Mental Toughness in Rehabilitation

1. Mental Toughness in Rehabilitation Download presentation at: http://mentaltoughnessamp.weebly.com/ Seth Haselhuhn, PhD, CSCS Washington State University

2. What is Mental Toughness? • The natural or developed psychological edge that enables an individual to: • Generally • Cope better than your opponents with the many demands (i.e., competition, training, lifestyle) that sport places on a performer • Specifically • Be more consistent and better than your opponents in remaining determined, focused, confident, and in control under pressure.

3. Having an unshakeable self-belief in your ability to achieve your competition goals. Considering Dweck’s (2000) Self-Theories, we want to encourage Incremental Beliefs and Mastery Orientations

4. Bouncing back from performance set-backs as a result of increased determination to succeed. Clear goals and feedback – really an unshakeable need to be successful

5. Having an unshakable self-belief that you possess unique qualities and abilities that make you better than your opponents Preparation and intelligence. We can feed this through our own self-confidence. It will rub off on them.

6. Having an insatiable desire and internalized motives to succeed Intrinsic motivation Autonomy, Competency, Relatedness. The culture of the program.

7. Remaining fully focused in the face of competition-specific distractions Concentration is an ability to focus attention. Athletes focus on executing rehabilitation movements.

8. Regaining psychological control following competition specific unexpected, uncontrollable events Relaxation and Energization Breathing Cognitive Appraisal Performance Expectations

9. Pushing back the boundaries of physical and emotional pain, while still maintaining technique and effort under distress in training and competition Self-talk cues for rehabilitation movements. Visualize pain scales, use as tool and challengenot warning and threat.

10. Accepting that competition anxiety is inevitable and knowing that you can cope with it. The hard is what makes it great. Focus on processand mastery orientation.

11. Not being adversely affected by others’ good and bad performances. Task oriented, self-referencing measures of success

12. Thriving on the pressure of competition. Intelligence – understand what “winning” means in rehab. Shortand long term goals. Emphasis on short term.

13. Remaining fully-focused on the task at hand in the face of competition-specific distractions. Process oriented goals for exercises and sessions. Focus on executing exercises – self vs. normative referencing.

14. Switching a sport focus on and off as required They are people first, don’t forget - we are not just mechanics.

15. Okay, so now what? Psychology of Athletic Injury

16. Cognitive Appraisal Model • Centered on how an individual interprets or appraises an injury determines how the individual will react emotionally. • The fact the injury has occurred is less critical to understanding the athlete's reaction than is the way in which in the injury is perceived by the athlete. • Popular models : • Lazarus and Folkham (1984) • Wiese-Bjornstal et al. (1998)

17. Lazarus & Folkman’s Model • Primary Appraisal “What is at stake?” • Goal importance • Impact attainment of personal goals • Ego Identity • Extent athlete identifies with goals, athlete identity, social status • Goal Uncertainty • Degree athlete is unsure about goal attainment

18. Lazarus & Folkman’sModel cont. • Secondary Appraisal “What can I do?” • Perceived Control • Assess personal coping efforts reduce source of uncertainty • Coping Potential • Athlete evaluates personal skills or strategies to deal with uncertainty

19. Lazarus & Folkman’s Model cont. • Overall Appraisal • Threat Appraisal • Less desirable, lower motivation, more external locus of control, entity mindset, helpless oriented • Challenge Appraisal • More desirable, higher intrinsic motivation, more internal locus of control, incremental mindset, mastery oriented

20. Lazarus & Folkman’s Model cont. Two types of coping in response Problem Focused Coping Emotion Focused Coping Focus efforts on changing feelings of stress Relaxation Avoidance Social Support Reappraisal • Focus efforts on changing sources of stress • Increase effort • Planning • Constructive Self-talk • Self-monitoring Never an “either/or” situation. Problem focused is generally more stable than emotion focused, however both types should be employed for the highest adherence and intrinsic motivation

21. Lazarus & Folkman’s Model cont. Primary Appraisal Something at stake? Yes No Not stressful! Secondary Appraisal Can I handle it? Yes No Overall Appraisal Challenge Threat Problem Focused Emotion Focused Emotion Focused Problem Focused Behavior Consequences

22. Integrated model of psychological response to the sport injury and rehabilitation process. Wiese-Bjornstalet al. (1998) Similar to Lazarus & Folkman Which of these factors can we affect? Which level of appraisal are we working with? Which type of focused coping should we be promoting?

23. Questions? For more information contact: sethh@uidaho.edu www.mentaltoughnessamp.weebly.com Comments?

24. Strategies for mental toughness

25. Self theories – Unshakeable? Entity Theorists Incremental Theorists Ability is product of effort and challenge. Develops with time. Learning – gain knowledge Improvement – apply it Mastery Oriented Ability improves when I work show me how. Task state/goal orientation Success = Self-references • Ability is an inherent quality of self. Relatively unchangeable. Global. • Stable – doesn’t change • Gift – can be honed • Helplessness Oriented • Ability is inherent, then what option do I have when I fail? • Ego state/goal orientation • Success = Norm references

26. Goal Setting 101 • Process, Process, Process! • Not about getting “things” done, about how we get to “done”. • Focus on technique and strategy execution • Then technique and strategy improvement • Specific and measureable • No “do your best” goals • Specific to enhance attention and concentration • Measureable to monitor progress/success - Write it down! Track it! • Moderate difficulty • Too easy? Anyone can do that, so what? Why am I here? • Too hard? What are we doing? Why am I here? Helplessness. • Controllable and flexible • Positive, constructive language • Buy in – not all “hugs and juice boxes” • Constructive language better, realistic and focused

27. Goal Setting 201 • Short and long term goals • Focus on short term goals closer to injury and with athletes with strong athlete identity • Both team and individual goals • In the clinic – team (i.e., athlete and ATC/PT) • At home – individual • Balance self and normative referencing measures of success • Self-referencing • success happens when I do better than I did before • Normative-referencing • success happens when I do better than other people Self-Beliefs Goals Consequences Entity Outcome Success and Failure Incremental Process Mastery

28. Motivation Hierarchy for Mental Toughness

29. High 1 Intrinsic Motivation 2 3 Self Determination Continuum Extrinsic Motivation 4 5 6 Amotivation 7 Low

30. Self talk • The steady stream of on-going thoughts or internal dialogue that constantly goes on in our minds. • Influences our moods, emotions, and ultimately our behavior. Self Talk ABC’s A = Activating Event • No Inherently stressful situations or events • “We are not disturbed by things, but by the views of which we take of them” – Epictetus B = Belief about the Event • Athletes attach positive or negative meanings to neutral events based on their highly automatic belief system C = Consequences • Our beliefs about the event lead to positive or negative consequences, both emotionally and behaviorally

31. Types of Self Talk • Positive Affirmations • Thoughts that focus on your desirable characteristics and qualities • Goals • Thoughts that keep your mind positively focused on the task-at-hand, promote high effort, and enhance persistence • Appraisals • Thoughts that determine the degree to which a situation is perceived as threatening or challenging. Promote appraising problems as challenges or opportunities to learn • Attributions • Reasons or explanations of success and failure. Encourage performers to attribute success and failure to factors they can control and change, such as effort, ability, and degree of preparedness • Cue Words • Quick reminders used during practice and competition

32. Types of Negative Thinking • Catastrophizing • expecting the worst • exaggerating the consequences • Overgeneralization • forming conclusions based on insufficient information • Blaming • not accepting responsibility for mistakes • Musturbation • must’s, should’s, and ought to’s • a form of concrete, inflexible, and unforgiving thinking

33. Types of Negative Thinking • Polarized thinking • good or bad, right or wrong, succeed or fail, etc. • leaves little room for mistakes or being human • Fear of Failure • “It is terrible and unbearable when my game is not the way I want it to be” • Social Approval • “I must win the approval of others and impress everyone who sees me perform”

34. The three “D”’s • Detect • Self-awareness of unconscious thought patterns • Disrupt • Thought Stopping • Dispute • Reframe using types of self-talk counterarguments

35. Attention • Acognitive process whereby you direct and maintain awareness of stimuli detected by the senses and use that information to make decisions and choose responses. • Width of attention • Broad focus • Attend to a large number of stimuli at the same time • (e.g., QB reading a defense or point guard executing a 3 on 2 fast break) • Narrow focus • Attend to a small number of stimuli • (e.g., golfer lining up a putt) • Direction of attention • Internal focus • Directed inward on thoughts and feelings • (e.g., monitor your body’s responses and mental skills). • External focus • Directed to events happening in the environment • (e.g., evaluating playing conditions)

36. Attentional Capacity • Controlled Processing • Focus on performing mechanics of a skill • Slow, deliberate, attention demanding process • Automatic Processing • Motor memory, perform without thinking • Fast, holistic, not attention demanding

37. Imagery 101 • Imagery is a form of simulation training where experiences are created or recreated in the mind. • Imagery is an experience similar to a sensory experience but arising in the absence of the usual external stimuli. • Imagined events have a similar effect on the nervous system and mental processes as actual events. • The brain can’t tell the difference between vividly imagined events and the real thing.

38. Imagery 101 • Factors affecting imagery effectiveness: • Type Of Task • Cognitive skills improve more compared to motor skills. • Use in rehab to focus on movement execution, healing • Playing Experience • More experienced performers benefit the most from imagery. • Need to be descriptive when teaching rehab movements • Imaging Ability • Imagery fundamentals can be improved through systematic practice. • Practice, Practice, Practice

39. Imagery 201 • Multi-sensory Process • Re-experience event realistically • Create a new “reality” • Include all senses • Vividness • Videotape-like quality, High-Def • Controllability • Imagine consistent excellence • Powerful tool – works both ways • Relaxation Training • Brain waves in “alpha” state • Complete focus – requires practice

40. Selected References and Recommended Readings Bauman, J. (2005). Returning to play: The mind does matter. Clinical Journal of Sport Medicine, 15(6), 432-435 Burton, D., & Raedeke, T. D. (2008). Sports psychology for coaches. Champaign, IL: Human Kinetics. Carr, C. M. (2006). Sport psychology: Psychologic issues and applications. Physical Medicine and Rehabilitation Clinics of North America, 17, 519-535 Clough, P., Earle, K., & Sewell, D. (2002). Mental toughness: The concept and it's measurement. In I. Cockerill (Ed.), Solutions in sport psychology (pp. 32-45). London: Thompson. Connaughton, D., & Hanton, S. (2008). Mental toughness in sport: Conceptual and practical issues. In S. Mellalieu, & S. Hanton (Eds.), Advances in applied sport psychology: A review (pp. 317-346). London: Routledge. Connaughton, D., Wadey, R., Hanton, S., & Jones, G. (2008). The development and maintenance of mental toughness: Perceptions of elite performers. Journal of Sports Sciences, 26(1), 83-95. Coyle, D. (2009). The talent code. New York: Bantam Crust, L. (2008). A review and conceptual re-examination of mental toughness: Implications for future researchers. Personality and Individual Differences, 45, 576-583. Crust, L., & Azadi, K. (2010). Mental toughness and athletes' use of psychological strategies. European Journal of Sport Science, 10(1), 43-51. Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination theory in human behavior. New York: Plenum Press. Dweck, C. S. (2000). Self-theories: Their role in motivation, personality, and development. New York: Psychology Press. Dweck, C. S. (2006). Mindset: The new psychology of success. New York: Ballantine Books. Ericsson, K. A., Krampe, R. T., & Tesch-Romer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363-406. Gould, D., Dieffenbach, K., & Moffett, A. (2002). Psychological characteristics and their development in Olympic champions. Journal of Applied Sport Psychology, 14(2), 172-204. . Green, S. L., & Weinberg, R. S. (2001). Relationships among athletic identity, coping skills, social support, and the psychological impact of injury in recreational participants. Journal of Applied Sport Psychology, 13(1), 40-59 Gucciardi, D. F., Gordon, S., & Dimmock, J. A. (2008). Towards an understanding of mental toughness in Australian football. Journal of Applied Sports Psychology, 20(3), 261-281 Gucciardi, D. F., Gordon, S., Dimmock, J. A., & Mallett, C. J. (2009). Understanding the coach's role in the development of mental toughness: Perspectives of elite Australian football coaches. Journal of Sport Sciences, 27(13), 1483-1496. Horn, T. (Ed.). (2008). Advances in sport psychology(3rd ed.). Champaign, IL: Human Kinetics. Jones, G., Hanton, S., & Connaughton, D. (2002). What is this thing called mental toughness? An investigation of elite sport performers. Journal of Applied Sport Psychology, 14(2), 205-218. Jones, G., Hanton, S., & Connaughton, D. (2007). A framework of mental toughness in the world’s best performers. The Sport Psychologist, 21, 243-264. Kreiner-Phillips, K., & Orlick, T. (1993). Winning after winning: The psychology of ongoing excellence. The Sport Psychologist, 7, 31-48. Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Mamassis, G., & Doganis, G. (2004). The effects of a mental training program on juniors pre-competitive anxiety, self-confidence, and tennis performance. Journal of Applied Sport Psychology, 16(2), 118-137. Walker, N., Thatcher, J., & Lavallee, D. (2007). Psychological responses to injury in competitive sport: A critical review. The Journal of the Royal Society for the Promotion of Health, 127(4), 174-180. Wiese-Bjornstal, D. M., Smith, A. M., Shaffer, S. M., & Morrey, M., A. (1998). An integrated model of response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10, 46-69 Williams, J. M. (Ed.). (2010). Applied sport psychology: Personal growth to peak performance (6th ed.). New York: McGraw-Hill. Williams , J. M. & Anderson, M. B. (1998). Psychosocial antecedents of sport injury: Review and critique of the stress and injury model. Journal of Applied Sport Psychology, 10(1), 5-25.