• unlimited access with print and download
    $ 37 00
  • read full document, no print or download, expires after 72 hours
    $ 4 99
More info
Unlimited access including download and printing, plus availability for reading and annotating in your in your Udini library.
  • Access to this article in your Udini library for 72 hours from purchase.
  • The article will not be available for download or print.
  • Upgrade to the full version of this document at a reduced price.
  • Your trial access payment is credited when purchasing the full version.
Buy
Continue searching

An individualized multimodal mental skills intervention for college athletes undergoing injury rehabilitation

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Jamie L Shapiro
Abstract:
Since the response to injury is both physical and psychological (e.g., Brewer & Cornelius, 2003; Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998), numerous researchers have advocated using psychological interventions in conjunction with physical therapy to optimize an athlete's recovery from injury. No empirical study has examined how to craft a mental skills intervention for injured athletes from initial post-injury assessment. The purpose of the present study was to explore injured athletes' experiences with a multimodal mental skills intervention to gain insight into how to create a mental skills plan for rehabilitation from initial post-injury assessment. Single subject and qualitative methodology were utilized. Six participants completed the approximately eight week study in which participants learned four mental skills: (1) goal setting; (2) relaxation; (3) imagery; and (4) managing self-talk. Using an ABCA or ACBA design, the impact of the interventions on the following eight variables was examined: (1) self-reported use of mental skills; (2) perceived effectiveness of mental skills; (3) satisfaction with mental skills interventions; (4) self-efficacy for rehabilitation; (5) self-efficacy for return to sport; (6) adherence; (7) attitude; and (8) speed of recovery. Participants showed varied responses to the mental skills interventions and reported several positive physical and psychological outcomes of using the mental skills. Participants demonstrated little change in self-efficacy for rehabilitation and return to sport, adherence, attitude, and speed of recovery over the course of the study, as most participants scored high throughout the study on these measures. Sport psychology consultants and future researchers may want to explore other post-injury assessment methods and choose less than four mental skills to focus on for a mental rehabilitation program with injured athletes. Athletic trainers can also incorporate simple mental techniques in rehabilitation to help athletes achieve positive outcomes.

iv TABLE OF CONTENTS

Introduction............................................................................................................................ 1 Methods.................................................................................................................................. 7 Participants........................................................................................................................ 7 Research Design................................................................................................................ 8 Variables........................................................................................................................... 9 Instrumentation................................................................................................................. 10 Demographics and background.................................................................................... 10 Mental skills................................................................................................................. 10 Monitoring of mental skills intervention..................................................................... 12 Self-efficacy for rehabilitation..................................................................................... 12 Self-efficacy for return to sport.................................................................................... 13 Adherence to rehabilitation.......................................................................................... 13 Recovery time and attitude towards rehabilitation...................................................... 14 Exit Interview............................................................................................................... 15 Procedures......................................................................................................................... 15 Baseline........................................................................................................................ 16 Interventions................................................................................................................ 17 Second baseline and final assessment.......................................................................... 18 Data Analyses................................................................................................................... 19 Results.................................................................................................................................... 19 Mental Skill Use in Sport.................................................................................................. 20 Self-reported Use of Mental Skills in Rehabilitation........................................................ 20

v Perceived Effectiveness of Mental Skills......................................................................... 25 Satisfaction with Mental Skills Interventions................................................................... 26 Additional Qualitative Data Regarding Mental Skills Interventions................................ 28 Self-efficacy for Rehabilitation......................................................................................... 29 Self-efficacy for Return to Sport....................................................................................... 30 Adherence to the Rehabilitation Protocol......................................................................... 30 Attitude During Rehabilitation......................................................................................... 30 Speed of Recovery............................................................................................................ 31 Discussion.............................................................................................................................. 31 Assessment of Mental Skill Strengths and Weaknesses................................................... 31 Self-reported Mental Skill Use Throughout the Study..................................................... 32 Perceived Effectiveness of the Interventions.................................................................... 35 Satisfaction with Mental Skills Interventions and Future Use of Skills........................... 36 Self-efficacy, Adherence, Attitude, and Speed of Recovery............................................ 38 Limitations........................................................................................................................ 40 Strengths........................................................................................................................... 42 Practical Implications and Future Directions.................................................................... 43 References.............................................................................................................................. 46 Tables..................................................................................................................................... 52 Figures.................................................................................................................................... 56 Appendices............................................................................................................................. 72 APPENDIX A. Review of the Literature.......................................................................... 72 Introduction.................................................................................................................. 72

vi Models of Psychological Responses to Sport Injury................................................... 72 Psychological Factors Associated with Injury Rehabilitation Outcomes.................... 76 Suggestions for Implementing Psychological Interventions for Sport Injury Rehabilitation............................................................................................................... 83 Empirical Research on Psychological Interventions for Injury Rehabilitation........... 86 Summary...................................................................................................................... 102 References.................................................................................................................... 104 APPENDIX B. Initial Interview....................................................................................... 111 APPENDIX C. Test of Performance Strategies-2............................................................ 112 APPENDIX D. Monitoring of Mental Skills Intervention............................................... 116 APPENDIX E. Athletic Injury Self-Efficacy Questionnaire............................................ 117 APPENDIX F. Modified State Sport Confidence Inventory............................................ 118 APPENDIX G. Athletic Trainer’s Patient Evaluation Form............................................ 119 APPENDIX H. Athlete-rated Adherence and Attitude Items........................................... 120 APPENDIX I. Exit Interview........................................................................................... 121 APPENDIX J. Pilot Research........................................................................................... 123 APPENDIX K. Approval from Institutional Review Board............................................. 130 APPENDIX L. Informed Consent Form for Athletes....................................................... 131 APPENDIX M. Informed Consent Form for Athletic Trainers........................................ 136 APPENDIX N. Self-ranking of Mental Skills Use........................................................... 140 APPENDIX O. Sample Outlines of Mental Skills Interventions..................................... 141 APPENDIX P. Sample Intervention Materials................................................................. 145 APPENDIX Q. Participant Graphs for: Self-efficacy for Return to Sport, Adherence, Attitude, Recovery Time......................................................................... 170

vii LIST OF TABLES Table 1. Demographic Information of Participants............................................................... 52 Table 2. Test of Performance Strategies (TOPS-2) Data....................................................... 54 Table 3. Satisfaction Ratings of Each Mental Skills Intervention......................................... 55

viii LIST OF FIGURES Figure 1a. Self-reported use of mental skills (strengths) for P1............................................ 56 Figure 1b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P1...... 56 Figure 2a. Self-reported use of mental skills (weaknesses) for P1........................................ 57 Figure 2b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P1.. 57 Figure 3a. Self-reported use of mental skills (strengths) for P2............................................ 58 Figure 3b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P2...... 58 Figure 4a. Self-reported use of mental skills (weaknesses) for P2........................................ 59 Figure 4b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P2.. 59 Figure 5a. Self-reported use of mental skills (strengths) for P3............................................ 60 Figure 5b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P3...... 60 Figure 6a. Self-reported use of mental skills (weaknesses) for P3........................................ 61 Figure 6b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P3.. 61 Figure 7a. Self-reported use of mental skills (strengths) for P4............................................ 62 Figure 7b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P4...... 62 Figure 8a. Self-reported use of mental skills (weaknesses) for P4........................................ 63 Figure 8b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P4.. 63 Figure 9a. Self-reported use of mental skills (strengths) for P5............................................ 64 Figure 9b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P5...... 64 Figure 10a. Self-reported use of mental skills (weaknesses) for P5...................................... 65 Figure 10b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P5................................................................................................................... 65 Figure 11a. Self-reported use of mental skills (strengths) for P6.......................................... 66 Figure 11b. Perceived effectiveness of mental skills (strengths) on rehabilitation for P6.... 66

ix Figure 12a. Self-reported use of mental skills (weaknesses) for P6...................................... 67 Figure 12b. Perceived effectiveness of mental skills (weaknesses) on rehabilitation for P6................................................................................................................... 67 Figure 13. Self-efficacy for rehabilitation for P1................................................................... 68 Figure 14. Self-efficacy for rehabilitation for P2................................................................... 68 Figure 15. Self-efficacy for rehabilitation for P3................................................................... 68 Figure 16. Self-efficacy for rehabilitation for P4................................................................... 69 Figure 17. Self-efficacy for rehabilitation for P5................................................................... 69 Figure 18. Self-efficacy for rehabilitation for P6................................................................... 69 Figure 19. Self-rated adherence and attitude for P1.............................................................. 70 Figure 20. Athletic Trainer-rated data for P3......................................................................... 70 Figure 21. Self-rated adherence and attitude for P3.............................................................. 70 Figure 22. Athletic Trainer-rated data for P1......................................................................... 71 Figure 23. Self-rated adherence and attitude for P6.............................................................. 71

Mental Skills Intervention

1 Introduction It is estimated that between three and 17 million children and adults incur sport and recreation injuries each year in the United States (Brewer, Anderson, & Van Raalte, 2002). Recovery from sport injury includes both physical and psychological factors. Wiese-Bjornstal, Smith, Shaffer, and Morrey (1998) proposed an integrated model of response to sport injury and rehabilitation. They maintain that personal, situational, and cognitive factors interact to influence one’s holistic responses to athletic injury. Accordingly, an athlete post-injury makes a cognitive appraisal of the injury and his/her self-efficacy, or belief in ability, to cope with the situation. The cognitive appraisals, emotional responses (e.g., mood, attitude, fear, grief), and behavioral responses (e.g., rehabilitation adherence, effort and intensity in rehabilitation, use of psychological skills) are believed to reciprocally influence each other throughout the recovery process. Taking into account the complexity of the response to injury, injured athletes will likely benefit from a rehabilitation protocol that incorporates both physical and psychological interventions. Several authors (e.g., Crossman, 1997, 2001; O’Conner, Heil, Harmer, & Zimmerman, 2005; Petitpas & Danish, 1995; Taylor & Taylor, 1997) have advocated the use of psychological interventions and have proposed methods for implementation. For example, Taylor and Taylor (1997) suggest assessing an athlete’s psychological needs prior to intervention and then tailoring the mental skills program to the athlete’s needs and preferences. Specifically, the authors encourage athletes to select one or two techniques per psychological need based on “comfort and liking” (p. 299). They specifically suggest that rehabilitation imagery be part of every program because of its generalized usefulness to recovery. Some interventions that the

Mental Skills Intervention

2 authors recommend including in the mental skills program include goal setting, relaxation, imagery, self-talk, social support, and confidence building. Although Taylor and Taylor (1997) based some of their recommendations on the literature, much of their practical advice was based on their experiences working with athletes. While this information is valuable for practitioners, it is also essential to examine what the literature says about psychological interventions with injured athletes. Some studies have been conducted that look at athletes’ self-reported use of psychological strategies and how these relate to rehabilitation outcomes. For example, Ievleva and Orlick (1991) found that fast healers retrospectively reported using more goal setting, positive self-talk, and imagery than slow healers; goal setting emerged as the most important healing variable. In another study, Scherzer et al. (2001) found that goal setting and positive self-talk were related to adherence measures. In another qualitative investigation, Driedger, Hall, and Callow (2006) found that rehabilitating athletes reported using imagery for a variety of purposes including: to help maintain sport skills, motivation, focus, healing, pain management, and future injury prevention. Milne, Hall, and Forwell (2005) found that mental rehearsal of rehabilitation exercises was a significant predictor of task self-efficacy for rehabilitation. Those researchers also found that task and coping self-efficacy were predictive of better rehabilitation adherence. Thus, practitioners should work to build athletes’ self-efficacy during the rehabilitation process to maximize outcomes. This lends support to self-efficacy theory (Bandura, 1977), which posits that the belief in one’s ability to perform a task is important for the accomplishment of behavioral outcomes. A major problem with the above studies is that they relied on retrospective recall of strategies reportedly used during recovery. Therefore, studies of psychological interventions,

Mental Skills Intervention

3 such as those where athletes learn mental skills (e.g., goal setting, relaxation, imagery, and managing self-talk), can help guarantee that athletes are using the skills. Psychological interventions for injured athletes have been perceived by athletes and athletic trainers (ATCs) to be at least moderately acceptable to use during injury rehabilitation (Brewer, Jeffers, Petitpas, & Van Raalte, 1994; Francis, Andersen, & Maley, 2000; Myers, Peyton, and Jensen, 2004; Ninedek & Kolt, 2000; Wiese, Weiss, & Yukelson, 1991). Researchers have found a preference for goal setting and positive self-talk over relaxation and imagery when exploring perceptions of injured athletes and physical therapists (Brewer et al.; Francis et al.; Ninedek & Kolt; Wiese et al.). Despite support that psychological techniques can benefit recovery, empirical intervention studies with injured athletes are somewhat scarce (Cupal, 1998). Intervention studies with injured athletes have been conducted for the following psychological techniques: goal setting, relaxation, imagery, cognitive restructuring, stress management, counseling, and combinations of these skills (multimodal interventions). Relative to goal setting, researchers have found that some injured athletes who set goals showed improved outcomes compared to control groups that did not set goals. Some of these outcomes included better performance on rehabilitation tasks (Theodorakis, Beneca, Malliou, & Goudas, 1997; Theodorakis, Malliou, Papioannou, Beneca, & Filactakidou, 1996), improved adherence to the rehabilitation program, and higher self-efficacy to complete the rehabilitation program (Evans & Hardy, 2002a). A qualitative follow-up study by Evans and Hardy (2002b) highlighted the importance of individual difference variables in response to the intervention, including goal type preference (long-term, short-term, outcome, or performance goals).

Mental Skills Intervention

4 Relaxation combined with guided imagery is another intervention that has been examined with injured athletes. With a sample of participants who had knee surgery, Cupal and Brewer (2001) found that those who practiced relaxation/imagery sessions for six months following surgery had significantly greater knee strength, less reinjury anxiety, and less pain than participants in the control and placebo groups. Handegard, Joyner, Burke, and Reimann (2006) explored the effects of relaxation combined with healing imagery with two injured male athletes. Qualitative statements indicated that the participants felt that the imagery helped give them a sense of control in their recovery and feel more mentally prepared to return to sport. Several other studies have evaluated multimodal psychological interventions with injured athletes. Johnson (2000) explored the effectiveness of a short-term psychological intervention for a sample of athletes with long-term injuries. The participants in the experimental group attended three different training sessions including: (1) stress management and cognitive control, (2) goal setting, and (3) relaxation/guided imagery. At the midpoint and at the end of rehabilitation, the experimental group had a higher overall mood state than did the control group. Ross and Berger (1996) investigated the efficacy of a cognitive-behavioral intervention, specifically stress inoculation training (SIT), on injured athletes’ postsurgical anxiety, pain, and physical functioning. This study was also multimodal in that athletes in the experimental group learned several skills as part of the stress inoculation training, including relaxation, imagery, and managing self-talk. Those researchers found that both state anxiety and pain decreased over time but more rapidly for participants in the treatment condition than the control condition. They also discovered that the treatment group reported significantly less anxiety and less pain than the control group. Finally, the researchers found that the mean number of days to recovery for the

Mental Skills Intervention

5 treatment group was significantly less than the mean number of recovery days for the control group. Evans, Hardy, and Fleming (2000) explored the efficacy of a multimodal intervention involving consultations with three injured athletes, using techniques such as goal setting, imagery, social support, verbal persuasion, and simulation training (i.e., executing skills during practice that were of concern due to the injury). Qualitative analyses indicated the usefulness of certain techniques during certain phases of rehabilitation. For example, participants implemented goal setting to improve motivation and adherence during the early and middle phases of rehabilitation, while it was used to build self-efficacy during the later phase of recovery. In a single subject study exploring relaxation and cognitive interventions with injured athletes, Naoi and Ostrow (2008) found inconsistent results among participants, with individual differences in mood and pain outcomes in response to the interventions. Participants perceived the cognitive intervention to be more effective on physical and psychological recovery than the relaxation intervention. Naoi and Ostrow’s study could have benefited from qualitative analyses to enhance the interpretability of the findings and learn more about participants’ experiences with the interventions. In another single subject study, Rock and Jones (2002) used both quantitative and qualitative measures to explore the impact of six counseling sessions over 12 weeks post-surgery for three injured athletes. By the end of the rehabilitation period monitored, mood disturbance had fallen below pre-surgery levels for all participants. Also, perceptions of rehabilitation progress increased while pain ratings decreased, although both fluctuated, particularly in response to setbacks. A concern with these findings is that it is difficult to determine if the above variables (mood, perceived progress, and pain) changed due to time or the intervention.

Mental Skills Intervention

6 Interview responses indicated that two of the three participants had favorable impressions of the intervention. The researchers also found that the intervention reduced the negative impact of setbacks on mood and perceptions of rehabilitation progress. Finally, the researchers highlighted the importance of considering individual differences during counseling, as each participant’s experience was unique. In many of the above intervention studies, the match between the intervention and the participant was not included in the design. In other words, the intervention was not chosen based on the athlete’s needs or preferences, but rather chosen by the researcher(s). Although two of the studies (Evans et al., 2000; Rock & Jones, 2002) used more flexible and individualized psychological interventions, none of these studies included a needs assessment before implementing the intervention, as Taylor and Taylor (1997) suggested. In addition, several studies highlighted the differences in individual responses to the psychological interventions (Evans & Hardy, 2002b; Evans et al., 2000; Naoi & Ostrow, 2008; Rock & Jones, 2002). However, few studies have explored these individual responses. The findings in the majority of psychological intervention studies provide some support for the positive benefits of such interventions for injured athletes, but what works best? How should practitioners working with injured athletes (e.g., sport psychology consultants, sports medicine professionals, counselors) craft a psychological skills intervention to best meet the needs of the injured athlete? Weinberg and Gould (2007) stated, “the most important psychological skills to learn for rehabilitation are goal setting, positive self-talk, imagery visualization, and relaxation training” (p. 457). How many of these skills should be chosen for a mental skills program for injured athletes? Should the skills be chosen based on “comfort and liking” as Taylor and Taylor (1997) suggested? “Comfort and liking” seems vague, and appears

Mental Skills Intervention

7 to suggest that skills should be chosen that the athlete is familiar with; however, one might argue that an athlete may benefit more from learning how to apply a new skill to injury recovery and to sport. The purpose of the present study was to examine individual injured athletes’ experiences with a personalized multimodal mental skills intervention in order to gain insight into how to create such an intervention from initial post-injury assessment. Both single subject and qualitative methodologies were used. It was hypothesized that the following dependent variables would improve during the intervention phases of the study: perceived effectiveness of mental skills, self-efficacy for rehabilitation, self-efficacy for return to sport, adherence, attitude in rehabilitation, and speed of recovery. Further, it was hypothesized that scores would be higher during the intervention phase for the mental skills that were identified as an athlete’s strengths (B phase) versus weaknesses (C phase). The same would be true for satisfaction ratings of the mental skills. For the dependent variable of self-reported use of mental skills, it was hypothesized that the use of all skills would increase during the intervention phase in which the skill was taught. Also, reported use of the skills identified as strengths would respond better to the intervention than those identified as weaknesses. Finally, all dependent variables measured would be higher during the second baseline than the first baseline, but they would not be higher than during the intervention phases. Methods Participants Participants who completed the study were five male athletes from an NCAA Division I University and one female athlete from an NCAA Division III University. Volunteer participants were recruited from the athletic training rooms of the two universities. A purposive sampling

Mental Skills Intervention

8 method was used. The five inclusion criteria were: (1) the athletes incurred acute injuries that required a rehabilitation period of at least two months; (2) the injury occurred during a sport activity; (3) the injury required an active rehabilitation (i.e., no cast where they were immobile or needed to rest only); (4) the injury was not career ending; and (5) the athlete had not experienced a re-injury. Athletes began participating in the study between 2 and 6 weeks post-surgery (M = 3.67, SD = 1.63). The mean age of participants was 19.3 (SD = 1.4). They reported that they were involved in the sports of wrestling (n = 3), soccer (n = 2), and cheerleading (n = 1). Participants all incurred injuries that required surgery, including surgery of the knee (n = 3), shoulder (n = 2), and ankle (n = 1). Participants identified themselves as Caucasian (n = 5) and Mexican American (n = 1). Additional participant information can be found in Table 1. Three athletic trainers (ATCs) who worked with the athletes in the study were also participants, as they completed assessments to evaluate the athletes’ adherence and progress. Two of the athletic trainers (male) worked at the Division I institution, while the other athletic trainer (female) worked at the Division III institution. Research Design The study used mixed methods, incorporating both quantitative and qualitative methodology. The quantitative aspect was a single-subject design, either ABCA or ACBA in nature. The “A” phase was baseline, the “B” phase was the intervention of the two mental skills that were identified as the participant’s “strengths,” and the “C” phase was the intervention of the two mental skills that were identified as the participant’s “weaknesses.” The length of the baseline phases (“A” phases) was two weeks, or a minimum of four data points. The lengths of the “B” and “C” phases were also two weeks or a minimum of four data points each. Since these

Mental Skills Intervention

9 phases included two mental skills interventions each (two strengths and two weaknesses), each mental skills intervention occurred for one week. The participant met with the researcher for one session per week for 20-40 minutes to learn how to use a mental skill and apply it towards injury rehabilitation and sport. Positive effects of a multimodal mental skills intervention with injured athletes (similar to the one in this study) have been found after one session of each intervention (Johnson, 2000). The strengths of this design are that it is more manageable and practical to conduct a multimodal intervention with single subjects rather than a large group. This design provided the researcher with insight into the preferences and perceived effectiveness of mental skills interventions with injured athletes and helped to understand the importance of individual differences to take into consideration when crafting and conducting such interventions. However, a major limitation of this design is the lack of generalizability to the larger population of injured athletes. The qualitative aspect of the study included the interviews (pre- and post-intervention), participant comments from the online journals or mental skills manual logs, and ATC comments from the surveys. The purpose of the pre-intervention interview was to help the researcher build rapport with participants and learn about participants’ background and injury experiences. The purpose of the post-intervention interview was to add to the interpretability of the quantitative data and allow the researcher to learn more about the participants’ preferences and experiences with learning the mental skills and applying them. Variables The independent variables were the four mental skills interventions of goal setting, relaxation, imagery, and self-talk. The eight dependent variables were: (1) self-reported use of

Mental Skills Intervention

10 each mental skill; (2) perceived effectiveness of each mental skill; (3) satisfaction with each mental skill intervention; (4) self-efficacy for rehabilitation; (5) self-efficacy for return to sport; (6) adherence to the rehabilitation protocol (athlete-rated and ATC-rated); (7) attitude during rehabilitation (athlete-rated and ATC-rated); and (8) speed of recovery. All dependent variables, except satisfaction with the mental skills intervention, were measured at least twice per week during the study. Satisfaction with the mental skills intervention was only measured during the intervention phases of the study (weekly). A requirement of single-case designs is that data be measured continuously (at least several times a week) because such designs measure the effects of interventions on variables over time (Kazdin, 1982). Instrumentation Demographics and background. Demographics and background information for each participant was obtained through an initial semi-structured interview (see Appendix B) which was audio recorded. Participants provided information about their age, gender, sport played, athletic history, description of current injury, date of injury and surgery, thoughts about the current injury and rehabilitation so far, previous history with injuries, and previous history with sport psychology/mental training. Participants were asked to provide contact information on a separate form (i.e., e-mail address and phone number) so that they could be contacted by the researcher throughout the study to schedule weekly meetings and to send reminders to complete assessments. The contact information along with a confidential code number of the participant were stored separately from the rest of the data. Mental skills. The athlete’s previous use of mental skills in sport was assessed with the Test of Performance Strategies-2 (TOPS-2; Hardy, Thomas, Sheppard, & Murphy, 2005; see

Mental Skills Intervention

11 Appendix C). The TOPS-2 is a 68-item instrument which measures an athlete’s use of selected psychological skills and techniques in both practice and competition. Although participants completed the entire instrument, only total subscales scores for goal setting, self-talk, relaxation, and imagery were used because those were the four intervention skills in the study. Participants reported how frequently they used a technique on a 5-point ordinal scale consisting of 1 (never) to 5 (always). The TOPS-2 is a modified version of the TOPS (Thomas, Murphy, & Hardy, 1999), which was found to have problems with fit statistics from confirmatory factor analysis. As a result, in the second version of the test, the authors added and subtracted several items and added another subscale to competition strategies. The nine subscales that measure use of psychological techniques in competition are: self-talk, emotional control, automaticity, goal setting, imagery, activation, relaxation, negative thinking, and distractibility. There are four items per subscale, resulting in 36 items for the competition strategies. The fit statistics for the nine-factor model were excellent (e.g., CFI = 0.98; Hardy, Thomas, Sheppard, & Murphy, 2005). There are eight TOPS-2 subscales that measure use of psychological skills in the practice setting, which include: self-talk, emotional control, automaticity, goal setting, imagery, activation, relaxation, and attentional control. There are four items per subscale, resulting in 32 items for the practice strategies. The fit statistics for the eight-factor model were very good (e.g., CFI = 0.97). Cronbach’s alphas were above 0.70 for all competition and practice subscales with the exception of the two competition subscales of automaticity (0.62) and distractibility (0.44). This was not a major concern for the present study because the current investigation focused on the scores for the practice and competition subscales of goal setting, relaxation, imagery, and

Mental Skills Intervention

12 self-talk and no inferential statistics were used to compare means or to correlate scores on these subscales. Monitoring of mental skills intervention. The athletes’ use of each mental skill along with their perception of the effectiveness of the intervention and satisfaction with the intervention were measured as single items (see Appendix D). Participants were asked to consider use and effectiveness of the mental skills over the past few days (since they last filled out an assessment). Mental skill use and perceived effectiveness were measured at least twice per week. Satisfaction was measured once per week (only during the intervention phases). All items were measured on a 10-point ordinal scale. The items assessing use of the mental skills stated, “How much did you use (goal setting, relaxation, imagery, or self-talk) in relation to your injury rehabilitation?” Answers were on a scale from 1 (did not use at all) to 10 (used very much). The perception of effectiveness items stated, “How much of an effect did (goal setting, relaxation, imagery, or self-talk) have on your injury rehabilitation?” over the past few days. Answers ranged from -5 (very negatively affected rehabilitation) to +5 (very positively affected my rehabilitation). Finally, the satisfaction item stated, “How satisfied were you with the mental skills intervention you learned this week?” Answers ranged from 1 (not satisfied at all) to 10 (extremely satisfied). Space was also provided for participants to comment on their use, perceived effectiveness, and satisfaction with the mental skill. Self-efficacy for rehabilitation. The Athletic Injury Self-Efficacy Questionnaire (AISEQ; Milne, Hall, & Forwell, 2005; see Appendix E) was used to measure the athlete’s self-efficacy in the rehabilitation setting. This is a 7-item instrument, which measures both perceived task and coping efficacy for rehabilitation. Task efficacy refers to confidence in one’s ability to successfully perform the required tasks in rehabilitation. An example of an item from this

Full document contains 187 pages
Abstract: Since the response to injury is both physical and psychological (e.g., Brewer & Cornelius, 2003; Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998), numerous researchers have advocated using psychological interventions in conjunction with physical therapy to optimize an athlete's recovery from injury. No empirical study has examined how to craft a mental skills intervention for injured athletes from initial post-injury assessment. The purpose of the present study was to explore injured athletes' experiences with a multimodal mental skills intervention to gain insight into how to create a mental skills plan for rehabilitation from initial post-injury assessment. Single subject and qualitative methodology were utilized. Six participants completed the approximately eight week study in which participants learned four mental skills: (1) goal setting; (2) relaxation; (3) imagery; and (4) managing self-talk. Using an ABCA or ACBA design, the impact of the interventions on the following eight variables was examined: (1) self-reported use of mental skills; (2) perceived effectiveness of mental skills; (3) satisfaction with mental skills interventions; (4) self-efficacy for rehabilitation; (5) self-efficacy for return to sport; (6) adherence; (7) attitude; and (8) speed of recovery. Participants showed varied responses to the mental skills interventions and reported several positive physical and psychological outcomes of using the mental skills. Participants demonstrated little change in self-efficacy for rehabilitation and return to sport, adherence, attitude, and speed of recovery over the course of the study, as most participants scored high throughout the study on these measures. Sport psychology consultants and future researchers may want to explore other post-injury assessment methods and choose less than four mental skills to focus on for a mental rehabilitation program with injured athletes. Athletic trainers can also incorporate simple mental techniques in rehabilitation to help athletes achieve positive outcomes.