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  • Daithí Ó Murchú

HEALTHY STRATEGIES FOR ATHLETES COPING WITH INJURIES Utilising Cognitive Behavioural Therapy (CBT)


....‘The body achieves what the mind believes’.

Athletes have a passion to compete. Most athletes just love their sport. Then the unthinkable happens! It seems to have slowly crept up on you. It’s not like there was any major injury or anything. You didn’t really feel anything pull, pop or strain. Perhaps it might have been a lot easier and more straightforward to deal with if you had experienced that. No, this was quite a bit more deceptive and devious. After a training session or event you noticed some pain and tenderness in your body. “No problem,” you thought to yourself. You’ve dealt with this 'dis-ease' before. You quickly attempt to dismiss it as nothing. The next day you notice that your 'dis-ease' is still there. “No big deal!” You try to ignore it and push through the pain. When training ends you start realizing that perhaps you were a bit foolish to have forced yourself to work through the pain. That night, when you can't even lift your leg, stretch your arm or push your foot to the ground, you start to get worried for the first time.

If you’re a serious athlete and have ever had an experience with an injury, then you KNOW that the physical hurt you feel is only one VERY small part of the overall pain that you have to go through now in the rehab process.

The mental pain caused by your injury and the temporary or permanent loss of your sport can be far more devastating than the strained or torn ligaments, pulled muscles, ripped cartilage or broken bones. Unless this type of pain is directly addressed and "treated", your overall recovery will be slow and incomplete.

Cognitive-Behavioural Therapy (CBT) is a system of psychotherapy that attempts to reduce excessive emotional reactions and self-defeating behaviour by modifying the faulty or erroneous thinking and maladaptive beliefs that underlie these reactions (Beck, Rush, Shaw & Emery, 1979). Based on the premise that maladaptive behaviour and emotion is “cognitively mediated” (Butler, Chapman, Forman & Beck, 2006), CBT has elicited much interest in the treatment of psychological problems both in and outside the realm of sport.

Evolving from a combination of behavioural-based (Wolpe, 1958; Skinner 1957) and cognitive-based approaches (Beck, 1970; Ellis, 1962), CBT emerged as a major form of psychology in the “cognitive revolution” of the 1970s (Dember, 1974). Assembled into a single coherent framework, the concepts of CBT offered a new and improved approach to understanding the complex reciprocal interactions between Cognition, Emotion, Physical reactions and Behaviour.

Specifically, the framework proposes that psychological disorders stem from the interaction of these four systems (McArdle & Moore, 2012), with environmental factors (e.g. social and cultural contexts) playing an influential role within these interactions.

While a substantial repertoire of techniques and methods are employed in CBT, all the therapies revolve around the notion that affective disorders are not due to undesirable events per se, but rather from the meanings clients give to events; therefore cognitive modification is vital to achieving positive therapeutic outcome (Clark & Steer, 1996). Central to this assumption, CBT interventions aim to alter dysfunctional thoughts either directly via cognitive techniques or indirectly through behavioural techniques.

The process of “strengthening positive behaviour and weakening negative behaviour towards a goal” (Behncke, 2004, p.8-9) has meant that CBT is inherently appealing to sport psychologists focusing on performance enhancement in athletes. Historically, the framework has had a strong impact on sport psychology’s development (Smith, 2006), and still, to this day, remains a dominant approach to cognitive and behavioural interventions in sport.

A popular CBT intervention aimed to improve athlete performance involves ‘positive self-talk’.

Following the CBT principles, self-talk involves activating mental processes to change existing thought patterns in an attempt to influence the occurrence of desired action or behaviour (Johnson, Hrycaiko, Johnson & Halas, 2004). Strong support for the effectiveness of self-talk has been generated research: For example, Landin and Hebert (1999) participants’ positive self-talk not only improved volleying performance in tennis, but also enhanced their attention and self-confidence. In a similar vein, findings from Theodorakis, Hatzigeorgiadis, and Chroni (2008) suggests that positive self-talk increases self-confidence, regulates effort, controls cognitive and emotional reactions and triggers automatic executions. It must be noted however, that the external validity of these findings are questionable as stronger support for the effectiveness of self-talk has been generated from laboratory-based studies, as opposed to field-based studies (Hardy, 2006).

In addition to positive self-talk, Luiselli and Reed (2011) suggest the goal setting and imagery are key cognitive-behavioural methods used to enhance athlete performance. With regard to the latter, imagery is based on the notion that‘the body achieves what the mind believes’ and as such, practitioners from a cognitive-behavioural perspective view images as functional equivalents of thoughts (Beck et al, 1979). Therefore, cognitively rehearsing the desired performance outcome enables athletes to regulate negative cognitive thoughts, ruminations and emotions. This self-controlling element is thought to improve the irrational thought and anxiety associated with athletes with a perfectionist mind-set (Achtiziger & Bayer, 2012).

Read More on CBT and athletes at; http://believeperform.com/author/laurentaylor/ &

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