Psychological Model of Psychological Response to

Athletic Injury and Rehabilitation

Case Studies

• David, 1:46 half-miler and NCAA I All American, is suffering from patellar-femoral syndrome. The coaches recently have been unhappy with his preseason, fall training. He rarely runs with the group and has missed several team meetings. The head track coach has notified David that if he does get involved with training that he will be drop from the track squad and stripped of his full ride scholarship. David is from Kenyan and needs the scholarship to stay in school which will result in him eventually being deported.

• If you were an athletic trainer assigned to treat David, How would you expect Dave to behave?

• How would you address Dave’s injury from the psychological perspective?

• David, 1:46 half-miler and NCAA I All American, is suffering from patellar-femoral syndrome. He is senior and has 3 meets left in the season. The team is favored to win conference and nationals. He is on a full ride at the university. The coaches expect him to run at the conference and national meets. He has the opportunity to represent Kenyan in the upcoming summer Olympics but if unhealthy he will lose his spot to another athlete. – If you were treating Dave what behaviors do you think Dave

would display?– How could you help Dave cope with the injury and still compete?– What would you do if you were Dave?

• Kevin, freshman starting forward in basketball at division III school, went up for rebound and was undercut by a defending player. He landed breaking his fibula in two places. The doctor performed surgery and pinned the fibula in place. Prior the surgery the surgeon informed Kevin that with proper rehab, he would be back playing next year. Kevin has no history of ever being injured prior to this fall.

• If you were an athletic trainer assigned to treat Kevin, How would you expect Kevin to behave?

• How would you address Kevin’s injury from the psychological perspective?

• Is Kevin’s history of not being injured a factor in his recovery?

• Kevin, senior starting forward in basketball at a Division I school, went up for rebound and was undercut by the defending player. He landed severely sprained his right ankle. The team has qualified to play in the NCAA I tourney and they are favored to win the National Championship. The doctor who treated Kevin indicated that playing on the ankle will make it worse. Doctor informed Kevin if he takes time off and rehabs, he should not have any long term problems with the ankle.

• If you were an athletic trainer assigned to treat Kevin, How would you expect Kevin to behave?

• How would you address Kevin’s injury from the psychological perspective?

Cognitive Appraisal Model

Identified 5 components relevant to psychological responses to athletic injury

Based on stress and coping process to athletic injury

Advantage of this model is it accounts for individual differences in response to athletic injury

Ultimate Goal of the Model

• Clinical Model in assessing post injury cognitive and emotional responses for planning appropriate physiological and psychological interventions.

Personal Factors

• Injury– History– Severity– Type– Perceived causes– Recovery status

• Individual Differences– Psychological– Demographic– Physical

Personal Psychological Factors

• Self-esteem

• Neuroticism

• Pessimism

• Anxiety

• Extroversion

• Injury History

• Sense of self

Situational Factors• Sport

– Type– Level of Competition– Time in the season– Scholarship athlete

• Social– Teammate influence– Coach influence– Family influence– Social support

• Environmental– Rehab environment– Accessibility to rehab

Response to Injury

Cognitive appraisal

Emotional Response

Behavioral Response

Recovery

Response to Injury

• The athlete cognitive appraisal of the injury interacts with the personality of athlete and the situational factors surrounding the injury.– Perceived severity– History of Injury– Ability to Cope

Emotional Response

• After cognitive appraisal by athlete about their injury, an emotional response will follow– Perceived as threat the athlete will emotional vent,

become anger,experience high anxiety, denial, disengagement, and depression

– If pessimistic engage in negative self-talk, and self-blame.

– If neurotic engage in loss of self, withdraw, and display changes in their personality.

– If overestimator become irrational about the severity of injury.

Behavioral Response

• After the emotional response the athlete will engage in positive or negative coping responses.– Adopt healthy coping responses physically,

emotionally or psychologically.• Learn new psychological skills and physiological exercise…

use injury as personal growth

– Adopt maladaptive coping responses• Career over, learned helplessness, blame others, use other

as the excuses, non compliance of rehab

Recovery or Delay in Recovery

Length and degree of complete recovery in reentry into the sport is dependent upon:– Severity and type of injury– Athlete’s cognitive appraisal and emotional

response to the injury– Athlete’s coping resources– Interventions both psychologically and

physiological

Psychosocial Role when working with the Injured

– Rehab must be viewed as an educational process

– Psychosocial role is vital• Support, encouragement, and reassurance• Positive communication that includes good

listening skills• Focus is on adherence to rehab through praise,

rewards, and corrective feedback.

Key Psycho-Social Factors

• Help the athlete set performance based goals

• Help the athlete find appropriate motivation strategies

• Provide social support– Athlete needs to maintain their social support

network (coaches, teammates, etc)

Manipulating the Situational Factors

• Flexibility in rehab scheduling

• Communicate with the athlete about the seriousness of the injury

• Provide a rehab center so it accessible, safe, and friendly

• Explain the purpose of each protocol and goals of each rehab session

Situational Factors

• Post injury emotional adjustment is positively related to situational variables

and social support.

Health professional needs to manipulate the situational factors and enhance social support.