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Yazıcı-Kabadayı S. Relationships between mental toughness, eustress-distress, and mindfulness in adolescents: A network analysis and mediator model testing. Stress Health 2024; 40:e3480. [PMID: 39264855 DOI: 10.1002/smi.3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 07/28/2024] [Accepted: 09/04/2024] [Indexed: 09/14/2024]
Abstract
The main aim of this study was to investigate adolescents' eustress-distress and mindfulness by examining mental toughness (MT) using network and mediator analyses. The study included 414 adolescents. The results showed that MT was positively related to eustress and mindfulness, but distress was negatively related to MT. Based on the network analysis findings, we tested mindfulness' mediating role in the relationship between eustress-distress and MT. The findings showed that mindfulness played a significant mediating role. However, the mediating role of mindfulness was negative for the relationship between distress and toughness and positive for eustress. These findings advance eustress, distress, and mindfulness as mechanisms for understanding the effects of MT. Considering current knowledge of MT, eustress, distress, and mindfulness, the results are discussed.
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Affiliation(s)
- Sema Yazıcı-Kabadayı
- Faculty of Education, Psychological Counseling and Guidance Program, Recep Tayyip Erdogan University, Rize, Turkey
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Kureshi S, Mendizabal M, Francis J, Djalilian HR. Conservative Management of Acute Sports-Related Concussions: A Narrative Review. Healthcare (Basel) 2024; 12:289. [PMID: 38338173 PMCID: PMC10855441 DOI: 10.3390/healthcare12030289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.
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Affiliation(s)
- Sohaib Kureshi
- Neurosurgical Medical Clinic, San Diego, CA 92111, USA
- TBI Virtual, San Diego, CA 92111, USA
| | | | | | - Hamid R. Djalilian
- TBI Virtual, San Diego, CA 92111, USA
- Departments of Otolaryngology, Neurological Surgery, and Biomedical Engineering, University of California, Irvine, CA 92697, USA
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Hassan S, Bhatti MI, Habib S, Fatima S, Bhader S, Khan NH, Jiang E. How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness. Front Psychiatry 2023; 14:1049008. [PMID: 37555007 PMCID: PMC10406444 DOI: 10.3389/fpsyt.2023.1049008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness. METHOD An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data. RESULTS Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment. CONCLUSION Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.
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Affiliation(s)
- Sajid Hassan
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Mazhar Iqbal Bhatti
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Shazia Habib
- Department of Applied Psychology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sidra Fatima
- University Gillani Law College, Bahauddin Zakariya University, Multan, Pakistan
| | - Sher Bhader
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Nazeer Hussain Khan
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Department of Animal Sciences, Quaid I Azam University, Islamabad, Pakistan
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
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4
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Clark JD, Mallett CJ, Moyle GM, Coulter TJ. Competitive Situations Requiring Mental Toughness in Women's Australian Rules Football. J Sports Sci 2023; 40:2412-2423. [PMID: 36683046 DOI: 10.1080/02640414.2022.2162239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In the last decade, mental toughness (MT) researchers have been interested in the behaviours exemplifying MT. Despite this interest, little attention has been paid to the competitive situations these behaviours occur in. Hence, the aim of the current study was to start addressing this gap by comprehensively focusing on the situations requiring MT in sport - specifically, the contextual demands linked to MT in women's Australian rules football. Focus groups and individual semi-structured interviews were conducted at two Australian rules football clubs after each competitive round of the 2020 season. Following analysis of participant responses, three broad situational categories were created, representing the psychological demands required by the player or team to successfully overcome in-game challenges. These categories were: context intelligence, attentional regulation, and emotional regulation. This study identified that situations requiring MT also required a degree of acceptance and commitment - alluding to a potential link between acceptance-commitment therapy (ACT) and MT. Conceptually, this view offers a new perspective on the psychological process of being mentally tough in competition. The link between ACT and MT also offers an avenue for MT development. Recommendations are made for incorporating these identified situations into regular training sessions following affective learning design principles.
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Affiliation(s)
- James D Clark
- School of Exercise and Nutrition Science, Faculty of Health Queensland University of Technology, Brisbane, Australia
| | | | - Gene M Moyle
- School of Exercise and Nutrition Science, Faculty of Health Queensland University of Technology, Brisbane, Australia
| | - Tristan J Coulter
- School of Exercise and Nutrition Science, Faculty of Health Queensland University of Technology, Brisbane, Australia
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Augustus AN, Zizzi S, Minkler T, Lindauer C. Mindfulness for the Moment: Adapting Interventions for the Period of the Sport Season. JOURNAL OF SPORT PSYCHOLOGY IN ACTION 2022. [DOI: 10.1080/21520704.2022.2103222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Andrew N. Augustus
- Sport, Exercise, and Performance Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Samuel Zizzi
- Sport, Exercise, and Performance Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Minkler
- Sport, Exercise, and Performance Psychology, West Virginia University, Morgantown, West Virginia, USA
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Wang Y, Tian J, Yang Q. On Mindfulness Training for Promoting Mental Toughness of Female College Students in Endurance Exercise. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5596111. [PMID: 34484394 PMCID: PMC8410402 DOI: 10.1155/2021/5596111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to examine the promoting effects of mindfulness training on female college students' mental toughness in endurance exercise. METHODS A cluster sampling method was used to select 60 female college students as subjects. Based on the body mass index (BMI), stratified randomization was used to divide them into the mindfulness-training group and the control group. Participants in mindfulness-training group had an 8-week mindfulness training, while participants in control group waited. Before and after training, Five Facet Mindfulness Questionnaire (FFMQ) and Connor-Davidson Resilience Scale (CD-RISC) were used for pretest and posttest, and paired t-test and covariance analysis were performed on pretest and posttest between-group data. RESULTS (1) Paired t-test results showed the posttest scores (26.67 ± 3.56; 20.97 ± 3.66; 126.53 ± 8.59) of the three dimensions of description, nonresponse and FFMQ total score of the mindfulness-training group were higher than the pretest scores (25.53 ± 3.74; 19.23 ± 3.59; 121.43 ± 6.78). Statistical significance was shown in their differences (t = -2.25; -2.70; -3.25, p < 0.05). However, there was no statistical significance in the pretest and posttest of control group. The covariance analyses showed the posttest scores of the mindfulness-training group in three dimensions of description, nonresponse, and FFMQ were higher than the posttest scores of the control group. Statistical significance was shown in their differences (F = 6.55; 6.08; 5.91; p < 0.05). (2) Paired t-test showed posttest scores (46.50 ± 5.93; 30.40 ± 3.75; 15.00 ± 2.34) were significantly higher than pretest scores (42.60 ± 7.68; 26.50 ± 4.32; 12.87 ± 2.51) in all dimensions of the mental toughness of the mindfulness-training group. Statistical significance was shown in their differences (t = -3.135, -4.765, -4.922, p < 0.01). However, there was no significant difference in the pretest and posttest scores in all dimensions of the mental toughness of the control group. The covariance analysis showed that the posttest scores of all dimensions of the mental toughness of the mindfulness-training group were higher than those of the control group, and the differences were statistically significant (F = 11.133, 12.101, 16.053, all p < 0.001). (3) Paired t-test showed that the posttest score of the mindfulness-training group on exercise intensity perception immediately after 800-meter endurance run (5.67 ± 2.61) was lower than the pretest score (7.03 ± 1.24) and the difference was statistically significant (t = 4.18, p < 0.001), while the difference was not statistically significant in the control group. The covariance analysis showed that the posttest score of the mindfulness-training group on exercise intensity perception was lower than that of the control group, and the difference was statistically significant (F = 15.81, p < 0.001). CONCLUSION Mindfulness training improved the level of female college students' mindfulness and mental toughness in their endurance sports, while reducing the fatigue feeling of female college students in endurance sports.
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Affiliation(s)
- Yi Wang
- School of Physical Education, Weinan Normal University, Weinan 714099, China
| | - Jing Tian
- School of Foreign Languages, Weinan Normal University, Weinan 714099, China
| | - Qingxuan Yang
- Department of Physical Education, Chang'an University, Xi'an 710064, China
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Determining Factors of Psychological Performance and Differences among Age Categories in Youth Football Players. SUSTAINABILITY 2021. [DOI: 10.3390/su13147713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Within the determining factors of psychological performance, mental toughness is considered a multidimensional factor, comprising cognitive, affective, and behavioural components together with self-confidence, which is related to success in sports performance as well as psychological health and well-being. The aim of this study was to analyse the relationship between different factors composing mental toughness and age categories in young football players, in order to determine the presence of specific psychological skills in their formative progression. A total of 118 male players (16.91 ± 2.42 years old) completed the Spanish version by Cernuda (1988) of the original Psychological Performance Inventory (PPI) by Loher (1982, 1986). The results indicated significant differences in four variables (negative energy control, attention control, visual and image control, motivational level) on three different age categories, where the U19 category showed the best results for all the variables, decreasing afterwards in the semi-professional category. Significant correlations were established between mental toughness variables and age categories, where the age category variable was significantly correlated in a positive way with attention control, visual and image control, and motivational level. In the same line, the variable self-confidence correlated positively with negative energy control, attention control, motivational level, attention control, and positive energy. The assessment of psychological variables such as mental toughness, taking into account the formative stage, may be helpful for both coaches and players when selecting adequate mental skill training for improving competitive performance and sporting success, as well as for positive and healthy psychological development and well-being.
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Relationship between Mindfulness, Psychological Skills, and Mental Toughness in College Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136802. [PMID: 34202770 PMCID: PMC8297292 DOI: 10.3390/ijerph18136802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Numerous studies have shown that dispositional mindfulness is positively associated with many mental abilities related to sports performance, including psychological skills and mental toughness. The purpose of this study was to explore the relationship between dispositional mindfulness, psychological skills, and mental toughness among different types of athletes. For this cross-sectional study, 101 college athletes were recruited. Their dispositional mindfulness, psychological skills, and mental toughness were measured by the Mindfulness Attention Awareness Scale (MAAS), Athletic Psychological Skills Inventory (APSI), and Traits of Mental Toughness Inventory for Sports Scale (TMTIS). Pearson’s correlation was used to calculate how dispositional mindfulness is associated with psychological skills and mental toughness. The results revealed that dispositional mindfulness is positively associated with comprehensive APSI (r = 0.21–0.36, p < 0.05), TMTIS overall (r = 0.27, p < 0.01), positive effort (r = 0.26, p = 0.01), and pressure (r = 0.30, p < 0.01). These findings suggest a positive linkage between mindfulness and the two examined psychological characteristics related to sports performance. Other approaches to increase mindfulness may be considered in the future.
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Titze C, Fett D, Trompeter K, Platen P, Gajsar H, Hasenbring MI. Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic! Scand J Pain 2021; 21:59-69. [PMID: 32892188 DOI: 10.1515/sjpain-2020-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In non-athletes, fear-avoidance and endurance-related pain responses appear to influence the development and maintenance of low back pain (LBP). The avoidance-endurance model (AEM) postulates three dysfunctional pain response patterns that are associated with poorer pain outcomes. Whether comparable relationships are present in athletes is currently unclear. This cross-sectional case-control study explored frequencies and behavioral validity of the AEM-based patterns in athletes with and without LBP, as well as their outcome-based validity in athletes with LBP. METHODS Based on the Avoidance-Endurance Fast-Screen, 438 (57.1% female) young adult high-performance athletes with and 335 (45.4% female) without LBP were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR) or "adaptive" (AR) pattern. RESULTS Of the athletes with LBP, 9.8% were categorized as FAR, 20.1% as DER, 47.0% as EER, and 23.1% as AR; of the athletes without LBP, 10.4% were categorized as FAR, 14.3% as DER, 47.2% as EER, and 28.1% as AR. DER and EER reported more pronounced endurance- and less pronounced avoidance-related pain responses than FAR, and vice versa. DER further reported the highest training frequency. In athletes with LBP, all dysfunctional groups reported higher LBP intensity, with FAR and DER displaying higher disability scores than AR. CONCLUSIONS The results indicate that also in athletes, patterns of endurance- and fear-avoidance-related pain responses appear dysfunctional with respect to LBP. While EER occurred most often, DER seems most problematic. IMPLICATIONS Endurance-related pain responses that might be necessary during painful exercise should therefore be inspected carefully when shown in response to clinical pain.
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Affiliation(s)
- Christina Titze
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Daniela Fett
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
- Federal Institute of Sports Science (BISp), Bonn, Germany
| | - Katharina Trompeter
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
| | - Hannah Gajsar
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
- Faculty of Health Science, University of Southern Denmark, J.B. Winsløws Vej 19, 3, DK-5000, Odense, Denmark
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Cooper KB, Wilson M, Jones MI. An Exploratory Case Study of Mental Toughness Variability and Potential Influencers over 30 Days. Sports (Basel) 2019; 7:sports7070156. [PMID: 31252575 DOI: 10.3390/sports7070156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore whether mental toughness varies across a 30-day training block and whether such variability is associated with specific antecedents. This exploratory case study research investigated mental toughness variability using the Mental Toughness Index (MTI) with thirteen elite master runners across a series of self-selected training sessions, followed by interviews and follow-up questionnaires, to identify primary influencers of variability. There were significant differences in the MTI scores between baseline (before the training period), and the minimum and the maximum reported score over five self-selected training sessions (p's < 0.004). The proceeding follow-up interviews and questionnaires then provided insights into factors influencing this intra-individual variability. These higher-level themes included foundational wellbeing, specific preparation, and actions utilized in the moment. This study is the first to demonstrate within-person MTI variability across specific training sessions and provides initial insights for both athletes and practitioners into potential influencers of mental toughness.
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Affiliation(s)
- Ken Bradford Cooper
- Department of Sport and Health Sciences, University of Exeter, St. Luke's Campus Exeter, Exeter EX1 2LU, UK.
| | - Mark Wilson
- Department of Sport and Health Sciences, University of Exeter, St. Luke's Campus Exeter, Exeter EX1 2LU, UK
| | - Martin Ian Jones
- Department of Sport and Health Sciences, University of Exeter, St. Luke's Campus Exeter, Exeter EX1 2LU, UK
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Gajsar H, Titze C, Levenig C, Kellmann M, Heidari J, Kleinert J, Rusu AC, Hasenbring MI. Psychological pain responses in athletes and non-athletes with low back pain: Avoidance and endurance matter. Eur J Pain 2019; 23:1649-1662. [PMID: 31220382 DOI: 10.1002/ejp.1442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/26/2019] [Accepted: 06/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dysfunctional psychological pain responses, namely fear-avoidance (FAR), including catastrophizing and helplessness, as well as endurance-related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non-athletes regarding psychological responses to pain. OBJECTIVES This study set out to compare FAR and ER between athletes and non-athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability. METHODS The 173 athletes and 93 non-athletes cross-sectionally reported how frequently they employ FAR and ER on the Avoidance-Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non-athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability. RESULTS Athletes reported lower frequencies of behavioural avoidance than non-athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non-athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non-athletes. CONCLUSIONS The results of the present study suggest that athletes and non-athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non-athletes and contribute to disability in both groups. SIGNIFICANCE Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non-athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non-athletes alike. However, both types of responses seem relevant to clinical pain management in athletes as well as non-athletes.
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Affiliation(s)
- Hannah Gajsar
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Christina Titze
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Claudia Levenig
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Michael Kellmann
- Unit of Sport Psychology, Ruhr University of Bochum, Bochum, Germany.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jahan Heidari
- Unit of Sport Psychology, Ruhr University of Bochum, Bochum, Germany
| | - Jens Kleinert
- Department of Health and Social Psychology, German Sport University Cologne, Cologne, Germany
| | - Adina Carmen Rusu
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Monika Ilona Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany.,Faculty of Health Science, Southern University of Denmark, Odense, Denmark
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