PSE 8 Stress, Mental Health & Wellbeing Introduction WiSe2425 PDF

Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft PSE8 Stress, mental health and wellbeing PSE 8.1 Stress, mental health and wellbeing in sport and exercise psych...

Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft PSE8 Stress, mental health and wellbeing PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology PSE 8.2 Diagnostics in stress, mental health and wellbeing in sport and exercise psychology PSE 8.3 Coaching and counselling skills for stress management, improving mental health and wellbeing PSE 8 Stress – Mental Health– Wellbeing 1  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Module overview PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology V. Abeln J. Belz F. Pels A. Degener C. Chermette Stress, mental health PSE 8.2 Diagnostics in stress, mental health and wellbeing in sport and and wellbeing exercise psychology J. Belz PSE 8.3 Coaching and counselling skills for stress management, improving mental health and wellbeing A. Gawlik PSE 8 Stress – Mental Health – Wellbeing 3  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Psychische Erkrankungen von Athlet*innen 1 von 3 Athlet*innen betroffen (2019) (Schuch et al. 2018, Gouttebarge et al. 2019) 16 – 34 % von aktiven und inaktiven Athleten (Gouttebarge et al. 2019) Höheres Auftreten bei Athleten im Vergleich zur allgemeinen Bevölkerung von: - Angst / Depression (33,6 %) - Zwangsstörungen - Bipolare Störungen - Störungen im Selbstwertgefühl - Selbstverletzungen - Aufmerksamkeitsdefizit / Hyperaktivitäts-Störung (5,4 %) - Essstörungen (-19% , -45% ) - Schlafprobleme (49 %) - Einsamkeit - Stress - Substanz-Missbrauch (19 % Alkohol) - Suizid (1 von 6) - Post-traumatische Stress Störungen - Spielsucht (8,2 %) (Quellen: IOC Mental health in elite athletes toolkit (2021); Forys & Tokuhama-Espinosa 2022) 7  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft What is this course about – 4 basic approaches o Subclinical (e.g. stress, arousal, pain) and clinical aspects (e.g. anxiety, burnout, depression, addictive behavior) o Physical activity as a cause (e.g. elite sport as a cause for burnout, injuries as a cause for injury anxiety, etc.) o Physical activity as a treatment (e.g. physical activity programs as an intervention for burnout, physical activity programs as an intervention for enhancing self-confidence) o Physical activity as a preventive strategy against clinical and non-clinical (non-diagnosable) PSE 8 Stress – Mental Health – Wellbeing 11  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Key compentencies PSE8 obtain in-depth theoretical insight into stress, mental health and wellbeing; structures and mechanisms for critical scientific observations, recitation, discussion and as basis for the practical use of sport psychological interventions critically regard and discuss neuroscientific literature and tools about physical activity treatments regarding mental health and wellbeing identify characteristics of a well-functioning and a less well-functioning psychological states to prevent, recognize and handle malfunctions and impaired psychological states in athletes or to refer athletes to specialists select, implement, critically evaluate specific diagnostics for aspects of stress, mental health and wellbeing apply life coaching and stress management methods develop interventions for individuals who want to increase or change their mental health and wellbeing PSE 8 Stress – Mental Health– Wellbeing 12  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Lecturing schedule Date Topic Lecturer 1 09.10.24 Introduction Abeln 2 16.10.24 Theories and models of stress and coping Belz theoretical aspects Theories and models concerning how physical activity impacts 3 22.10.24 Belz stress 4 30.10.24 Psychological antecedents of sport injury Belz 5 06.11.24 Psychological responses to sport injury Belz subclinical aspects 6 13.11.24 Stress and depression in German elite athletes Belz 7 20.11.24 Loneliness and physical activity Pels 8 27.11.24 Substance use disorders Chermette 9 04.12.24 Depression Degener 10 11.12.24 Eating disorders Degener (sub)clinical aspects 11 18.12.24 Body image (of athletes) Degener 12 08.01.25 Anxiety disorders Degener 13 15.01.25 Physical activity as a treatment Degener 14 22.01.25 Neurophysiological aspects of physical activity treatments Abeln 15 29.01.25 Neuroimaging of stress and well-being Abeln theoretical aspects PA as a treatment PA as a cause 13  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Assessment Written exam multiple choice 45 questions, 1.5 min / question (60 min) Time and date will be announced later (expected 1st week after lecturing period) Grade is 100% written exam multiple choice (PSE8.1) PSE 8 Stress – Mental Health – Wellbeing 14  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft What is stress? Stress = Physical and mental response to a stressor Stressor = force that acts on a (biological) system Distress = psychological reaction created by stressors, which can be an emotional, cognitive, or behavioral response. Part of the stress response that includes also biological and physiological reactions to stressors. Buckworth et al., 2013: credit:http://www.taunusreiter.de/use-it-or-lose-it.jpg Stress is an imbalance in physiological systems that activates physiological and behavioral responses to restore balance. PSE 8 Stress – Mental Health – Wellbeing 17  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft THE COMPLEX NATURE OF STRESS BEHAVIORAL PERSPECTIVE DEVELOPMENTAL PERSPECTIVE BIOLOGICAL PERSPECTIVE SOCIOCULTURAL PERSPECTIVE STRESS COGNITIVE PERSPECTIVE WHOLE-PERSON PERSPECTIVE  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Official Definition WHO, 2001 & 2016: Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community Contributes to efficient human functioning Ability to adapt and respond when encountering physical, mental or social challenges Physical and mental health intertwine PSE 8 Stress – Mental Health – Wellbeing 20  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft The mental health spectrum Keyes (2004): State of recognizing personal Target strengths and capacities to support mental health „Languisher“ are greatly at risk of depression and physical disorders Languishing people may be highly prevalent among young people Data from the US: 11% 17% Huppert, 2005 PSE 8 Stress – Mental Health – Wellbeing 21  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Health as a continuum Active mental sub-syndrom Good mental Peak illness illness Normal health performance (frequent (occasional (asymptomatic) (Flow zone) symptoms) symptoms) ° of psychological wellness/distress and effective/reduced functioning Lardon & Fitzgerald, 2013 PSE 8 Stress – Mental Health – Wellbeing 22  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft healthy – unhealthy // subclinical - clinical Classification systems of diseases = systematic method of generalization based on standardized criteria PSE 8 Stress – Mental Health – Wellbeing 25  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Classification systems of diseases and mental disorders International statistical Classification of Diseases and related health problems WHO Diagnostic and Statistical Manual of Mental Disorders APA http://apps.who.int/classifications/icd10/browse/2016/en#/F40-F48  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft What is wellbeing? Psychological wellbeing is about lives going well Combination about feeling good and functioning effectively It is not about feeling good all the time Concept of Feeling good = positive emotions of happiness and contentment, interest, engagement, confidence, affection Concept of functioning effectively = development of one’s potential, having some control over one’s life, having a sense of purpose (e.g. working towards valued goals), and experiencing positive relationships Huppert, 2009 PSE 8 Stress – Mental Health – Wellbeing 30  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Drivers of well-being Personality strongest predictor of usual emotional style Extraversion appears to drive positive emotional characteristics Neuroticism appears to drive negative mood and common mental disorders is related to how well we function psychologically Demographic factors Gender effect concerning ill-being but little evidence for well-being U-shaped relationship between age and mental well-being (single item) Martial status is associated with higher life satisfaction and lower rates of psychological ill- being BUT causation is unclear PSE 8 Stress – Mental Health – Wellbeing 31  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Drivers of well-being Socioeconomic Factors Higher level of income and socioeconomic status as positive influence (Dolan et al., 2008) Higher educational qualifications have mostly a protective function against poor mental health, but with decreasing progression (Dolan et al., 2008), (controversial ⍯ Chevalier & Feinstein, 2006) Income inequality is associated with well-being (-) and psychological disorder (+) Unemployment is associated with the presence of mental health problems (e.g. Evans & Repper, 2000) PSE 8 Stress – Mental Health – Wellbeing 32  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft Drivers of well-being Demographic and socioeconomic factors account for only 10% of the variation in psychological well being between individuals (Argyle, 1999) Personality factors account for about 20% of variation (Abbott, et al., 2008) PSE 8 Stress – Mental Health – Wellbeing 33  Dr. Vera Abeln Institut für Bewegungs- und Neurowissenschaft WHO (Five) Well-Being Index 35 https://www.psykiatri-regionh.dk/who-5/Documents/WHO-5%20questionaire%20-%20English.pdf  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Theories and models of stress and coping PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology [email protected] 1  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology 1. Stress theories and models Stimulus-oriented Life-Event-Theory (Holmes and Rahe, 1967) approaches Reaction-oriented General Adaption Syndrome (Selye, 1950) approaches Transactional Model of Stress (Lazarus, 1984) Cognitive approaches Conservation of Resources (Hobfoll, 1988) [email protected] 3  Dr. Johanna Belz Stimulus-oriented Institute of Psychology approaches Section Health & Social Psychology Life-Event-Theory (Holmes & Rahe, 1967) Major life changes are stressful and the accumulation of life changes leads to changes in health. It is irrelevant, whether the event is positive or negative. Social Readjustment Rating Scale (SRRS): 43 Life Change Units − Measures the intensity and length of time necessary to accomodate a life event, regardless of the desirability of this event The more changes or life events experienced over the past three years, the more vulnerable a person may be to distress. [email protected] 4  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Cons Individual‘s appraisal of an event is irrelevant Individuals‘ coping options were ignored Studies show significant correlations between life events and illness, but only small effect sizes [email protected] 5  Dr. Johanna Belz Reaction-oriented Institute of Psychology approaches Section Health & Social Psychology General Adaption Syndrome (Selye, 1950) Stress is the nonspecific response of the body to any demand made upon it. − Same pattern of physiological response to any kind of demand Triphasic structure: 1. Stage of alarm reaction 2. Stage of resistance 3. Stage of exhaustion [email protected] 6  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology General Adaption Syndrome (Selye, 1950) alarm reaction resistance exhaustion stressor resistance time [email protected] 7  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Cons No individual differences in responses to stress Psychological factors are not considered [email protected] 8  Cognitive Dr. Johanna Belz approaches Institute of Psychology Section Health & Social Psychology Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) “Stress is conceptualized as a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and as endangering well-being.” [email protected] 9  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) person primary emotional reaction appraisal transaction stressful situation harm/loss, threat, challenge coping secondary environ- appraisal ment decision, evaluation coping options [email protected] 10  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Cons Individual-centered approach, relations to other people were not considered Distinction between appraisal and coping is difficult to justify [email protected] 11  Cognitive Dr. Johanna Belz approaches Institute of Psychology Section Health & Social Psychology The Conservation of Resources Model (Hobfoll, 1988) Psychological stress is defined as a reaction to the environment in which there is… a) the threat of a net loss of resources. b) the net loss of resources. c) a lack of resource gain following the investment of resources. Resources = objects, personal characteristics, conditions, etc. [email protected] 12  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Cons Stress is always linked with a loss of resources [email protected] 13  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Difficulties in stress-related research 1. Various definitions of stress 2. Different types of measures Perceived Stress Questionnaire (Fliege et al., 2005) − e.g. „You feel frustrated.“ Salivary free cortisol … [email protected] 17  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Various definitions of stress Stress is conceptualized as a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and as endangering well- being. (Folkman & Lazarus, 1986) Stress is an imbalance in physiological systems that activates physiological and behavioral responses to restore balance. Stressors are the forces that act on a biological system to cause stress. (Buckworth et al., 2013) [email protected] 15  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Various definitions of stress Stress is a negative emotional experience accompanied by predictable biochemical, cognitive, and behavioral changes that are directed toward altering the stressful event or accommodating to its effects. (Baum, 1990) [email protected] 16  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping "...constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person“ (Lazarus & Folkman, 1984) [email protected] 21  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) emotion-focused coping person primary emotional reaction appraisal transaction stressful situation harm/loss, threat, challenge coping secondary environ- appraisal ment decision, evaluation coping options problem-focused coping [email protected] 22  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping terminology Problem-focused vs. emotion-focused (Lazarus & Folkman, 1984) Adaptive vs. maladaptive (e.g., Skinner & Beers, 2016; Erdmann & Jahnke, 2008) Functional vs. dysfunctional (e.g., Shulman, Seiffge-Krenke, & Samet, 1987) … (Nicholls & Polman, 2007) [email protected] 25  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping strategies of athletes Gender differences Female athletes assessed stressful situations as more negative compared to male athletes Female athletes showed higher levels of anxiety and used emotion- focused coping strategies more often compared with male athletes Female athletes experienced more intense stress from their coaches than male athletes Female athletes were more likely to use strategies of searching for emotional support and instrumental support in threat situations Male athletes reported using the strategy of relying on a sense of humor more frequently than female athletes did (Nuetzel, 2023) [email protected] 28  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping strategies of athletes Performance level differences Elite male athletes more frequently had an approach coping style, and non-elite male athletes more frequently had an avoidance coping style Elite female athletes more frequently had an avoidance coping style and non-elite females more frequently had an approach coping style Coping strategies and mental health Problem-focused coping is associated with lower levels of anxiety and emotion-focused coping is associated with higher levels of neuroticism Results showed positive correlations between proactive coping, moderate physical activity, self-efficacy, and mental health (Nuetzel, 2023) [email protected] 29  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Functionality of coping strategies Associations found in competitive sports: Emotion-focused coping  negative affect, higher levels of neuroticism Problem-focused coping  positive affect, lower levels of anxiety Emotion-focused and avoidance coping  higher cognitive anxiety, higher levels of neuroticism (Nicholls & Polman, 2007; Nuetzel, 2023) [email protected] 30  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping during competitive suffering episodes Results Negative feelings about goal attainment moderately predicted problem-focused coping use Negative feelings about of goal attainment strongly predicted emotion-focused coping use Avoidance coping use decreased over time (Evans et al., 2014) [email protected] 37  Dr. Johanna Belz Institute of Psychology Section Health & Social Psychology Coping during competitive suffering episodes Discussion Endurance athletes who fall behind their goals during competition experience competitive suffering Endurance athletes will adapt their coping efforts to manage reactions to goal failure Participants increased attempts to regulate emotion and change the reality of the situation when they were experiencing the greatest intensity of negative goal attainment feelings (Evans et al., 2014) [email protected] 38  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Theories and models on how physical activity affects stress PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology [email protected] 1  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology … but first … clarification of definitions “Physical activity (PA) is any bodily movement produced by skeletal muscles that results in energy expenditure above resting (basal) levels. PA broadly encompasses exercise, sports, and physical activities done as part of daily living, occupation, leisure, and active transportation.” “Exercise is a behavioral subset of PA and is defined as PA that is planned, structured, and repetitive and has as a final or intermediate objective the improvement or maintenance of physical fitness.” (Caspersen, 1985, S. 126) [email protected] 4  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Theoretical background: Transactional Model of Stress Starting point (Lazarus & Folkman, 1984) [email protected] 6  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 1. Direct relationship between stress and exercise Stress Exercise a) Stress has an effect on exercise. b) Exercise has an effect on stress. c) Stress and exercise bidirectionally affect each other. (Klaperski, 2018) [email protected] 7  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 1. Direct relationship between stress and exercise Study overview: Cross-sectional studies: There is a clear majority of studies which found a small to moderate negative relationship between exercise and perceived stress. Often, effects were stronger for participants who engaged in more vigorous exercise or who were active more often. Longitudinal studies: On the one hand exercise might be able to reduce perceived stress levels and on the other hand high perceived stress might also cause reductions in exercise participation.. (Klaperski, 2018) [email protected] 9  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 1. Direct relationship between stress and exercise Taking into account existing correlational and experimental evidence, it can be concluded that exercise and perceived stress are most often negatively correlated with each other and that this negative relationship is caused by two effects: (1) perceived stress exercise behavior (2) exercise perceived stress (Klaperski, 2018; Stults-Kolehmainen & Sinha, 2014) [email protected] 10  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 2. Stress-buffer effect hypothesis Exercise Stress Health There is an indirect relationship between stress and exercise. Exercise moderates the stress-health relationship and reduces detrimental effects of chronic stress on health. (Gerber & Pühse, 2009, Klaperski, 2018) [email protected] 11  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 2. Stress-buffer effect hypothesis Exercise buffers against the health-damaging effects of stress. Two possible stress regulating mechanisms are  the strengthening of psychosocial resources and  the reduction of stress responses. Both mechanisms affect how stressors are being evaluated (cognitive appraisal) and how much a person reacts to stress (stress reactivity).  Exercise acts as moderator of the stress-health relationship. (Klaperski, 2018) [email protected] 12  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology What are the 2 effects that exercise can have on stress-health relationship? 2. Stress-buffer effect hypothesis Exam Exam (Fuchs & Klaperski, 2018) [email protected] 13  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 2. Stress-buffer effect hypothesis (figure by Klaperski, 2018) [email protected] 14  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Preliminary conclusion and limitations  Cross-sectional, longitudinal (and experimental) studies provide support for the stress reducing effects of exercise and the stress- buffer effect of exercise. (Klaperski, 2018) [email protected] 16  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Tentative practical implications Exercise seems to be effective in reducing and regulating stress, particularly in very stressful periods. Exercise might fulfill its stress-regulating role best when it is being done regularly. Ideally, exercising should become a habit but at the same time it should never be perceived as an additional stressor. (Klaperski, 2018; Stults-Kolehmainen & Sinha, 2014) [email protected] 18  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 3. Cross-stressor adaptation hypothesis This hypothesis assumes that regular exercise leads to adaptations in the stress response systems that induce decreased physiological responses to psychological stressors.  Exercise helps the body regulate the hypothalamic- pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), all of which play significant roles in the physiological stress response.  Specific adaptations to physical activity translate to unspecific adaptations to psychosocial demands. (Gerber, 2012; Sothmann, 2006) [email protected] 19  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 3. Cross-stressor adaptation hypothesis (Gerber, 2012; Sothmann, 2006) [email protected] 20  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 4. Physical activity/exercise and affect Exercise and PA participation is consistently associated with positive mood and affect. Aerobic exercise has small-to-moderate positive effects on vigor, and small-to-moderate negative effects for fatigue, confusion, depression, anger and tension. Experimental trials support the effect of moderate exercise on psychological well-being. Exercise is related to positive changes in self-esteem and related physical self-perceptions. (Biddle et al., 2015) [email protected] 23  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 5. Physical activity/exercise and depression Systematic review & meta-analysis Results: Inverse curvilinear association: the greatest differences in risk of depression observed between low doses of PA, suggesting most benefits are realized when moving from no activity to at least some Accumulating an activity volume equivalent to 2.5 hours of brisk walking/week associated with 25% lower risk of depression, and at half that dose, risk 18% lower compared with no activity Only minor additional benefits were observed at higher PA levels (Pearce et al., 2022) [email protected] 26  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 5. Physical activity/exercise and depression Exercise may decrease depression by exerting a regulatory influence on the monoamine (neurotransmitter) system and the HPA axis. (Buckworth, 2002; Salmon, 2001) [email protected] 28  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology 6. Physical activity/exercise and anxiety Acute and habitual exercise may reduce stress-induced anxiety by facilitating the synthesis of relevant neurotransmitters and through adaptations in the central nervous system. (Buckworth, 2002; Salmon, 2001) [email protected] 30  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological antecendents of sport injury PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology [email protected] 1  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Incidence of sport injuries In Germany, an estimated 2 million injuries occur in athletic and recreational sport every year Injury rates in U.S. high schools estimated at 12-30% per year At least 50% of participants in amateur athletics each year suffer from injuries that preclude participation Injury risk for elite soccer players is between 65%-91% during one season (for overviews refer to Kleinert, 2020 and Johnson, 2007) [email protected] 5  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Antecedents of sport injuries Physical factors are the main cause for sport injuries Psychological factors can also contribute to the occurence of sport injuries Relation between sport injuries and psychological factors is primarily stress-related  e.g., situation is perceived as threatening → increase in state anxiety → change in focus or attention and muscle tension → increased chance of injury Exam (Andersen & Williams, 1998; Pal et al., 2021; Kleinert, 2020) [email protected] 6  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Stress and injury model Framework for the prediction and prevention of stress-related injuries that includes cognitive, physiological, attentional, behavioral, intrapersonal, social, and stress history variables Assumption of two basic mechanisms behind stress-injury relationship: (1) Increases in general muscle tension and attention deficits during stress (2) Individuals who have personality traits that tend to worsen the stress response and few coping resources will, in a stressful situation, be more likely to appraise the situation as stressful, exhibit greater muscle tension and attentional changes, and thus be at greater risk of injury compared to individuals who have the opposite profile (Andersen & Williams, 1998) [email protected] 8  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Stress and injury model Personality History of Coping factors stressors resources Stress response Potentially Cognitive Physiological/ stressful attentional Injury situation appraisals changes Interventions (adapted from Andersen & Williams, 1998) [email protected] 9  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Exam what belongs to what General coping Stress and injury model behaviors Social support system Stress management Mental skills Personality History of Coping Medication factors stressors resources Stress response Potentially Cognitive Physiological/ stressful attentional Injury situation appraisals changes Interventions (adapted from Andersen & Williams, 1998) [email protected] 10  Dr. Johanna Belz Exam what belongs to what Institute of Psychology Dept. Health & Social Psychology Life events Stress and injury model Daily hassles Previous injuries Personality History of Coping factors stressors resources Stress response Potentially Cognitive Physiological/ stressful attentional Injury situation appraisals changes Interventions (adapted from Andersen & Williams, 1998) [email protected] 11  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Hardiness Locus of control Exam what belongs to what Sense of coherence Stress and injury model Competitive trait anxiety Achievement motivation Personality History of Coping factors stressors resources Stress response Potentially Cognitive Physiological/ stressful attentional Injury situation appraisals changes Interventions (adapted from Andersen & Williams, 1998) [email protected] 12  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Stress and injury model Personality History of Coping factors stressors resources Stress response Potentially Cognitive Physiological/ stressful attentional Injury situation appraisals changes Cognitive restructuring Relaxation skills Thought stoppage Autogenics/meditation Confidence training Imagery/mental rehearsal Fostering realistic expectations Distraction/desensitization Fostering team cohesiveness Interventions Medication modification (adapted from Andersen & Williams, 1998) [email protected] 13  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological antecedents of sport injury – Empirical evidence Athletes who possess few coping skills and little social support at greater risk of athletic injury when experiencing major life changes Athletes who have low self-esteem, are pessimistic and low in hardiness experience more athletic injuries Athletes who have higher levels of trait anxiety experience more athletic injuries (Weinberg & Gould, 2015) [email protected] 14  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological antecedents of sport injury related to stress Systematic review Results Stress and anxiety are two notable psychological variables which are associated with predicting injury in different sports It was found that stress and anxiety can influence the risk of injuries, injury frequency, and injury severity in athletes. Limitations The review did not include athletes with disabilities This review only focused on stress and anxiety variables although there are many other psychological predictors of injury (Pal et al., 2021) [email protected] 20  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological antecedents of sport injury – GSU study I Results Psychological states and risk of injury  Greatest impact on injury occurrence = factor perceived physical energy (OR = 7.4).  The risk of an injury in participants who feel sociable (OR = 2.2) or sleepy is doubled (OR = 2.3) (Kleinert, 2007) [email protected] 24  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological antecedents of sport injury – GSU study II Results Psychological states and risk of injury  Light injuries predominantly in athletes who perceived their physical health state as bad  Medium injuries more often in athletes who perceived themselves as less trained and simultaneously very outgoing (sociable, communicative)  Serious injuries predominantly in athletes who stated to be in a bad mood prior to the start of the match (Kleinert, 2007) [email protected] 29  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology GSU studies I and II – Practical implications Short-term oriented strategies should be developed to select participants who are at higher injury risk  Identification of critical state constellations shortly before or at the beginning of an achievement situation Depending on the interpretation of diagnostic data, preventive interventions could vary (e.g., relaxation techniques, concentration on physical preparation, …) (Kleinert, 2007) [email protected] 31  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology GSU studies I and II – Practical implications Importance of improving the athletes' abilities of body perception, concentration, and physical self-confidence Teach athletes to take responsibility for one's own body and health → helpful in the prevention of sport injuries Repeated introspection skills (e.g., long-term use of self- perception oriented adjective lists) are helpful to develop these competencies (Kleinert, 2007) [email protected] 32  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Sport Injury Trait Anxiety Scale (SITAS) Low situational competency (Cronbachs α =.81)  “I was already injured in such a situation”  “Top performances are required” High situational importance (Cronbachs α =.79)  “A lot is at stake for me”  “To perform successfully means a lot to me” Situational loss of control (Cronbachs α =.72)  “I notice that I am distracted”  “I am dependent on a partner” (Kleinert, 2002a) [email protected] 33  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Psychological responses to sport injury PSE 8.1 Stress, mental health and wellbeing in sport and exercise psychology [email protected] 1  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury The 5 stage-model 1. Disbelief, denial, and isolation 2. Anger, directed inward (anger-in) or outward (anger-out) 3. Bargaining with everyone 4. Depression 5. Acceptance (Hardy & Crace, 1990) [email protected] 6  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury Criticism of the 5-stage model: Athletes do not follow a stereotypical pattern or necessarily experience each emotion in these five stages Many athletes have more than one of these emotions and thoughts simultaneously or revert back to stages You can expect injured individuals to exhibit three general categories of responses: 1. Injury-related information processing 2. Emotional upheaval and reactive behavior 3. Positive outlook and coping (Udry et al., 1997) [email protected] 7  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury 1. Injury-related information processing The injured athlete focuses on information related to the pain of the injury The athlete is aware of the extent of the injury The athlete questions how the injury happened The athlete recognizes the negative consequences or inconvenience of the injury (Udry et al., 1997) [email protected] 8  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury 2. Emotional upheaval and reactive behavior Once the athlete realizes that he/she is injured, he/she may become emotionally agitated Athlete feels emotionally depleted Athlete experiences isolation and disconnection Athlete feels shock, disbelief, denial, or self-pity (Udry et al., 1997) [email protected] 9  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury 3. Positive outlook and coping The athlete accepts the injury and deals with it The athlete initiates positive coping efforts The athlete exhibits a good attitude and is optimistic The athlete is relieved to sense progress (Udry et al., 1997) [email protected] 10  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Emotional adjustment to injury Signs of poor adjustment to injuries Feelings of anger and confusion Obsession with the question when one can return to play Denial (e.g., “It’s no big deal”) Repeatedly coming back too soon and experiencing re-injury Dwelling on minor physical complaints Guilt about letting the team down Withdrawal from significant others Rapid mood swings Statements about futile nature of rehab (“It’s all over for me anyways!”) (Petitpas & Danish, 1995; Weinberg & Gould, 2007, 2015) [email protected] 11  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Injury and depression in sport Of injured athletes, 27% to 51% report at least mild or moderate symptoms of depression post-injury The reported numbers of injured athletes with clinically significant levels of depression are inconsistent and percentages range between 4% to 12% Most of the studies that compare depression scores of injured and non-injured athletes reveal significant differences (for an overview refer to Kleinert et al., 2020) [email protected] 13  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Integrated Model of Psychological Response to Sport Injury and Rehabilitation Personality characteristics, history of stressors, coping resources, and interventions influence athletes’ stress response and the subsequent likelihood of injury The same factors that determine injury risk also influence athletes’ psychological response to injury Key premise: Each individual may respond differently to an injury depending upon one’s assessment of the meaning of the injury, its perceived consequences, and one’s ability to cope with the consequences (Wiese-Bjornstal et al., 1998) [email protected] 21  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Integrated Model of Psychological Response to Sport Injury and Rehabilitation Cognitive appraisals are hypothesized to influence athletes’ emotional and subsequent behavioral responses in a cyclical fashion  Athletes’ thoughts about their injury impact on their emotions, which in turn influence behaviors (e.g., rehabilitation adherence) Many personal and situational factors influence the manner, in which athletes appraise or assess their injury (Wiese-Bjornstal et al., 1998) [email protected] 22  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Reacting to injured athletes Favorable attitudes/reactions Be emphathetic Be patient and have realistic expectations Inform the athlete about the injury and process of recovery Support the athlete in dealing with potential setbacks Promote social support of the athlete (e.g., within the team) Enable and support sport psychological support (Ievleva & Orlick, 1991; Weinberg & Gould, 2007, 2015) [email protected] 25  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Role of sport psychology in sport injury process Cognitive restructuring Relaxation skills Thought stoppage Autogenics/meditation Confidence training Imagery/mental rehearsal Fostering realistic expectations Distraction/desensitization Fostering team cohesiveness Medication modification (adapted from Andersen & Williams, 1998) [email protected] 29  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Role of sport psychology in sport injury process Injury-Illness Phase Help the athlete deal with the emotional unheaval that accompanies the onset of injury Rehabilitation-Recovery Phase Help the athlete sustain motivation and adherence to rehabilitation protocols Return to Full Activity Phase Full recovery is not complete until the athlete can return to normal functioning within his or her sport (Bianco et al., 1998) [email protected] 30  Dr. Johanna Belz Institute of Psychology Dept. Health & Social Psychology Role of sport psychology in sport injury process The psychology of sport injury: A consensus statement Regarding injury risk, form strong relationships with your athletes, screen athletes frequently for psychosocial stress and perceived recovery Regarding rehabilitation, incorporate elements of mindfulness and acceptance-based practices and cognitive-behavioral-based programs to improve coping Regarding return to sport, utilize strategies that facilitate athletes’ sense of competence, autonomy, and relatedness and facilitate clear lines of communication between athletes, coaches, and medical staff (Traenus et al., 2024) [email protected] 31 Substance Use (Disorder) PSE8.1 Stress, mental health and wellbeing in sport and exercise psychology  Sabine Mustermann Sabine Mustermann Institution Institution Physical Activity and Substance Use Smoking and Physical Activity pa ↑ smoking ↓ adults and adolescents Kacynski et al., 2008 leisure me ac vity ↑ smoking ↓ only in men but not in women Schroder et al., 2003 pa ↑start smoking ↓in children Audrain-McGovern et al., 2003 pa ↑ in smokers a empt to quit ↑ deRuiter et al., 2008 pa ↑ in smokers confidence about abstaining ↑ King et al., 1996 pa ↑ in smokers successfully quit ↑ Abrantes et al., 2009 3  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Physical Activity and Substance Use Alcohol and Physical Activity pa ↑ alcohol ↑ in adults French et al., 2009 pa ↑ binge drink ↑ in adults Vickers et al., 2004 hazardous drinking ↑ pa ↓ Liangpunsakul et al., 2010 BUT findings diverge when considering sex, age and type of exercise PSE 8 Stress – Mental Health – Wellbeing SUD  Sabine Mustermann Sabine Mustermann Institution Institution Physical Activity and substance use Generally activity ↑ illict drug use ↓in adolescents Inconsistent findings when considering sex and type of activity PSE 8 Stress – Mental Health – Wellbeing 5 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut PA as a protective factor Generally PA including sport is associated with positive health outcomes PA decrease many of the physical and mental health issues young people can experience  prevention of subsequent substance use Dunton et al., 2011 PA enhance protective factors as increased social wellbeeing, improved self esteem, … Moore & Werch, 2005 PA as potential strategy to reduce individuals‘ desires to engage in other reward seeking behavior such as substance use Fontes-Riberio et al., 2011 PSE 8 Stress – Mental Health – Wellbeing 6 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Sport as a risk factor Individuals who are at risk of developing addiction certain sport conditions encourage substance use Lisha & Sussmann, 2010 Mediating factors in relationship sport participation and drug use Type of sport team sport at greates risk for binge drinking Terry-McElrath & O‘Malley, 2011 Setting school or community Talafierro et al., 2010 PSE 8 Stress – Mental Health – Wellbeing 7 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Sport as a risk factor Contexts Familial history, stability and illness Perceived acceptability of alcohol School culture and social atmosphere Sport culture, demands, and expectations Termination of sport involvement Mechanisms Personal characteristics (e.g. low self esteem, feelings of inferiority, need for social acceptance, high competitiveness) Coping strategies Easy access to substances PSE 8 Stress – Mental Health – Wellbeing 9 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Why do athletes use drugs? producing pleasure relieving pain and stress improving socialization recovering from injury enhance performance McDuff & Baron, 2005 PSE 8 Stress – Mental Health – Wellbeing 10 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Which substances? Higher rates Anabolic androgenic steorids Amphetamines Human growth hormone Epo Rates of alcohol use among college athletes are higher than in general population (men 75% to 93%, women 71% to 93%) Spit tobacco is used extensively by male professionals and collegiate athletes (rates in soccer rises in the past decades) Rates of substance dependance rather low  most addictive substances are often used episodically (alcohol, tobacco) difference in playing season and off season McDuff & Baron, 2005 PSE 8 Stress – Mental Health – Wellbeing 11 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Alkoholgehalt von einem typischen Glas Bier, Wein und Wodka (in Gramm) Alkoholgehalt von einem Glas Bier, Wein und Wodka 25 20 20 19 Alkoholgehalt in Gramm 15 10 6,4 5 0 0,5 Liter Bier 5%vol 0,2 Liter Wein 12%vol 0,02 Liter Wodka 40%vol Hinweis(e): Weltweit; 2016 Weitere Angaben zu dieser Statistik, sowie Erläuterungen zu Fußnoten, sind auf Seite 8 zu finden. 2 Quelle(n): Uni Rostock (Universitätsmedizin); ID 163913  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut scoring AUDIT Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol abuse, as well possible alcohol dependence For women and men over age 65 a score of 7 as cut off point PSE 8 Stress – Mental Health – Wellbeing 17 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut What to do with a positive AUDIT score Risk level Intervention AUDIT score Zone I Alcohol education 0-7 Zone II Simple Advice 8-15 Zone III Simple Advice plus Brief Counseling and 16-19 Continued Monitoring Zone IV Referral to Specialist for Diagnostic Evaluation and 20-40 Treatment Babor et al., 2001 PSE 8 Stress – Mental Health – Wellbeing 18 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut Diagnoses of substance use disorders In DSM-5 replacement of substance abuse and substance dependence with substance use disorders Each substance has its own substance use disorders criteria, criteria are similar across the different substances In general – a problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least 2 symptoms occurring in a 12 month period PSE 8 Stress – Mental Health – Wellbeing 24 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut DSM V know the categories and that there are 11 criteria social risky use impairment (8-9) (5-7) Pharmacological impaired control criteria (1-4) 11 (10-11) identified criteria PSE 8 Stress – Mental Health – Wellbeing 25 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut DSM-5 criteria of SUD 1. Substance is often taken in larger amounts or over a longer period of time than was intended. 2. Persistent desire or unsuccessful efforts to cut down or control substance use. 3. Great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects 4. Craving or strong desire to use the substance. impaired control (1-4) 11 identified criteria PSE 8 Stress – Mental Health – Wellbeing 26 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut DSM-5 criteria of SUD 5. Recurrent use resulting in failure to fulfill major role obligations at work, school, home. 6. Continued substance use despite having persistent or recurrent social or interpersonal problems. 7. Important social, occupational or recreational activities are given up or reduced because of drug use. impaired social cotrol impairment (1-4) (5-7) 11 identified criteria PSE 8 Stress – Mental Health – Wellbeing 27 SUD  Dr.Sabine Mustermann Chloé Chermette PsychologischesInstitution Institut DSM-5 criteria of SUD 8. Recurrent substance use in situations in which it is physically hazardous. 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. social impairment (5-7) impaired Risky use control (8-9) (1-4) 11 identified criteria PSE 8 Stress – Mental Health – Wellbeing 28 SUD  Dr.Sabine social Mustermann Chloé Chermette impairment Risky use (5-7) (8-9) PsychologischesInstitution Institut Pharmacological impaired control criteria DSM-5 criteria of SUD (1-4) 11 identified (10-11) criteria 10. Tolerance, as defined by either of the following: a. a need for markedly increased amounts of the substance to achieve intoxication or desired effect b. a markedly diminished effect with continued use of the same amount of substance 11. Withdrawal, as manifested by either of the following: a. characteristic with