Stress and Anxiety
Athletics has a complexity beyond being able to perform a physical skill at a consistently optimal effort. Team dynamics, the emotional well being of the team, can influence the outcome of an event. Stress and anxiety can become crippling to a team or an individual athlete at any time for several different reasons. If an athlete is injured, stress and anxiety can also become an overwhelming problem during the healing process. An athlete’s adherence to rehabilitation and attitude can become non-compliant. However, athletes can be educated on how to manage or eliminate stress and anxiety during activities. Injured athletes can practice methods to improve the rehabilitative process and adherence to a program.
Most athletes associate stress and anxiety with injuries. However, stress and anxiety can infiltrate an athlete’s world. An athlete can feel pressure to succeed, pressure of failing, fear of injury, fear of re-injury, or anxiety about overcoming an injury. Some athletes have to overcome the fear and anxiety associated with returning to sports. “The major sources of stress that have been reported by sports performers include fear of failure, concerns about social evaluation by others (particularly the coach), lack of readiness to perform, and a loss of internal control over one’s environment.
There is a difference between stress and anxiety. Stress exists when a perceived situation and abilities to handle the perceived situation are not equal (Ray and Wiese-Bjornstal, 1999). “It is a response that we can learn to change and to regulate unstressed people are more effective, healthier, and happier” (Performance Media, 2006).
“Performance stress comes from social evaluation and the feeling of threat to one’s ego that evaluation brings” (Performance Media 2006). Signs of negative stress include the following: having low self confidence, making negative comments about yourself, being more self-critical, consistently performing under your ability (particularly in pressure situations), having trouble sleeping the night before an event, experiencing difficulty getting loose before a competition, and feeling ill or upset before an event (Performance Media 2006). Anxiety is a cognitive response to a physiological reaction (Ray and Wiese-Bjornstal, 1999).
Symptoms of general anxiety include muscle soreness, trembling restlessness, fatigue, shortness of breath, tachycardia, sweating, dizziness, nausea, vomiting, being on edge, startled response, loss of concentration, poor sleeping patterns, and irritability (Ferraro, 1999).
“The intensity of the anxiety that is felt before and during sports is so gripping, immediate and debilitating, that one feels compelled to provide fast relief for those anxious athletes” (Ferraro, 1999). “Anxiety comes from concern over the lack of control over circumstances” (Mind Tools, 1999). During a competitive event, adrenaline can be released. Adrenaline release can have positive and negative effects. Positive effects include the physiological arousal alertness as the body is prepared for explosive activity (Mind Tools, 1999). Athletes and their support system need to identify the stressors and then formulate an individualized plan to manage the stressors. “A fragmented or enfeebled self system can give way to temporary states of psychosis when under extreme pressure during competition” (Ferraro, 1999). “Shame and embarrassment are constant threats in sports because the game is usually played in front of people” (Ferraro, 1999).
“Psychological factors have been found to play important roles in the occurrence of and recovery from a sport injury” (Brewer, 2003). When an injury occurs, an athlete may go through the grieving process. In order for the athlete to progress, the athlete must complete the grieving process. The five stages of grieving include denial, anger, bargaining, depression, and acceptance (Crust, 2006). In addition to the five stages of grief, athletes also report feeling of distress, shock, guilt, isolation, and loneliness (Bloom & et al, 2004). In order to deal with an injury, an athlete needs to be educated about the injury and rehabilitative process. An athlete can begin to decrease anxiety by accepting responsibility for an injury, monitoring attitude, establishing a support system, setting attainable goals (short and long term), and instituting a cross-training approach into the healing process (ABOUT, 2006). “For some athletes the injury might take the athlete away from a team or a social structure that gives them a sense of belonging and security” (Niggemeyer, 1998). The level of stress occurring after an injury can be reflective of the athlete’s personality, history of stressors coping recourses, and stress management methods (Hedgepath & Sowa, 1998). Positive reinforcement and encouragement incorporated in the rehabilitative process can help ensure confidence in returning to activity (Niggemeyer, 1998). ” The psychological impact associated with injury has been shown to affect motivation, positive self-talk, concentration, and feeling of control during rehabilitation sessions” (Hedgepath & Sowa, 1998). After becoming injured, an athlete may have fear regarding returning to play, losing position, and increased pain. Reducing the fear of re-injury can possibly result in an adherence to the rehabilitative process (Crust, 2006). Poor adjustment can evolve into non-compliance and can inhibit the healing process (Crust, 2006). Six characteristics were identified among athletes having difficulty adjusting to injury. The characteristics identified were: feelings of anger and confusion, obsession with the question of when to return to sports, denial, exaggerated bragging about accomplishments, rapid mood swings, withdrawal from significant others, fatalistic thinking, and dwelling on minor complaints (Crust, 2006).
“To change an individual’s reaction to pressure requires making changes in two main categories: 1) thoughts, feelings, and perceptions of stressful situations, and 2) the physical bodily responses to stressful conditions” (Performance Media 2006). “Stress and coping are ways the body reacts and adapts to stressors to return to a state of equilibrium after a traumatic event” (Hedgepath & Sowa, 1998). In order for a stress management technique to be used properly, the athlete’s environment, personality, and ability to effectively use the technique need to be taken into account (Hedgepath & Sowa, 1998). “Through implementing stress management techniques or reinforcing lifestyle buffers, the athlete learns to share control of the rehabilitation process with the athletic trainer” (Hedgepath & Sowa, 1998). Stress and anxiety management strategies can cease an athlete’s stress and anxiety. Other benefits of implementing stress and anxiety management include: decreasing pain, decreasing the occurrence of an injury, increasing the adherence of rehabilitation, enhancing physical healing, assisting in adjustment to being injured improved coping with the stress of the injury, and enhancing mental readiness to return to full participation (Ray & Wiese- Bjornstal, 1998). “A calm explanation, reassurance and involvement in the rehabilitation plan can counteract psychological disturbance” (Geffen, 2003). Psychological strategies that can be implemented in order to achieve a positive outcome include visual rehearsal, emotive rehearsal, body rehearsal, thought stoppage, and mental practice (Niggemeyer, 2006). Effective methods to decrease stress and ellicit coping techniques include: social support, relaxation techniques, imagery, thought stoppage, modeling, behavior-rehearsal, coping with frustration, and establishing a positive environment (Ray and Wiese- Bjornstal, 1998). The role of the support systems has been shown to play a vital role in recovery and rehabilitative process and to affect the adherence to rehabilitation. Support systems can educate and help implement intervention strategies and psychological rehabilitation techniques (Bloom & et al, 2004). Some of the techniques include imagery, relaxation modeling, goal setting, positive self-talk, pain management, education, stress management, and cognitive reconstruction (Bloom & et al, 2004). Athletes who report having lack of social support or high stress related to life events are more likely to sustain injury (Ray & Wiese-Bjornstal, 1998). All of the previously mentioned techniques are effective. However, an athlete needs to find the technique that meets his/her needs and one which he/she feels comfortable executing.
Athletes can be faced with stress and anxiety prior and during their sporting activities. Sports is no longer ‘just a game’; some athletes feel tremendous external pressure and internal stress to succeed and perform to perfection. Being placed in the media spotlight in the sport world can become a positive or negative stress for an athlete. Identifying and accepting the onset of stress and anxiety is a positive first step. Selecting and implementing the appropriate stress and/or anxiety management technique accomplish the next step to overcoming and managing the source of the stress and anxiety. “Sport psychology consultants are trained to help athletes understand how pressure affects them, and then introduce them to strategies to help them overcome the effects of pressure” (Ott & Van Puymbroek, 2006). These strategies are useful for athletes to prepare for an event, to overcome the anxiety and fear associated with injuries and the rehabilitative process, and to deal with stress. Stress and anxiety experienced during the rehabilitative phase can be inhibiting and can affect the adherence to the commitment of healing process.
Some techniques that can apply, such as thought stoppage, imagery, reframing, and establishing a positive environment, enhance the rehabilitative process. Athletes should also establish a rapport with their athletic trainers and support systems. A support system can result in adherence to the rehabilitative process. If injury occurs, the athlete’s support system can alleviate the grieving process. In order for athletes to prevent or eliminate the occurrence of stress and anxiety issues, management strategies should be implemented. Implementing and effectively applying a stress a management technique can become an essential element in an athlete’s routine. In addition to the daily routine, the athlete can implement the select technique to daily life stressors.
ABOUT: Sports Medicine. (n.d.). Dealing with Injuries.
Retrieved November 14, 2006, from http://www.sportsmedicine.about.com/od/injury/a/dealingwithinjury.htm
Bloom, A., Horton, A., McCory, P., & Johnston, K. (2004). Sport Psychology and Concussion: New Impacts to Explore.
Retrieved November 14, 2006, from http://bjsm.bjm.com/cgi/comtent/full/38/5/519
Brewer, B. (2003). Developmental Differences in Psychological Aspects of Sport-Injury Rehabilitation.
Retrieved November 14, 2006, from http://www.pubcentral.nih.gov/articlerender.fcgi?artid=164904
Crust, L.(n.d.). Psychological Rehabilitation Techniques- What Psychological Rehabilitation Techniques Work Best in Getting an Athlete Back to Full Activity After Injury.
Retrieved November 14, 2006, from http://www.sportsinjurybulletin.com/archive/psychological-rehab.html
Ferraro, T. (1999). A Psychoanalytic Perspective on Anxiety in Athletes.
Retrieved September 20, 2006, from http://www.athleticinsight.com/Vol1Iss2/Psychoanalytic_Anxiety.htm
Geffen, S. (2003). Rehabilitation Principles for Treating Chronic Musculoskeletal Injuries.
Retrieved November 14, 2006 from http://www.mja.com.au/public/issues/17805030303/gef10392_fm.html
Hardy, L. (1992). Psychological Stress, Performance, and Injury in Sport.
Retrieved November 14, 2006, from http://www.oxfordjournals.org/cgi/content/abstract/48/3/615
Hedgepath, E., & Sowa, C. (1998). Incorporating Stress Management into Athletic Injury rehabilitation. Journal of Athletic Training. 33(4): 372-374
Mind Tools. (n.d.). Stress, Anxiety, and Energy.
Retrieved November 14, 2006 from http://www.mindtools.com/stresscn.html
Niggemeyer, K. (n.d.). Overcoming injuries.
Retrieved November 14, 2006, from http://www.womenssportsfoundation.org/cgi-bin/iowa/athletes/article.html?record=206
Ott, K. & Van Puymbroek, M. (2006). Does the Media Impact Athletic Performance?
Retrieved September 20, 2006 from http://www.thesportjournal.org/2006Journal/Vol9-No3/Ott.asp
Performance Media. (2006). Stress Management.
Retrieved September 20, 2006 from http://www.performance-media.com/stress-management.php
Performance Media. (2006). What Produces Stress?
Retrieved September 20 from http://www.performance-media.com/stress-management2.php
Ray, R., & Wiese-Bjornstal, D. (1999). Counseling in Sports Medicine. Champaign: Human Kinetics