The Mythical The Mythical ZoneZone

How to find yours for Peak How to find yours for Peak Performance in your sport.Performance in your sport.

Dr. Batool Kazim, MDDr. Batool Kazim, MD

Southborough Medical CenterSouthborough Medical Center

The Mythical ZoneThe Mythical Zone

The Zone is a state of being when The Zone is a state of being when you have the ability to perform at you have the ability to perform at your highest level when it matters.your highest level when it matters.

It can also be described as being It can also be described as being your best friend and not your worst your best friend and not your worst enemy at crucial times whether in enemy at crucial times whether in sports or other areas of your life, sports or other areas of your life, esp. under pressure.esp. under pressure.

Sports Psychiatry: Sports Psychiatry: Strategies for Life Strategies for Life

Balance & Peak Balance & Peak PerformancePerformanceDavid R.McDuff, M.DDavid R.McDuff, M.D

W www.mdsports.netW www.mdsports.net dmcduff52@gmail.comdmcduff52@gmail.com

McDuff DR, Morse E, White R: Professional and Collegiate Team Assistance Programs: Services and Utilization in Clinics in Sports Medicine. Edited by Toffler I and Morse E, Elsevier Inc, 4:943-958, 2005.McDuff DR, Baron D. Substance Use in Athletics: A Sports Psychiatry Perspective in Clinics in Sports Medicine. Edited by Toffler I & Morse E, Elsevier Inc. 4:885-897, 2005.McDuff DR. Sports Psychiatry: Strategies for Life Balance & Peak Performance, American Psychiatric Pub, Wash DC, Apr 2012

Mental Aspects Mental Aspects of the Gameof the Game

““Ninety percent of Ninety percent of the game is half the game is half mentalmental”” Jim WohlfordJim Wohlford

Sports Sports PsychiatryPsychiatry

Learning ObjectivesLearning Objectives Identify the traits of high achieving athletesIdentify the traits of high achieving athletes Describe the scope of practice of applied sports Describe the scope of practice of applied sports

psychiatry & psychologypsychiatry & psychology Utilize a five-step model of peak performance Utilize a five-step model of peak performance

and life balanceand life balance Implement stress control & sleep-energy management Implement stress control & sleep-energy management

routinesroutines Identify common athletic substance problems & Identify common athletic substance problems &

organize brief interventions organize brief interventions Utilize a four-step model of injury recovery Utilize a four-step model of injury recovery Diagnose and treat the common mental disordersDiagnose and treat the common mental disorders Improve clinical skills working with youth & womenImprove clinical skills working with youth & women’’s s

sports and with foreign-born athletessports and with foreign-born athletes Increase consultative skills for working with teams, Increase consultative skills for working with teams,

coaches, and medical staffscoaches, and medical staffs

D.M. MD

The Mythical ZoneThe Mythical Zone

Traits of High Traits of High Achieving Achieving AthletesAthletes

Believe It!Believe It! BBalances Sports & other Life Areasalances Sports & other Life Areas EEncourages & Supports Teammatesncourages & Supports Teammates LLets Go of Mistakes/Defeats Easilyets Go of Mistakes/Defeats Easily IImage about Self & Abilities is Positivemage about Self & Abilities is Positive EEnjoys Training & Competitionnjoys Training & Competition VVisualizes Successisualizes Success EEvaluates Performance & Outcomevaluates Performance & Outcome IIntensity (Maintains Focus & ntensity (Maintains Focus &

Aggression)Aggression) TTalk (Uses Positive Affirmations)alk (Uses Positive Affirmations)  

D.M. MD

Emotional Competencies Emotional Competencies

of High Achieving of High Achieving AthletesAthletes

Emotional Control Emotional Control (manage feelings & (manage feelings & impulses despite competitive pressure)impulses despite competitive pressure)

Self-awarenessSelf-awareness (maintain perspective (maintain perspective between ideal & actual play)between ideal & actual play)

Internal motivation Internal motivation (passion for (passion for practice, play, and getting better)practice, play, and getting better)

Empathy Empathy (compassion and support of (compassion and support of others)others)

Socialization Socialization (effective communication (effective communication and bonding)and bonding)

Rick Aberman 2011; www.lennickaberman.comRick Aberman 2011; www.lennickaberman.com

D.M. MD

Traits of High Achieving Athletes: Traits of High Achieving Athletes: AAttention, ttention, RReactivity, eactivity, CCoping(ARC)oping(ARC)

Automatic AttentionAutomatic Attention--HighHigh (Zone Trait) (Zone Trait) ““Intense Effortless FocusIntense Effortless Focus””

Automatic ReactivityAutomatic Reactivity--LowLow (Zone Buster) (Zone Buster) ““Excessive Negative Thinking & Excessive Negative Thinking & Physiological ArousalPhysiological Arousal”” Automatic CopingAutomatic Coping--HighHigh (Zone Facilitator) (Zone Facilitator) ““Inhibition of R-L Brain Transfer of Negative Inhibition of R-L Brain Transfer of Negative

EmotionsEmotions”” Carlstedt RA (2007) Integrative Evidence-Based Athletic Assessment & Carlstedt RA (2007) Integrative Evidence-Based Athletic Assessment &

Intervention: A Field Tested & Validated Protocol. Intervention: A Field Tested & Validated Protocol. J Amer Board Sport J Amer Board Sport Psychology.Psychology. 1:1-30. 1:1-30.

D.M. MD

Sports Psychiatry: Sports Psychiatry: Scope of PracticeScope of Practice

Eight Core SkillsEight Core SkillsMental Preparation-Mental SkillsMental Preparation-Mental SkillsStress Recognition & ControlStress Recognition & ControlSleep & Energy RegulationSleep & Energy RegulationSubstance Prevention/ControlSubstance Prevention/Control Injury Recovery & Pain ControlInjury Recovery & Pain ControlMental Disorder ManagementMental Disorder ManagementDevelopmental & Cultural CompetenceDevelopmental & Cultural CompetenceWorking With Teams & Medical StaffsWorking With Teams & Medical Staffs

D.M. MD

Performance Enhancement Performance Enhancement

Injury Recovery Substance MisuseMental DisordersSleep & Energy

Mental Preparation Team Consultation

Cultural CompetenceStress Control

Fitness Injury Sports Skill Training

Nutrition Energy Mental Profile

Talent Experience Life Balance Family & Coaches

D.M. MD

D.M. MD

Breathing Positive Focus Visualization Motivation & Relaxation Self-Talk & Attention & Imagery & Persistence

Goal Setting and Self Evaluation

Pre-Competition Routine

Emotional Control/Intensity Regulation

Competitive Self-Confidence

Talent Fitness, Nutrition Life Balance and Experience and Injury Prevention and Stress Control

Confidence Pyramid

D.M. MD

Peak PerformancePeak Performance““GAME TIPSGAME TIPS””

GGrowth: rowth: ““progress not perfectionprogress not perfection”” AAttention: ttention: ““no pressure in the presentno pressure in the present”” MMotivation: otivation: ““you get what you createyou get what you create”” EEmotion: motion: ““pace, donpace, don’’t racet race”” TThought: hought: ““actions follow thoughtsactions follow thoughts”” IImage: mage: ““what you see is what you getwhat you see is what you get”” PPreparation: reparation: ““practice aids performancepractice aids performance”” SSelf-Confidence: elf-Confidence: ““perform to a + self-imageperform to a + self-image

D.M. MD

Mental Preparation Mental Preparation TrainingTraining

Relaxation Training Relaxation Training Affirmations & Positive Self TalkAffirmations & Positive Self Talk Imagery/VisualizationImagery/Visualization Attention & ConcentrationAttention & Concentration Motivation & PersistenceMotivation & Persistence Goal SettingGoal Setting Precompetitive Routine DevelopmentPrecompetitive Routine Development Intensity RegulationIntensity Regulation Building Self-ConfidenceBuilding Self-Confidence

D.M. MD

Mental Preparation Mental Preparation

Primary Goal:Primary Goal: to develop a set of to develop a set of

mental & behavioral skills that mental & behavioral skills that

allow athletes to consistently allow athletes to consistently

perform at the upper end of his/her perform at the upper end of his/her talent range under a variety of talent range under a variety of

competitive circumstances. competitive circumstances.

D.M. MD

Mental Preparation Mental Preparation

Quality Preparation Quality Preparation ““Ready to CompeteReady to Compete””

Competitive Follow Thru Competitive Follow Thru ““Get the Job DoneGet the Job Done””

Accurate Self Evaluation Accurate Self Evaluation

““React to ResultsReact to Results”” Charles Maher, Ph.D.Charles Maher, Ph.D.

Mental Preparation Training: Mental Preparation Training: RelaxationRelaxation

““Stress is anything that causes energy Stress is anything that causes energy to be expended-recovery is anything to be expended-recovery is anything that allows energy to be recaptured-that allows energy to be recaptured-balancing stress and recovery is balancing stress and recovery is fundamental to becoming a tough fundamental to becoming a tough competitorcompetitor””

Example:Example: teaching relaxation teaching relaxation techniques to a lacrosse goalie with techniques to a lacrosse goalie with excessive tension & divided attention.excessive tension & divided attention.

Mental Preparation Training:Mental Preparation Training:Imagery/VisualizationImagery/Visualization

““If the scene that you are perceiving If the scene that you are perceiving has a high level of personal meaning has a high level of personal meaning for you, then you will tend to imprint for you, then you will tend to imprint it more intensively & later you will be it more intensively & later you will be able to recall it more clearly and able to recall it more clearly and completelycompletely””

Example: Example: low confidence in a ice low confidence in a ice hockey goaliehockey goalie

D.M. MD

Mental Preparation Training:Mental Preparation Training:Focus & Attention Focus & Attention

““Focus on the positive not the Focus on the positive not the negative, the present not the past, negative, the present not the past, the process not the result, the target the process not the result, the target not an image of the selfnot an image of the self””

Example: Example: divided attention in a divided attention in a platform diver and level 8 gymnast.platform diver and level 8 gymnast.

D.M. MD

Mental Preparation:Mental Preparation:Affirmations &Affirmations &

Positive Self TalkPositive Self Talk

““The mental message will dictate the The mental message will dictate the physical action and help determine physical action and help determine its qualityits quality””

Example:Example: introducing positive self- introducing positive self-talk professional golfer whose recent talk professional golfer whose recent performance had been inconsistentperformance had been inconsistent

D.M. MD

Mental Preparation: Mental Preparation: Goal SettingGoal Setting

““Goals set without commitment are Goals set without commitment are wasted-goals serve you, expectations wasted-goals serve you, expectations serve othersserve others””

Example: Example: reducing expectations and reducing expectations and establishing realistic practice and game establishing realistic practice and game goals in a high school soccer player goals in a high school soccer player

D.M. MD

Mental Preparation:Mental Preparation:Pre-competitive Routine Pre-competitive Routine

““The typical athlete goes all-out during The typical athlete goes all-out during competition. Thatcompetition. That’’s easy. The s easy. The exceptional athlete goes all-out to exceptional athlete goes all-out to prepare for competition. Thatprepare for competition. That’’s difficult.s difficult.

Example:Example: developing a pre-practice developing a pre-practice routine in a mistake-prone quarterback routine in a mistake-prone quarterback and a game routine in distractible and a game routine in distractible starting pitcher. starting pitcher.

D.M. MD

Mental Preparation:Mental Preparation:Intensity RegulationIntensity Regulation

““The difference between the clutch The difference between the clutch player & the choke player is that the player & the choke player is that the clutch player gets his state of clutch player gets his state of relaxation and intensity level under relaxation and intensity level under control before the actioncontrol before the action””

Example: Example: controlling competitive controlling competitive aggression and mistakes in a aggression and mistakes in a defensive back defensive back

D.M. MD

Mental Preparation:Mental Preparation:Building Building

Self-ConfidenceSelf-Confidence

““The greatest obstacle on the road to The greatest obstacle on the road to confidence is fear-the successes we confidence is fear-the successes we have achieved in the past are more real have achieved in the past are more real than the failures we fear in the futurethan the failures we fear in the future””

Example: Example: developing consistency developing consistency through visualization, positive self-talk through visualization, positive self-talk and body focus in a special teams and body focus in a special teams football playerfootball player

D.M. MD

D.M. MD

Sports Psychiatry: Sports Psychiatry: Stress Control TipsStress Control Tips

Know the factsKnow the facts Recognize symptoms earlyRecognize symptoms early Trigger relaxationTrigger relaxation Think positively/look calmThink positively/look calm Develop supportDevelop support Take regular breaksTake regular breaks Improve time managementImprove time management Stay informed/ignore rumorsStay informed/ignore rumors

D.M. MD

Sports Psychiatry: Sports Psychiatry: Energy RegulationEnergy Regulation

Three energy systems (phosphate, Three energy systems (phosphate, anerobic glycolysis, aerobic anerobic glycolysis, aerobic metabolism)metabolism)

Food, fluid, electrolyte resupplyFood, fluid, electrolyte resupply Wakefulness & alertness, acute fatigueWakefulness & alertness, acute fatigue Sleeping, sleep debt, jet lag & napsSleeping, sleep debt, jet lag & naps Chronic fatigue, & burnoutChronic fatigue, & burnout Stimulants & stimulating activitiesStimulants & stimulating activities

D.M. MD

D.M. MD

Sports Psychiatry:Sports Psychiatry:Substance MisuseSubstance Misuse

AlcoholAlcohol Marijuana & OtherMarijuana & Other CannabinoidsCannabinoids StimulantsStimulants Anabolic Steroids &Anabolic Steroids & Other Muscle MassOther Muscle Mass BuildersBuilders

D.M. MD

AlcoholAlcohol’’s Negative s Negative Performance EffectsPerformance Effects

Diuresis & dehydrationDiuresis & dehydration Lateness & poor preparationLateness & poor preparation Carbohydrate metabolismCarbohydrate metabolism Hangover & reaction timeHangover & reaction time Fights, falls, arrestsFights, falls, arrests Poor sleep qualityPoor sleep quality Weight gainWeight gain Unprotected sex-STDsUnprotected sex-STDs

D.M. MD

Anabolic Androgenic Anabolic Androgenic Steroids & Other Steroids & Other

Muscle Mass BuildersMuscle Mass Builders

Anabolic SteroidsAnabolic Steroids Peptide Hormones, Growth FactorsPeptide Hormones, Growth Factors Beta-Adrenergic AgonistsBeta-Adrenergic Agonists Hormone AntagonistsHormone Antagonists Diuretics & Masking AgentsDiuretics & Masking Agents Case Study: AAS Use/InjuryCase Study: AAS Use/Injury Case Study: AAS AddictionCase Study: AAS Addiction

D.M. MD

Sports Psychiatry: Common Sports Psychiatry: Common

& Less Serious Injuries& Less Serious Injuries

Ankle SprainsAnkle Sprains Shin SplintsShin Splints Hamstring StrainsHamstring Strains Knee StrainsKnee Strains Patellar Tendinitis & Patellar Tendinitis & Tracking ProblemsTracking Problems Shoulder/Elbow StrainsShoulder/Elbow Strains

D.M. MD

Sports Psychiatry: Serious InjuriesSports Psychiatry: Serious Injuries

Brain contusion & concussionBrain contusion & concussion Cervical spine/cord & paralysisCervical spine/cord & paralysis Eye & Dental InjuriesEye & Dental Injuries FracturesFractures Knee disruptionsKnee disruptions Dehydration & heat injuryDehydration & heat injury Shoulder & elbow dislocationsShoulder & elbow dislocations Lumbar spine injury & painLumbar spine injury & pain Muscle, tendon & ligament tearsMuscle, tendon & ligament tears

D.M. MD

Sports Psychiatry: FourSports Psychiatry: FourStages of Injury RecoveryStages of Injury Recovery

Acute InjuryAcute Injury RehabilitationRehabilitation Return to PlayReturn to Play Departure from Departure from

SportsSports

D.M. MD

Sports Psychiatry:Sports Psychiatry:Common Mental DisordersCommon Mental Disorders

AdjustmentAdjustment ADHD/LearningADHD/Learning AnxietyAnxiety Mood & GriefMood & Grief Sleep & EatingSleep & Eating Impulse/Anger ControlImpulse/Anger Control Pain & SomatoformPain & Somatoform Prescription Med MisusePrescription Med Misuse

D.M. MD

Sports Psychiatry:Sports Psychiatry:Treatment StrategiesTreatment Strategies

Support networkSupport network Environmental changeEnvironmental change Perspective shiftPerspective shift Brief therapyBrief therapy Sleep medsSleep meds ADHD medsADHD meds Anxiety medsAnxiety meds Depressions medsDepressions meds Chronic Pain medsChronic Pain meds

D.M. MD

Sports Psychiatry: Mental Sports Psychiatry: Mental Disorders-Case StudiesDisorders-Case Studies

Adjustment-I donAdjustment-I don’’t play enought play enough Anxiety-I get so nervous I vomitAnxiety-I get so nervous I vomit Sleep-I think too much at bedtimeSleep-I think too much at bedtime Anger Control-IAnger Control-I’’m always frustratedm always frustrated ADHD-I knew I wasnADHD-I knew I wasn’’t learningt learning Eating-I binged to relieve stressEating-I binged to relieve stress Grief-we knew he was taking themGrief-we knew he was taking them Depression-the divorce got to meDepression-the divorce got to me Pain Disorder-ItPain Disorder-It’’s just like other hips just like other hip

D.M. MD

D.M. MD

ConclusionConclusion

Quick review of mental skills:Quick review of mental skills:

5 Basic Skills:5 Basic Skills:RelaxationRelaxationPositive Self TalkPositive Self TalkImagery/VisualizationImagery/VisualizationFocus/Attention ShiftingFocus/Attention ShiftingCommitment/PersistenceCommitment/Persistence

ConclusionConclusion

Complex Skills:Complex Skills:Goal SettingGoal SettingSelf-EvaluationSelf-EvaluationPre-Game RoutinePre-Game RoutineIntensity/Emotional RegulationIntensity/Emotional RegulationStress ControlStress Control

This is just a start……This is just a start……