Bachelor Thesis

HALMSTAD

UNIVERSITY

Bachelor's Programme in Psychology - Sport andExercise, 180 credits

Anxiety as a mediating factor ofperfectionism and needs thwarting inrelation to exercise dependence in teamsports

Sport and Exercise Psychology (61-90),15 credits

Halmstad 2020-02-13

Jenny Bengtsson, Ulrika Skräddar

Bengtsson, J., & Skräddar, U. (2020). Anxiety as a mediating factor of perfectionism and

needs thwarting in relation to exercise dependence in team sports. (Bachelor Thesis in

Sport and Exercise Psychology, 61-90 ECTS). School of Health and Welfare: Halmstad

University.

Abstract

The main aim of this study was to investigate the relationship between exercise

dependence, basic psychological needs, perfectionism and anxiety. Specifically, the

purpose was to examine if the relationship between psychological needs thwarting and

exercise dependence as well as socially prescribed perfectionism and exercise

dependence was mediated by anxiety. Participants were 59 team sport athletes with the

mean age 20.36 years from twelve different team sport clubs in Sweden. Data were

analysed using PROCESS tool in the program Statistical Package for the Social Science

(SPSS). The PROCESS analysis indicated that anxiety did not mediate the relationship

between psychological needs thwarting and exercise dependence or socially prescribed

perfectionism and exercise dependence. Further, the results showed that needs thwarting

and perfectionism had a direct effect on exercise dependence. This indicates that needs

thwarting and socially prescribed perfectionism should be considered risk factors for

exercise dependence in team sports. Anxiety did not predict exercise dependence. Based

on the findings, exercise dependence is a complex process where different personal and

social factors interact. Further research is recommended to increase the understanding

about potential risk factors and mediating mechanisms that can explain how exercise

dependence develop in team sports.

Keywords: anxiety, basic psychological needs, exercise dependence, mediation,

needs thwarting, perfectionism, self-determination theory, socially prescribed

perfectionism

Bengtsson, J. & Skräddar, U. (2020). Ångest som medierande variabel i relationen

mellan perfektionism, behovsfrustration och träningsberoende inom lagidrott.

(Kandidatuppsats i idrott-och motionspsykologi, 61-90 hp). Akademin för hälsa och

välfärd: Högskolan i Halmstad.

Sammanfattning

Syftet med denna studie var att undersöka sambandet mellan träningsberoende, de

grundläggande psykologiska behoven, perfektionism och ångest. Mer specifikt var syftet

att undersöka om ångest kunde mediera förhållandet mellan behovsfrustration och

träningsberoende samt förhållandet mellan socialt orienterad perfektionism och

träningsberoende. Deltagarna bestod av 59 lagidrottare med medelåldern 20.36 från tolv

olika idrottsföreningar i Sverige. Data analyserades med PROCESS i programmet

Statistical Package for the Social Science (SPSS). PROCESS analysen visade att ångest

inte kunde mediera förhållandena mellan behovsfrustration och träningsberoende eller

socialt orienterad perfektionism och träningsberoende. Vidare visade resultaten att

behovsfrustration och perfektionism hade en direkt effekt på träningsberoende. Detta

indikerar att behovsfrustration och socialt orienterad perfektionism kan vara potentiella

riskfaktorer för träningsberoende inom lagidrott. Ångest kunde inte predicera

träningsberoende. Baserat på resultaten så kan man dra slutsatsen att träningsberoende är

en komplex process där många olika personliga och sociala faktorer interagerar. Mera

forskning behövs för att öka förståelsen för potentiella riskfaktorer och medierande

mekanismer som kan förklara hur träningsberoende uppstår inom lagidrott.

Nyckelord: behovsfrustration, grundläggande psykologiska behov, mediering,

perfektionism, självbestämmandeteorin, socialt orienterad perfektionism,

träningsberoende, ångest

1

The positive health benefits of physical activity are well known, and regular

exercise is recommended for obtaining a healthy lifestyle (Statens folkhälsoinstitut 2017;

Warburton, Nicol, & Bredin, 2006). However, excessive exercise can have adverse

consequences, such as increased risk for injury, anxiety when unable to exercise and

inferences with other life domains (Schreiber & Hausenblas, 2015).

At first, I seemed able to balance the time I spent training with the time I spent

with my friends. But my regimens engulfed me at an astonishing pace. No sooner

had I latched on to an obsession with burning at least four hundred calories on a

specific elliptical machine than I had to add at least a half hour of weight lifting to

my routine. I didn’t see anything wrong with turning down invitations to social

events to stay at the gym. I wasn’t even concerned when I couldn’t focus in class

because all I’d be thinking about was how I’d work one muscle group one day and

another the next. Exercise quickly became the primary source of my happiness,

self-esteem, and sense of stability. I didn’t realize until many years later, when I

had an emotional meltdown upon learning couldn’t exercise due to an injury, how

pathological my behavior had gotten. (Schreiber & Hausenblas, 2015, p. 33)

This compulsive exercise behaviour shares some of the same features of other

addictions and has therefore been labelled “exercise dependence” or “exercise addiction”

(Berczik et al., 2012). Although scholars have investigated the exercise dependence

phenomenon during the last thirty years, it is still an understudied subject (Egorov &

Szabo, 2013; Marques et al., 2019). Previous research have found associations between

exercise dependence and different personality characteristics such as perfectionism (Hall,

Hill, Appleton, & Kozub, 2009), anxiety and negative mood states (Back, Josefsson,

Ivarsson, & Gustafsson, 2019; Grandi, Clementi, Guidi, Benassi, & Tossan, 2011). The

basic psychological needs are another factor that has been linked to exercise dependence

(Costa, Coppolino, & Oliva, 2016; Edmunds, Ntoumanis, & Duda, 2006). However, the

relationship between exercise dependence and these factors is not completely understood.

An attempt to better understand these relationships is to identify potential mediating

processes that account for these relations.

The main focus in previous studies has been on individual athletes and regular

exercisers, and until today few studies have investigated exercise dependence within team

sports only (Marques et al., 2019). Considering the negative impact exercise dependence

can have on physical and mental health, it is of interest to explore how different

psychological factors relate to each other and what the underlying mechanisms are that

determine the development of exercise dependence (Grandi et al., 2011). A better

understanding of the antecedents and mediating processes for exercise dependence would

help to improve prevention and treatment strategies (MacKinnon & Fairchild, 2009).

Exercise dependence

Researchers have over the years used various terms to name the phenomenon of

exercise dependence, such as compulsive, excessive or obligatory exercise or running

addiction (Kerr, Lindner, & Blaydon, 2007). In the present study the term exercise

dependence will be used. Hausenblas and Symons Downs (2002a) define exercise

dependence as “a craving for leisure-time physical activity, resulting in uncontrollable

excessive exercise behavior, that manifests in physiological (e.g. tolerance/withdrawal)

and/or psychological symptoms (e.g. anxiety, depression when unable to exercise)” (p.

90). Exercise dependence is characterised by several symptoms. These were enumerated

by Hausenblas and Symons Downs (2002b) as: (1) tolerance, increased amount of

tolerance for exercise or diminished effect by continuing the same amount of exercise, (2)

withdrawal symptoms, for example anxiety when not able to exercise, (3) intention effect,

2

longer and bigger amount of exercise sessions than initially intended, (4) absence of

control, unsuccessful effort to have control over exercise habits, (5) time, time spent

active to acquire exercise (e.g. exercise vacations), (6) conflict, occupational, recreational

or important social activities are unprioritized or neglected in advantage of exercise, and

(7) continuance, exercise routine continues despite knowledge of recurrent physical or

psychological problems that likely have been caused by the exercise habit. Hausenblas

and Symons Downs (2002b) considered that at least three or more of the enumerated

seven criteria are indicative of exercise dependence. Furthermore, based on the criteria of

exercise dependence, Hausenblas and Symons Downs (2002b) also mean that the subjects

can be classified into the following categories: individuals at risk for exercise dependence

(individuals showing strong symptoms on several criteria), nondependent-symptomatic

(individuals showing some symptoms but do not meet the criteria for exercise

dependence) and nondependent-asymptomatic (individuals showing no symptoms of

exercise dependence). Previous research has distinguished between primary and

secondary exercise dependence. Primary is when the exercise is an end in itself and

secondary is excessive exercise in combination with an eating disorder (Veale, 1995).

Exercise behaviour seems to exhibit corporated clinical features to substance dependence.

Although a clinical definition of such behaviour is yet to be distinctly specified and it is

not recognized in a diagnostic terminology (Hausenblas & Symons Downs, 2002a). A

study by Costa, Hausenblas, Olivia, Cuzzocrea and Larcan, (2013) shows that all ages are

plagued by exercise dependence but it is considered more common among people

younger than 35 years. Previous research have reported prevalence rates ranging from 0.3

to 42%, but the suggested estimation for regular exercisers is 3-7% and for professional

athletes 6-9% (Marques et al., 2019). Studies that have compared individual and team

sport athletes have reported no or only small differences between groups regarding the

prevalence rate (Kovacsik, Soós, de la Vega, Ruíz-Barquín, & Szabo, 2018; Lichtenstein,

Larsen, Christiansen, Støving, & Bredahl, 2014; Szabo, de la Vega, Ruíz-Barquín, &

Rivera, 2013). The risk rate for exercise dependence in these studies varied between 7

and 19 % for the team sport athletes. Based on previous findings, exercise dependence

seems to exist in various types of sports. However, it is not clear whether it is more or

less prevalent in team sports than individual sports since team sport athletes have been an

understudied population in exercise dependence research. Further studies are needed to

get a better overview and understanding about this issue among team sports (Lichtenstein

et al., 2014; Marques et al., 2019). Several factors have been linked to exercise

dependence, and one that has been highlighted in previous studies is anxiety (e.g. Back et

al., 2019).

Anxiety

Anxiety is a psychological established term that is characterized by feelings of

worry, tailspin or dread and is one of the most widely experienced psychiatric symptoms

(Stonerock, Hoffman, Smith, & Blumenthal, 2015). Regular physical activity is in

general believed to have a positive impact on mood and anxiety (Ströhle, 2009).

According to the Cognitive Appraisal Hypothesis (Szabo, 1995), an individual may use

exercise as a way of coping with life-stress and worries. With time, the individual

becomes dependent of the exercise routine in order to handle the stress and anxiety, and

when forced to reduce the amount of exercise, withdrawal symptoms emerge (e.g.

increased anxiety and negative mood) (Szabo, 1995).

Previous research on exercise dependence have found that non-dependent

symptomatic individuals displayed significantly higher scores of anxiety and hostility

than non-symptomatic (Grandi et al., 2011). Consistently, anxiety was found to be a main

predictor for exercise dependence in regular exercisers (Back et al., 2019), and Costa et

al. (2013) also found a positive correlation between negative mood states and exercise

3

dependence. In a sample of the general population, obsessive-compulsiveness and trait-

anxiety were linked to higher levels of commitment to exercise (Spano, 2001). Based on

these findings, anxiety may be a significant risk factor in the development of exercise

dependence. Another factor that has been investigated in previous exercise dependence

research is the concept of basic psychological needs (Costa et al., 2016; Edmunds et al.,

2006).

Basic psychological needs theory

Self-determination theory (SDT) is often used to describe people's motivation and

why they engage in a certain behaviour (Deci & Ryan, 2000). SDT consists of several

sub-theories and one of them is Basic psychological needs theory. According to this

theory, humans have three innate psychological needs: autonomy, competence and

relatedness. Autonomy refers to the degree to which the individual experiences a feeling

of control over the behaviour and can make independent choices. The need for

competence refers to the feeling of being able to accomplish challenging tasks, while

relatedness means the individual’s feeling of belongingness to other people. In order to

achieve optimal functioning and well-being all three needs have to be satisfied. Deci and

Ryan (2000) see humans as active organisms who seek environments and activities where

growth and satisfaction of the needs can be fulfilled. However, if the environment does

not provide opportunities for the individual to satisfy the needs, it can have negative

consequences for the psychological health. This phenomenon is called needs thwarting

(Deci & Ryan, 2000) and can be described as a process between the social context and

the person, where thwarting occurs when the environment is controlling or actively

demeans the person’s ability (Bartholomew, Ntoumanis, Ryan, & Thøgersen-Ntoumani,

2011a). For example, in a team sport setting the athlete could experience competence

thwarting if the coach and/or other team members do not provide opportunities to fulfil

the athlete’s potential. Similarly, the athlete could experience relatedness thwarting if the

athlete feels excluded from the team. These factors could possibly be a driving force that

make the athlete train more in order to feel adequate. Just because a person feels

incompetent it does not necessarily indicate that the need for competence is thwarted. It

could be due to lack of skills, and this would lead to a feeling of dissatisfaction

(Bartholomew et al., 2011a).

According to Basic psychological needs theory (Deci & Ryan, 2000), thwarting of

the psychological needs can make the individual develop compensatory behaviour or

need substitutes like extrinsic motivational regulations, which eventually leads to ill-

being. Compensatory behaviour is characterised by releasing self-control, rigid

behavioural patterns (compulsively holding on to a certain behaviour because it provides

a sense of structure and security) and oppositional defiance (a resistance to engage in

socially requested activities) (Vansteenkiste & Ryan, 2013). These are similar to some of

the symptoms of exercise dependence, for example absence of control, conflict with

social relationships and exercising to avoid withdrawal symptoms and longer than

intended. Therefore, exercise dependence might also be considered as a compensatory

behaviour caused by needs thwarting. Rigid behavioural patterns is a way to protect the

individual from negative emotions that results from needs thwarting, but it also prevents

the individual from dealing with inner thoughts and emotions (Deci & Ryan, 2000). As

suggested by Szabo (1995) some individuals may turn to exercise to decrease feelings of

anxiety and life-stress. Theoretically, the training regimen could turn into a rigid

behaviour when the individual increases the amount of exercise as a strategy to gain a

sense of control and to decrease the negative emotions.

Previous research has confirmed the assumption that needs thwarting would have

a negative impact on health and well-being, while satisfaction of the needs would lead to

positive health outcomes. Studies have shown that high needs satisfaction could predict

4

positive affect and well-being (Bartholomew, Ntoumanis, Ryan, Bosch, & Thøgersen-

Ntoumani, 2011b; Deci & Ryan, 2000). In sport contexts, psychological needs thwarting

predicted exhaustion and psychological ill-being (Bartholomew et al., 2011a; Gunnell,

Crocker, Wilson, Mack, & Zumbo, 2013) and other negative outcomes, such as

depression, negative affect, disordered eating and burnout (Bartholomew et al, 2011b).

There is a lack of studies that have investigated how psychological needs thwarting

influences the development of exercise dependence, but a study by Costa et al. (2016)

shows a positive relationship between needs thwarting and exercise dependence.

However, these studies only describe correlations and do not say anything about other

factors that might contribute to the negative outcomes associated with needs thwarting.

Bartholomew et al. (2011a) recommend that future studies should continue to examine

how needs thwarting is connected to maladaptive outcomes in sport settings. Considering

its connection to exercise dependence and psychological ill-being, there might be

mechanisms like anxiety that mediate the relationship between needs thwarting and

exercise dependence. Costa et al. (2016) found that basic psychological needs thwarting

had a mediating effect on the relationship between maladaptive perfectionism and

exercise dependence. These findings indicate that needs thwarting as well as

perfectionism are relevant factors that could increase the risk for exercise dependence.

Perfectionism

Perfectionism is considered as a multidimensional concept. Hewitt and Flett

(1991) divide perfectionism into three dimensions: self-oriented (setting high standards

on oneself), other-oriented (demanding perfection from other people) and socially

prescribed perfectionism (a perception that other demand perfection from oneself). In

sport psychology literature, perfectionism is a debated concept. Some authors claim that

some of the dimensions are linked to positive outcomes and that it therefore should be

distinguished between adaptive and maladaptive perfectionism (Flett & Hewitt, 2005).

Flett and Hewitt (2005) perceive perfectionism mainly as a maladaptive characteristic.

Previous research that have investigated potential factors linked to exercise

dependence show that some personality characteristics might have an impact on the

development of exercise dependence, and perfectionism has been highlighted in several

studies (e.g. Costa et al., 2016; Hausenblas & Symons Downs, 2002b). Both self-oriented

and socially prescribed perfectionism has been found to be positively related to exercise

dependence (Hall et al., 2009; Miller & Mesagno, 2014). Results from another study

showed that self-oriented perfectionism was the only unique predictor of all exercise

dependence symptoms and socially prescribed perfectionism predicted two of the

symptoms (Hill, Robson, & Stamp, 2015). Further, Hagan and Hausenblas (2003) found

that individuals “at risk” for exercise dependence were more perfectionistic than non-

dependent individuals. To date there are not many studies that have investigated potential

underlying factors that can explain why some perfectionistic individuals are at higher risk

for exercise dependence. Unconditional self-acceptance is one factor that has been found

to mediate the relationship between perfectionism and exercise dependence (Hall et al.,

2009). The authors of that study recommend further investigation of different

psychological mechanisms behind the perfectionism-exercise dependence relationship.

For the present study, anxiety was chosen as a mediating variable for investigation.

Maladaptive perfectionism, like perfectionistic concerns (i.e. fear of making

mistakes and of negative social evaluation), socially prescribed perfectionism and

pressure from team members or coach, could possibly lead to more negative affect,

anxiety and perception of external pressure (Limburg, Watson, Hagger, & Egan, 2017;

Mallinson & Hill, 2011). This is confirmed by previous research which have found a

positive correlation between the dimension of perfectionistic concerns and anxiety in

non-clinical populations (Gnilka, Ashby, & Noble, 2012). A meta-analysis shows that

5

both perfectionistic concerns and strivings were significantly related to different

psychopathological outcomes, with perfectionistic concerns having larger effect than

perfectionistic strivings on for example anxiety, depressive symptoms and obsessive-

compulsive disorder symptoms (Limburg et al., 2017). Another meta-analysis by Hill,

Mallinson-Howard and Jowett (2018) examined the relationship between perfectionism

and different psychological variables in sports. The study found a difference between

samples of team sport athletes and individual athletes regarding the relationship between

perfectionistic concerns and cognitive anxiety, with team sport athletes showing a

stronger correlation. It might be argued that socially prescribed perfectionism (similar to

perfectionistic concerns) would play a bigger role in team sports compared to individual

sports because of the unique psychological processes that exist in team sports. The

greater social interactions in team sports can, on one hand, provide support and a feeling

of relatedness, but it can also increase fears of failure and perceived perfectionistic

demands (Hill et al., 2018). For this reason, the dimension of socially prescribed

perfectionism will be in focus of the present study.

Perfectionistic concerns and socially prescribed perfectionism can be unique

factors that force the athlete to increase the training so that the athlete can live up to the

high standards set by others. However, an underlying factor could be anxiety since these

dimensions of perfectionism are associated with negative affect and anxiety (Limburg et

al., 2017). In that case, the athlete could also use the increased training as a way to cope

with anxiety and pressure, as suggested by Szabo (1995). By including anxiety into the

equation, that could possibly explain the relationship between perfectionism and exercise

dependence better.

Previous findings indicate that both individual and team sport athletes are plagued

by exercise dependence, but the reported difference in prevalence rate between these two

groups is small (Lichtenstein et al., 2014). The majority of previous studies have mainly

included athletes from individual sports (Marques et al., 2019). Therefore further studies

are needed to get a better understanding if team sport athletes are plagued by exercise

dependence to the same extent as individual athletes, and what factors that could explain

why some individuals become dependent and some not (Hausenblas & Symons Downs,

2002b). Results from previous studies show that anxiety, needs thwarting and

perfectionism are associated with exercise dependence. A limitation of these studies is

that they are mainly cross-sectional and do not say anything about other intervening

factors. In order to understand the whole process of how one variable (e.g. needs

thwarting) affects another (e.g. exercise behaviour), it is important to explore mediating

variables. In this type of process, the mediator transfers the effect of one variable on

another variable (MacKinnon, Fairchild, & Fritz, 2007). By identifying mediating

processes, it is also easier to develop efficient interventions that can focus on the

significant variables (MacKinnon & Fairchild, 2009). According to the Interactional

model for exercise dependence (Egorov & Szabo, 2013), it is an interaction of various

personal, social, environmental factors and motive for exercise, combined with sudden

life-stress, that determine if the training is used as a coping strategy for stress. All

individuals that experience needs thwarting or perfectionistic demands from others do not

necessarily develop exercise dependence, and it is therefore important to investigate

potential mediators that could explain the interaction between different factors and how

these increase the risk for exercise dependence. Considering the negative impact exercise

dependence can have on physical and mental health, it is important to get a better

understanding about potential risk factors in order to develop prevention strategies.

6

Aim and hypotheses

Based on previous research and the theoretical frameworks discussed above, the

aim of this study was to investigate if anxiety mediates the relationship between needs

thwarting and exercise dependence, as well as the relationship between socially

prescribed perfectionism and exercise dependence in team sports. For this purpose, two

mediation models were tested (see Figure 1 and 2). The hypotheses of this study were

that anxiety mediates the relationship between needs thwarting and exercise dependence

(H1) and that anxiety mediates the relationship between socially prescribed perfectionism

and exercise dependence (H2).

Figure 1

Mediation model of the relationship between needs thwarting (predictor) and exercise

dependence (outcome), mediated by anxiety (mediator)

7

Figure 2

Mediation model of the relationship between socially prescribed perfectionism

(predictor) and exercise dependence (outcome), mediated by anxiety (mediator)

Method

Participants

59 participants (40 women, 18 men, 1 other) from twelve different team sport

associations in Sweden participated in the study. The participants were between 15 and

37 years old (M = 20.36, SD = 4.77). The sports represented were volleyball (n = 31),

football (n = 10), floorball (n = 17) and ice hockey (n = 1). The participants competed at

division two (n = 15), division one (n = 24) or in the highest national league (n = 20).

Measures

The questionnaires begun with demographic questions regarding gender, age,

level of competition and type of sport. The questionnaires were based on the

measurements chosen for this study and they are described in more detail below.

Exercise Dependence Scale Revised (EDS-R)

A Swedish version (Lindwall & Palmeira, 2009) of The Exercise Dependence

Scale-Revised (EDS-R) (Symons Downs, Hausenblas, & Nigg, 2004) was used to

measure the risk of exercise dependence. The Swedish scale has been proved to be

reliable and valid for measuring exercise dependence (Lindwall & Palmeira, 2009). This

self-rating scale consists of 21 items that measures seven symptoms: withdrawal,

continuance, tolerance, lack of control, reduction, time and intention effects. The

participant rates the statements on a six-point Likert scale (1 = never, 6 = always).

Examples of statements are “I continually decrease my exercise duration to achieve the

desired effects/benefits”, “I exercise to avoid feeling anxious”, “I spend a lot of time

exercising” and “I exercise despite recurring physical problems”. Higher points on the

scale indicates higher risk of exercise dependence. Based on the scores, the participants

are classified as either at risk for exercise dependence (scoring 5 or 6 on at least three of

the criteria), nondependent-symptomatic (scoring 3 or 4 on at least three of the criteria) or

nondependent-asymptomatic (scoring 1 or 2 on three or more of the criteria) (Symons

Downs et al., 2004). In the current study Cronbach's alpha was 0.86.

Psychological Need Thwarting Scale (PNTS)

8

PNTS (Bartholomew et al., 2011a) is a self-rating scale for measuring perceived

psychological needs thwarting in sport contexts. The questionnaire consists of 12

statements divided into the sub-categories autonomy, competence and relatedness, e.g. “I

feel prevented from making choices with regard to the way I train”, “There are situations

in my sport where I am made to feel inadequate” and “In my sport, I feel I am rejected by

those around me”. The respondents answer the statements at a seven-point Likert scale (1

= strongly disagree, 7 = strongly agree). Cronbach's alpha for the total scale was 0.87 in

the current study.

Hospital Anxiety and Depression (HAD)

HAD, a measurement for general anxiety by Zigmond and Snaith (1983) is a 14-

item instrument composed for examination of anxiety and depression among non-clinical

populations. It has been found to show good validity and sensitivity (Bjelland, Dahl,

Tangen Haug, & Necelmann, 2002). HAD includes two different subscales, anxiety

(HAD-A) (e.g., I get a sort of frightened feeling like 'butterflies' in the stomach) and

depression (HAD-D) (e.g., I feel as if I am slowed down). The scales are a four-point

scale with range 0 (never) to 3 (always). Each subscale varies from 0- 21 as a total score.

In this study, the 7-item subscale for anxiety (HAD-A) was used. 6 points or lower on

HAD-A indicate no symptoms of anxiety, 7-10 points mild to moderate anxiety and 11

points or more indicate a potential anxiety disorder. In this study, Cronbach's alpha was

0.80.

Multidimensional Perfectionism Scale

To measure the participants’ level of socially prescribed perfectionism the

Multidimensional Perfectionism Scale (Hewitt & Flett, 1991) was used. This

measurement includes 45 statements, of which 15 measure socially prescribed

perfectionism on a seven-point Likert scale (1 = strongly disagree, 7 = strongly agree).

Examples of questions are “I find it difficult to meet others’ expectations of me” and

“People around me think I am still competent even if I make a mistake”. In the present

study a Swedish version of the scale was used (Saboonchi & Lundh, 1997). Cronbach's

alpha was 0.84 in the current study.

Design and procedure

The study used a two-time point measurement design. The predictors

perfectionism and basic psychological needs and the mediator anxiety were measured at

the first time. Two weeks later the outcome variable exercise dependence was measured.

The aim with using a design with several measurements was to increase the efficiency.

Rather than using a cross-sectional design with only one measurement, a design with two

or more measurements can increase the understanding of how psychological phenomena

develop over time (Stenling, Ivarsson, & Lindwall, 2016). A temporal separation of the

measurement of the predictor and outcome variable is also beneficial for reducing risk of

method biases, since it makes the participants’ prior responses less salient and thus

reduces the participants’ ability to use previous answers in later stages (Podsakoff,

MacKenzie, Lee, & Podsakoff, 2003).

Various team sport associations in Sweden were contacted by email, telephone

and personal contact. They received an invitation to participate and an information letter

with a description of the study, ethical issues and contact information. Twelve teams with

approximately 195 players in total confirmed their interest to participate in the study. The

questionnaires were distributed online. The purpose with having the questionnaires online

was to reach participants from different areas of the country and give the participants the

opportunity to answer the questions when it suited them best, but within a time limit. A

leader of the teams that had confirmed their interest to participate in the study received a

link to the survey. That person was then asked to share the link with the team players. A

reminder about each questionnaire was also sent out to the teams that participated.

9

An information part with ethics like “the data will be treated confidentially, they

have the right to withdraw from the study at any time” was presented in the beginning of

the survey, which was in line with the ethical standards of APA (American Psychological

Association, 2017). This was followed by an informed consent that the participants had to

agree to in order to proceed and complete the questionnaires. The participants always had

the ability to reach one of the writers of the study if there were any questions. In order to

create a personal code, the participants had to answer two short questions. This was done

in order to ensure the participants confidentiality and so that the data from the two

measurements could be combined. No unauthorized person had access to the list of codes

or the measurement data. When the analyse was done the list of codes was destroyed.

Data analysis

Data was analysed using the Statistical Package for the Social Science (SPSS).

Descriptive statistics were computed for all the variables. Based on the total score on the

EDS-R, the participants were classified as “at risk”, “nondependent-symptomatic” or

“nondependent-asymptomatic” using the scoring procedure for EDS-R (Symons Downs

et al., 2004). In order to test the study’s hypotheses, two separate mediation analyses

were performed using the PROCESS tool (Hayes, 2013). Mediation analysis can give a

better understanding of the relationships between variables and it is a frequently used

method in psychological research. Mediation is a process of when a mediating variable

transfers the effect of an independent variable to a dependent variable. In the case of

significant mediation, the independent variable (X) has an indirect effect on the

dependent variable (Y) through the mediator (M) (MacKinnon & Fairchild, 2009). In the

present study the aim was to test if needs thwarting (X) had an indirect effect on exercise

dependence (Y) through anxiety (M) (Figure 1), and if socially prescribed perfectionism

(X) had an indirect effect on exercise dependence (Y) through anxiety (M) (Figure 2).

The mediation analyses also describe the direct effect of the two independent variables on

the mediator (path a), and the mediator's direct effect on the dependent variable (path b).

Additionally, the mediation analyses test the direct effect of the independent variables on

the dependent variable (path c’). In the mediation analyses bootstrapping with 95%

confidence interval was used. The indirect effect is significant if zero is not included in

the 95% confidence interval (Preacher & Hayes, 2004). For all the statistics a significance

level of p <.05 was used.

Results

Descriptive statistics for the variables psychological needs thwarting, socially

prescribed perfectionism, anxiety and exercise dependence is presented in Table 1. Based

on the total score on EDS-R, 15 participants (25%) were classified as at risk for exercise

dependence, 42 participants (71%) were classified as nondependent-symptomatic and one

participant was classified as nondependent-asymptomatic. One participant was excluded

from the classification due to missing values. Based on the sum score on HAD-A, 20

participants (34%) reported no anxiety problems, 19 participants (32%) mild to moderate

anxiety and 20 participants (34%) were classified as having a potential anxiety disorder.

10

Table 1

Descriptive statistics (mean and standard deviation) for the variables exercise

dependence, anxiety, needs thwarting and socially prescribed perfectionism

Descriptive Variable N M SD

ED 59 3.75 0.76

HAD-A 59 8.15 3.86

PNT 59 3.23 1.08

SPP 59 3.30 0.80

Note. ED = Exercise dependence, HAD-A = Anxiety, BPN = Psychological needs

thwarting, SPP = Socially prescribed perfectionism.

Mediation analyses

The results from the first mediation analysis indicated a significant model, F(2,56)

= 7.06, p <.00. Psychological needs thwarting had a significant direct effect on exercise

dependence, β =.43, p <.00. The results also showed that needs thwarting significantly

predicted anxiety, β =.62, p <.00. Anxiety did not predict exercise dependence, β =.18, p

=.25. Furthermore, the results showed that psychological needs thwarting did not have an

indirect effect on exercise dependence via anxiety, ab =.11, 95% CI [-.05, .33]. A more

detailed overview of the analysis is presented in Table 2.

Table 2

Regression results from mediation analysis of the effect of psychological needs thwarting

on exercise dependence via anxiety

Model Value SE p CI(lower) CI(upper)

Model without mediator

PNT ED .43 .08 .00

R2 x-y .18 .00

Model with mediator

PNT HAD-A (a) .62 .05 .00

HAD-A ED (b) .18 .21 .25

PNT ED (c’) .32 .11 .04

Indirect effect .11 .10 -.05 .33

R2 -m .39 .00

R2 -y .20 .00

Note. PNT = Psychological needs thwarting (x), ED = Exercise dependence (y), HAD-A

= anxiety (m).

The second mediation analysis indicated a significant model, F(2,56) = 9.20, p

<.00. Socially prescribed perfectionism had a significant direct effect on exercise

dependence, β =.49, p <.00. The results also showed that perfectionism significantly

predicted anxiety, β =.63, p <.00. Anxiety did not predict exercise dependence, β =.11, p

=.48. Furthermore, the results showed that socially prescribed perfectionism did not have

an indirect effect on exercise dependence through anxiety, ab =.07, 95% CI [-.12, .27]. A

more detailed overview of the analysis is presented in Table 3.

11

Table 3

Regression results from mediation analysis of the effect of socially prescribed

perfectionism on exercise dependence via anxiety

Model Value SE p CI(lower) CI(upper)

Model without mediator

SPP ED .49 .11 .00

R2 x-y .24

Model with mediator

SPP HAD-A (a) .63 .07 .00

HAD-A ED (b) .11 .21 .48

SPP ED (c’) .42 .14 .01

Indirect effect .07 .10 -.12 .27

R2 -m .40 .00

R2 -y .25 .00

Note. SPP = Socially prescribed perfectionism (x), ED = Exercise dependence (y), HAD-

A = anxiety (m).

Discussion

The aim of this study was to investigate if anxiety mediated the relationship

between psychological needs thwarting and exercise dependence as well as socially

prescribed perfectionism and exercise dependence in a team sport population. The results

showed that anxiety did not have a significant mediating effect on these relationships.

Further, both needs thwarting and socially prescribed perfectionism had a significant

direct effect on exercise dependence. The results also showed that needs thwarting and

perfectionism predicted anxiety, while anxiety did not predict exercise dependence.

The results from this study indicate that team sport athletes are at risk for exercise

dependence, which other studies also have shown (Kovacsik et al., 2018; Lichtenstein et

al., 2014). Furthermore, 34% of the participants showed symptoms of a potential anxiety

disorder, which is about the same percent (25-43%) reported by professional football

players across Europe (Gouttebarge, Backx, Aoki, & Kerkhoffs, 2015). In comparison to

the 14,8% prevalence rate of anxiety disorder found in Back et al. (2019) study on

exercise dependence, this could be considered high. However, the results in the present

study did not show a significant association between anxiety and exercise dependence.

This contradicts the findings from previous studies where anxiety was found to be a

significant predictor for exercise dependence (Back et al., 2019; Grandi et al., 2011). A

possible explanation why anxiety did not have a direct or a mediating effect on exercise

dependence could be due to the characteristics of the sample. While previous studies have

mainly used regular exercisers, university students or members of fitness centres, this

study focused on team sport athletes. According to the Cognitive Appraisal Hypothesis

(Szabo, 1995) some individuals might use training as a coping mechanism to reduce

stress and anxiety. Although the participants in the present study showed high symptoms

of anxiety, they might not use the training as a coping mechanism for anxiety to the same

extent as exercisers or individual athletes. Some of the participants in the present study

were active in sport associations that competed at the highest national level. Athletes in

those teams might have better access to a sport consultant or have coping skills for

emotional regulation (Gould, Dieffenbach, & Moffett, 2002; Katsikas, Argeitaki, &

Smirniotou, 2009) which they can use as a more efficient coping strategy for stress and

general anxiety instead of excessive exercise. For exercisers or athletes who do not have

12

the same available resources regarding their training, the risk for using exercise as a

method to cope with anxiety could potentially be higher. Further, Egorov and Szabo

(2013) suggest that athletes might have more mastery-oriented motives for exercise, like

performance enhancement, compared to recreational exercisers who use more therapeutic

motives for exercise, like improving mental and physical health or coping with stress.

According to DiLodovico, Dubertret and Ameller (2018), runners who exercise for losing

weight (i.e. secondary exercise dependence) might also be more prone to use exercise as

a way to change their mood. Exercise dependent individuals for whom the exercise is the

primary goal in itself, might not use exercise for mood regulation to the same extent. The

motive for exercise could therefore be of importance when investigating how anxiety is

related to exercise dependence. Although this is not an argument for that team sport

athletes would not be at risk for exercise dependence, it rather emphasizes that the risk

factors may differ depending on the sample of investigation. In team sports, certain

mechanisms, like perfectionism or needs thwarting, may be more important in the

development of exercise dependence than anxiety.

A drawback with the Cognitive Appraisal Hypothesis is that it does not account

for other factors that determine if an individual uses training as a coping strategy.

According to the Interactional model, it is a combination of different personal and social

factors and motives for exercise together with life-stress that determine if an individual

develop exercise dependence (Egorov & Szabo, 2013). Considering the results of the

present study and the Interactional model, it seems like the process of who and how

exercise dependence develops is complex since there might be many different factors that

interact and increase the risk for exercise dependence. The factors that were investigated

in the current study might not completely explain the development of exercise

dependence for this population. Instead of anxiety, there might be other psychological or

environmental factors in combination with needs thwarting and perfectionism that

increase the risk for exercise dependence among athletes in team sports.

The results from the mediation analysis did not confirm the first hypothesis that

needs thwarting would have an indirect effect on exercise dependence through anxiety.

However, there was a direct effect of needs thwarting on exercise dependence, which is

in line with previous research (Costa et al., 2016) and indicates that needs thwarting

could be a risk factor for exercise dependence. The results suggest that when the training

environment demeans the athlete’s ability or actively thwarts the need for relatedness, it

can trigger the athlete to increase the amount of training, which eventually might lead to

an addiction for exercise. According to Basic psychological needs theory, individuals

who experience needs thwarting can develop compensatory behaviour (Deci & Ryan,

2000). Compensatory behaviour is manifested by rigid behavioural patterns, releasing

self-control and oppositional defiance, which are similar to some of the criteria for

exercise dependence (e.g. continuance, conflict and absence of control) (Hausenblas &

Symons Downs, 2002a; Vansteenkiste & Ryan, 2013). The direct effect of needs

thwarting on exercise dependence that was found in the present study indicates that

exercise dependence could be a type of compensatory behaviour.

Previous research have found associations between needs thwarting and

psychological ill-being (Bartholomew et al., 2011a; Gunnell et al., 2013), and the results

in the present study confirm these findings since needs thwarting predicted anxiety. It

also strengthens the theory that psychological needs thwarting would have a negative

impact on the psychological health (Deci & Ryan, 2000). Even if previous studies have

found that needs thwarting had a significant direct effect on exercise dependence (Costa

et al. 2016) this relationship could not be explained in this study by anxiety as a mediator.

In addition to the possible explanations discussed above, this might indicate that

thwarting of the psychological needs can cause other types of psychological ill-being, for

example frustration or low self-esteem (Vansteenkiste & Ryan, 2013), rather than

13

anxiety, and that these psychological factors could play a mediating role in the

relationship between needs thwarting and exercise dependence.

In addition to the basic psychological needs, Self-determination theory (SDT) also

consists of goal contents and regulatory processes through which the goals are achieved.

According to SDT, all three parts have to be considered to get a complete understanding

of an individual’s psychological development and well-being (Deci & Ryan, 2000). Few

studies have investigated the role of goal contents on exercise dependence, but previous

findings indicate that certain motives, especially extrinsic goals for exercise are

associated with exercise dependence (Sicilia, Alcaraz-Ibáñez, Lirola & Burgueño, 2017).

As mentioned, the motives for exercise can differ depending on the athletic level and

affect the development of exercise dependence (Egorov & Szabo, 2013). Therefore it

could be important to consider the goal contents in combination with the basic

psychological needs when exploring factors that can mediate the relationship between

needs thwarting and exercise dependence.

Perfectionism is a factor that has been associated with exercise dependence in

several studies (e.g. Hall et al., 2009; Miller & Mesagno, 2014) and the results from the

current study confirm this relationship. This indicates that individuals who perceive that

others demand perfection from oneself might have an increased risk for engaging in

excessive amounts of exercise in an attempt to live up to these standards. The results in

the present study showed that socially prescribed perfectionism predicted anxiety. This

contributes to previous research that has found that this dimension of perfectionism could

have a negative impact on the psychological health (Limburg et al., 2017). It also

indicates that socially prescribed perfectionism is rather a maladaptive than adaptive

characteristic, which confirms other researchers’ conception of perfectionism (Flett &

Hewitt, 2005).

The second hypothesis of this study was not confirmed, since anxiety did not

mediate the relationship between socially prescribed perfectionism and exercise

dependence. Although anxiety could not transfer the effect from socially prescribed

perfectionism on exercise dependence, it does not rule out that other factors could have a

mediating role in the relationship between perfectionism and exercise dependence. Apart

from anxiety, maladaptive perfectionism can lead to other psychopathological outcomes,

such as depressive symptoms, eating pathology or OCD (Limburg et al., 2017). These

factors could have a stronger mediating effect than general anxiety on the perfectionism-

exercise dependence relationship. About one third of the participants in the present study

reported mild to moderate levels of general anxiety and one third high levels. For some

athletes, concern over mistakes and other maladaptive dimensions of perfectionism are

likely to increase the anxiety levels, and specifically competitive anxiety (Flett & Hewitt,

2005). The perceived competitive anxiety and pressure could then lead to behavioural

consequences, for example the athlete trains more in order to avoid failure, and could

therefore be a stronger predictor and mediator of exercise dependence than general

anxiety for the sample of the present study. Although it is difficult to say anything about

the participants’ level of competitive anxiety, the results from the mediation analysis

might have been different if another type of anxiety had been used as a mediator.

Another explanation why anxiety did not mediate the relationship between

socially prescribed perfectionism and exercise dependence might be due to the fact that

there are several dimensions of perfectionism. Previous studies have for example used the

dimensions self-oriented perfectionism and perfectionistic self-presentational styles,

which were also associated with anxiety and negative emotions, as well as with exercise

dependence (Hall et al., 2009; Hill et al., 2015). Hill et al. (2015) conclude that self-

imposed perfectionism can predict exercise dependence to a larger degree than perfection

demanded by others. By using a different dimension with anxiety as a mediator the

outcome of the analysis might have been different.

14

25% of the athletes in the present study were classified as at risk for exercise

dependence, which is lower than risk rates found in professional triathletes (41%)

(Blaydon & Lindner, 2002) and Australian elite athletes (34%) (McNamara & McCabe,

2012), but considerably higher than risk rates of 7-19% for team sport athletes found in

previous studies (Kovacsik et al., 2018; Lichtenstein et al., 2014). These varying results

and high risk rates could be attributed to methodological differences and the athletes’

high commitment (Szabo, Griffiths, de la Vega Marcos, Mervó, & Demetrovics, 2015).

Symptoms of exercise dependence are for example loss of control over the behaviour and

increased amount of training. A dependent team sport athlete who has scheduled training

sessions many times a week, would have to do excessive training before or after the

scheduled training. That would be considered challenging, if not physically impossible.

The relatively high risk rates of exercise dependence reported by the athletes in this and

previous studies could therefore be explained by the interpretation of the items of the

scale (e.g. “I continually increase my exercise frequency to achieve the desired effects”,

“I spend a lot of time exercising”) (Szabo et al., 2015). A majority of team sport athletes

also have a trainer who plans the training and keeps an eye on the athlete. This is seldom

the case for an exerciser, for whom it could be more difficult to know when the training

becomes “too much”. Apart from EDS-R, previous studies have used different measures

to examine the prevalence of exercise dependence, such as Exercise Addiction Inventory

(Terry, Szabo & Griffiths, 2004), Obligatory Exercise Questionnaire (Pasman &

Thompson, 1988) and Commitment to Exercise Scale (Davis, Brewer & Ratusny, 1993).

The problem with this is that some of the measures fail to capture both the psychological

and physiological aspects of exercise dependence, and that they are not based on the

clinical criteria for substance dependence (Symons Downs et al., 2004).

Method discussion

The current study used a two-time point measurement design in order to enhance

the understanding of the psychological mechanisms and how they interact (Stenling et al.,

2016). A temporal separation of the measurements is a way to control for method biases

and could be considered a strength of this study. Another procedure that was conducted to

reduce biases was to keep the participants’ answers anonymous (Podsakoff et al., 2003).

Cronbach’s alpha for all the measurements used in the present study were high, which

indicates high reliability and internal consistency (Mitchell & Jolley, 2013). The different

measurements have been used frequently in previous studies where they have displayed

good validity. To collect the data, self-reported questionnaires were used. This entails

possible risks for bias, such as social desirability and participants answering the questions

without reflecting on them (Mitchell & Jolley, 2013; Podsakoff, et al., 2003). However,

the authors kept the questionnaires relatively short in order to increase the response rate.

Of 195 players, only 59 participants completed both questionnaires. The low response

rate could be explained by the fact that each team leader confirmed the participation on

behalf of the whole team and was the distributer of the questionnaires, which increased

the distance between the researchers and the participants. If the researchers had attended

a training session and distributed the questionnaires directly to the participants, this might

have increased the response rate. However, by having the questionnaires online it was

possible to reach athletes from different areas of the country and it also gave the

participants the opportunity to answer whenever it suited them best.

A limitation of self-reported questionnaires for measuring exercise dependence is

that it only gives an estimate about the risk rate for exercise dependence rather than a

clinical diagnosis (Szabo et al., 2015). Another problem is the interpretation of the items

on the scale, which may differ depending on the culture, gender or level of competition.

Further, some of the previous studies have also used other types of measures than EDS-R.

All these factors can make it difficult to compare and draw valid conclusions about the

15

results. Other factors to consider are that the sample in the present study only represented

four different sports and the majority were women. The generalizability of the results to

other team sports is therefore limited.

Implications

The findings of this study contribute to the research on exercise dependence by

identifying needs thwarting and socially prescribed perfectionism as risk factors. The

results and the theory of Basic psychological needs could be useful when planning

prevention strategies for exercise dependence in team sports. Based on the findings, it is

important for athletes and people working in sport settings to not put pressure and high

perfectionistic standards on other team members. To prevent thwarting of the

psychological needs, it is important to create a training environment where all athletes

can have an influence on the training routine and where they can fulfil their potential and

experience relatedness to other team members. From a research perspective, it would be

relevant to conduct new studies and interventions to get a better understanding of how

and why needs thwarting and perfectionism increase the risk for exercise dependence in

team sports. The results also contribute to previous research that have investigated the

relationship between anxiety and exercise dependence, by showing that anxiety is not

necessarily a significant predictor for exercise dependence in all populations or sport

contexts.

The results from the present study indicate that exercise dependence is prevalent

in team sports. It is therefore of importance to increase awareness about this issue since

exercise dependence can have negative consequences for physical and mental health. It

could not only affect the individual athlete but also the rest of the team. If an athlete

becomes exercise dependent there is a risk for injuries which can force the athlete to step

aside. This could negatively affect team cohesion and the team’s performance level.

Future research

The results in the present study showed that anxiety was not a significant

mediator, but there might be other psychological and/or environmental factors that act as

underlying mechanisms and increase the risk for exercise dependence. Future research

should continue to explore underlying mechanisms that could explain different risk

factors’ relationship with exercise dependence. The finding of anxiety’s non-significant

correlation to exercise dependence contradicts the results of previous works. Future

studies should continue to investigate in what type of contexts and populations anxiety

can increase the risk for exercise dependence. In the current study the different

dimensions of needs thwarting were analysed as a whole unit. In future studies it could

therefore be of interest to analyse the different needs separately in order to see if one need

has a bigger impact than the others on exercise dependence. Team sport athletes are an

underrepresented group in the research field of exercise dependence, and more studies are

needed to get a better understanding about this issue and the consequences that exercise

dependence can have on the individual athlete as well as the team. Previous studies in the

field of exercise dependence have primarily used self-reported questionnaires and cross-

sectional designs. To get a better understanding for the exercise dependence phenomenon

it is recommended for future studies to use qualitative research methods like in-depth

interviews with persons showing symptoms of exercise dependence. This can bring

clarity in the high risk rates reported by some groups of athletes and if it is only an

indication of the athlete’s high commitment to training or if there are other underlying

psychological causes (Szabo et al., 2015). Longitudinal research designs with several

measurements could also be applied to better understand how the phenomenon of

exercise dependence develops over time (Stenling et al., 2016), for example by following

youth sport teams over several years that are striving for an elite career.

16

Conclusions

The findings in this study confirm that also team sport athletes are plagued by

exercise dependence. The prevalence rate of 25% highlight the importance of recognizing

team sport athletes showing symptoms of exercise dependence, since this can have

negative consequences for a person’s health. The findings of this study support the earlier

notion that psychological needs thwarting and socially prescribed perfectionism are

related to exercise dependence and should therefore be considered important risk factors.

Further, the study showed that anxiety was not a predictor nor a mediator for exercise

dependence in team sports. More research in this area is recommended to get a better

understanding of different risk factors and mediating mechanisms that can increase the

risk for exercise dependence in team sports.

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