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

Cognitive Appraisal ModelWiese-Bjornstal (2019); Wiese-Bjornstal, Smith, Shaffer & Morrey (1998)

•

Dynamic Recursive Model Meeuwisse, Tyreman, Hagel, & Emery (2007)

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

ZenZoneDigital@gmail.comhttp://zenzonedigital.net/

http://swimsportpsychology.com/https://fencingsportpsychology.com/

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