Stress and Anxiety in Athletics
All athletic trainers should be concerned with how stress and anxiety affect their athletes. Many athletes struggle with stress and anxiety on a daily basis. Each athlete reacts to the stress and anxiety differently. The purpose of this paper is to explore the differences between stress and anxiety, as well as how these conditions affect athletes.
Review of Literature
What is Stress?
Martens, Vealey, and Burton (1990) stated, “stress has been defined as stimulus, intervening and response to variables by different researchers. As a stimulus variable stress is a precipitator; as an intervening variable, a mediator; and as a response variable, a behavior.” There are many factors which can cause stress for an athlete. There are two ways these are demonstrated, the stress model and the stress response process. See the diagrams below.
Stress Model, Graham-Jones & Hardy (1990)
The stress model demonstrates what factors affect stress in sport. Stress can affect performance, the way an athlete responds to the stress can affect it, and the management of the stress can negatively or positively affect the athlete’s stress level.
The stress response process (shown below) consists of five stages. Stage 1 is the environmental demand; stage 2 is the athlete’s perception of the environmental demand; stage 3 is the stress response to the environmental demand; stage 4 is the behavioral consequences of the stress response to the behavioral demand; stage 5 is the return to a homeostatic position.
Stress Response Process, Reilly & Williams, 2003
Stress is a factor of life that affects everyone, but athletes tend to suffer from it more than non-athletes, due to the amount they are required to balance, between schoolwork, practices and games, as well as family pressures and everyday life.
The study of stress in sport lies within the realm of sport psychology. There are many disorders which are related to stress. Typically an athlete is diagnosed with general stress disorder, but there are more specific stress disorders as well. These disorders include, but are not limited to, obsessive-compulsive disorder (OCD), depression, and post-traumatic stress disorder (PTSD). Stress can be manifested in people with OCD because the person will become so obsessed with their traditions, whether it is the number of times they must turn a light off, or clean their hands, if the person does not do it the correct number they will because stressed and will consume their thoughts until they go and correct it.
Depression can cause a person to become stress, and stress can cause depression because a person will become preoccupied with what is stressing them out, and will begin to focus only on that and soon not find pleasure in their normal everyday activities which will end up like a snowball effect and continue to get worse, unless they get help. Post-traumatic stress disorder is not usually a disorder that affects athletes but sometimes it may, especially after a traumatic car accident, or serious injury. PTSD is a very serious condition that can lead to further problems such as suicide. This is a condition not to be taken lightly and if the athlete is showing any signs of PTSD, they should be referred to a counseling center in order to get proper treatment.
There are many different stress disorders, many which need specialized treatment. At any time an athletic trainer feels like the athlete’s stress level is becoming too high and unmanageable then the athlete needs to set up with a counseling center so they can get proper help, and tools to help lower their stress level.
Signs and Symptoms
There are many signs and symptoms of stress, and everyone is different, so one sign or symptom described by one athlete may not be what another athlete experiences. Ray and Weise-Bjornstal (1999) described seven categories in which an athlete may experience stress. These categories are: affective, behavioral, biological/physiological, cognitive, imaginal, interpersonal, and sensory (Ray and Weise-Bjornstal, 260). Each category has its own signs and symptoms. Affective signs and symptoms include: anxiety, anger, guilt, depression, shame and feeling sorry for oneself. Behavioral signs and symptoms include: sleeping disturbances, restlessness, aggressive behavior, alcohol or drug abuse, sulking, crying, poor performance, absenteeism, and clenched fists. Biological or physiological signs and symptoms include muscle tension, increased heart rate, indigestion, stomach spasms, pain and headaches.
Cognitive signs and symptoms are frustration, worries, distortion, exaggeration, unrealistic performance expectations, self-defecting statements and self handicapping. The imaginal signs and symptoms include images of failure, images of reinjury, flashbacks of being injured, images of helplessness, and images of embarrassment. The interpersonal signs and symptoms include withdrawal, manipulation and argumentation. The last category, sensory, includes tension, nausea, cold sweat, clammy hands, pain and butterflies in the stomach (Ray and Weise-Bjornstal, 260). There are many signs and symptoms of stress, which are not all experienced by each person, and each person can experience a variety of signs and symptoms.
There are many ways an athlete can respond to stress. Many times athletes do not handle stress properly, nor do they know how to, so they must seek outside help in order to deal with it. Healthy ways for athletes to deal with stress are to engage in pleasurable activities, take care of their body, maintain a positive perspective, laugh, practice relaxation techniques, talk to others, and get help from a professional. Many athletes do not know how to handle their stress and usually need help when it comes to dealing with the stress. Due to this fact many times the athletic trainer or coach is the first person the athlete turns to when they are stressed out. The coach and athletic trainer both need to know the available resources and know the proper steps to go to in order to get the athlete the proper help they need.
Related Health Problems
There are many health problems related to high levels of stress. These include, but are not limited to, irritable bowel syndrome, diabetes, skin disorders, such as hives, ulcers, respiratory conditions, and sexual dysfunction. These conditions do not occur over night and tend to occur over an extended amount of time. Once an athlete develops one of these other conditions the athletic trainer and health care providers need to sit down with the athlete and try to figure out the cause of the condition. They need to keep in mind that stress could be the underlying cause and suggest ways for the athlete to help deal with their stress. The athlete may need to also adjust their eating habits as well as make other lifestyle changes to help manage their stress and health problems.
What is Anxiety?
As defined above anxiety is “the emotional or cognitive dimension of physiological arousal” (Ray and Weise-Bjornstal, 258). Hann (2000) stated “of all the psychological factors thought to influence sport performance, anxiety is often considered the most important,” which explains why so much research has concentrated on stress and anxiety in athletes. The two types of anxiety studied are state and trait anxiety. State anxiety has been said to be the “anxiety intensity at a given time,” where as trait anxiety is said to be “an individual’s general tendency to experience elevations in state anxiety when exposed to stressors” (Hann, 2000). Hanin proposed that “each athlete possesses an optimal zone or range of anxiety most beneficial for performance” (Hann, 2000). This optimal zone is different for each athlete and is known as their Zones of Optimal Functions (ZOF). Research has shown that “some individuals can tolerate a wide range of anxiety intensity before experiencing a decline in performance, whereas others perform best only when anxiety lies within a very narrow range” (Hann, 2000). Research has shown that too much anxiety can negatively affect an athlete’s sport performance, but if the amount of anxiety is within the athletes ZOF then the results will be positive.
There are a variety of anxiety disorders, each with their own signs and symptoms, even though many of the signs and symptoms overlap, each athlete may experience different signs and symptoms and will not experience all of them. The following are some of the more common types of anxiety disorders: panic disorder, agoraphobia, generalized or specific social anxiety disorder, adjustment disorders and depression. These are not all of the anxiety disorders, but are the more common ones an athletic trainer may have an athlete experiencing.
Signs and Symptoms
There are many different signs and symptoms that signify anxiety. Some of these signs and symptoms include raging heartbeat, difficulty breathing, paralyzing terror, nervousness, shaking, stress, heart palpitations, dizziness, lightheadedness, nausea, trembling, sweating, shaking, choking, chest pains, distress, fear, fright, hot flashes or sudden chills, and tingling sensations in the fingers and toes. Many of these symptoms can be debilitating for the athletes experiencing them. Once these symptoms get out of the athlete’s zone of optimal functioning they will not be able to participate to their maximum ability.
There are many ways an athlete can respond to anxiety as well. Many times athletes do not handle stress or anxiety properly, nor do they know how to, so they must seek outside help in order to deal with it. Healthy ways for athletes to deal with anxiety are to learn specific ways that help them to relax and get comfortable in the situation that is causing them to be anxious. These can include, but are not limited to, engaging in pleasurable activities, take care of their body, maintaining a positive perspective, laughing, practicing relaxation techniques, talking to others, and getting help from a professional. Many athletes do not know how to handle their stress and anxiety and usually need help when it comes to dealing with these issues. An athletic trainer needs to be aware of the resources available for their athletes so they are able to properly help their athlete when they are suffering from stress and anxiety.
Related to Health Problems
Untreated anxiety can cause a variety of health problems for the athlete. These can include, but are not limited to: depression, ulcers, sexual dysfunction, inner conflict which can lead to illness, run down immune system which can contribute to more illnesses, inability to live a normal life, and obsessive-compulsive disorder. These conditions to do appear over night, but come on after many months or years of an athlete experience extreme amounts of anxiety. Many athletes do not know who to get help from when their anxiety becomes too much for them to handle. When this happens the athletic trainer needs to step in and supply the athlete with resources that can help the athlete, whether it is to see a specialist or learn to use one of the coping mechanisms below.
Coping Mechanisms of Both Stress and Anxiety
There are a variety of coping mechanisms available for athletes who may be suffering from stress or anxiety. Each athlete needs to figure out which one works best for them, and that may take them a while as they need to try out each mechanism for a while to see if it works for them. There are many methods available including “hypnosis, progressive relaxation, visualization, biofeedback, autogenic training, mediation, negative thought stoppage, and confidence enhancement” (Hann, 2000). Reilly and Williams (2003) stated seven different demand categories in which an athlete may need to alter in order to lower their levels of stress and anxiety, these categories include: “physical demands, psychological demands, environmental demands, expectations and pressure, relationship issues, life direction concerns and uncategorized stress sources.” In each category Reilly and Williams listed a variety of coping mechanisms the athlete can use to help limit stress and anxiety in that category. For physical demands they suggest, “rational thinking, pre-competition mental preparation, changing to healthy acting attitudes and behavior, and training hard and smart.” For psychological demands they suggested using “pre-competition mental preparation, management, positive focus and orientation, and training hard and smart.”
Environmental demands did not have many coping mechanisms they but Reilly and Williams suggests “time management and prioritization, as well as isolation from the stressor and deflection.” Ways for the athletes to deal with the stress from high expectations and pressure to perform at their highest standard include “positive focus and orientation, training hard and smart, rational thinking, positive self talk, social support, pre-contemplation mental preparation and anxiety management.” The athlete has many relationships with other people which can add to their stress level, to combat these the athlete should try “positive focus and orientation, social support, striving for a positive working relationship, isolation and deflection, as well as rational thinking and positive self-talk.” Life direction concerns affect everyone, not just athletes. Ways to help deal with life direction concerns include “time management and prioritization, rational thinking and positive self-talk.”
Uncategorized stress sources can be dealt with through “reactive behaviors, social support, isolation and deflection” (Reilly and Williams, 2003). Above are a variety of techniques an athlete can use to help lower their stress and anxiety levels for a variety of stressors. Graham-Jones and Hardy suggest “self-regulation training which helps cope with stress and enhancing the likelihood of peak performance” (1990). Graham-Jones and Hardy also suggest using “goal setting, imagery, and attentional control,” (1990), in order to properly manage stress and anxiety disorders. There are a variety of methods available for athletes to use in order to help reduce their stress and anxiety. Many times it is a case of trial and error in order for the athlete to find what works best for him or her.
How Stress and Anxiety Affect Athletes
There are many factors which can cause an athlete to experience stress or anxiety. The factors which can increase stress and anxiety are: physical demands, psychological demands, environmental demands, expectations and pressure to perform to a high standard, significant other stressors, relationship issues and life direction concerns (Reilly and Williams, 2003). There are four proposed main reasons for competitive stress response before competition which include:
1. “Assumption that the athlete’s mental set prior to competitive can affect subsequent performance.
2. Assumption that the athlete has some control over his or her mental preparation during the pre-contemplation period.
3. At a practical level, this period is much more accessible to researchers than the period of competition itself.
4. If pre-competition anxiety is a negative source of performance variance than the clinician can assist in developing an appropriate pre-competition state.” (Graham-Jones and Hardy, 1990).
Research has shown that “intercollegiate athletes experience greater psychopathology. Examples include: more problems with alcohol, and are at a greater risk for eating disorders symptomatology” (Storch, et al, 2006). Storch, et al, (2006) also found that “female athletes reported higher levels of depressive symptoms, social anxiety, and non-support than male athletes and male/female non-athletes.” These factors all tie into the athlete and their performance, which can lead to the performance issues discussed below.
Athletes who suffer from stress and anxiety and do not learn to control their symptoms will soon have issues that will cross over into their performance. Hann (2000) found “sports psychologist have long believed that high levels of anxiety during competition are harmful, worsening performance and even leading to dropout.” Dropout is a bad result for athletes to have due to poorly managed stress and anxiety, but Hann also found “another widely accepted assumption is that all positive emotions facilitate sport performance” (2000), which has actually been proven to not be true. Performance is especially affected when an athlete has suffered an injury and is stress and anxious about their return to their sport. Mann, et al found “the psychological issues related to injury most frequently discussed with patient-athletes were fears about reinjury, fears about surgery, unwillingness to be patient with recovery and rehabilitation, avoidance of rehabilitation or sports-related activities and concerns that the consequences of the injury will disappoint others” (2007).
Storch, et al, (2006) found a “particularly problematic issue is that athletes greatly underutilize school counseling and mental health services.” Many athletes report a “need for counseling regarding time management, stress, burnout, and fear of failure, anxiety, depression and performance related issues” (Storch, et al, 2006). There are many ways that stress and anxiety negatively affects sports performance, which the athlete needs to consider in order to get help.
Results if Poorly Managed
There are a few results that athletic trainers never want to have happen to their athletes if they are overstressed or anxious which includes overload, burnout, dropout, and maladaptive fatigue syndrome. Hackfort and Spielberger (1989) found that burnout results from “high or conflicting demands, that results in overload, low social support, low autonomy, low rewards, low demands which leads to boredom.” Overload and burnout are common among athletes especially at the higher levels of sports, such as collegiate athletes. “Elite athletes have dropped out of sports at the peak of their careers maintaining that they are ‘burned out’ and that participation has become too aversive for them to continue” (Hackfort and Spielberger, 1989).
Maladaptive fatigue syndrome occurs when the athlete does not get help to control their stress or anxiety and the symptoms do not go away and the athlete constantly suffers from the symptoms. Hann (2000) defined the “emotions of adaptive and maladaptive fatigue syndrome to include: anger, hostility, anxiety, confusion, depression, sadness, lack of vigor and apathy.” Once an athlete begins showing signs of maladaptive fatigue syndrome the athlete needs to seriously consider quitting their sport and getting professional help. Some athletes with maladaptive fatigue syndrome need to be admitted to a psychotherapy facility in order to receive the best treatment.
Burnout, overload, dropout and maladaptive fatigue syndrome are conditions that an athletic trainer does not want their athletes to experience. The athletic trainer should supply resources for the athlete before their condition gets to this level, even if it is to just send them to the counseling center on campus.
Summary and Conclusions
Stress and anxiety affect everyone daily, but research has found that many athletes struggle with these conditions more than the rest of the population. “Despite the well-documented benefits from exercise and sports participation on mental health, some athletes will at times experience psychological, emotional, and behavioral problems” (Mann, et al, 2007). “Many factors which can influence the performer’s psychological state and so alter it from the optimum required for their performance” (Graham-Jones and Hardy, 1990). Many athletes struggle to handle the stress and anxiety that comes along with a full class load, the demands of their sport, as well as the pressures of their family and friends. Athletic trainers need to be sure they help their athletes utilize the counseling center, and other techniques to help limit their stress and anxiety.
As an athletic trainer with several athletes who have suffered from various types of stress and anxiety I have learned a lot from this research, which will help me help my athletes to the best of my ability. I also learned that when I cannot handle the athlete’s situation I need to refer the athlete to our counseling center on campus. I have not made use of our counseling center previously because our counseling center is only open a couple of days a week, for the entire campus. Overall this paper helped me learn more specifics about stress and anxiety and a variety of ways I can help my athletes cope with their stress and anxiety.
Graham-Jones, J. & Hardy, L. (1990). Stress and performance in sport. New York, New York: John Wiley & Sons.
Hackford, D., & Spielberger, C.D. (1989). Anxiety in sports: An international perspective. New York, New York: Hemisphere Publishing Corporation.
Hann, Y.L. (2000). Emotions in sports. Champaign, Illinois: Human Kinetics.
Hatzigeorgiadis, A., & Biddle, S.J.H. (2008). Negative self-talk during sport performance:
Relationships with pre-competition anxiety and goal-performance discrepancies; Report. Journal of Sport Behavior, 31:3, 237-254.
Kerr, J.H. (1997). Motivation and emotion in sport: Reversal theory. East Sussex, UK: Psychology Press Ltd.
Mann, B.J., Grana, W.A., Indelicato, P.A., O’Neill, D.F., & George, S.Z. (2007). A survey of sports medicine professionals regarding psychological issues in patient-athletes. American Journal of Sports Medicine, 35:12, 2140-2147.
Martens, R., Vealey, R.S., & Burton, D. (1990). Competitive anxiety in sport. Champaign, Illinois: Human Kinetics Books.
Ray, R., Wiese-Bjornstal, D.M (1999). Counseling in Sports Medicine. Champaign, Illinois: Human Kinetics Books.
Reilly, T., & Williams, A.M. (2003). Science and soccer. New York, New York: Routledge (Tyler & Francis Group).
Storch, E.A., Storch, J.B., Killiany, E.M., & Roberti, J.W. (2006). Self-reported psychopathy in athletes: A comparison of intercollegiate student-athletes and non-athletes. Journal of Sport Behavior, 28:1, 86-98.