student-athlete mental health summit
TRANSCRIPT
Student-Athlete Mental Health Summit Presented by:
Hosted by:
Psychology of Sports Injury John Heil, Psychological Health Roanoke, Sport & Clinical Psychologist
Karen Cogan, US Olympic & Paralympic Committee, Sports PsychologistJeremy Summers, US Fencing, Athletic Trainer/Chiropractor
• Coaches PanelDavid Shaw, Stanford University, Head Football Coach
Kyle Kepler, University of Utah, Cross Country/Track CoachKelsie Chaudoin, Stanford University, Assistant Women’s Rowing Coach
Adam Wright, UCLA, Men’s & Women’s Head Water Polo Coach
Injury & Mental Health: A Systems View
• Part 1: Early InterventionStraightforward; Monitoring
• Part 2: PreventionStakeholders & Behaviors
• Foundation ConceptsInjury & Mental Health-Mutual InfluenceBody & Mind-Interacting Impact
Systems Plan–Early Intervention, Prevention
• Early InterventionAnxious-Depressive Symptoms in Injured
AthletesMental Health Screening:
1-Self-Report & 2-Observation
• PreventionComprehensive Review of Mental Health & Behavioral Factors in Non-Injured Athletes
Stakeholders & Roles
Part 1: Early Intervention
• Positive Adaptation• Sub-Clinical Symptoms• Diagnosable Disorders
Insurance Reimbursable
• Monitoring Self-Report & Observation
Stone, Turkkan, Bachrach, Jobe, Kurtzman, Cain (2000)
Psychological Dynamics: Mind & Body• THREAT ANXIETY
• Uncertain Future
• Psych-“Fear” Reinjury; Team Status; Finances
• Bio- Autonomic symptoms Vigilance, Motor Tension
Negative Emotions during Rehabilitation, Impact on RTPMeta-Analysis; Sub-Clinical Symptoms
Ivarsson, Tranaeus, Johnson, & Stenling (2017)
• LOSS DEPRESSION
• Function & Roles NOW
• Psych-“Empty Present”Sadness, Helplessness, Apathy
• Bio-Neurovegetative SymptomsLethargy, Sleep, Pain Sensitivity
Exercise-Protective Factor for DepressionMajor Depressive Disorder Working Group of the Psychiatric
Genomics Consortium; N=~~140,000Choi, Chen, Stein, Klimentidis, Wang, Koenen, & Smoller (2019)
Mental Health Screening @ Injury
• Plan 1 “In-Out” Start of Treatment & Return to Play
• Plan 2 “MultiPoint” Proactive – Reactive
• Standardized Screening Criteria Pre-Season Screen
Treatable InjurySurgical; Season Ending Injury
Plan 1 - “In-Out” Monitoring: Self-Report Inventory• At InjuryDepression-PHQ-9; Anxiety-GAD-7• Brief, Concise, Easily Scored• Widely used - Clinical & Research• Multiple Languages• Can reproduce/translate/distribute
• At Return to PlayThe Injury-Psychological Readiness to Return to Sport Scale (I-PRRS)• Brief, Concise, Easily Scored• Limited Content/Construct Validity
Self-Report Bias
The Injury-Psychological Readiness to Return to Sport Scale: (I-PRRS)
1. My overall confidence to play is--2. My confidence to play without pain is--3. My confidence to give 100% effort is--4. My confidence to not concentrate on the injury is--5. My confidence in the injured body part to handle the demands of the situation is--6. My confidence in my skill level/ability is--
Total score_________
Glaser (2009)
Athlete Injury Checklist• Practical, Intuitive, Minimally
Intrusive-Unscored
• Talking Points - Structure Conversation about Athlete
• Cross Check w/ Self Report
• Use by (One/Multiple) Sports Medicine & Coaches &…
• Cross Check with Stakeholders
Step-wise approach: LOOK, LOOK, LISTEN
LOOK -- at the “Situation” Circumstances that can be discovered through
careful observation of day-to-day behaviorLOOK -- at the “Personal”
Psychological factors that are unseen, but may be revealed with careful consideration of what
the athlete says and does LISTEN
How the athlete responds to open-ended questions that follow from what is seen by
looking at the “Situational” and the “Personal”
Athlete Injury Checklist
• LOOK-SituationalPoor Compliance with Rehab
Lack of Social Support
• LOOK-PersonalLoss / Threat
Pain Complaints
• LISTENLife Problems
Confidence Crisis
Plan-2 “MultiPoint” Monitoring• ReactiveProblem Specific Disruption/Controversy?
• ProactiveTraining Room Monitoring
Repeat Single Item Measures (Pain/Mood)Athlete-Directed Monitoring & Intervention
Podlog, Heil, Iriye, Bergeson, & Hall (2016)
Superimposed on Plan1 “In-Out”
Plan 2: Reactive–Problem Specific, e.g., Pain
• Medical Myths & Misconceptions“Sensory & Emotional”
IASP Task Force (1994)
• Impact on Treatment & Provider-Athlete Relationship
• Monitor: McGill Pain Q Melzack, R. (1975)
Heil & Podlog (2012); Brolinson & Sampson (2003)
Opioids: Confounding of Use & Abuse
“Opioids serve as the cornerstone for severe acute postoperative pain management”
Opioid Use Epidemic
Emerging Consensus Guidelinese.g., ACL; Rotator Cuff: 7days (ideal) to 6 weeks
Medication PitfallsSelf-Medication of Psych Distress, Sleep
Interagency Guideline on Prescribing Opioids for Postoperative Pain-Supplemental Guidance/ Summary of Opioid Prescribing Practices for
Perioperative Pain, (2018, July)
Part 2: PreventionSystem-Wide Athlete Management • Role of Athlete Mental Health & System
Behaviors in Injury
• Stakeholders/Influencers…More than: Athletic Training - Strength & Conditioning
Sport GovernanceCoaching Practices
OvertrainingSleep
HazingCritical Incidents
Mechanisms of InjuryAthlete-Psych
e.g., anxiety, recent stressorsX
Athlete-Physicale.g., physical maturation, injury history
&Environment-Psych
e.g., pressure to performX
Environment-Physicale.g., weather, overtraining
• Etiologies- multifactorial causes of injury
• Susceptibilities – Athlete Centric/Internal risk factorsPsych- -thoughts, feelings, behaviors, e.g., personality traits, stress history
Physical - neuromuscular control, flexibility, strengthe.g., physical maturation, injury history, anatomy
• Vulnerabilities- Sport Centric/External risk factors Psych -coach, official, parent, or opponent behaviors
e.g., social expectations; performance pressuresPhysical - situational-environmental hazards
e.g., weather, overtraining, facilities
Sport Governance & Administration
Bloom & Caron (2019)
Harmer (2015)
• Science• Policy• Coaching• Culture
Money Ball Effect: Tradition over Science Shoulder Injury in Swimmers
Arm Entry Below Shoulder• Decreased Injury Risk
Less Stress = Force w/o Propulsion• Increased Velocity
“Seldom Coached”Bias of Conditioning over Biomechanics
Havriluk (2018)
SLEEPRisk Factor• Increased Sports Injuries• Influences Pain
Milewski, et at, (2014)
Finan, Goodin & Smith (2013)
Protective FactorStanford Men’s Basketball• Sprint Speed & Reaction Time• Free Throw & 3-Point Shooting
Monitor: Athlete Sleep Screening Questionnaire (ASSQ)Samuels, James, Lawson, Meeuwisse (2016)
Mah et al (2011); Walker (2017)
Overeaching vs. Overtraining
• Load - Recovery Balance
Training Load + … Lifestyle Load (e.g, Exams, Family Issues, Team Travel)
Monitoring: Meeusen & De Pauw (2019)
General Adaptation Syndrome Selye (1936, 1950)
Joint Consensus Statement of the European College of Sport Science and the American College of Sport Medicine Medicine (2013)
Training as InjuryInoculation
• Protective FactorMental/Physical Training LoadOptimal to Athlete
Meeuwisse et al. (2007)
• Recovery + …
• Individualized Training ?Akin to Injury w/Reduced Participation
HAZING: Scope & SeverityPsychological Injury-Medical Injury
“Team Injury”
University of Maine Study11,000 students; 53 Colleges
55%-Sport Teams & Org’s25%-Coaches Aware
>50%-Pictures on WebAllan & Madden (2008)
Deaths Yearly since 1959Nuwer (2019)
*Hall of Fame NFL player Bart Starr remained silent for decades about his college hazing, covered-up by a
lifetime of carefully crafted public statements (Goodman, 2016)
HAZING: Accountability?Canadian Mandated Sports Policies66 Provincial & National Sport Organization
Absent PoliciesOnly ~1/3 Have Hazing/Bullying Policies
Reporting BarriersOnly 4 Provide Contact Info For Harassment Officer
Donnelly et al (2014)
Where is Safeguarding in Sport Psychology Research and Practice?
Kerr & Stirling (2019)
Resource: Sport Hazing, Theory, Research & Practicehttps://www.commonwealthgames.org/hazing-research
Critical Incidents in Sport:Catastrophic & Fatal Injury
Profound, Far-Reaching & Enduring Impact
Increase in Lost Time Injury following Death of Teammate (U of U Football)
Heil, Henschen, Emmerson, & Bean (1989)
Sport as Touchstone in Healing ProcessVT Shootings & Role of Sport
Heil, Bennett, Brolinson, & Goforth (2010)
Athey, & Heil (2011) Psychological First Aid: Field Operations Manual. VAMC National
Center for PTSD
Stress-Related Growth
• Organismic Valuing TheoryJoseph & Linley (2005)
Innate Drive to Modify Worldview Positively after Trauma
Post Traumatic Growth (PTG)Post Traumatic Stress Disorder (PTSD)
Positive Accommodation - Growth Pre-Trauma Function - Recovery
Negative Accommodation – Distress
REMARKABLE RECOVERY
Return to Play at Higher LevelInjury as LearningSport Skill-Rehab Skill Transfer
• Body Awareness Heightened• Pain Assessment Enhanced• Mental Skills Sharpened• Psychological Momentum• Sport Revalued
Heil (1993); Wadey, Clark, Podlog, & McCullough (2013) Podlog, Heil & Podlog (2019)
Dr. John Heil, DA, FAASP, FAPALicensed Clinical Psychologist
Certified Mental Performance Consultant-Emeritus, CMPC-E
Psychological Health * Roanoke2840 Electric Rd., Suite 200, Roanoke, VA 24018
Phone-Office: 540-772-5140; Direct: 540-772-5147;Fax: 540-772-5157jheil@PsychHealthRoanoke.comwww.PsychHealthRoanoke.com
[email protected]://zenzonedigital.net/
http://swimsportpsychology.com/https://fencingsportpsychology.com/
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