Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis

Anxiety Disorders in Athletes

Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and harassment and abuse in sport. Anxiety may negatively impact sport performance. Specific types of anxiety may have unique presentations in athletes. It is important to rule out general medical and substance-related causes of anxiety symptoms. Psychotherapy and pharmacology treatment options should be considered, bearing in mind athletes' environmental circumstances and physiologies.

Depressive Disorders in Athletes

Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tools have been developed specifically for athletes such as the Sport Mental Health Assessment Tool (SMHAT). The management of the depressed athlete should involve an individualized approach, with methods such as counseling, interpersonal therapy, or cognitive behavioral therapy being used. Some may require antidepressant medication. Depressive disorders are also linked to sucidality in athletes, and the team physician and sporting organisation should have a crisis management plan in place for mental health emergencies. Tackling the stigma that remains in sport is a key part to improving mental wellbeing for all athletes.

A Critical Review of Existing Evidence-Based Sport Psychological Interventions for College Athletes with Comorbid Attention Deficit-Hyperactivity Disorder and Sport-Related Concussions

ABSTRACT

The preventive efficacy of mental skills in reducing the risk of sport-related concussions (SRC), facilitating rehabilitation post-SRC, and enhancing mental performance was assessed in individuals with comorbid attention deficit-hyperactivity disorder (ADHD) and SRC. ADHD, characterized by behavioral disruptions linked to hyperactivity and impulsivity, poses an increased risk of severe injuries among student-athletes. Annually, over 10,000 mild Traumatic Brain Injuries (mTBI), including SRC, are diagnosed in National Collegiate Athletic Association (NCAA) student-athletes. Despite the high incidence, there remains a limited understanding of how sport psychological interventions can effectively prevent and rehabilitate SRC in student-athletes with ADHD. This article explores the intricate relationship between ADHD and SRC in NCAA-affiliated student-athletes, focusing on identifying optimal sport psychological interventions for injury prevention, treatment, and performance improvement. The analysis aims to inform the integration of this knowledge into comprehensive services for student-athletes, encompassing prevention, rehabilitation, and performance enhancement strategies.

The effectiveness of rational emotive behavior therapy (REBT) and mindfulness-based intervention (MBI) on psychological, physiological and executive functions as a proxy for sports performance

BACKGROUND

In the current study, we conducted a comparative analysis involving three distinct groups: one receiving group-based rational emotive behavior therapy (REBT), another undergoing a mindfulness-based intervention (MBI), and a third group serving as the control. The aim of the study was to explore the effectiveness of the two interventions on specific psychological (competitive anxiety, perfectionism, irrational beliefs), physiological (salivary cortisol levels), and neurocognitive (executive functions: working memory, inhibition, cognitive flexibility) functions in Hungarian junior ice hockey players.

METHODS

The participants consisted of 10 females and 36 males (NREBT=12, NMINDFULNESS=14, NCONTROL=20). We used questionnaires to assess competitive anxiety, perfectionism, and irrational beliefs. The components of executive functions were measured using a computerized testing system, while cortisol levels were examined through salivary samples. Prior to and after the interventions, each participant underwent all measurements, after which we conducted repeated measures ANOVA on our data.

RESULTS

We found REBT to be an effective intervention for the regulation of competitive anxiety, perfectionism, and irrational beliefs as well as for improving some components of executive functions (inhibition and cognitive flexibility). Mindfulness was found to improve athletes' processing speed and set-shifting abilities, which are related to cognitive flexibility and metacognitive processes.

CONCLUSION

In conclusion, we explore implications of these findings regarding how each approach is posited to enhance sports performance, using neurocognitive functions as a proxy. These findings are useful for further research and practical implications.

Association of Mindfulness with Perfectionism, Exercise Self-Efficacy, and Competitive State Anxiety in Injured Athletes Returning to Sports

Injured athletes often face performance challenges upon returning to the field, influenced by external factors and negative emotions. This study investigates how mindfulness is associated with perfectionism, exercise self-efficacy, and competitive state anxiety in athletes recovering from injuries. Using snowball sampling and convenience sampling methods with a cross-sectional dataset of 359 participants from southern China (collected between October and November 2022), we employed structural equation modelling to analyse the relationship between mindfulness and competitive state anxiety in returning athletes. The results reveal that mindfulness interventions enhance exercise self-efficacy, boost task-related confidence, reshape perfectionism towards a positive outlook, and decrease competitive state anxiety. This study establishes positive correlations between perfectionism and competitive state anxiety, and a negative correlation between exercise self-efficacy and competitive state anxiety. Moreover, exercise self-efficacy and perfectionism partially mediate mindfulness's positive impact on competitive state anxiety. In conclusion, this research highlights mindfulness's potential to alleviate perfectionism and competitive state anxiety while enhancing exercise self-efficacy among athletes on the road to recovery.

Effect of yoga and mindfulness on psychological correlates in young athletes: A meta-analysis

BACKGROUND

This meta-analysis planned to assess the impact of yoga and mindfulness practice in reducing stress and anxiety to improve athletes' sports performance.

METHODS

Several databases were electronically searched for eligible articles till September 2022. Participants aged 18-45 yrs, male and female, and recreational athletes from different sports were included. Athletes' stress, competitive anxiety, and sports performance were measured. The mean difference or standardized mean difference with a 95% confidence interval was calculated in RevMan software 5.4. The fixed effect model was applied to test the statistical significance difference and heterogeneity (p < 0.05). The GRADE pro evidence was also created to assess the quality of evidence.

RESULTS

Results were analyzed with pooled data from fifteen articles. Forest plots showed an overall significant effect of yoga and mindfulness on Mindfulness [Z = 4.13 (p < 0.0001)] [(I2 = 48%), MD -2.6, (95% CI, -3.85, -1.37)] and flow state [Z = 9.49 (p < 0.00001)] [(I2 = 85%), SMD 3.13, (95% CI, 2.48, 3.77)]. The insignificant effects were noted on attention and awareness [Z = 1.51 (p = 0.13)] [(I2 = 25%), SMD -0.26, (95% CI, -0.60, 0.80)], and action and acceptance [Z = 0.43 (p = 0.67)] [(I2 = 0%), MD 0.20, (95% CI, -0.69, 1.08)]. We also observed a significant effect for the comparison of stress [Z = 6.56 (p < 0.00001)] [(I2 = 76%), SMD -0.74, (95% CI, -0.97, 0.52)] and an insignificant effect for comparing anxiety [Z = 1.62 (p = 0.11)] [(I2 = 14%), SMD -0.31, (95% CI, -0.69, 0.07)].

CONCLUSION

The findings of this meta-analysis provides valuable insights to the beneficial or complementary effects of yoga and mindfulness on athletes' psychological health and sports performance.

Effects of Mindfulness-Based Interventions on Promoting Athletic Performance and Related Factors among Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

In recent years, mindfulness-based interventions (MBIs) have been widely applied in competition sports with respect to athletic performance and mental health promotion, whereas evidence of randomized controlled trials (RCTs) has not been well summarized. Therefore, this study aimed to systematically review and meta-analyze the existing evidence on the effects of MBIs on improving athletic performance, mindfulness level, mindfulness-related psychological components (e.g., acceptance, self-compassion, flow), and mental health (e.g., burnout, stress, psychological well-being) among athletes. Following the PRISMA guidelines, a literature search was implemented on five electronic databases (Web of Science, PubMed, Scopus, ProQuest, and ScienceDirect) and relevant review papers. The article selection, risk of bias assessment, and data extraction were performed by two investigators independently. The standardized mean difference (SMD) was calculated to evaluate the effects of interventions using the random effect model. Among the 1897 original hits, thirty-two eligible RCT studies were included in the systematic review, of which seven were involved in the meta-analysis. The results showed that MBIs were effective in promoting athletes' athletic performances (by narrative synthesis), mindfulness-level (n = 3; SMD = 0.50, 95% CI = [0.17, 0.83]; I² = 45%, p = 0.16), and mindfulness-related psychological components (n = 5; SMD = 0.81, 95% CI = [0.53, 1.10], I² = 77%, p =0.001), while no significant intervention effects were found on the mental health of athletes (n = 4; SMD = -0.03, 95% CI = [-0.35, 0.29], I² = 89%, p < 0.001). Our findings preliminarily support the potential effectiveness of MBIs, whereas more high-quality RCTs were needed in the future.