The ISSP Manual of Sports Psychiatry

Ira D. Glick, Stull Todd, Danielle Kamis, Ira D. Glick, Stull Todd, Danielle Kamis

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780415792486
• eBook ISBN: 9781351813358
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The ISSP Manual of Sports Psychiatry is the first text describing the role of a sports psychiatrist. Covering both individual as well as team sports, contact and non-contact, from childhood through late adulthood, the manual describes the role of sports in our culture and details the psychiatric interventions associated with players and their teams. The editors take a broad focus, covering topics from neuroscience-psychiatric and psychological aspects, performance enhancement, team chemistry and dynamics, organizational issues to working with medical, orthopedic/surgical and neurologic colleagues to provide comprehensive prevention and treatment to enhance well-being and performance. This text will be invaluable to medical and psychiatric physicians, psychologists and other mental health professionals, as well as athletes, trainers, leagues and their commissioners, sports writers-and even "fans" anxious to understand what is going on with their teams.

1Parameters of Sports Psychiatry Consulting

Dan Begel

In any athletic contest, things happen that cannot be explained by hard work or talent. Surprising achievements and unexpected failures during competition evoke reference to intangible factors, among them subterfuge, divine intervention, and psychology. Over the years, the athletic community has developed ways of talking about, understanding, and attempting to influence these intangible factors, especially psychological ones. The entire community, in fact, has a lively interest in things mental, and this has created a fertile environment for the work of sports psychiatry. The essentially intangible nature of mental process, however, is disconcerting to many. In sports, it is what you do, not what you think and feel, that counts. Thus, the sports psychiatrist consulting a team or sports organization will be greeted with a paradoxical blend of receptivity and discomfort. Here are some things to keep in mind when entering this complex arena:

•Most of the athletes you encounter will be receptive, even hungry, for your services.

No one knows better than the person on the field that what is happening off the field or in the mind affects performance. But opportunities for athletes to process thoughts and feelings are limited by the availability of trained professionals. Those closest to the athletes—including coaches, administrators, families, business partners, and so on—are often devoted to the athlete’s overall well-being and are interested in discussing personal and performance issues. They have given you a head start. But as untrained persons, they may harbor a naive idea that by telling a person what to think and feel that person will think and feel it. Feelings and thought are a matter of self-regulation. Lay people, moreover, are generally unprepared for how their own needs for career, reputation, redemption, and self-esteem may subtly retard the listening process. This is especially true in sports, where feelings and needs often run high. The result is that much of what an athlete feels is private but pressing for expression. It is a great relief to most athletes to have a professional person ask the right questions without prior assumptions or self-interest, and thereby to be given an opportunity to talk.

•You will be viewed with caution or suspicion by coaches and administrators, no matter how receptive they may appear to be.

As a sports psychiatrist, you will inevitably be stepping on the coach’s toes. Next to winning, the greatest satisfaction a coach can have is promoting the personal maturation and happiness of their athletes. The best coaches understand their athletes well and work hard to foster a trusting, helpful relationship. Keep in mind that the coach’s role is a powerful one. Coaches act as surrogate parent, role model, confidant, and source of inspiration and knowledge. A coach’s decision is to be obeyed without question. Enter the psychiatrist, stirring up feelings, establishing a private dialogue, promoting autonomous judgment, encouraging people to talk about matters often swept under the rug. Smart coaches understand that this is all a necessary part of the process of removing encumbrances to performance and freeing the athlete and the team to express itself. Nevertheless, unknown forces have unknown consequences, and this ambiguity will make coaches and administrators cautious about your presence.

•As sports psychiatrist, you will be involved with everyone associated with the team.

Sports psychiatry is community and consultation psychiatry. As team psychiatrist you may, at various times, attend practices, hang out in the training room, attend banquets and social functions, and have a variety of conversations with administrators, owners, coaches, medical personnel, families, agents, police officers, lawyers, and journalists, as well as the athletes themselves. You may be called upon to give presentations to the whole team from time to time. All of this is an important part of the job. The entire team can be considered your patient, and to help an individual within it will often require that the team act as co-therapists as well. Two problems immediately arise in this circumstance. First, because a good part of your work is public, your personality, idiosyncrasies, and areas of ignorance will be exposed. Keep your sense of humor. Second, because there are so many random conversations with a variety of people, confidentiality will inevitably be compromised to some degree. Be careful about what you say. Keep your opinions to a minimum.

•Be alert to temptation.

In earlier times we spoke of “countertransference,” the tendency in a helping relationship for the helper to perceive the person being helped as an object of gratification. In sports psychiatry, countertransference may take many forms. Among them are mentioning the names of well-known athletes you have worked with, taking credit for a team or athlete’s success, revealing confidential information in an attempt to enhance one’s standing, and using athletes to meet one’s social or emotional needs. The pull of countertransference is especially strong in sports because of its inherent beauty, physicality, and drama. But beyond whatever income sports psychiatry consulting may provide, the only clinically appropriate personal gratification is the pleasure of helping others achieve good health in their work and their play, just as always. Be skeptical of the temptations and thrills that may come your way.

•Know, and be ready to explain, your services, your limitations, and your point of view.

A significant portion of a sports psychiatrist’s work involves teaching. Most of us have developed our own philosophy within the biopsychosocial perspective of our field. This philosophy may be embellished with spiritual elements, concepts from physics, history, or politics, and various scientific or ethical prejudices. No one will want to know everything you think, however. Each person will want to know what pertains to them, and so you may find yourself explaining, say, mindfulness techniques or recovery options, repeatedly and in various ways. Your conversations will be more like those with family, friends, private patients, and casual acquaintances than like presentations to a large audience. Explaining your methods and viewpoint freely to the team and its associates is important. It shows respect for the others’ intelligence, reassures the community that you have reasons for what you do, and, most of all, it creates a shared vocabulary for talking about mental and emotional experience, promoting a culture of helpfulness within the team.

•Think twice when prescribing, or not prescribing, medications.

The athletic community is inherently skeptical of psychopharmacology. The idea that central nervous system drugs will impair physical performance, dampen aggression, and render athletes timid is widely held. In prescribing medication for an athlete, it is important to think about the requirements of their sport and possible effects on endurance, vision, coordination, emotional intensity, and other athletic functions. Controlled studies of sport-specific side effects are few to nonexistent, so you will have to rely on your own experience, the experience of other sports psychiatrists, and, of course, the athlete’s report of subtle effects. Explaining the range of possibilities and establishing an equal collaboration are important for helping an athlete overcome a threshold of resistance to a needed treatment. An exception to the general skepticism toward pharmacology pertains to drugs that may have performance-enhancing properties. Inevitably, you will be asked to prescribed a stimulant, anabolic agent, or other potential performance enhancer. This may come as a direct request or it may be hinted at in the course of an athlete’s shopping for a willing prescriber. For athletes training in Olympic sports, prepare yourself in advance by deciding what you think about therapeutic use exemptions (TUEs).

•Be ready to act and to change.

Sports are both instinctual and sublime. They tap every instinct with which we are endowed, including the athletic instinct itself, and they encompass, as well, a rich intelligence and history that touches all aspects of life. This confluence of knowledge with force will be certain to challenge your professional vanity, your intellectual preconceptions, and your sense of personal security. It is best to welcome this challenge. Unlike the office, where you are boss, on the team you are just another player. You will be called upon to act spontaneously when the ball is metaphorically thrown your way. Innocuous encounters will become clinical. You will be perplexed from time to time by things said and done and you will discover new clinical options even at moments of high anxiety about your work. In being open to this process, the experience of consulting to an athletic team will expand your clinical abilities in ways that will have an impact on your work outside of sports as well.

Bibliography

Burton, R. (2000). Psychiatric consultation to athletic teams. In D. Begel & W. Burton (Eds.), Sport psychiatry: Theory and practice (pp. 229–248). New York: W. W. Norton.

Currie, A., & Owen, B. (Eds.), (2016). Sports psychiatry. Oxford: Oxford University Press.

Reardon, C., & Factor, R. (2010). Sport psychiatry: A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Medicine, 40(11), 961–980.

Part I

Non-Contact Sports

2Running

Claudia Reardon

Introduction

Today, the sport of running includes many different activities: cross-country running, track and field, road racing (including relatively short distances up to ultrarunning events), and recreational, noncompetitive running. This chapter addresses psychiatric aspects that may occur in some or all of these activities.

Unlike many organized sports, running appears throughout history. Ancient man ran hundreds of miles tracking and hunting food (Chen, 2006). Running for sport evolved when the Ancient Greeks began the Olympic games in 776 BC, with one of the first recorded Olympic events being a sprint from one end of the Olympic arena to the other. Local competitive running, especially in rural Europe, may have started as part of religious festivals, with time estimates ranging from 1829 BC to 632 BC (Delaney & Madigan, 2009). Running for fitness may have started in the sixteenth century when swordsmen within the upper classes and nobility began using running as a training technique. Recreational running’s relatively recent surge in popularity is credited to Arthur Lydiard from New Zealand, with his formation of the Auckland Jogger Club, and to Bill Bowerman from the United States with the publication in 1966 of his successful book, Jogging.

Figure 2.1Running

Thus, running has evolved from an activity pursued for the purposes of survival, to one pursued voluntarily for competition and recreation. As a primarily individual sport, runners must face their own limits, as opposed to many other team-based or combat sports in which athletes often literally face members of the opposing team. This important dynamic may contribute to some of the psychiatric issues recognized within the sport of running. Issues that specifically arise relatively commonly in running relate to exercise addiction, eating disorders, anxiety, depression, substance use, and other medical conditions. These will all be addressed, including symptomatic presentation and treatment considerations, within this chapter.

Psychiatric Aspects of Running

Exercise Addiction

Many studies have addressed excessive exercise as a compulsive behavior, and have variably labeled it as “exercise addiction” (Sachs & Pargman, 1979), “exercise dependence” (Cockerill & Riddington, 1996), “compulsive exercise” (Dalle Grave, Calugi, & Marchesini, 2008), “positive addiction” (Glasser, 1976), or “obligatory running” (Yates, Leehey, & Shisslak, 1983). As the latter label suggests, running is the sport often studied in these reports. While the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not include exercise addiction, it is increasingly recognized as one type of behavioral addiction (Egorov & Szabo, 2013).

Similar to other addictions, exercise addiction can be defined as excessive exercise undertaken to provide either pleasure or relief from internal discomfort (e.g., from stress or anxiety). It is characterized by repeated failure to control the behavior and maintenance of the behavior in spite of negative consequences (Goodman, 1990). Associated symptoms include tolerance (increasing amounts of exercise needed to get the desired effect), withdrawal (anxiety, irritability, restlessness, and insomnia in the absence of exercise), lack of control (unsuccessful attempts to cut down), intention effects (unable to adhere to one’s intended exercise regimen), time (great amount of time spent preparing for, engaging in, or recovering from exercise), reduction in other activities, and continuing to exercise despite knowing it is causing problems (Griffiths, 2005).

Exercise addiction and eating disorders have been closely correlated. Eating disorders are often accompanied by extreme levels of physical exercise, commonly in the form of vigorous aerobic activity such as running. Patients may have primary or secondary exercise addiction (Kurimay, Griffiths, Berczik, & Demetrovics, 2013). In primary exercise addiction, compulsive exercise is the primary concern, and exercise itself is the objective. In secondary exercise addiction, weight loss is the objective, as driven by an eating disorder (Kurimay et al., 2013). Male athletes have been shown to have higher rates of primary exercise addiction than female athletes, and females, higher rates of secondary exercise addiction (Blaydon & Lindner, 2002).

Exercise addiction prevalence varies based on the population studied, with higher rates found in professional athletes compared to recreational ones (Kurimay et al., 2013). Within running specifically, one study found that, of those participating in a US four-mile road race that attracts runners of all levels, 26% of 240 male runners and 25% of 84 female runners were classifiable as “obligatory runners” (Slay, Hayaki, Napolitano, & Brownwell, 1998). “Obligatory runners” were defined as scoring high on the Obligatory Running Questionnaire (Blumenthal, O’Toole, & Chang, 1984), which includes Likert scale items such as “When I miss a scheduled exercise session I may feel tense, irritable, or depressed”; “I will not exercise if I feel sick or injured”; and “If I feel I have overeaten, I will try to make up for it by increasing the amount I exercise.” Another study found that 30.4% of triathletes were found to have primary exercise addiction, and another 21.6% secondary exercise addiction (Blaydon & Lindner, 2002...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• Notes on Contributors
• Introduction: What is Sports Psychiatry?
• 1 Parameters of Sports Psychiatry Consulting
• Part I Non-Contact Sports
• Part II Contact Sports
• Conclusion: The Culture of Sports: Global Issues and Challenges
• Index