Dr Bell and Dr Johnson are from the School of Physical Education, Sport & Exercise Science, Ball State University, Muncie, Indiana; and Dr Jutte is from the Department of Sport Studies, Xavier University, Cincinnati, Ohio. Dr Bell is now with Dr Rob Bell, LLC, Indianapolis, Indiana.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Lisa S. Jutte, PhD, ATC, Department of Sport Studies, Xavier University, 3800 Victory Parkway, Cincinnati, OH 45207-6312; e-mail: firstname.lastname@example.org.
Part I of this Pearls of Practice series highlighted the need for Sport Psychology Consultants (SPCs). Part II of this series identified the most common barriers preventing SPCs from joining the sports medicine team. Part III identifies 3 techniques commonly used by SPCs.
The sport psychology literature is full of various strategies and performance enhancement techniques for all types of issues.1 Several factors can play a part in both the physical and psychological healing process for an injured athlete, including injury severity, rehabilitation process duration, coping skills, previous injury history, and current life stressors. As part of a sports medicine team, addressing these issues is the specialty of the SPC. This article briefly highlights 3 common strategies often used by SPCs: confidence building, imagery, and goal setting.
The relationship of confidence on athletes’ performance has been well documented.2 Unfortunately, injury can alter one’s thoughts, feelings, and behaviors and can negatively alter one’s confidence level.
The process of enhancing confidence begins with the assessment of an athlete’s mental skills. Introductory sessions with an injured athlete are focused on building rapport while identifying the athlete’s sources of confidence. Recent research suggests that SPCs should include confidence profiling measures to assist with intake assessments and protocols.2 After strengths and shortcomings are processed and identified, the athlete and SPC can collaborate on specific intervention strategies.
Often, an individual’s cognitive patterns serve as underlying causes of decreased self-confidence. These thoughts can often become irrational during a period of injury due to one’s inability to practice or compete. For example, an athlete’s thought patterns frequently center on all-or-nothing thinking, such as “I will never be at the level I once was.” or “I won’t return to my position.” As a result, an SPC can implement strategies to address one’s self-talk, intended to refute the unproductive thinking patterns. In other words, an SPC would put doubts in the athlete’s doubts.2 Developing positive affirmations is a critical and deliberate step for enhancing and repairing confidence.
Second, imagery is an important sport psychology technique that can be transferred into the rehabilitation environment. Athletes have reported imagery to be the most important mental training technique; however, research has shown that sports medicine professionals are reluctant to implement imagery due to a lack of competence.3 Imagery consists of creating–recreating experiences in the mind and is often coupled with additional techniques such as goal setting and relaxation. Various theories exist regarding imagery’s efficacy on both sport performance and the healing process.3
One imagery framework is to have athletes envision their “possible selves.”4 Imagery is best used by having a guided script by which athletes can verbalize their responses and focus on solutions to their problem. Depending on the rehabilitation phase, SPCs can guide athletes through the imagery process to assist with completing successful recovery milestones. For example, athletes with a glenohumeral labrum tear can develop a “possible self” during the various stages of injury by visualizing themselves as extending their arm completely or throwing the ball with teammates.
Imagery can also guide individuals toward envisioning a successful return to sport. These guided imagery sessions allow athletes to envision the process of successful outcomes. In addition, SPCs can guide athletes to envision the social support network associated with the rehabilitation process. Thus, imagery sessions are often combined with questions such as “Who else would notice your progression?” Imagery sessions are also coupled with building confidence through enhanced self-images, such as proper outlooks and positive self-esteem.
Finally, SPCs can assist athletes with the process of successfully returning to sport. Although athletic trainers regularly help injured athletes with goal setting, there is a possible disconnect after athletes’ return to sport with which SPCs can assist. Returning to sport often involves overcoming psychological stressors, which athletes have identified as reduced confidence, adapting to increased intensity of competition, fear of reinjury, and increased anxiety.5 Detailed goal-setting strategies can alleviate these stressors. Three types of goals are outcome, performance, and process.2 Outcome-based goals are centered on the competitive results of an event in relation to competitors (eg, win a starting spot). Performance-based goals are focused on performance accomplishments devoid of outside competitors (eg, shoot 50%). Process-based goals are the strategies and actions one wants to implement (eg, execute quality shots).
Athletes have a natural tendency to focus solely on outcome-based goals; however, this can be detrimental because it neglects possible setbacks and does not provide a road map for addressing the process of returning to sport. By using process and performance goals, athletes’ motivation and confidence can be enhanced by clarifying expectations and directing attention toward manageable goals, rather than unrealistic outcome-based goals frequently associated with physical behavior.
The goal-setting sessions between SPCs and athletes first focus on the education of proper goal-setting principles, including length of goals, number of goals, recording procedures, and evaluation methods. Next, SPCs can assist athletes with setting specific and achievable, process-oriented goals, which are centered on aspects within the athletes’ control. For example, an effective strategy is for athletes to write out a “goal of the week.” Sport psychology consultants can then have athletes rate the severity of the stressors and explore what will be different in their lives when progressing toward or achieving the goal.
In addition, one technique is to ask the athlete the “miracle” question: “When you woke up and you realized you no longer had this problem, what would be the first small sign that would show you are doing something different?” Answers that stem from this question are usually steps of progress and confidence in achievable performance goals that are unique to the psychosocial elements of rehabilitation.
These aforementioned methods are by no means a comprehensive set of strategies. However, these techniques are examples of interventions regularly used by SPCs to enhance athletes’ rehabilitation experience and provide a comprehensive approach toward the overall rehabilitation environment.
Implications for Clinical Practice
In this three-part Pearls of Practice series, we have shown that athletes have psychosocial needs after injury and during the rehabilitation process. Sport psychology consultants are specifically trained to attend to athletes’ psychosocial needs after injury. Athletic trainers and physicians should consider ways to eliminate the barriers of incorporating SPCs in the sports medicine team, thus improving athletic health care.
- Gill DL. Psychological Dynamics of Sport and Exercise. 3rd ed. Champaign, IL: Human Kinetics; 2008.
- Hays K, Thomas O, Maynard IW, Butt J. The role of confidence profiling in cognitive-behavioral interventions in sport. The Sport Psychologist. 2010; 24(3):393–414.
- Morris T, Spittle M, Watt A. Imagery in Sport. Champaign, IL: Human Kinetics; 2010.
- Markus H, Nurius P. Possible selves. Am Psychol. 1986;41(9): 954–969. doi:10.1037/0003-066X.41.9.954 [CrossRef]
- Evans L, Hardy L, Fleming S. Intervention strategies with injured athletes: an action research study. The Sport Psychologist. 2000;14(2):188–206.