A guide for understanding Mental Health and Thriving in elite sport
The Olympic Games. A prestigious event in the sporting world that occurs every 4 years. It is logical to propose that every athlete in competitive sport dreams of one day participating. Those who are Olympians hold themselves to extreme standards, but at what cost? Striving to compete among the best in the world can be considered a “double-edged sword”. On one hand, athletes may receive recognition for all the hard work through public praise and winning medals on the global stage. On the other hand, nobody sees the dedication behind closed doors of reaching that point and the potential debilitative implications on their health.
Athletes have started to give voice that they do not receive the same support for mental health, as they do physical health. Alexi Pappas was diagnosed with clinical depression after the Rio 2016 Olympics and described the disorder in her documentary like having a “scratch on the brain”. There is a vast support network to rehabilitate and recover for a physical injury, such as a hamstring strain, yet there is a lack of availability of sport psychologists and psychiatrists to deal with mental health issues in elite athletes. Her comment (shown below) exemplifies the need for change in the perception of mental health in elite athletes. Michael Phelps is known in the realms of sport to be the greatest Olympian of all-time, yet he was suffering in silence as illustrated from his quote below. We put high achievers such as Olympians on a pedestal, but the question we should be asking ourselves is: are these athletes merely surviving or thriving?
“What if we looked at mental health the same way we do physical health?”ALEXI PAPPAS – RIO 2016 OLYMPIAN
“I didn’t want to be alive anymore”MICHAEL PHELPS – SWIMMER, MOST DECORATED OLYMPIAN OF ALL TIME
After reading this blog you should be able to
- Understand the prevalence and importance of mental health in elite sport.
- Understand the construct of “thriving” and its relevance in the sporting context.
- How to facilitate thriving for optimal performance and functioning.
What does the research tell us about mental health in elite sport?
Elite athletes experience a unique range of stressors that increase their susceptibility to mental ill-health. In the last decade, systematic reviews have reported that up to 34% of current elite athletes are likely to have experienced symptoms of anxiety and depression (3). This can be considered the darker side to sport. The elite sports culture, with its heavy training demands and constant drive to improve performance, only serve to heighten the risk to mental ill-being.
Below are factors within high level sport that compromises mental well-being (11):
- Maladaptive perfectionism
- Low social support
One key factor that is prominently discussed is the stigma surrounding mental health in sport (7). Stigma is the most reported factor preventing elite athletes with mental health issues from seeking help, in the belief that mental ill-health is a sign of weakness (11). Often it is only when going through the process of athletic retirement that athletes pull pieces of a puzzle together and gain a perspective that they were not functioning to a healthy level. While they were performing, they may experience denial about any signs of mental health problems they had, possibly because they are blinded by their strong desire to succeed and perception of weakness. Despite the advancement of knowledge and understanding of mental illness in athletes, there is still the weight of feeling like a burden of disclosing how we are really feeling. Improving the mental health literacy of key stakeholders and governing bodies in elite sport could be a vital step to improving the mental well-being of elite athletes (4).
Due to these factors and prevalence of mental ill-being in high achievers, there has been an increased need to develop a comprehensive framework that provides support to these athletes as an early intervention (see 9).
What do I mean by “Thriving”?
As well as the highs, all athletes also have lows throughout their athletics career, whether it is through sustaining an injury or hitting a plateau in performance, these experiences help contribute to their maturation and growth. Thriving is the dual experience of both development and success that encapsulates both the individual’s physical and mental health (1). Development is the progressive improvement in an individual’s psychological, physical and social domains in life. For example, an athlete could be refining a technical skill to utilise in the next competition or developing psychological skills, such as imagery. Success relates to the quality of the execution of an action where the individual fulfils personal achievement, that is mastery focused or self-referenced. For example, a 400m Hurdler may have the goal to make the Olympic final or achieve a personal best during the competition.
Thriving is a global construct that impacts all domains of an individual’s life. When athletes are thriving, they are experiencing holistic functioning (2). To fulfil this, an elite athlete must have high levels of perceived well-being and performance (Figure 1). Where this is achieved it satisfies the dual criterion of development and success, thus leading to sustained thriving.
Due to the subjectivity of thriving an athlete may perceive their well-being to be functioning, but this may not be the case. For individuals who are competing to the highest level and achieving success, this may not be a reflection of how they feel on the inside. For example, referring back to Michael Phelps, he fulfilled the criteria for high performance due to the plethora of medals obtained during his swimming career, however his state of mental health was compromised. Subsequently, his well-being could be considered to be a negative spotlight and Phelps was merely surviving as an athlete. Alternatively, an athlete could be experiencing high-levels of well-being, but perceive to have low levels of performance, whereby there is a block in sport specific skills and overall task execution (13).
I have proposed a 2×2 model (Figure 2) to outline the content mentioned in this section.
How can we influence thriving for athletic performance?
There are two factors that influence thriving: Personal and Contextual Enablers (1)
Sustained development from these factors facilitates thriving through two potential processes. Firstly, enablers should satisfy the 3 basic psychological needs: autonomy, competence and relatedness. Needs satisfaction in sport psychology research has many positive attributes, such as enhancing optimal functioning, well-being (i.e. vitality) and act as a catalyst for autonomous motivation (12). Secondly, enablers should elicit a challenge appraisal. Athletes who are striving to be the best will encounter multiple ranges of stressors in their careers. Cognitively appraising a stressor as a challenge (fostering of task engagement and create an opportunity for a positive change), is more desirable than perceiving a stressor to be a threat (fosters avoidance behaviours) (6). When athletes adopt a challenge appraisal this is considered to be a prerequisite for thriving.
There is no fundamental reason why the listed enablers should be constrained to the realms of sport and are applicable in other domains of life, for example for performance in the workplace environment.
I have provided two strategies for each enabler of how athletes, coaches or significant others can facilitate thriving.
Personal enablers are characterised by attitudes, cognitions, and behaviours of an individual.
- Develop a positive perspective
Whilst it may sometimes be easier to focus on the short comings and negative aspects of situations, this will not lead to sustained thriving. A positive outlook on events is where an athlete has high levels of self-efficacy, is optimistic, can maintain task engagement, is honest of their values and can cope when threatened with adversity or stressors. Possessing these key qualities is essential to facilitate thriving as the athlete is hopeful for future expectations.
One strategy to enhance such qualities is through positive self-talk. These are statements spoken solely to the athletes themselves which can bolster encouragement and self-assurance. This is a psychological skill whereby athletes can make the most of a potentially bad situation and view themselves in a positive light.
Positive self-talk should (14):
✓Improve confidence, concentration and performance
✓ Be embedded into the daily routine of the athlete
Figure 3 is an example of the differences between positive and negative self-talk after a poor swimming race
- Become more proactive
Those who are considered the highest of achievers, i.e., Olympians, are thought to have strong desire to seek out new challenges. Being proactive means decision making should be more purposeful and appropriate to their overall accomplishments, in turn helping them thrive. One way that an athlete can become more proactive and sustain continued development is through Goal Setting. An athlete could be deprived in well-being due to an injury being a perceived barrier to pursuing their targets. Setting goals is a useful way of accepting the situation you are in and developing a way of moving on for a more positive future. The SMART acronym is a well known format for helping athletes structure and asses these goals (5). Goals can be short- or long-term.
For example, a long-term goal could be making it to the next Olympics and could be structured in the following way:
S – SPECIFIC: “I want to qualify and compete in the Paris 2024 Olympics”.
M – MEASURABLE: Assess performances throughout the season and world rankings.
A – ACHIEVEABLE: “Last season I was x seconds away from the Olympic A standard”.
R – RELEVANT: Aspiration of being the best in the world, whilst still young and healthy.
T – TIME-BOUND: Utilise the next four-year Olympic Cycle to develop as an athlete to achieve this.
Contextual Enablers are characterised by climates which can encourage task engagement, leading to thriving.
- Create a challenge environment
Athletes should train and develop in circumstances that provide a suitable balance of challenge and difficulty (1). If an environment contains high levels of hinderance stressors, for example coaches eliciting need thwarting behaviours and tasks are perceived to be too difficult for the athlete, this is debilitative to task engagement and undermines thriving.
We want to promote a training environment whereby athletes are task-oriented, this is where athletes master skills and feel competent. Coaches can foster this through making sure they are promoting task-oriented (mastery) climates that are need supportive to an athlete’s basic psychological needs (12).
A task-oriented climate should (8):
✓Reduce maladaptive outcomes
✓ Decrease anxiety, stress and burnout
✓Elicit positive responses to situations
✓ Create learning atmospheres where athletes can progress skills
2. Build a support network
Forming relationships allows the athlete to feel comfortable in disclosing personal information on mental health issues, this could be with family members, coaches, physiotherapists, training partners or teammates, nutritionists etc. (10). Social support is the exchange of resources between individuals, where the provider or recipient perceives the action to enhance the recipient’s well-being. Low social support has been identified as a key factor for ill-health, this holds the importance of building close bonded relationships to help athletes thrive (11).
A network that promotes social support can help guide the athlete through goals that need to be accomplished and overcome challenging tasks that may act as a barrier to well-being and success. These people within the athlete’s life act as social agents creating a facilitative environment for thriving in sport (1). The better the quality of these relationships, the better the athlete can develop and succeed.
Research has shown that relational support from an athlete’s family members or partners can help relieve stress caused by pressures of meeting the demands of being an athlete (1). Training schedules and rest periods should be closely examined to see if the athlete is getting enough time to spend with significant others. The coach can provide feedback, in the form of informational support, on performance to promote the athlete’s development and success, this is likely to facilitate athlete’s perception of competence, resulting in thriving (12).
Social support should (14):
✓ Lead to greater performance outcomes
✓ Be provided when requested
✓ Be matched and appropriate to the demands and needs of the athlete
Figure 4 is presented in order to illustrate the key strategies discussed that can help facilitate thriving
Take Home Messages
- 1/3 of elite athlete’s experience symptoms of depression and anxiety, highlighting the importance of support of athlete’s mental health in elite sport and utilising frameworks to intervene early on.
- Thriving is where athletes are holistically functioning and have sustained levels of development and success.
- Thriving is supported through the process of fulfilling athlete’s basic psychological needs and through adopting challenge appraisals
- The athlete, coach and various significant others around the athlete can facilitate thriving through various personal and contextual enablers
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