Research on rehabilitation of multiply injured athletes shows no convincing evidence that physiological factors exclusively can explain injury-proneness in sport. Neither can any single psychological factor characterize the injury-prone athlete. Injury-proneness seems to be best explained by a complex web of extrinsic and intrinsic risk factors. The present study focused on a comparison of mental factors and coping strategies of high-level athletes with sport injuries. A psychological profile of 25 multiply injured athletes was compared to 14 first-time seriously injured athletes. Factors such as impulsiveness, risk-taking attitude, introaggression, and psychic anxiety did not differentiate multiply injured athletes from other athletes with injuries. The first-time-injured group, however, had psychological difficulties associated with long-term injuries or other serious life crises. The first-time-injured athletes tended to experience the rehabilitation period as stressful, and they showed less self-confidence and scored lower on an overall mood scale than the multiply injured athletes.
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The Multiply Injured versus the First-Time-Injured Athlete during Rehabilitation: A Comparison of Nonphysical Characteristics
Urban Johnson
A Three-Year Follow-Up of Long-Term Injured Competitive Athletes: Influence of Psychological Risk Factors on Rehabilitation
Urban Johnson
The rehabilitation of 77 competitive athletes with long-term injuries was followed for 2–3 years from the time of the injury with the aim of identifying potential risk factors in rehabilitation. Seven athletes not returning to competitive sport despite favorable physical records were compared with 5 athletes who returned despite unfavorable records and with 65 athletes whose rehabilitation met expectations. Twelve tests were employed on four different occasions. The results suggested that being younger, being female, and having had no previous experience with injury characterized the nonreturning athlete. An insufficient mental plan for rehabilitation and a predominantly negative attitude toward it, as well as restricted social contacts with fellow athletes and a low mood level, appeared to accompany a problematic and prolonged rehabilitation. It was concluded that the nonreturning, long-term injured athlete can be identified as early as the beginning of the rehabilitation process.
Short-Term Psychological Intervention: A Study of Long-Term-injured Competitive Athletes
Urban Johnson
Objective:
To explore the effectiveness of psychological interventions for a sample of competitive athletes with long-term injuries.
Design:
Modified 2-group, pretreatment and posttreatment (repeated measure).
Patients:
58 patients, 14 in the experimental group and 44 in the control group.
Interventions:
Three intervention strategies: stress management and cognitive control, goal-setting skills, and relaxation/guided imagery.
Main Outcome Measure:
Mood level was used as the outcome variable.
Results:
The experimental group had a higher overall mood level at the midpoint and end of rehabilitation and were also feeling more ready for competition than the control group was, both as rated by themselves and by the treating physiotherapist The only strategy to show statistical differences was relaxation/guided imagery.
Conclusions:
The results of this study support the idea that a short-term intervention has the potential to elevate mood levels in competitive athletes with long-term injuries.
On the Swedish Road to Becoming a Professional Practitioner in Sport and Exercise Psychology: Students’ Views, Hopes, Dreams, and Worries
Urban Johnson and Mark Andersen
The field of sport and exercise psychology (SEP) has experienced a steady growth, and the professional practice and training of students has evolved over that time. Based on 2 past studies, the purpose was to describe a 2015 cohort of SEP students’ hopes, dreams, and worries about the future. The authors performed a thematic content analysis of essays from undergraduate students based on cohorts from 1995, 2005, and 2015. The results showed that the most recent students expressed more worries about the current situation in relation to perceptions about the future of their potential professional practice than the past groups. Four tendencies for the future emerged: continued development of applied sport psychology, increased interdisciplinary exchange and integration, inclusion of exercise and health as a vital part of the field, and increased acceptance of cultural variations. Implications for future professional practice and training in SEP are discussed.
“Be Mindful Even Though It Hurts”: A Single-Case Study Testing the Effects of a Mindfulness- and Acceptance-Based Intervention on Injured Athletes’ Mental Health
Karin Moesch, Andreas Ivarsson, and Urban Johnson
Injury is a serious setback for athletes and might jeopardize mental health. The aim of this study is to investigate if a mindfulness- and acceptance-based intervention can improve mindfulness (nonreactivity and acting with awareness), acceptance, and well-being, and decrease the level of symptoms of anxiety and depression. A single-case design with multiple, staggered, and nonconcurrent baselines was used. Six seriously injured athletes took part in an 8-week intervention and repeatedly completed questionnaires on all variables for the duration of the study. The results showed that, on average, there were significant clinical changes between phases in nonreactivity, well-being, and acceptance. No effect was seen in the two remaining scales. On an individual level, two participants showed effects in all scales, two participants in some of the scales, and two participants in the scale nonreactivity. Results are discussed in light of existing research, and implications for practitioners’ clinical methods are presented.
Psychological Predictors of Injury Occurrence: A Prospective Investigation of Professional Swedish Soccer Players
Andreas Ivarsson, Urban Johnson, and Leslie Podlog
Context:
Athletes participating in sport are exposed to a high injury risk. Previous research has found a great number of risk factors (both physiological and psychological) that could increase injury risk.1 One limitation in previous studies is that few have considered the complex interaction between psychological factors in their research design.
Objective:
To study whether personality, stress, and coping predicted injury occurrence in an elite soccer population based on a hypothesized model.
Design:
Prospective.
Participants:
56 (n = 38 male, n = 18 female) Swedish Premiere League soccer players were selected based on convenience sampling.
Intervention:
Participants completed 4 questionnaires including the Swedish Universities Scales of Personality,2 Life Events Survey for Collegiate Athletes,3 and Brief COPE4 during the initial questionnaire administration. Subsequent to the first meeting, participants also completed the Hassle and Uplift Scale5 once per wk for a 13-wk period throughout the competitive season.
Main Outcome Measures:
A path analysis was conducted examining the influence of personality traits (ie, trait anxiety), state-level stressors (ie, negative-life-event stress and daily hassles), and coping on injury frequency.
Results:
Results of the path analysis indicated that trait anxiety, negative-life-event stress, and daily hassle were significant predictors of injury among professional soccer players, accounting for 24% of the variance.
Conclusion:
The findings highlight the need for athletes, coaches, and medical practitioners to attempt to reduce state-level stressors, especially daily hassles, in minimizing injury risk. Educating and training athletes and coaches in proactive stress-management techniques appears warranted.
Bayesian Structural Equation Modeling in Sport and Exercise Psychology
Andreas Stenling, Andreas Ivarsson, Urban Johnson, and Magnus Lindwall
Bayesian statistics is on the rise in mainstream psychology, but applications in sport and exercise psychology research are scarce. In this article, the foundations of Bayesian analysis are introduced, and we will illustrate how to apply Bayesian structural equation modeling in a sport and exercise psychology setting. More specifically, we contrasted a confirmatory factor analysis on the Sport Motivation Scale II estimated with the most commonly used estimator, maximum likelihood, and a Bayesian approach with weakly informative priors for cross-loadings and correlated residuals. The results indicated that the model with Bayesian estimation and weakly informative priors provided a good fit to the data, whereas the model estimated with a maximum likelihood estimator did not produce a well-fitting model. The reasons for this discrepancy between maximum likelihood and Bayesian estimation are discussed as well as potential advantages and caveats with the Bayesian approach.
Career Assistance to a Team in Crisis-Transition: An Intervention Case Study in Swedish Elite Handball
Johan Ekengren, Natalia Stambulova, Urban Johnson, Andreas Ivarsson, and Robert J. Schinke
In this paper, the authors share how a career assistance program was developed, implemented, and evaluated with a Swedish elite handball team. Within this case study, the initial version of the career assistance program’s content was created based on the career-long psychological support services in a Swedish handball framework and the first author’s applied experiences. During implementation, the head coach was terminated unexpectedly, and the team appeared in a crisis. This transitional situation led to modification of the career assistance program to help the players cope with changes. Eighteen players took part in eight workshops dealing with various aspects of their sport and nonsport life (e.g., performance, training, lifestyle, recovery, and future planning) with crisis-related issues (e.g., coping with uncertainty) incorporated. Mixed-methods evaluation revealed the players’ perceived increase in personal resources (awareness and skills) and decrease in stress and fatigue. Reflections on working in applied sport psychology from a holistic perspective in a dynamic real-life setting are provided.
Injury Prevention in Sweden: Helping Soccer Players at Risk
Urban Johnson, Johan Ekengren, and Mark B. Andersen
This study examined the effectiveness of a prevention intervention program to lower the incidence of injury for soccer players with at-risk psychosocial profiles. The Sport Anxiety Scale, the Life Event Scale for Collegiate Athletes, and the Athletic Coping Skills Inventory-28 were used to screen for psychosocial risk factors outlined in the stress and injury model (Williams & Andersen, 1998). Thirty-two high injury-risk players were identified and randomly assigned to treatment and control groups. Injuries of participants were reported by their coaches. The intervention program consisted of training in 6 mental skills distributed in 6 to 8 sessions during 19 weeks of the competitive season. The results showed that the brief intervention prevention program significantly lowered the number of injuries in the treatment group compared with the control group.
Things We Still Haven’t Learned (So Far)
Andreas Ivarsson, Mark B. Andersen, Andreas Stenling, Urban Johnson, and Magnus Lindwall
Null hypothesis significance testing (NHST) is like an immortal horse that some researchers have been trying to beat to death for over 50 years but without any success. In this article we discuss the flaws in NHST, the historical background in relation to both Fisher’s and Neyman and Pearson’s statistical ideas, the common misunderstandings of what p < 05 actually means, and the 2010 APA publication manual’s clear, but most often ignored, instructions to report effect sizes and to interpret what they all mean in the real world. In addition, we discuss how Bayesian statistics can be used to overcome some of the problems with NHST. We then analyze quantitative articles published over the past three years (2012–2014) in two top-rated sport and exercise psychology journals to determine whether we have learned what we should have learned decades ago about our use and meaningful interpretations of statistics.