboratory tests
• Interviews with significant others (with permission)

Non-substance related disorders

• Includes topics such as Gambling disorder, Gaming disorder, Internet-use disorder.
• Presented for the first time in the 11th edition of the ICD manual.

The role of physical activity in the treatment of substance use disorders

• Physical activity can reduce craving and withdrawal symptoms and also improve mood—thus acting as a protective factor.
• Physical activity results in beneficial effects on general, psychosocial, and neurobiological aspects of wellbeing.
• Physical activity is therefore a potential intervention.

Loneliness

• Loneliness is an unpleasant experience due to a perceived deficiency in social relations, either quantitatively or qualitatively.
• Three core elements of loneliness are: an unpleasant experience, a deficiency in relationships and subjectivity.
• Loneliness can be defined as the absence of intimate attachments, face-to-face interactions or social identities, and can have biological and evolutionary significance.
• Loneliness can be protective, but when it's sustained or problematic it can lead to physical and mental health consequences.

Interventions for improving social skills and reducing loneliness

• Interventions to improve social skills include:
• improving conversational skills and ability to give and receive compliments
• enhancing social support through self-support groups
• increasing opportunities for social interaction through recreational programs
• Addressing maladaptive social cognition (most effective)

Loneliness in performance sport

• Research indicates that individuals involved in individual sports experience higher levels of loneliness compared to those in team sports.
• Studies highlight a possible correlation between depressive symptoms and performance failure.
• Female athletes may report greater instances of loneliness compared to male athletes in the same situations

Stress and Depression in Elite Athletes

• A biopsychosocial model is used:
• biological factors (genetic predispositions, physical disabilities, pain)
• psychological factors (personality, beliefs, perceptions, coping)
• Social factors (peer conflicts, family circumstances, school)
• The model suggests these factors influence vulnerability to stress, leading to both physical health problems and mental health problems like depression.

Depression and Organic Causes and Correlations

• Many various medical conditions may present with symptoms that are similar to depression.
• Medical issues such as: Tuberculosis, HIV/AIDS, Cancer, Hypertension, Diabetes Melitus, and Myocardial Infarction may present similar related symptoms.

Organic Resemblance of Depression

• Hypothyroidism is characterized by a variety of symptoms that can manifest similarly to depressive symptoms.
• Some conditions such as Anaemia, and Malnutrition frequently are related to a reduction in energy levels, which can sometimes imitate depressive symptoms. It's crucial to note these symptoms can appear in other conditions as well

Depressive episode ICD-10/11 criteria

• A-criteria: Depressive mood, in most parts of the day, almost every day, not changed due to outside factors; loss of interest/joy in activities, reduced drive or fatigue.
• B-criteria: Loss of self-consciousness/-worth, unfounded self-reproach or unreasonable guilt, recurrent thoughts on death or suicide, concentration difficulties, or hesitation/indecision, psychomotor agitation or inhibition, sleep disturbances, loss/increase in appetite/weight.
• Somatic criteria: loss of interest/pleasure, loss of appetite, loss of weight, loss of libido, waking up early.

Classification of Depressive Episodes (Severity)

• Severity of depressive episodes is based on the number of symptoms present (classified as Mild/Moderate/Severe episodes).

Common Risk Factors for Depressive Episodes

• There are a number of different predispositions and risk factors for the development of depressive episodes.
• Psychosocial stress, genetic disposition (especially from immediate relatives), trauma, the presence of somatic diseases, or other comorbidities represent potential risk factors.
• Women more often have been reported to have higher rates of depression.
• The age of onset of depressive symptoms (earlier onset is generally linked to higher prevalence).

Treatment for Depression in Athletes

• Psychotherapy
• Anti-depressive medication
• The involvement of a trained specialist (such as a sport psychologist)

Body Image

• Body image is a construct that comprises the perception, cognition, emotions, and behaviors related to one's own body.
• Elements such as negative body image, eating disorders, dissatisfaction with appearance, weight, shape, and body surveillance are factors that frequently are related to negative body image.
• There is evidence that exposure to sociocultural appearance ideals can also create a negative body image, leading to further issues and concerns

Influences and prevention of body image issues

• Media, peer groups, and familial influences play a role in the development of body image concerns, but also may be modifiable factors.
• Positive interventions include avoiding negative comments from parents and others, providing positive media examples, fostering healthy physical activity habits, and actively promoting a broader body image definition.

Sport and Movement Therapy in Psychiatric/Psychosomatic Disorders

• Movement therapy in this context is an interdisciplinary approach using movement, activities, and training methodology to help athletes manage and prevent, as well as treat, issues such as anxiety, depression, and eating disorders.
• The approach has several goals and perspectives including; activation, awareness, mindfulness, body awareness, physical training, dealing with emotional issues relating to fear, aggression, performance/achievement concerns, concentration, and communication with others.
• The goals may include helping patients to gain greater control over their body and emotions, develop a clearer relationship with their body, manage aggression, resolve emotional tension, and improve regulation of their emotions.