Lecture 2 Psychosocial variables involved in injuryillness and rehabilitation'

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Lecture 2 Psychosocial variables involved in
injury/illness and rehabilitation.

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Sport, exercise and physical activity injury

• Psychological antecedents to injury
• Psychological responses to injury
• Psychological factors that influence
  rehabilitation

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Stress and injury

• Cognitive appraisal of situation and resources
• Stress response
• Physiological attentional changes

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Personality

• Internal or external locus of control
• Self-esteem
• Competitive trait anxiety
• Hardiness (3 x Cs)
• Achievement motivation

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History of stressors

• Major life events
• Daily hassles
• Previous injury

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Coping resources

• Social support
• Stress management skills
• General coping behaviours (sleep habits,
  nutrition)

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Psychological factors in prediction and
prevention of sport related injury

• Study 1 470 rugby athletes
• they showed that social support, the type of
  coping, and previous injury interacted to
  maximize the relationship between life stress and
  injury.
• Study 2
• 6 session cognitive behavioural stress
  management intervention with 48 athletes who were
  identified as at risk psychological profile for
  injury. The intervention condition participants
  reported missing less time due to injury compared
  to non-intervention group, an increase in coping
  resources and a decrease in worry.
• (Maddison and Prapevessis, 2005)

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Interventions

• Schomer 1990
• taught marathon runners how to use attentional
  control strategies using associative techniques,
  after the intervention there was less likelihood
  of injury with heavy training.
• Davis 1991
• taught sport skill imagery and progressive
  muscular relaxation for 25 swimmers and an
  American football team, 52 and 33 reduction in
  injuries for swimmers and footballers
  respectively.

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Interventions

• Psychosocial Factors Injury in Dance
• Study 1 Relationship between Stress Injury
• (Noh, Y. E., Morris, T., Andersen, M. B.
  (2005). Psychosocial stress and injuries in
  dance A prospective study. International Journal
  of Sport and Exercise Psychology, 3, 7-25.)
• Life Events Stress, Sport Event Stress
• Coping Strategies
• Social Support
• Prospective Injury frequency and duration

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Interventions

• Psychosocial Factors Injury in Dance
• Study 2 Interviews Stress Coping in Dancers
• (Morris, T., Noh, Young Eun. (2007).
  Research-based Injury Prevention Interventions in
  Sport and Dance. In D. Pargman, (Ed.)
  Psychological Bases of Sport Injuries. (3rd ed.)
  Morgantown, WV Fitness Information Technology)
• Interviews
• Sources of Stress
• Coping Strategies

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Interventions

• Psychosocial Factors Injury in Dance
• Study 3 Intervention to Enhance Coping Skills
• (Noh, Young Eun, Morris, T., Andersen, M.B.
  (2007). Psychological intervention programs for
  reduction of injury in ballet dancers. Research
  in Sports Medicine, 15, 13-32.)
• Interventions Coping Skills vs Autogenic
  Training vs Stretching
• Effect on Coping Skills (Athletic Coping
  Inventory 28)
• Injury frequency duration for 9 months

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Psychological responses to injury

• Cognitive
• Emotional
• Behavioural

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Grief Reaction (Kubler-Ross, 1969)

• Typical ? reactions to injury include
• Denial
• Anger
• Bargaining
• Depression
• Acceptance and reorganization

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Psychological reaction
Normal or expected response e.g. sadness, fear,
anger, optimism, motivation
Abnormal or pathological response e.g. anxiety
disorder, pathological fear, depression
Psychological response
Psychological adjustment
Normal adjustment
Pathological or maladjustment
Cognitive e.g. optimism Emotional e.g.
hopefulness Behavioural e.g. compliance
Cognitive e.g. ongoing irrational
thoughts Emotional e.g. intense unresolved
grief Behavioural e.g. chronic non-compliance
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Cognitive responses

• Common thoughts
• Will I ever be able to get back into the team?
  Will I ever be able to do my walking programme
  again? Will I ever get better?
• Increased negative thoughts and self-talk
• Changes in self-esteem and self-confidence

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Emotional responses

• Sadness, fear, anger, frustration and confusion
  are all common emotional reactions.
• 24 of injured athletes experience clinically
  meaningful levels of psychological distress
• (Brewer et al 2004)
• Emotional inhibition and grief

• Depression is related to impaired immune function
• Fear has been found to increase pain threshold
  (stress-induced analgesia)
• Anxiety has been related to decrease pain
  threshold (hyper-vigilance)

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Behavioural responses

• Alterations of appetite, sleep disturbance, and
  irritability are common post-injury.
• Main behavioural response is that of
  rehabilitation adherence and the use of coping
  mechanisms throughout rehabilitation.

• Social support seeking behaviour
• Malingering behaviour

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Positive responses

• Athletes suggested that they
• became mentally tougher
• learned more about their own psychological
  limitations
• learned more empathy towards other athletes
• had more time to increase identity outside of
  sport
• Had more time to develop psychological skill
  training

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Personality and dispositional tendencies that
influence rehabilitation

• Identity
• Coping
• Optimism / pessimism
• Health locus of control
• Self perceptions and efficacy
• Perfectionism
• Hardiness

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Signs of poor adjustment

• Obsession with when can I return to work /
  sport
• Continual denial of injury severity and response
  to recovery
• Repeatedly coming back too soon and experiencing
  re-injury
• Unreasonable fear of re-injury
• General impatience and irritability
• Exaggerated bragging about accomplishments
• Dwelling on minor physical complaints
• Guilt about letting the team/coach down
• Withdrawal from significant others
• Rapid mood swings
• Feeling that no matter what is done, recovery
  will not happen
• Withdrawal from significant others
• Petitpas Danish (1995), Med, Sci Sport Ex 2006

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Summary

• State of the clients personal and social lives
  and their interpretations of, and responses to,
  medical events are characterised by a wide
  variety of thoughts, feelings and behaviours that
  have a direct bearing of the success of which
  they rehabilitate and recover.