This time around, I wanted to do a bit of a different post. I am currently a sport psychology student and continuing on to my doctorate studies next year (so excited!) – to this end, I write so much due to assignments required of me during graduate school; therefore, I wanted to share a case study in sport psychology that I wrote. Below is the case study and following is how I would have approached such athlete. It will give you a peak of some of the work I do as a student and eventually work I will do as a practitioner. I trust you will enjoy! :)
Sarah is a competitive cyclist. She is well respected by the peloton and her teammates and often finds herself on the podium. She loves training and racing and also loves the camaraderie she has with her teammates. She is a very strong and confident rider. At the beginning of the season, Sarah had a serious crash on her bike during a race. She was on a fast steep descent when another cyclist crossed her wheel and Sarah went down. The result of the crash left her with a broken wrist, broken jaw, a mild concussion, and road rash on her face and body.
She was out of racing for two months. After three weeks she was able to get on her bike and train. While riding, most of the time she felt good until a car got to close to her and then she would get extremely tense and nervous. In the past two weeks she has entered two races, but was again extremely nervous and unsure of herself. Before the crash she could easily move through the pack for positioning and in these past two races she stayed off the back because she was afraid of moving through the pack and crashing. At both races, other cyclists went up to her to tell her what an inspiration she is to them for continuing to race. However, in your initial phone contact with her she tells you, “I’m sick of people coming up to me and asking me how I’m doing and looking at me like they feel sorry for me. I just want to move on from this.” At this point she is unsure if she wants to continue with racing. She is afraid of crashing again, but does not want to quit racing out of fear.
She would like to try and race and then decide whether or not she would like to continue instead of just quitting “out of fear”. She was frustrated with her performance in the last two races because of her fear of crashing and also frustrated because she felt that her fitness wasn’t there. She has a race coming up in two weeks and she would like to be competitive in it. She also tells you that the woman who caused the crash will also be in this race and she is still very angry with her and doesn’t know how to deal with that situation.
Now how I would approach Sarah:
Many athletes discover the bittersweet experience of being active and athletic. That is, for many athletes, an injury is part of their sport experience (Cheadle, 2018a). Sarah, a competitive cyclist, who is strong and a confident rider, found herself experiencing just that – an injury causing her to be out of the game for two months.
Sarah experienced a broken wrist, broken jaw, a mild concussion, and road rash on her body and face due to the injury. While speaking to Sarah on the phone, it was evident that there were some main issues to work through. One, fear of becoming injured again. For example, while riding she felt good for the most part, but when a car got close to her she became very tense and nervous. Second, during riding, she would position herself in the back of the pack of other riders because she was afraid of moving through the pack and crashing. Stated differently, per her words, “I am afraid of crashing, but I do not want to quit racing out of fear.” It is evident from the two preceding examples that Sarah is experiencing emotional responses, such as being tense and nervous, but more importantly the fear of getting injured again.
Furthermore, a third main issue that is presented is the decrease in self-confidence. For instance, she entered into a race after her injury and she expressed being extremely nervous and unsure of herself. She is questioning her ability and skill to ride as she did before. A fourth and final major issue identified is the strong anger she still feels towards the woman who “caused” the accident. Is there possible resentment that may be lingering for too long towards the woman? Could the feeling of anger impact her ability to move forward?
While four main issues have been identified and Sarah has shared an abundance of information, there is still further information I would want to know. At the onset of our sessions, I would like to know exactly what the behavior she is trying to change is. I could assume through our phone conversation that she is looking to change the fear of re-injury; however, I may find that in actuality she may have other behaviors she is looking to modify. Second, I would like to explore why she would want to change this behavior? I would be looking for her “oomph” and background in the need to change – and again I can assume the why, but it is important for me to hear it directly from the client. Third, what would it mean to Sarah if she successfully changed? Fourth, what obstacles will get in her way to change? Lastly, I would begin to explore solutions with her. For example, I would ask Sarah: “What solutions can we think of to help overcome these obstacles?”
Considering the information gathered, such as major issues and further questions, it would be appropriate to identify theories to Sarah’s case. For instance, according to the Stages of Grief (as cited in Cheadle, 2018a) injured athletes experience a linear progression of stages: 1) denial, 2) anger, 3) bargaining, 4) depression, and 5) acceptance. In accordance with this model, Sarah illustrates being in the anger stage. Sarah describes being very angry at the people involved (i.e., the woman that “caused” the crash), which is part of the anger stage description. Equally important, the Affective Cycle Theory (Heil, 1993) addresses three cycles injured athletes experience, such as determined coping, distress, and denial. Per the definition of distress in this model, distress is encountering negative emotional responses toward injury – such responses include the following: anger, fear, anxiety, shock, etc. With this fact in mind, it would be appropriate to state that Sarah is in the cycle of distress.
There is one red flag that stands out the most with Sarah. This red flag being the response she has toward the woman that “caused” the crash. I am curious to further explore this feeling of anger she has; there could be deeper seated challenges that are not evident at the forefront. If there are deeper issues that are supporting this anger, a clinical issue may arise in response to her anger. For instance, could she be having cognitive distortions occurring? That is, is she focusing on specifics aspects of the injury that are not necessarily imperative? (Beck & Emery, 1985) By exploring the emotion of anger, Sarah and I can identify if she is, for example, showing signs of selective abstraction (i.e., cognitive distortions of the mind) or if the anger is a chronic emotion that could cause clinical issues.
Continuing on with the examination of Sarah’s case, it would be important to take note of personal factors and external factors that may be present for her. Personal factors that may be present are the possible isolation she might be experiencing due to injury. In other words, as known from research injured athletes can experience isolation from the team as injury takes them away from the team in order to recover (Kubler-Ross, 1969; Rotella, 1982). External factors to consider are her environment, work, and other people around her. Are the preceding external factors serving her? At this time I do not see major external factors, but a definite topic to explore with Sarah.
In evaluating the preceding information as a whole, it is certain that there are psychological interventions, such as mental skills, that can be recommended to Sarah. Assisting Sarah in setting goals will help her focus on forward movement (Cheadle, 2018b). Setting goals, within injury rehabilitation, has been perceived as the most effective skill (Hamson-Utley, Martin, Walters, 2008); therefore, giving further confidence to teach Sarah the skill of goal setting. Additionally, the thought stopping technique can assist in healing any negative emotions Sarah is dealing with, but more importantly, dealing with her fears of getting injured again (Cheadle, 2018b). By applying the thought stopping technique coupled with reframing, Sarah can change her perception of competence and control she has. Lastly, encouraging her to use thought stopping and reframing to avoid seeing her injury as a challenge, but as an opportunity to focus on other items. Such as, are there other parts of her sport or fitness she would like to improve on during this time? Overall, introducing the two mental skills techniques mentioned will help build back her confidence and work through the fear of becoming injured again. This would be the start in the development of Sarah’s game plan to success.
Beck, A.T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Cheadle, C. (2018a). Psychology of injury: Introduction to injury [PowerPoint slides]. Retrieved from https://nu.blackboard.com/webapps/blackboard/content/listContent.jsp?course_id=_85785_1&content_id=_6466658_1&mode=reset
Cheadle, C. (2018b). Psychology of injury: Interventions [PowerPoint slides]. Retrieved from https://nu.blackboard.com/webapps/blackboard/content/listContent.jsp?course_id=_85785_1&content_id=_6466657_1&mode=reset
Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic trainers’ and physical skills within sport injury rehabilitation programs. J Athl Train, 43, 258-264. doi:10.4085/1062-6050-43.3.258.
Heil, J. (1993). A psychologist’s view of the personal challenge of injury. In J. Heil, (Ed.), Psychology of Sport Injury. (pp. 33 – 48). Champaign, IL: Human Kinetics.
Kubler-Ross, E. (1969). On Death and Dying, New York: Macmillan.
Marshall, J. S., & Paterson, L. (2017). The Brave Athlete: Calm the F*ck Down and Rise to the Occasion. Boulder, CO: Velopress.
Rotella, R. J. (1982). Psychological care of the injured athlete. In D.N. Kunlund (Ed.), The Injured Athlete. (pp. 213-224). Philadelphia: Lippincott.
Thoughts? Lets connect via Instagram (I am pretty active on there!) @sugeyhealth :)