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Mind, Body and Sport: Anxiety disorders

An excerpt from the Sport Science Institute’s guide to understanding and supporting student-athlete mental wellness

By Scott Goldman

As a licensed psychologist working in a number of sports at the collegiate level, I’ve had the opportunity to interact with all kinds of athletes, many of whom have experienced anxiety that has affected their personal lives, their academic efforts and their athletics performance.

This is not an uncommon experience. Nearly one in three adolescents in the United States (31.9 percent) meet criteria for an anxiety disorder. Of those, half begin experiencing their anxiety disorder by age 6. NCAA research shows that almost 85 percent of certified athletic trainers believe anxiety disorders are currently an issue with student-athletes on their campus.

Signs and symptoms of an anxiety disorder can include the following:

  • Feeling apprehensive
  • Feeling powerless
  • Having a sense of impending danger, panic or doom
  • Having an increased heart rate
  • Breathing rapidly
  • Sweating
  • Trembling
  • Feeling weak or tired

While everybody experiences some of these symptoms from time to time, student-athletes with anxiety disorders experience these symptoms frequently and severely enough to negatively affect their ability to function to their potential.

To best help someone with an anxiety disorder, it is recommended that the provider know the emotional construct of anxiety and understand basic treatments, interventions and referrals. (It also is recommended that the provider recognize Mowrer’s two-factor theory of avoidance, which is discussed in the accompanying sidebar.)

Anxiety as an emotional construct

Whether discussing “performance” anxiety or anxiety disorder (a phobia or generalized anxiety), the construct of this emotion remains relatively similar. Specifically, anxiety has a unique set of properties that distinguishes it from other emotions. For athletes and non-athletes, the thoughts and feelings that induce anxiety tend to be about the future.

The future element causing anxiety for the individual is typically a perceived threat or danger. It should be noted that two types of threats exist – a threat to safety (“that guy has a gun pointed at me”) and a threat to ego integrity (“if I lose, then I am a loser”).

Anxiety has cognitive and physiological elements. Physiological symptoms may include muscle tension, headaches, gastrointestinal issues, increased heart rate and difficulty breathing.

Treatments for athletes

Because the demands on athletes are somewhat unique, any fear and avoidance problems must be assessed differently. Thus, the functioning of an athlete with an anxiety problem may present differently than the functioning of a non-athlete. 

For example, some athletes may be functioning well below their personal norm but may not meet the standard criteria for an anxiety disorder. Specific examples are found in the differences between post-traumatic stress disorder (PTSD) and the experience of a traumatic championship loss. PTSD may occur after a bobsled accident that critically injures one teammate and leaves two others hospitalized. The surviving, non-injured athlete may experience the inciting event (the crash) with fear of ever competing again with sufficient speed to win or with avoidance of teammates who have been hospitalized.   Personal failure deemed to account for the loss of a major championship, however difficult, may not meet the criteria for anxiety disorder. Sport psychologists are called on to distinguish this important difference, noting degree and the full scope of symptom expression.

Psychological intervention to reduce the impact of the inciting stimulus – to teach effective coping – flows from intelligent diagnosis. There are many empirically validated treatments for anxiety and anxiety disorder. Licensed mental health professionals can work to adapt these treatments to the athlete’s unique needs and goals. For some athletes, their anxiety disorder may be grounded in the sport experience, and it may be useful to treat it within the framework of sport performance.

 

Applying Mowrer’s Two-Factor Theory of avoidance learning to sport

A key for diagnosing anxiety in athletes lies in understanding that fear and avoidance are two different, but not independent, learning processes.

In the well-established Mowrer Two-Factor Theory, fear was a product of sign learning. Specifically, an event occurs in which the individual connects a signal to a noxious event. For example, if someone was petting a dog (a signal) and was bitten by the dog (a noxious event), they may connect that petting all dogs induces being bitten, when in reality most interactions with dogs are innocent and likely beneficial.

The second factor of Mowrer’s theory is that avoidance was a product of solution learning, trial-and-error learning, or response substitution. In other words, when someone avoids the noxious event, they feel a sense of relief. The sense of relief ultimately serves as a reward to the person, which reinforces the notion to avoid the noxious event.

Using the same example, the individual who has been taught to fear dogs will become anxious near dogs or dog-like scenarios, and they will feel a sense of relief when they avoid dogs. Further, the sense of relief will strengthen the avoidance response. In other words, the more the person avoids dogs, the more fearful they will become of dogs.

If an elicited fear for a student-athlete is never extinguished, then avoidance will continue to be reinforced because it provides relief. Thus, an elicited fear affects avoidance and avoidance affects an elicited fear. For example, if a student-athlete pairs shooting the basketball (a signal) with failure and public ridicule (a noxious event), they may develop a fear and avoid taking a shot.

When providing this example, it is important to note that emotions are not disorders. Emotional experiences fall on a quantitative spectrum (low to high intensity) as well as a qualitative spectrum (healthy to unhealthy). When an emotional experience is too frequent, too intense, lasts too long, or is too disruptive, it can become transformed into a disorder.

 

About the Author

Scott Goldman is the director of clinical and sport psychology for the University of Arizona’s athletics department. Scott provides direct patient care to the student-athletes as well as consulting services for the coaches and staff. His clinical experience includes working in university counseling centers, rehabilitation centers, private and government-funded psychiatric children’s hospitals, school counseling centers, and outpatient therapy institutes. Scott serves on the advisory board for STEP UP!, a bystander intervention program that has been adopted by more than 100 universities and colleges. Scott earned his bachelor’s degree in psychology from Tulane University and a master’s degree and Ph.D. in clinical and school psychology from Hofstra.