The Role of Sport Psychology and Psychiatry

What Is Sport Psychology?


  • The American Psychological Association (APA) defined sport psychology (SP) as

    • Helping athletes apply psychological principles to achieve improved or optimal sport performance and mental health (MH)

    • Increasing knowledge regarding the impact of sport/exercise and physical activity on psychological development, health, and well-being over the lifespan

  • The APA is expanding the definition of SP, as a result of its SP Proficiency certification program, to include psychological skills, optimizing the well-being of athletes, dealing with organizational and systemic issues in sport settings, and understanding social and developmental issues related to sports participation.

  • In a multidisciplinary context, SP is increasingly seen as a strong component of the sports medicine team.

  • Psychology has played a well-established and vital role in physical medicine and rehabilitation (PMR) programs; hence, its application in sports medicine is only natural.

  • Increasing references to psychological factors or influence of emotional/MH factors on physical health and sports injury recovery and performance.

    • Team Physician Consensus Statements (TPCS) discussing sports injuries and concussion have commonly included psychological factors.

    • The National Collegiate Athletics Association (NCAA) publication “Mind, Body and Sport: Understanding and Supporting Student-Athlete Mental Wellness” depicts a bidirectional arrow between sports medicine and sport psychology.

  • Although it is clear that physical injuries, illness, or disease can directly affect athletic performance and/or participation, psychological factors (broadly defined to include behavioral, emotional, or cognitive patterns; personality variables; developmental or adjustment issues; or diagnosable clinical issues) are also critically important to optimal athletic performance.

  • Within the sports medicine team, a sport psychologist is involved in psychological care and consultation with athletes at all levels of competition.

  • SPs use their training and experience to provide a unique contribution to the sports medicine team in dealing with injuries. They can address factors (e.g., stress) that may influence the risk of injuries as well as the psychological factors related to recovering from injury (see Appendix A). SPs can help in the management of concussion patients with prolonged/persistent symptoms, many of which are often caused by emotional or psychological or psychiatric factors.

Qualifications of a Sport Psychologist

  • Influence of history: Sport psychology has emerged from its roots in motor learning and kinesiology research and applications of clinical and counseling psychology principles to athletic settings. As a result, there are a range of sport psychology practitioners: academicians and researchers in exercise and sport science to applied/clinical psychologists.

  • U.S. Olympic Committee (USOC): In the early 1980s, the USOC created a Registry of SPs that was divided into three categories: educational, clinical, and research. This led to current and ongoing efforts by USOC SPs to include only those practitioners who meet the standards and certain criteria in their educational training and supervised practice in sport psychology. USOC Registry members are often involved in consulting with elite/Olympic athletes or teams or serve as regional referrals to athletes or teams.

  • Association for Applied Sport Psychology (AASP)—Certified Consultant in Sport Psychology status: The AASP reviews and approves individual credentials, coursework, and experience, certifying that these consultants meet the standards in their educational training in sport science and psychology; it supports the AASP Ethical Code and provides information about the role of psychological factors in sports and physical activity to individuals and organizations. Consultants can teach athletes specific mental, behavioral, psychosocial, and emotional control skills for sports and physical activity. Consultants with clinical or counseling training are qualified to work with athletes having clinical disorders or issues emerging out of injury.

  • APA Division 47 (Exercise and Sport Psychology): Involved in ongoing efforts at creating a standard for proficiency in sport psychology that “encompasses training in the development and use of psychological skills for optimal performance of athletes, in the well-being of athletes, in the systemic issues associated with sports setting and organizations, and in developmental and social aspects of sports participation” (see ).

  • Importance of licensure: For clinical issues and/or emotional disorders in athletes, a referral to a licensed mental healthcare provider is essential; a referral to a provider who has experience in working with athletes is optimal. Other providers/practitioners may offer “sport psychology consultation,” focusing on mental skills training or performance enhancement. Qualified clinical or counseling psychologists may also provide performance enhancement consultation. The title of “psychologist” is typically one that requires licensure by states; therefore, practitioners identifying themselves as “SPs” should be licensed and have competency (education and training) in the field of sport and performance psychology.

Sport Psychologist Roles

  • A psychological skills training consultant typically educates athletes or teams about mental skills that enhance performance. These skills include goal setting, relaxation, imagery or visualization, positive self-talk, arousal regulation, increased concentration/focus, precompetitive routine/mental preparation, adaptability/handling pressure, time management, and general communication skills. Team consultation can enhance communication and cohesion among athletes.

  • A licensed clinical sport psychologist can provide the same services that a psychological skills training consultant can, but he/she can also provide assessment and interventions to athletes dealing with MH issues. Assessments can include the following:

    • Classification or diagnosis of a presenting issue as well as identifying etiology or contributing factors

    • Acquiring a specific and detailed understanding of personal and sport-specific issues or problems

    • Interview, behavioral observation, psychological testing, neuropsychological testing, and completion of inventories or questionnaires

    • Integration of an athlete’s predisposing factors, precipitating factors, and current maintenance factors

    • A specialized role for a clinical sport psychologist with training and experience as a neuropsychologist involves evaluation and consultation regarding sport concussion. This role involves evaluation of neurocognitive, emotional, and reported physical symptoms following a concussion. Sport neuropsychologists will use neuropsychological testing to assess cognitive status and provide inputs to team physicians and/or the sports medicine team (see Chapter 39 : Head Injuries). In addition, sport neuropsychologists can evaluate, and in certain cases, treat the often overlooked emotional symptoms of concussion.

Performance Enhancement

  • Athletes can be referred to a sport psychologist for guidance in adding, developing, and/or improving mental skills to improve performance.

  • Areas for consultation (7 Cs):

    • Commitment issues dealing with motivational concerns (e.g., burnout or mental fatigue) and may involve developing goal-setting skills

    • Control skills are usually important for athletes who must have control over their body and movements as well as their minds; as athletes progress upward at various competitive levels, the importance of control over thoughts, emotions, and reactions becomes increasingly important. Athletes must learn to handle pressure (arousal control) and develop relaxation skills in order to find the level of arousal associated with optimal performance. Visualization or imagery skills are useful in improving control and focus.

    • Concentration is crucial for successful performance. This skill involves not only the initial focus but also the ability to refocus and deal with inevitable distractions. Focus on task-relevant skills is crucial for optimal performance.

    • Confidence is a factor that athletes (and coaches) describe as primary in successful athletic performance. Confidence is an expectation of success; it is linked to optimism, belief in self, and positive self-talk. Certain athletes focus on having confidence regarding outcomes, whereas others focus on having confidence about being able to put forth effort and concentrate on what they need to do. Slumps are examples of a loss of confidence.

    • Communication skills can be described as both interpersonal and intrapersonal. It is helpful to improve communication among teammates or between athletes and coaches (interpersonal) as well as between individual athletes in terms of how they communicate within themselves (intrapersonal). Moreover, development of positive and adaptive self-talk is associated with successful performance.

    • Consistency skills are associated with developing consistent efforts in practice and games and developing precompetitive routines and mental preparation skills. Precompetitive routines help build confidence in athletes by producing a reliable and predictable response to the behavioral sequence.

    • Competence skills are related to helping athletes see themselves as competent and capable competitors and people; they can identify with qualities of resilience, flexibility, and mental toughness. Self-statements such as “I can cope. I can handle it” are part of possessing competency skills. Competency overlaps with confidence but is more reflective of self-efficacy (knowing what you need to do and when to do it and believing you can do it) .

    • Athletes also need courage and coping skills, particularly when dealing with injuries.

Sport Psychiatrists

  • Provide support to the sports medicine team and may provide medication evaluation and treatment as an adjunct to sport psychology service

  • Can be helpful in managing various MH conditions (e.g., depression, anxiety, eating disorders [EDs], substance abuse, attention deficit disorder [ADHD], personality disorders, impulse control disorders, and psychosomatic illnesses).

  • The International Society for Sport Psychiatry (ISSP) is an organization that applies the practice of psychiatry to the world of sports at all levels.

Psychological Issues in Athletes

Clinical Concerns

  • Clinical concerns include anxiety, depression, stress reactions, adjustment reactions, phobias, substance abuse, eating disorders, and burnout; all of these can be associated with performance decrements. NCAA student-athletes may face stressors/pressures that are unique in comparison with their nonathlete peers; scheduling demands, physical stress and fatigue, stereotyping effects, and the dual role of student and athlete.

  • Athletes are not immune to MH issues. Survey data reflects that student-athletes struggle with anxiety and depression but may be less likely to report such issues than their nonathletic peers. Given this, athletic trainers, team physicians, and coaches can play important screening and supportive referral roles. General stress, interpersonal relationships, and sleep difficulties are associated with depression and anxiety.

  • Psychoeducational efforts around MH or behavioral needs by the NCAA and athletic departments provide important options for student-athletes, and such efforts can decrease the stigma associated with seeking MH treatment.

  • Treatment from a licensed MH professional is indicated for clinical issues; for athletes, finding a professional with sport psychology experience is preferable. If prescription medication is considered, a sport psychiatrist along with a clinical psychologist may work together and provide diagnosis, treatment goals, psychotherapy (individual or family), and/or pharmacotherapy. Treatment outcomes are optimized if there is an established referral pathway for MH issues and an interdisciplinary team approach.

Mood Disorders

Mood disorders involve significant deviation from normal mood states with significant cognitive, behavioral, and physical symptoms that usually affect daily functioning and performance.

Major Depression

Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on The Role of Sport Psychology and Psychiatry

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