Effect of Mindfulness Based Stress Reduction (MBSR) in Increasing Pain Tolerance and Improving the Mental Health of Injured Athletes

Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases

The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.

Regular use of acupressure mats reduces perceived stress at subjective but not psychophysiological levels: Insights from a three-week relaxation training

Acupressure mats are promoted as stress management tools for easy and effective self-application, promising reduced stress and increased well-being. However, the scientific evidence for these effects is based on few experimental studies and lacks the examination of acupressure mats as a solitary relaxation tool. Our study aimed to examine which changes in stress and well-being can be expected from the use of acupressure mats by healthy young people on the subjective and psychophysiological level. Unexperienced participants practiced relaxation for three weeks either with an acupressure mat or without any tools (active control group [CG]). As a results, subjective well-being and stress decreased, while sleep quality and concentration endurance increased across groups. Blood pressure (BP), heart rate (HR), pain threshold and pain tolerance did not change significantly from pre- to post-training measurements. Most importantly, no significant differences were found between groups, indicating that training with an acupressure mat yielded no superior effects compared with an active control condition in healthy young students. As a conclusion, taking time to relax has some but limited beneficial effects on the subjective levels independent of the specific method for healthy students. Potential beneficial effects of acupressure mats might be bound to specific impairments, such as tension pain.

Effect of six-week short-duration deep breathing on young adults with chronic ankle instability-a pilot randomized control trial

BACKGROUND

Chronic ankle instability (CAI) is the most common injury in youth sports, which leads to psychological stress from doubting their performance. Cost effective and easy to access tool to reduce the stress among this target group are desired. Therefore, the purpose of this study was to investigate the effect of adding on intervention with short-duration deep breathing (SDDB) alongside with conventional physiotherapy (CP) among young adults with chronic ankle instability (CAI).

METHODS

Total of 30 CAI participants attended physiotherapy, who were randomly assigned into control and experimental groups. The participants in the experimental group received combined intervention (SDDB + CP), and the control group received CP for 6 weeks. The effectiveness of interventions was assessed at 3 intervals with a battery of questionnaires (Visual Analog Score, Cumberland Ankle Instability Tool, Mindful Attention Awareness Scale, and Oxford Happiness Questionnaire) at the end of week 3, week 6, and week 12 as follow-up. A two-way repeated measures of ANOVA was applied to report the statistical significance at p < 0.05.

RESULTS

The results showed a better improvement in pain, balance, happiness, and mindfulness attention among participants in the experimental group, with a significant improvement in mindful attention over the time point as compared to the control group.

CONCLUSION

The findings provide insight into incorporating SDDB additions to the existing CP for better CAI management. Breathing techniques that improve attention and happiness play a vital role in CAI, which recommends the biopsychosocial approach in chronic injury rehabilitation.

TRIAL REGISTRATION

Current Controlled Trials using Clinical Trials Registry under ID number NCT04812158 retrospectively registered on 23/03/2021.

Psychological Readiness to Return to Sport After Shoulder Instability

» The shoulder is the most commonly dislocated joint in the body, representing 50% of all major joint dislocations. This injury occurs most commonly in contact sports and may be treated either nonoperatively (rest, immobilization, and physical therapy) or surgically.» Several factors contribute to an athlete's recovery after shoulder injury, including psychological readiness that has been identified as having a significant impact on athlete's rate of return to sport. The psychological readiness of athletes can be quantified using patient-reported outcome measures and psychological assessment tools.» Managing priorities and expectations, mood, social support, and confidence have all been identified as factors that affect readiness to return to play. Kinesiophobia was the most common factor reported in patients interviewed after arthroscopic Bankart repair.» Psychological interventions including cognitive behavioral therapy and mindfulness are aimed at reducing the effects of psychological factors and mood states by decreasing stress, anxiety, and kinesiophobia. These interventions may also increase the rates of return to sport after shoulder instability.

Measurement of stress-induced sympathetic nervous activity using multi-wavelength PPG

The onset of stress triggers sympathetic arousal (SA), which causes detectable changes to physiological parameters such as heart rate, blood pressure, dilation of the pupils and sweat release. The objective quantification of SA has tremendous potential to prevent and manage psychological disorders. Photoplethysmography (PPG), a non-invasive method to measure skin blood flow changes, has been used to estimate SA indirectly. However, the impact of various wavelengths of the PPG signal has not been investigated for estimating SA. In this study, we explore the feasibility of using various statistical and nonlinear features derived from peak-to-peak (AC) values of PPG signals of different wavelengths (green, blue, infrared and red) to estimate stress-induced changes in SA and compare their performances. The impact of two physical stressors: and Hand Grip are studied on 32 healthy individuals. Linear (Mean, s.d.) and nonlinear (Katz, Petrosian, Higuchi, SampEn, TotalSampEn) features are extracted from the PPG signal's AC amplitudes to identify the onset, continuation and recovery phases of those stressors. The results show that the nonlinear features are the most promising in detecting stress-induced sympathetic activity. TotalSampEn feature was capable of detecting stress-induced changes in SA for all wavelengths, whereas other features (Petrosian, AvgSampEn) are significant (AUC ≥ 0.8) only for IR and Red wavelengths. The outcomes of this study can be used to make device design decisions as well as develop stress detection algorithms.

Heightened adolescent emotional reactivity in the brain is associated with lower future distress tolerance and higher depressive symptoms

Distress tolerance, the ability to persist while experiencing negative psychological states, is essential for regulating emotions and is a transdiagnostic risk/resiliency trait for multiple psychopathologies. Studying distress tolerance during adolescence, a period when emotion regulation is still developing, may help identify early risk and/or protective factors. This study included 40 participants (mean scan age = 17.5 years) and using an emotional Go-NoGo functional magnetic resonance imaging task and voxel-wise regression analysis, examined the association between brain response during emotional face processing and future distress tolerance (two ± 0.5 years), controlling for sex assigned at birth, age, and time between visits. Post-hoc analyses tested the mediating role of distress tolerance on the emotional reactivity and depressive symptom relationship. Whole-brain analysis showed greater inferior occipital gyrus activation was associated with less distress tolerance at follow-up. The mediating role of distress tolerance demonstrated a trend-level indirect effect. Findings suggest that individuals who allocate greater visual resources to emotionally salient information tend to exhibit greater challenges in tolerating distress. Distress tolerance may help to link emotional reactivity neurobiology to future depressive symptoms. Building distress tolerance through emotion regulation strategies may be an appropriate strategy for decreasing depressive symptoms.

Visual respiratory biofeedback to improve visuospatial cognition and cardiac interoception in migraineurs: a study protocol for a randomized controlled trial

Objectives

Migraine is a complex neurological disorder that typically presents with unilateral cephalgia associated with cognitive impairment and reduced interoception. These symptoms result in socio-economic repercussions due to reduced productivity, efficiency, and work performance. Therefore, along with headache management, improving cognition and interoception should also be significant therapeutic targets to effectively manage migraine. To achieve this, we propose to explore the role of a yoga-based visual respiratory biofeedback (VRB) as a possible therapeutic strategy.

Methods and analysis

At least 64 participants will be recruited for the trial after screening for eligibility criteria, using the migraine screening questionnaire and Montreal cognitive assessment test. They will be randomly allocated (1:1) to either the experimental group receiving a 20-min session of yoga-based VRB or the control group who will be asked to watch a documentary film for the same duration. Visuospatial cognition will be assessed by the Corsi block-tapping task, and cardiac interoceptive accuracy will be assessed by the heartbeat counting task at baseline and immediately after the intervention. Based on the distribution and variance of the data obtained, analysis will be conducted based on linear mixed models using SPSS version 28.0.1.0, with a two-sided p-value of < 0.05 considered to be statistically significant.

Discussion

To the best of our knowledge, this is the first study to design and assess the effects of yoga-based biofeedback therapy on cognition and cardiac interoception in migraineurs. Furthermore, we postulated that pranayama's therapeutic effects might be enhanced by using visual yogic respiratory biofeedback. Considering the socio-economic burden of migraine, if found effective, VRB investigated in the trial could be considered as a therapeutic strategy.

Clinical trial registration

ClinicalTrials.gov CTRI, CTRI/2023/03/050430.

A-trait and risk-taking behavior in predicting injury severity among martial arts athletes

Introduction

Trait anxiety (A-trait) can be seen as a multiplicative function of the person-situation interaction. Considering risk-taking behavior (R-TB), literature highlights instrumental and stimulating risk. The aim of the research is to investigate the level of A-trait (in physically dangerous conditions and in new, unusual situations) and the level of R-TB (instrumental and stimulating risk) in athletes, and to verify to what extent A-trait and risk-taking behavior predict injury severity.

Materials and methods

One hundred and fifty-four senior martial arts athletes from grappling combat sports, striking combat sports and mixed martial artists (MMA) participated in the study. For assessing trait anxiety and risk-taking behavior, the Romanian adaptation of the Endler Multidimensional Anxiety Scales (EMAS), respectively the Romanian adaptation of the Makarowski's Stimulating and Instrumental Risk Questionnaire were used.

Results

Using multivariate analysis of variance, significant differences between athletes (according to the sports disciplines practiced), in terms of A-trait and R-TB, were examined. Next, we checked the existing correlations between injury severity, A-trait and R-TB scores in athletes practicing striking combat sports, grappling combat sports and MMA. To verify whether there are significant differences in terms of trait anxiety, stimulating and instrumental risk between athletes who have suffered mild, moderate and/or severe injuries and athletes who have suffered only minor/mild injuries, t-Test for Independent Samples was used. Binomial logistic regression procedures were, also, performed, predicting athletes' likelihood of injury, based on R-TB and A-trait.

Conclusion

A moderate or slightly below average level of anxiety in new, unusual situations and a higher level of instrumental risk are linked with a decreased likelihood of severe injuries in athletes. Martial arts athletes (in entire sample) who have suffered more severe injuries are more adrenaline-seeking in competition and use less rational thinking, taking more pleasure in just performing technical executions, regardless of the outcome.

Influence of Mindfulness on Levels of Impulsiveness, Moods and Pre-Competition Anxiety in Athletes of Different Sports

Training in emotional regulation skills is one of the most important resources for the adaptation of athletes to contexts of sports pressure, especially during competitions. This study explored the effects of a mindfulness programme (Flow Meditation) on levels of impulsivity, mood and pre-competition anxiety-state in a sample of athletes (N = 41, 22.83 ± 5.62 years). Participants were randomly assigned to an intervention group (N = 21; 14 males and 7 females) which received the intervention over 10 weeks (a weekly session) and a control group (wait-list; N = 20; 13 males and 7 females). The variables under study were assessed through different questionnaires at pre- and post-test (T1-T2) in both groups. The mindfulness intervention was effective in reducing impulsivity (cognitive (t = -4.48, p ≤ 0.001, Cohen's d = 1.40), both motor (t = -4.03, p ≤ 0.001, Cohen's d = 1.20) and unplanned (t = -5.32, p ≤ 0.001, Cohen's d = 1.66)), mood (tension (t = -4.40, p ≤ 0.001, Cohen's d = 1.37), depression (t = -4.56, p ≤ 0.001, Cohen's d = 1.42), anger (t = -7.80, p ≤ 0.001, Cohen's d = 2.47), somatic anxiety (t = -5.28, p ≤ 0.001, Cohen's d = 1.65), and cognitive anxiety (t = -6.62, p ≤ 0.001, Cohen's d = 2.07) in the intervention group compared to the control group and with large to very large effect sizes. Mindfulness is a factor that enhances athletes' ability to cope with high sport pressure and the healthy management of competition (e.g., fear of failure), or with their daily life.

The Effect of Mindfulness-Based Stress Reduction on Restless Legs Syndrome in Hemodialysis Patients: A Randomized Clinical Trial

Background: There is currently no definitive cure for restless legs syndrome (RLS), and the common treatments are only used to reduce symptoms. Mindfulness-based stress reduction (MBSR) is an intervention that has shown beneficial effects in many mental and physical disorders.Purpose: This study aimed to determine the effect of MBSR on RLS in hemodialysis patients.Methods: This study was a randomized clinical trial involving 60 hemodialysis patients with RLS recruited by convenience sampling each group. Inclusion criteria were patients with RLS diagnosis, age 18-65, Hb>10, no cognitive disorders, ability to read and write, no vision or hearing problems, and history of hemodialysis ≥6 months. The intervention group received eight sessions of the MBSR program, and the control group received routine care in a government dialysis center. International Restless Legs Syndrome Scale and Restless Legs Syndrome Severity Scale were used to measure RLS. Statistical analyses were conducted using independent and pair t-test and ANCOVA.Results: Significant difference was found in the severity the RLS (Mean(SD) score) between the intervention group (12.90(4.58)) and the control group (22.27(4.19)) (95% CI:-11.66 to -7.08, p<0.0001). The effect size between groups was obtained based on Cohen’s d of 2.13.Conclusion: MBSR showed a significant reduction in the severity of RLS in hemodialysis patients. This preliminary study suggests that MBSR can be a promising treatment option in the management of RLS patients.

Mindfulness and Regulatory Emotional Self-Efficacy of Injured Athletes Returning to Sports: The Mediating Role of Competitive State Anxiety and Athlete Burnout

Usually, both external environmental factors and internal psychological factors affect the self-efficacy of athletes returning to sports after an injury. Based upon COR theory, this study investigated mindfulness interventions' effects on competitive state anxiety and burnout in injured athletes who are returning to sports. The study was conducted in South China from March to April 2022. The snowball and convenience sampling methods were used to select high-level sports teams' injured athletes returning to sports, and a questionnaire survey was administered, from which 433 valid samples were obtained. Amos v. 26 was used to analyze the data. The results showed that mindfulness has a significant negative effect on competitive state anxiety and burnout, such that after strengthening the mindfulness intervention, athletes' competitive state anxiety and burnout decreased and regulatory emotional self-efficacy increased. Further, this study indicated that athletes are prone to negative emotions after injury, and among athletes who returned to sports after injury, those with mindfulness interventions reported lower levels of competitive state anxiety and burnout. Hence, the study demonstrated that mindfulness can improve regulatory emotional self-efficacy in injured athletes who are returning to sports by reducing competitive state anxiety and burnout.

Coping Skills for Oncology Patients: A Practical Guide

OBJECTIVE

To present a practical how-to guide on implementing a coping skills intervention for patients with cancer facing surgery.

DATA SOURCES

A review of the literature on coping and coping skills and on assessing the impact on patients' emotional status.

CONCLUSION

Developing and presenting a brief coping skills program is possible within the confines of perioperative preparation for oncology patients. Such coping skills help develop a sense of self-efficacy, personal control, and resilience. Patients are responsive to the program and seem to practice their home assignments in a satisfactory manner.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses can implement some of or all of the program with their patients. The coping skills fall under the mandate of a variety of health care professionals and are readily available to present to patients. The preoperative period is a suitable time to engage patients to learn coping skills.

Current concepts and practical applications for recovery, growth, and peak performance following significant athletic injury

For decades, physicians, athletic trainers, and other health care professionals have worked to standardize the recovery process following injury to enhance patient outcomes and to help set appropriate goals for return to competition. Traditionally, these efforts have focused primarily on physical and/or physiological aspects of healing with little consideration for psychological aspects. Concurrently, mental health professionals who work with athletes have developed strategies to enhance performance and minimize negative influences of mental aspects of recovery while promoting approaches that include mental as well as physical recovery. Several strategies have emerged that further encourage a multi-faceted and interdisciplinary approach when helping injured patients return to participation. While important in a healthy population, the practical applications of these strategies are likely more critical for an athlete working through the recovery process with an ultimate goal of returning to competition. Despite these realities, both practical experience and a dearth of literature point to the traditional athletic healthcare providers’ common focus on physical aspects of recovery and psychological professionals’ focus primarily on mental aspects has resulted in sub-optimal outcomes compared to the likely benefits of an integrated approach. This article is intended to characterize current concepts in the fields of sport psychology and mental health concerning the importance of mental aspects of recovery in returning to play. Next, the authors will examine how modern theories can influence practice and discuss how these strategies can be effectively integrated and leveraged to enhance recovery and the athlete’s enjoyment of the rehabilitation and ultimately restoration process.

Investigating the Psychophysiological Response to Grade One Muscular Injuries in Professional Australian Football Athletes

The purpose of this study was to examine Australian Football athletes' responses to a grade one muscular injury from a psychophysiological perspective to understand the strength of the association between stress, optimism, and cortisol. Forty-five players listed with one professional Australian Football club volunteered for this study. Inclusion criteria consisted of sustaining a muscular injury during the course of the season with four-weeks predicted recovery time (as diagnosed by club medical staff, n=9). The control group were age, position, and career history matched players from the same sample. Players were also matched for their personality (10-item Big Five Personality Inventory) and fluid intelligence (Raven's Standard Progressive Matrices). Injured players and matched controls completed perceived stress and optimism measures (paper-based questions) as well as salivary cortisol testing once per week for four weeks. Significant increases in cortisol (p=0.015) and perceived stress (p<0.001) were observed in injured players, along with a reduction in optimism (p<0.001) returning by week 4. A significant positive correlation was found between perceived stress and cortisol (r= 0.426), and significant negative correlations observed between optimism and cortisol r= -0.257 and perceived stress r= -0.391. This study showed that athletes were significantly stressed and less optimistic during the first two-weeks of recovery compared to matched controls. While not statistically significant, large effects observed in cortisol and stress in the week prior to returning to competition in the injured group suggest these results demonstrate that a multi-modality approach can improve understanding of psychophysiological stress following a grade one muscular injury in Australian Football athletes.

The Effects of Mindfulness-Based Strategies on Perceived Stress and Psychobiosocial States in Athletes and Recreationally Active People

The mindfulness-based stress reduction (MBSR) programme is gaining increasing attention in sport and physical activity domains. This programme comprises three meditation practices: mindful yoga, body scan, and sitting meditation. In this study, we aimed to examine the effects of a dynamic (mindful yoga) strategy and a static (a combination of body scan/sitting meditation) strategy on participants’ psychobiosocial states (PBS), perceived stress (PS) and mindfulness levels in athletes and recreationally active (RA) people. Thirty-four participants (athletes = 18; RA participants = 16) were assigned to a dynamic intervention strategy, and another 34 (athletes = 19; RA participants = 15) were assigned to the static intervention strategy. Before the intervention, after the intervention and three weeks later, the Italian versions of the PBS scale, the PS scale and the Mindful Attention Awareness scale were administered. RM-(M)ANOVAs revealed that intervention strategies improved functional PBS, reduced PS and enhanced mindfulness levels in both athletes and RA participants after the intervention (p < 0.001, ηp2 = 0.605). However, improved functional PBS after the intervention (p < 0.001; d = 0.62) and stable PS levels at follow-up (p = 1) were observed mainly in athletes. The findings reinforce the view of the importance of the body as a means to improve emotional and health processes, and support the use of mindfulness strategies in sport to enhance individuals’ well-being.

An updated systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches, officials and parents

BACKGROUND

Interventions designed to increase mental health awareness in sport have grown substantially in the last 5 years, meaning that those involved in policy, research and intervention implementation are not fully informed by the latest systematic evaluation of research, risking a disservice to healthcare consumers. Hence, our aim was to update a 2017 systematic review that determined the effect of sport-specific mental health awareness programmes to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. We extended the review to incorporate parents as a source of help-seeking and report the validity of outcome measures and quality of research design that occurred since the original review.

METHODS

Sport-specific mental health awareness programmes adopting an experimental or quasi-experimental design were included for synthesis. Five electronic databases were searched: Psychinfo, Medline (OVID interface), Scopus, Cochrane and Cinahl. Each database was searched from its year of inception to June 2020. As all of the outcomes measured were derived from psychometric scales, we observed statistically significant quantitative effects on the basis of p < .05, and a small, medium or large effect size as d = .2, .5 or .8, respectively. Risk of bias was assessed using the Cochrane and QATSQ tools.

RESULTS

Twenty-eight articles were included from the 2048 retrieved, eighteen additional articles since the original review. Eighteen studies targeted athletes, five with coaches, one sport officials (i.e. referees), one 'at-risk children' and three with parents. One of the studies was a combination of athletes, coaches and parents. In terms of study outcomes, health referral efficacy was improved in seven studies; twelve studies reported an increase in knowledge about mental health disorders. Proportionally, higher quality research designs were evident, as three of ten studies within the previous review did not demonstrate a high risk of bias, whereas thirteen of the eighteen additional studies did not display a high risk of bias. However, only one study included a behaviour change model in both the programme design and evaluation.

CONCLUSIONS

Our updated systematic review provides evidence of the benefits of mental health awareness interventions in sport; these benefits are mainly for athletes and show improvements in the methodological design of recent studies compared to the first review. There was also evidence of the extension of programme delivery to parents. In conclusion, researchers, practitioners and policy makers should consider methodological guidance and the application of theory when developing and evaluating complex interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016040178.

Dispositional Mindfulness May Have Protected Athletes from Psychological Distress During COVID-19 in Australia

Promoting athlete wellbeing has become a priority in elite sport, and the COVID-19 pandemic has accentuated the need for a comprehensive understanding of risk and protective factors. Existing sport research has not yet considered whether specific cognitive factors such as dispositional mindfulness and executive function may protect athletes against psychological distress. In a sample of high-performance Australian football athletes (n = 27), we administered measures of dispositional mindfulness (MAAS), executive function (AOSPAN; eStroop), and psychological distress (APSQ) at pre-season, coinciding with the initial (2020) COVID-19-related sport shutdown in Australia. Measures of executive function and psychological distress were re-administered at the end of the COVID-19 affected competitive season in 2020. Athletes reported significantly elevated psychological distress relative to previous estimates of distress among high-performance athletes established in prior studies. Executive functions, including working memory and inhibitory control were not significantly associated with psychological distress or dispositional mindfulness at either timepoint. However, baseline mindfulness was associated with reduced distress at both pre-season (r = −0.48, p = .03) and end of season (r = −0.56, p = .004), suggesting that dispositional mindfulness may have afforded protective buffering against symptoms of distress. Correlation data alone does not establish a directional connection from mindfulness to reduced distress, and future research is required to elucidate this association and/or establish the mechanism/s by which dispositional mindfulness may protect against psychological distress in this population.

Mindfulness Matters: Use and Perceptions of Mindfulness Practices Among Athletic Trainers

CONTEXT

Mindfulness practices are effective for injury or illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for health care professionals' wellbeing and improving patient outcomes and safety. However, mindfulness has not been studied in athletic trainers.

OBJECTIVE

To investigate athletic trainers' use of mindfulness practices and their perceptions of its importance for self-care and patient or client care.

DESIGN

Cross-sectional study.

SETTING

All athletic training practice settings.

PATIENTS AND OTHER PARTICIPANTS

A total of 547 athletic trainers who were currently practicing completed the survey.

MAIN OUTCOME MEASURE(S)

We developed an 18-item survey that measured use (1 = never to 6 = very frequently) and perceptions (1 = strongly disagree to 7 = strongly agree) of mindfulness practices. Mann-Whitney U or Kruskal-Wallis tests with post hoc pairwise comparisons were performed to assess differences in use (P < .05). A related-samples Wilcoxon signed rank test was calculated to assess differences in participants' perceptions between self-care and patient or client care.

RESULTS

Overall, 86% (n = 471) of respondents reported involvement in some form of mindfulness practice, with females (median [interquartile range] = 4 [2-5] versus males: 3 [2-4]; P < .002), those not in a committed relationship (4 [2-5] versus those in such a relationship: 3 [2-4]; P = .048), and those without children in the home (4 [2-5] versus those with children in the home: 3 [2-4]; P = .040) describing the highest frequency of use for self-care. Females (4 [2-4] versus males: 3 [2-4]; P < .001), those without children in the home (3 [2-4] versus those with children in the home: 3 [2-4]; P = .036), and those in emerging (4 [2-4]; P = .003) or collegiate (3 [2-4]; P = .006) settings most frequently incorporated mindfulness into patient or client care. Overall frequency of use for self-care was higher than for patient or client care (4 = occasionally [2-4] versus 3 = rarely [2-4]; P < .001). Mindfulness practices were perceived as more important for self-care than for patient or client care (6 [5-7] versus 5 [5-6]; P < .001).

CONCLUSIONS

Athletic trainers perceived mindfulness practices as more important for personal wellbeing and used them, albeit occasionally, more for self-care than for patient or client care. Differences in gender, relationship status, children, and setting were observed. Mindfulness-based interventions for athletic trainer wellbeing and patient-centered care and implementation barriers should be explored.

Examining the Effects of Mindfulness-Acceptance-Commitment Training on Self-Compassion and Grit among Elite Female Athletes

BACKGROUND

Mindfulness-based interventions are well-established in the field of psychotherapy, and such interventions have also gained increased attention in the field of sport psychology, either to cope with psychological pressure or to improve an athlete's performance. The goal of the present study was to examine whether a Mindfulness-Acceptance-Commitment (MAC) program could increase self-compassion and grit among elite female athletes compared to an active control condition. To this end, we performed a randomized trial among female adult athletes.

METHODS

Forty female adult athletes (M_age = 22.22, SD = 2.40) were randomly assigned either to the Mindfulness-Acceptance-Commitment group (n = 20; 7 group sessions, 60 min each) or the active control group (n = 20; 7 group sessions, 60 min each). At baseline, seven weeks later at the end of the study and again four weeks later at follow-up, participants completed a series of self-rating questionnaires on mindfulness, self-compassion and grit.

RESULTS

Dimensions of mindfulness, self-compassion and grit improved over time, but more so in the Mindfulness-Acceptance-Commitment condition compared to the active control condition. Improvements remained stable from the study end to follow-up.

CONCLUSIONS

While the active control condition improved dimensions of mindfulness, self-compassion and grit among female adult athletes, improvements were much stronger in the Mindfulness-Acceptance-Commitment condition. Importantly, improvements in the Mindfulness-Acceptance-Commitment condition remained stable over a time lapse of four weeks at follow-up after study completion, suggesting that the Mindfulness-Acceptance-Commitment intervention appeared to improve cognitive-emotional learning processes.

Mindfulness in Athletes

ABSTRACT

Interventions to promote athlete health and performance have traditionally been focused on the physical elements of injury and training. More recently, however, increasing attention has been placed on the mental aspects of athlete health, with emerging evidence suggesting that injury risk and athletic performance are significantly affected by athlete well-being. Mindfulness meditation has been shown to have significant benefits for a number of physical and mental health outcomes in various clinical populations, and recent research has explored how mindfulness may enhance athletic performance, improve athlete mental health, reduce injury risk, and perhaps even facilitate recovery from injury. As awareness of mindfulness as a noninvasive, low-risk, and accessible intervention increases in the Western society, use among athletes has increased as well. Health care providers should be aware of this evidence in order to guide athletes regarding the use of mindfulness as an intervention to potentially improve athlete health and performance.

Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain

OBJECTIVES

This study evaluated the feasibility, acceptability, and potential effectiveness of a hybrid skills-based group intervention, dialectical pain management (DPM), for adults with chronic pain who are receiving long-term opioid therapy. DPM adapts dialectical behavior therapy, a rigorous psychotherapeutic approach to emotion dysregulation, to treat disorders of physiological dysregulation.

METHODS

Individuals with chronic pain (N = 17) participated in one of two 8-week DPM intervention cohorts. At pre-test and post-test, participants completed quantitative self-report assessments measuring pain intensity and interference, depressive symptoms, pain acceptance, beliefs about pain medications, and global rating of change. Within 2 weeks after the intervention, participants completed qualitative interviews to assess participant satisfaction and obtain feedback about specific intervention components.

RESULTS

Of the 17 enrolled, 15 participants completed the group with 12 (70%) attending six or more sessions. Participants reported high satisfaction with the intervention. Preliminary findings suggested a significant increase in pain acceptance and a significant reduction in depressive symptoms. Participants also reported an improved relationship with their pain conditions and increased flexibility in responding to pain and applying coping skills. Several participants showed a reduction in opioid dosage over the course of the intervention.

DISCUSSION

Findings support that DPM is a feasible and well-received intervention for individuals with chronic pain. Additional research with a control group is needed to further determine the intervention's efficacy and impact.

Relationship between Mindfulness, Psychological Skills, and Mental Toughness in College Athletes

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.

The Mental Side of the Injured Athlete

The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population. One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.

Emotional Reactions and Adaptation to COVID-19 Lockdown (or Confinement) by Spanish Competitive Athletes: Some Lesson for the Future

The Coronavirus Covid 19 (SARS-CoV-2) pandemic has produced terrible effects in the world economy and is shaking social and political stability around the world. The world of sport has obviously been severely affected by the pandemic, as authorities progressively canceled all level of competitions, including the 2020 Olympic Games in Tokyo. In Spain, the initial government-lockdown closed the Sports High-performance Centers, and many other sports facilities. In order to support athlete's health and performance at crises like these, an online questionnaire named RECOVID-19, was designed to assess how athletes were living their lives during such periods of home confinement. The main purpose of the questionnaire was to assess the impact of prolongued confinement on athlete's psychological, emotional, and behavioral performance. One thousand, two hundred forty-eight athletes participated in the survey. They had the fllowing characteristics: (Mean age = 22.31 ± 11.49, Female: 53%), who compete at National (N: 1017, Mean age = 21.58 ± 11.42, Female: 52%) and International level (N: 231, Mean age = 25.56 ± 11.22, Female: 57%). Results showed that during the confinement period, those athletes who lacked motivation reported a higher level of stressful thoughts, more behavioral problems, and greater emotional upheaval (anger, fatigue, tension, and depression). However, those athletes who accepted confinement measures as necessary, and were in favor of respecting the rules of social isolation, fostered positive emotional states such as feelings of friendship. In addition, the availability of some sport equipment together with the ability to continue some training, were (1) protective factors against emotional stress, lack of motivation and behavioral problems; and (2) they were associated with greater respect for, and adherence to, confinement rules. Gender differences, tested by multigroup analysis, revealed that coping activities were more often associated to negative emotional states among women, whereas the ongoing availability of training information and future conditions were equally protective factors for both genders. This study also showed that receiving coaching, support and completing frequent training routines seem to be valuable tools to prevent or reduce some of the harmful effects of isolation on athlete's emotional well-being. The conclusions derived from this research would possibly help sport authorities to design supporting policies and plans to support athletes and trainers in future disruptive health crises.

Psychological Profile in Female Cyclists and Its Relationship with Age, Training Parameters, Sport Performance, and Injury Incidence

Previous studies have highlighted the importance of psychology on sports performance and its relationship with the incidence of sport injuries. The objectives of the present investigation were: (1) to analyze the psychological profile of female cyclists as a function of age, training parameters, sport performance, and injuries suffered and (2) to design a model to predict their psychological profile. Sixty-one female cyclists participated in the study. Differences were found as a function of a competitive category for team cohesion (F = 5.035; p = 0.002), sport level effect on performance evaluation (F = 5.030; p = 0.004) and team cohesion (F = 64.706; p = 0.000), the effect of having reached the podium in the last competition on performance evaluation (t = 2.087; p = 0.041) and motivation (t = 4.035; p = 0.000), and injury severity on stress management (F = 6.204; p = 0.008). The factors that affected the psychological profile of the female cyclists the most, in addition to the independent psychological parameters, were the number of podiums in the last year and the years of cycling experience. In conclusion, there is an interaction between the psychological profile, sociodemographic variables, training, performance, and injuries suffered in female cyclists.

Effect of mindfulness on physical activity in primary healthcare patients: a randomised controlled trial pilot study

Abstract

Increased physical activity can have health benefits among inactive individuals. In Sweden, the healthcare system uses physical activity on prescription (PAP) to motivate patients to increase their physical activity level. Mindfulness may further heighten the internal motivation to engage in physical activity. However, previous research has not demonstrated clear evidence of such an association.

Aim

Examine the feasibility of the study design as a preparation for a full-scale study, and examine the differences, between three interventions, in change over time in physical activity levels and in related variables.

Method

Comparison between three different interventions in an ordinary primary health care setting: PAP, mindfulness, and a combination of PAP and mindfulness. Physical activity was measured with self-report and ACTi Graph GT1X activity monitor. Statistical analysis was performed with a mixed-effect model to account for repeated observations and estimate differences both within groups and between groups at 3- and 6-months follow-up.

Results

Between September 2016 and December 2018, a total of 88 participants were randomised into three groups. The total dropout rate was 20.4%, the attendance rate to the mindfulness courses (52% > 6 times) and the web-based mindfulness training (8% > 800 min) was low according to the stated feasibility criteria. Eleven participants were excluded from analysis due to low activity monitor wear time. Neither the activity monitor data nor self-reported physical activity showed any significant differences between the groups.

Conclusion

The study design needs adjustment for the mindfulness intervention design before a fully scaled study can be conducted. A combination of PAP and mindfulness may increase physical activity and self-rated health more than PAP or mindfulness alone.

Trial registration

ClinicalTrials.gov, registration number NCT02869854. Regional Ethical Review Board in Lund registration number 2016/404.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00810-6.

“Be Mindful Even Though It Hurts”: A Single-Case Study Testing the Effects of a Mindfulness- and Acceptance-Based Intervention on Injured Athletes’ Mental Health

Injury is a serious setback for athletes and might jeopardize mental health. The aim of this study is to investigate if a mindfulness- and acceptance-based intervention can improve mindfulness (nonreactivity and acting with awareness), acceptance, and well-being, and decrease the level of symptoms of anxiety and depression. A single-case design with multiple, staggered, and nonconcurrent baselines was used. Six seriously injured athletes took part in an 8-week intervention and repeatedly completed questionnaires on all variables for the duration of the study. The results showed that, on average, there were significant clinical changes between phases in nonreactivity, well-being, and acceptance. No effect was seen in the two remaining scales. On an individual level, two participants showed effects in all scales, two participants in some of the scales, and two participants in the scale nonreactivity. Results are discussed in light of existing research, and implications for practitioners’ clinical methods are presented.