Psychosocial Strategies with Injured Athletes - Research Paper Example

Psychosocial Strategies with Injured Athletes Introduction Athletes often encounter various injuries during their sports activities. Some of these injuries may be simple and may be easily dealt with, like muscle cramps. However, some of them may turn out to be major injuries, like fractures. For many of these athletes, their goal during these injuries is to quickly recover and to be competitive again. Health care professionals who are assigned to help these athletes recover have to consider various theories and strategies. Psychosocial strategies are some of these strategies which are often considered in order to determine how to deal with said injuries. These strategies have various levels of applicability and effectiveness based on the patient’s case and on the patient’s injuries. This paper shall draw on relevant research literature, underpinned by Wiese-Bjornstal, et.al. (1998) model of response in order to critically discuss how two psychosocial strategies can be used to help injured athletes expedite their recovery and return to their sport. It shall define the key points and terms which would be used in this paper. It shall outline the Wiese-Bjornstal, et.al., model and critically discuss psychosocial strategies. It shall also use evidence of theory and practice relationship. Discussion Wiese-Bjornstal model This model is basically an extension of the Andersen and Williams’ antecedents-to-injury model (Horn, 2008, p. 413). The Wiese-Bjornstal model (Wiese-Bjornstal, 1998, p. 46) basically sets forth that the same antecedents which might bring about an injury may also be the very same factors which may affect postinjury adjustment. They emphasize that various personal factors like personality, development level, and injury level; and situational factors like time, season, sport ethos, and available social support affect the way athletes take in and contemplate their injuries (Horn, 2008, p. 413). How athletes would contemplate their injuries also affects their behavioural and emotional responses to recovery (Horn, 2008, p. 413). The Wiese-Bjornstal model is also recursive. In other words, “it captures the dynamic nature of injury responses and rehabilitation” (Horn, 2008, p. 413). In this case, if an athlete suffers a setback during the rehabilitative process, he may then reassess the injuries in terms of their severity and their consequences (Horn, 2008, p. 413). Previous cognitive models did not include the assessment of severity and its consequences. This is the advantage of the Wiese-Bjornstal model as it provides a more comprehensive approach which “allows stage and cognitive appraisal models to be viewed as complementary rather than competing approaches” (Horn, 2008, p. 413). The Wiese-Bjornstal model is more advantageous than other traditional models because it has gone through the process of empirical testing. It is also a model which is specific to sports injuries, taking into consideration the factors which are associated with injuries encountered by athletes (Horn, 2008, p. 413). It often assesses the impact of social factors and social relationships within the athletic community which may prompt athletes to keep competing even after injuries. Frontera (2003) also demonstrates how the Wiese-Bjornstal model can be applied to injured athletes undergoing rehabilitation. For example, the cognitive response of athlete to injury may be one of doubt and of the negative outcomes of the injury. In this instance, a negative emotional response is likely to result from the injury and the rehabilitative process (Frontera, 2003, p. 161). If, on the other hand, the response of the athlete is more positive, then a more positive emotional response to the injury and rehabilitative process may ensue (Frontera, 2003, p. 161). The Wiese-Bjornstal model is also an appropriate model for athletes during sports injuries because they provide guidance for interventions which help improve rehabilitative outcomes. Moreover, the situational and personal factors are open to modifications (Frontera, 2003, p. 161). It is a flexible model which is geared towards improving the social support system in sports. Psychosocial strategies Psychosocial strategies are strategies which consider both the psychological and the social factors or aspects of the athlete in order to appropriately determine interventions and rehabilitative approaches. Two of such strategies discussed in this paper shall cover the mental-skill strategies and systematic desensitization. Mental-skill strategies Mental skill strategies are those which help athletes cope with the stress and the different challenges which they are bound to encounter while competing and while they are injured. Coping is part of mental skills strategies and it has been defined as the “cognitive and behavioural efforts to master, reduce, or tolerate demands” (Ray & Wiese-Bjornstal, 1999, p. 43). Based on a preventive aspect, coping includes activities or applied interventions like avoiding stress by making life adjustments, decreasing demand levels and developing coping capabilities (Brewer, as cited by Singer, et.al., 2001). These resources demand different behaviours and social networks which help an individual cope with the disappointing and joyful moments of life (Ray & Wiese-Bjornstal, 1999, p. 43). Coping also includes general coping behaviours, stress management, and mental skills (Ray & Wiese-Bjornstal, 1999, p. 43). Sports medicine experts can help when the coping mechanisms of athletes are inadequate. They can help point out coping strategies like talking with friends and family and keeping a journal in order to surround athletes with a strong support system and to also help relieve their stress. By also teaching athletes on how to deal with their daily challenges and activities, these athletes can turn their daily activities into non-stressful events and restructure their activities into more relaxing endeavours (Singer, et.al., 2001). A paper by Blanco, et.al., (1999, p. 157) sought to evaluate the psychological processes seen in injuries and illnesses among elite skiers. The analysis of the respondents’ answers reveal that the sports injuries covered three different phases: the injury-illness phase, the rehabilitation-recovery phase, and the return to full activity phase (Blanco, et.al., 1999, p. 157). Each of the different stages was also noted with different events which caused skiers different levels of stress. The study was able to establish that there is a relationship between a person’s injuries and a person’s return to full recovery (Blanco, et.al., 1999, p. 157). The issue of risks taken by the client largely relies on the decisions athletes make about their life A person’s coping mechanisms can also be fortified through his social support system. Social support as explained and illustrated by the Hardy and Crace model (as quoted by Blanco & Eklund, 2001, p. 89) sets forth that social support may be divided into several elements such as emotional support (listening support, emotional comfort, and emotional challenge); information support (reality confrontation, task appreciation, and task challenge); and tangible support (material and personal assistance). These elements demonstrate how multidimensional the process is in meeting multiple goals which can later lead to improved client outcomes (Blanco & Eklund, 2001, p. 89). And in assessing which social support processes to apply in a sport, “it would be best to use measures that are sport-specific and that allow individual relationships to be examined in isolation” (Blanco & Eklund, 2001, p. 89). Each client is after all different. What may work for one may not actually work for another. Therefore, it is best to apply social support processes after an analysis and assessment of patient needs have been undertaken by the health professional. In a paper Kennedy, et.al. (2000, p. 157), authors set out to analyse the psychological impact and the coping strategies following spinal cord injury resulting from sports injuries and other incidents. The authors were able to establish that coping is a mediator of emotional reactions and there is a relationship between coping and emotional outcomes (Kennedy, et.al., 2000, p. 157). The paper was conducted as a prospective longitudinal multiple wave panel design and it used repeated and standard measures across nine observational periods from the injury to the community placement (Kennedy, et.al., 2000, p. 157). The paper was able to reveal that 6 weeks after the injury, about 64% variance in depression was seen after the use or non-use of three coping strategies. Coping measures which were gathered 6 weeks after the injury registered 67% of the variance in depression at 1 year post-discharge (Kennedy, et.al., 2000, p. 157). The study concluded that there is a significant relationship between coping and adjustment. With better coping skills and techniques, an injured patient can have a better chance at improving on his chances at recovery and rehabilitation. In a paper by Blanco (2001, p. 376), she set out to assess the social support findings which emerged from a research covering 10 elite downhill skiers who recovered from serious sports injuries. The analysis revealed that the skiers needed different types of emotional, informational, and tangible support from the time the injury occurred until the time they were able to return to full recovery (Blanco, 2001, p. 376). The study also revealed that the athletes were more or less satisfied with the support they were able to receive and that such support reduced their stress levels and it also helped to motivate them during their recovery process (Blanco, 2001, p. 376). Again, in this paper we see the importance of social support in helping the injured athletes cope with their injury and eventually to help them return to full practice. Relaxation techniques are strategies which are also part of the mental-skill strategies. Techniques in this aspect involve control and relaxation of muscles and bodies. This can help bring about a surge of confidence in a person’s body and overall framework. “The ability to consciously relax also enhances the muscles’ capability to recuperate after a physical training session” (Ray & Wiese-Bjornstal, 1999, p. 44). Regular practice can help athletes master relaxation techniques, allowing recovery from stressful workouts and avoiding the dangers that such workouts may bring to the athlete. The use of imagery is also another mental skill strategy which helps relax a person’s mind and facilitate mental conditioning processes. Imagery is also preventive medicine which can often decrease the effect of stressors and thereby reduce the potential for injury (Ray & Wiese-Bjornstal, 1999, p. 44). A study as cited by Murphy (2005, p. 226) mentions how a well controlled study of 30 people undergoing ACL reconstructive surgery were divided into 3 groups: one receiving relaxation techniques alongside physical therapy; another group receiving support and encouragement with the physical therapy; and the last group receiving physical therapy only (Murphy, 2005, p. 226). The study revealed that those who received relaxation alongside their physical therapy had greater knee strength, less pain experience and fewer risks for reinjury during the rehabilitative process (Murphy, 2005, p. 226). Another case also illustrates how skiers who were asked to be patient ended up with a better rehabilitative process as compared to other injured athletes who did not go through a more relaxed rehabilitative process (Murphy, 2005, p. 226). Imagery is also discussed by various authors as an effective assistive tool during rehabilitation from sports injuries. Results from researches reveal that imagery has a curative and soothing effect on a person’s psyche. “By viewing the human being as a package that contains a constant interchange between mental and physiological functions, one recognizes the interdependence of one’s actions” (Sheikh & Corn, 1994, p. 159). There is a mental element involved in the rehabilitative process and such element is strengthened by the bolstering effect of enticing imagery. Studies have even pointed out the contribution of imagery to the immune system and how imagery can improve a person’s capacity for mental imaging; how it helps in the vasoconstriction and vasodilatation; and how it can increase the heart rate (Sheikh & Corn, 1994, p. 159). Other studies also point out how imagery can produce biological responses like salivation, increase in papillary size, increase in heart rate, increase in blood glucose, and changes in skin temperature (Sheikh & Corn, 1994, p. 159). The effect of mental imagery on a person who is going through the physical rehabilitative process is vital to the recovery of the patient. These images entice an improved well-being which then translates to better patient outcomes. Positive self-talk and stopping negative thoughts as tools of rehabilitation in instances of sports injuries are theorized as relevant signs which can help settle anxiety and useless thoughts. Studies reveal that athletes who often react negatively to stress cannot properly make the necessary mental and physical adjustments (Ray & Wiese-Bjornstal, 1999, p. 44). The process of replacing negative thoughts with positive ones is a difficult and often challenging process because understandably when athletes are in pain and are sidelined by their injury, they have trouble coming up with positive thoughts. But the process of positive self-talk is nevertheless a strong means of encouragement for sports athletes. It is important to note that “the preponderance of research supports the hypothesis that positive self-talk creates better or “no worse” performance” (McKeag, et.al., 2007, p. 599). Negative self-talk often makes the athlete tenser and more frustrated. Theorists and practitioners point out that an athlete who adopts more positive self-talk will be calmer, more relaxed, and centred (McKeag, et.al., 2007, p. 599). A paper by Evans, et.al. (2006, p. 22) is keen in pointing out that although there is sufficient support for imagery and self-talk in sport psychology literature, there is decreased support for these processes in the rehabilitative stage. The authors point out that there are limited studies which help support the fact that self-talk and imagery can help a person during the rehabilitative process. The lack of studies weakens the rationalization process involved in recovery process (Evans, et.al., 2006, p. 22). Nevertheless, it is still important to note that self-talk and imagery work well during the coping process of an injury and in the process of competing as an athlete. It serves many athletes well and many of them have adopted this technique in most aspects of their lives. It is therefore, not too incomprehensible to consider it as an effective tool during the rehabilitative process. Systematic desensitization Systematic desensitization consists of a combination between the training of injured athletes and relaxation and imagery in order to cope with the feelings of anxiety created by the injury and the rehabilitative process (Ray & Wiese-Bjornstal, 1999, p. 48). This strategy is a lengthy and gradual process for the athlete as he goes through his emotions, as he explores said emotions and their impact on his person. Authors point out that in starting this process, it is important to achieve a state of relaxation. This stage has to be mastered before proceeding to the next stage of the desensitization process (Ray & Wiese-Bjornstal, 1999, p. 48). When the athlete is not relaxed, he shall now assess each emotion or fear. Each fear is imagined while staying at a calm and collected mental state. Fears may include those of pain, early retirement due to the injuries, or permanent disability. During the re-evaluation of each fear or emotion, a person may feel anxiety (Ray & Wiese-Bjornstal, 1999, p. 48). At this point, the athlete would continue to feel each and every emotion until the feelings of fear or anxiety fade away or disappear. This process is repeated, until the entire athlete’s fears are overcome and forgotten. After this process is mastered by the patient, he is now ready to consider a more positive outlook about his injuries and about the rehabilitative process (Ray & Wiese-Bjornstal, 1999, p. 48). When the outlook of the patient is now based on a more enlightened and positive view of the future and of his injuries, his fears and anxious thoughts are dealt with appropriately or, in effect, are systematically desensitized. The counter conditioning model, as discussed by Singh (2008, p. 247) is the basis for systematic desensitization. “Specifically, if stimuli that elicit anxiety are paired with a response that neurologically inhibits fear, those stimuli lose anxiety-arousing capacity” (Singh, 2008, p. 247). There is a corresponding reaction made by the system in order to counter the fears and anxiety felt by the injured client. Anxiety-antagonistic responses may be applied; however relaxation is mostly used in order to teach clients to conquer various fears. Studies point out how progressive relaxation training is often applied, however other techniques such as biofeedback and autogenic relaxation may also be applied (Singh, 2008, p. 247). It is also important to note that the process of desensitization often starts from the least of the client’s fears. As the client learns to conquer each fear, he moves on to a higher fear, until he gets to finally confront the thing he fears the most (Singh, 2008, p. 247). Experts point out that this process of desensitization should be administered by an expert. When the client shows signs of distress or uncontrollable anxiety, then the process should be stopped. The process would then again return to the relaxation stage. The client is then again exposed to his fear. The process is repeated until the relaxed state of the client is more dominant over his fears (Singh, 2008, p. 247). A paper by Wilson, et.al. (2006, p. 80) set out to evaluate Italia Soccer Training and how biofeedback and neurofeedback can be used as tools in order to maximize a person’s performance. The paper discussed that systematic desensitization comes after a relaxed state is achieved. In most instances, an injured athlete will be prompted to visualize himself in the playing field (Wilson, et.al., 2006, p. 80). He also watches videos of his past performances. In cases where there is a tense biological response to a certain incident as seen or as imagined by the athlete, then the athlete would again be guided towards a relaxed state. The desensitization process is often continued until the athlete can see himself and view the incident and the rehabilitative process with less anxiety and less fear (Wilson, 2006, p. 80). For the injured athlete, the desensitization process involves the process of slowly and gradually stripping away a person’s inner defences in order to reveal a more open and less fearful athlete. The fear of being injured again and of having to physically go through the risks of injury in the field may put off an athlete into working hard during the rehabilitative process. Through the systematic desensitization process, the athlete can slowly face his fears and be more cooperative during his rehabilitative activities. He may even learn to anticipate getting back to his sport and playing again knowing that there are still risks involved. Wagman & Khelifa, (1996, p. 260) discussed how systematic desensitization is a crucial element in the resolution of psychological issues in sport injury rehabilitation. The paper assessed specific guidelines which can be followed when sizing up athletes and counselling them on their activities. When applying specific guidelines it is possible for the trainer to establish trust and rapport; become familiar with the athlete’s injury; and to get the athlete to commit to the treatment (Wagman & Khelifa, 1996, p. 257). The study admitted that, more often than not, athletes are treated for their injuries without proper attention given to their psychological needs. The paper then went on to demonstrate that interventions during the rehabilitative period can help eventually achieve a more relaxed and effective recovery for the patient. The interventions include cognitive restructuring, rational emotive therapy, systematic desensitization, panic mitigation, coping rehearsal, career adjustment technique, confidence training, positive self-talk, thought stoppage, relaxation skills, imagery, motivation, and concentration skills (Wagman & Khelifa, 1996, p. 260). Systematic desensitization as discussed by Wagman and Khelifa also emphasizes how important it is for the athlete to gradually adjust his thinking in order to overcome his fears. Conclusion Athletes encounter injuries at many points in their life. Most of these injuries are often very likely to temporarily cripple or bench them. In the process of recovery, various psychosocial strategies may be applied in order to speed up their recovery process. The Wiese-Bjornstal model is a crucial model to consider during sports injuries. The Wiese-Bjornstal model basically states that factors which may bring on an incident may be the very same factors which would affect a person’s recovery. Therefore in considering the psychosocial strategies which may be applied in the process of recovery, the mental-skills strategies and the systematic desensitization were considered for this paper. Mental skills strategies include coping skills, social support skills, relaxation, imagery, and positive self talk. These mental skills strategies all serve to fortify a person’s emotional and psychological well-being, ensuring that the client views his injuries in a more positive light and thereby secure a more positive outcome. Systematic desensitization is about helping the patient gradually overcome his fears and later to have a clearer and less fearful view of his return to full activity. Through clear and effective processes, it may be possible to achieve encouraging client recovery. 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