All therapists like to think that they provide the magic touch that gets their patients better. However, when considering all social determinants of health, the influence of medical interventions toward recovery from musculoskeletal injury is only 20%(1). You put your best effort into helping patients get better, but your effectiveness is up against other competing... MORE
Keeping athletes mentally healthy during a pandemic
In this third installment in a series relating to COVID-19, Trevor Langford focuses on how to maintain an athlete’s mental wellbeing, focus, and motivation during this unprecedented time.
Global lockdown and social distancing have forced athletes the world over to adapt their daily routines. With competitions canceled or postponed, it is hard for athletes and their support teams to prepare for the unknown. This fluctuating schedule can affect an athlete’s training program, mental wellbeing, and possibly their desire to exercise. Never has an athlete’s support network been more critical.
The COVID-19 pandemic has greatly affected the sporting world with the postponement of the Olympics, the Paralympics, and the temporary cessation of all major sports. Athletes will often plan their lives around a sporting competition and potentially put other life experiences, such as career opportunities, children and marriages, on hold until afterward. With their competitions and life’s benchmarks taken away, athletes may feel a range of emotions (see table 1)(1). Both the athlete and the support personnel miss the camaraderie experienced in training as teams and training partners isolate from each other. These relationships are essential for mental wellness, and life can become very lonely for someone who is used to a regimented routine. Athletes may also isolate in a different country from friends or family, as that is where their sports contract requires them to stay.
Table 1: Athlete’s feelings as a result of self-isolation and cancellation of events (1).
|Due to social isolation, athletes may feel:|
|Less prepared as a result of the lockdown.|
|They are at a competitive disadvantage.|
|Worried and may catastrophize their thoughts (i.e. what if I get infected with the coronavirus or what if I lose my house or my athlete funding).|
|Socially isolated and lonely.|
|Disconnected from usual social networks and healthy outlets.|
|Emotionally vulnerable if they know someone who has become ill like a family member, co-athlete, or a support team member.|
|Lost or confused as to their life direction and worried about their next step.|
With no sporting events for the media to cover at present, coverage is now focused on the development of the COVID-19 pandemic, possibly adding to an athlete’s worry and anxiety. If an athlete has experienced mental health issues previously, such as anxiety, depression, obsessive-compulsive disorder (OCD), mood disorder, insomnia, or post-traumatic stress disorder (PTSD), an event of this scale could trigger or exacerbate these syndromes. The nature and severity of the symptoms that the athlete experiences dictate the level of care they should seek. Mood, low-level anxiety, and sleep disorders are likely successfully treated by a psychologist or counselor(1). More severe presentations, such as severe anxiety, OCD, eating disorders, self-harm, or suicidal thoughts, necessitate a referral to a psychiatrist(1).
Risk factors for poor mental health
Multiple factors may predispose an athlete to poor mental health. A sports-related injury, lackluster performance, overtraining, and the type of sport played – those who play individual sports are at a higher risk for poor mental health than team sports – are all risk factors (2). Other risk factors may include major events, such as the current global situation, isolation, and impaired sleep patterns(2). The second article in this three-part series focuses on strategies to improve sleep patterns and circadian rhythms. Younger preadolescent athletes may identify more with these recommendations. Without a doubt, whether a young member of a formation league, or a seasoned professional, the recent pandemic and widespread lockdown can negatively and significantly impact athletes’ mental health.
The hierarchical model of motivation
In 1943, Abraham Maslow published the five stages of human needs, a bottom-up hierarchical motivational model demonstrating how an individual can achieve their full potential in life, (see figure 1)(3). The lower four levels are considered deficiency levels. When humans are deprived of their physiological, safety, love, and esteem needs, they become motivated to obtain them. For example, the longer someone goes without food, the more hungry they become, and the more motivated they are to search for and obtain it. Once the lower four levels are securely in place, individuals are in a position to focus on the top phase of the actualization model. The things obtained during the self-actualization level come from within, not from an external source. Therefore, this stage is considered a growth phase.
Figure 1: Maslow’s five stage motivational model of human needs(3)*.
*Used with permission, Saul McLeod(3).
During this time of economic uncertainty, athletes too may experience food or housing insecurity. In contrast, other athletes won’t be affected economically by the pandemic. Therefore, each athlete’s situation is different, and all should be handled with sensitivity. An athlete’s support team must focus on the welfare of the individual, not only the athlete’s training program. According to Maslow’s model, not until an athlete’s basic needs are met, are they in a position to grow and carry out the self-actualization phase.
Promote an athlete’s mental wellbeing by encouraging balance in their daily activities. The absence of pleasurable activities, a sense of achievement from usual set tasks, or connecting with others can affect mood and cause low feelings (see figure 2)(4). A pleasurable activity could be reading, listening to music, or watching something funny on the television. Encourage athletes to create a list of tasks. For example, household chores, an exercise session, or a range of administrative type jobs checked off of a to-do list give a feeling of accomplishment.
Figure 2: Mental wellness balance*.
*Image © Psychology Tools (2020), used with permission(4).
Encourage compliance with a regular training routine when possible. Exercise releases endorphins, the body’s natural ‘feel-good’ hormones, and thus, promotes feelings of mental wellbeing. Gym closures may require athletes to get creative with household items to maintain their strength and conditioning (Insert link to 1st article). Help athletes develop sport-specific goals to work toward with the tools they have during this time of isolation.
Video technology is in a boom phase currently, and there many outlets such as Zoom, Go To Meeting, WhatsApp, and Facetime, which allow for interaction with others. The video chats allow athletes continued connection with support staff for physio appointments and training updates. It also affords them a means to stay connected to a team atmosphere. Conduct regular video discussions where athletes can express their concerns and worries. The realization that others share the same feelings helps relieve anxiety and fosters wellbeing (see table 2).
Table 2: Guidelines for supporting mental wellbeing (5).
|Stay up-to-date with the current situation||While the media coverage can be overwhelming in modern times, it is also important to stay up-to-date on guidelines.|
|The World Health Organization (WHO) is a reliable source for obtaining the latest guidelines: https://www.who.int/emergencies/diseases/novel-coronavirus-2019|
|Spend time in self-reflection||Try to have time outdoors in green spaces|
|Revise goal setting and consider future directions within your sport|
|Practice relaxation and mindfulness|
|Maintain a daily routine||Keep a regular schedule of everyday activities such as meal times and bedtimes, to ensure healthy sleep patterns.|
|Encouragement from sports professionals||Athletes look to clinicians and trainers for support; therefore, continue frequent contact with those in your care .
While the priority for all at the current time is to stay healthy and free from the COVID-19 virus, it is also a time of high stress and worry. Athletes are accustomed to structure and a disciplined routine, and this time is anything but that. Implement measures to help athletes maintain their mental balance and focus. Encourage them to participate in activities that provide pleasure, a sense of achievement, and connect them socially with their support network.
At this stressful time, individuals need recourses where they can seek support. Below are a series of links where athletes and support staff can connect to gain additional mental health support.
- BJSM, March 2020.
- Sports Med, 2019, 5, 46.