Coaches are People Too: An Applied Model

of Stress Management for Sports Coaches

Jim Taylor

Nova University

Abstract

This paper examines the growing concern over stress among sports coaches.  In particular, it provides an applied model of stress management in coaching which explores some of the significant causes of stress and outlines a five-step stress management program designed to address the special needs and concerns of coaches.  The model is based on an integration of previous theoretical and empirical research both within and outside of sports.  The first step, perceptions of coaching, assists coaches in understanding their perceptions, beliefs, and motivations for coaching.  The second step, identification of primary stressors, involves clarifying to coaches their most significant sources of stress.  The third step, identification of symptomatology, allows for the specification of the manner in which the stress is manifested in the individual coaches.  The fourth step, development of coping skills, provides a structure within which coaches may cope effectively with stressors.  Finally, the fifth step, building support systems, describes how a broad-based social support system may contribute to the effective management of stress.

                                     Coaches are People Too: An Applied Model

                                       of Stress Management for Sports Coaches

It is a commonly held belief that coaches are, in general, overworked and underpaid.  They are often under a great deal of pressure to succeed and their positions can be tenuous.  These issues can contribute to a wide variety of personal problems on the part of coaches.  Traditionally, considerable attention has been paid to difficulties that are experienced by athletes at all levels of sports.  However, little consideration is given to similar problems that coaches must face.  Many people simply do not realize that “coaches are people too”.

It is important for the mental, emotional, and physical health of coaches that individuals within the athletic community appreciate that coaches have doubts, worries, fears, and other problems.  Moreover, these issues can lead to more serious difficulties that will affect the coaches as individuals and in their involvement with their athletes.              There is, fortunately, a growing awareness of the mental health of coaches among both the laypeople (Borges, 1989a; Borges, 1989b; Borges, 1989c; Borges, 1989d) and professionals (Caccese & Mayerberg, 1984; Capel, Sisley, & Desertrain, 1987; Dale & Weinberg, 1989; Smith, 1986).  This concern has emerged due to the media scrutiny surrounding several highly visible professional coaches who left their positions as a result of burn-out and the inappropriate behavior of other well-known coaches (Klein, 1985; Looney, 1985; Wolff, 1989).  However, despite the growing interest, there has been little work done in the development of a practical model of stress management for coaches.

The causes of stress and how it can be managed effectively has been well-researched over the last two decades (for reviews, see McLeroy, Green, Mullen, & Foshee, 1984; Meichenbaum & Jaremko, 1983; Murphy, 1984).  From this literature, various models of stress management have emerged (Lazarus & Folkman, 1984; McInerney, 1984; Smith & Ascough, 1985).  In addition, recently, stress management has begun to be applied specifically to the sports setting.  In particular, Smith (1980) adapted his cognitive-affective model to athletes.

However, to date, there has been no work done to adapt these models to the particular, and sometimes unique, needs of coaches.  In order to address this issue, the present paper proposes an applied model of stress management for coaches that incorporates some of the general knowledge offered by previous theorists while, at the same time, taking into consideration the specific needs of coaches and the particular demands of the coaching profession.  Moreover, the model will address both the causes of stress for coaches and how the stress may be managed effectively.        The present conceptualization also adds to previous considerations by incorporating a number of issues into the model.  First, it provides a more detailed delineation of the individual coaches’ own perception and beliefs about their work environment.  Second, it identifies the stressors that are specifically related to coaching.  Third, the model furnishes a detailed discusssion of specific stress management techniques for each important level of intervention.  Fourth, it indicates how these strategies may be applied to the particular needs and demands of coaches.  Finally, the model includes a social support component to complement the individual coaches’ intrapersonal efforts at managing stress.  The goal of the present model is to allow coaches to reduce the stress they derive from their work effectively.  This reduction of stress will enable them to build a sound foundation for maintaining motivation, enhancing satisfaction and enjoyment, and, in general, to improve the quality of their professional and personal lives.

This model was developed out of the author’s work as a sport psychologist at many levels of coaching including scholastic, junior-elite, collegiate, world-class, and professional.  The implementation of this program by the author has produced supportive, though anecdotal, evidence.  As a consequence, the present model was formulated in order to provide a framework from which to further investigate stress management in coaching.  Before the model is presented, however, it is first necessary to provide a sound theoretical and empirical foundation and justification for the development of such a model.  As a result, a brief review of relevant research will be offered.

How Stressful is Coaching?

In order to justify the need for the development of an applied model of stress management for coaches, it is necessary to demonstrate that coaching is, indeed, stressful.  At present, though, there is a dearth of empirical literature in this area.  Moreover, the research that has been conducted has produced equivocal findings.   For example, Kroll and Gendersheim (1982), in a study of male scholastic coaches, found that coaching was considered by the majority of the sample to be stressful.  Furthermore, Malone and Rotella (1981) assert that if coaches are not able to effectively cope with stress, they will be susceptible to burnout.

However, not all of the research has been supportive of this relationship.  In a study of Canadian collegiate coaches, Wilson and Bird (1984) indicated that coaches exhibited less stress than individuals in other occupations.  They also found, though, that certain environmental factors, i.e., longer hours, full-time status, and losing seasons, were related to higher levels of stress.  Caccesse and Mayerberg (1984) reported similar findings in their study of college coaches.  They further indicate, however, that  female coaches and those with less experience evidenced the most amount of stress.  Based on this limited evidence, it appears that coaching may not, in general, be significantly stressful.  However, there seem to be a number of personal and environmental factors that, when present, will cause coaching to be stressful.

Unfortunately, there has been no empirical exploration of stress among elite-amateur or professional coaches.  However, as discussed previously, there is considerable anecdotal and clinical evidence to at least warrant concern and further investigation (Klein, 1985; Looney, 1985; Wolff, 1989).  Moreover, there is a significant amount of research in other related areas, such as in education and industrial/organizational psychology, that provides further justification for additional study.

In particular, evidence of significant stress was reported in research examining public agency employees (Ganster, Mayes, Sime, & Tharp, 1982) and secondary school teachers (Payne & Furnham, 1987).  Similar findings emerged in studies investigating women from dual-earner families (King, Winett, & Lovett, 1986), business professionals (Bruning & Frew, 1987), and hospital employees (Jones, Barge, Steffy, Fay, Kunz, & Wuebker, 1988).  Considering the limited amount of research available on coaching stress, the similarities of these populations to coaches, and the heterogeneity of the groups that were studied, it seems reasonable to generalize these findings to the coaching population and use them as justification to further explore stress in coaching.

Primary Sources of Stress for Coaches

In order to develop a model of effective stress management for coaches, it is first necessary to identify the significant sources of stress that are experienced by coaches at different levels of competition.  Unfortunately, as with other areas of coaching stress, there is little research available to draw firm conclusions.

Most of the literature to date has examined the importance of role conflict and role ambiguity on stressful reactions by coaches.  Kahn, Wolfe, Quinn, Snoek, and Rosenthal (1964) delineate role conflict by describing three types (each of which is meaningful for coaches).  First, interrole conflict involves a person possessing several roles that require inconsistent behaviors.  For instance, coaches might want to have a low-key, democratic relationship with their athletes and, at the same time, must, periodically, discipline them harshly.  Second, intrarole conflict indicates that a person has a role from which different people expect opposing behaviors.  Little League coaches may find that parents of some of the team members want to emphasize fun and mastery while others want to win.  Third, person-role conflict suggests that a role demands behaviors that are incongruent with the individual’s beliefs, values, or skills.  A collegiate coach, for example, might feel pressured by the athletic director to use recruiting techniques to sign a talented athlete that are against his beliefs.

Outside of sport, there is considerable evidence to indicate that this factor is a significant precursor to stress and decreased performance (Cherniss, 1980; Kahn, 1978).  Role conflict was found to be especially influential with persons who had to deal with people both within and outside of their primary organization.  This finding has clear implications for coaches who must interact with people within, i.e., athletic directors and management, and outside, i.e., fans and media, of their team or club.  Kahn (1978) further states that the most typical kinds of role conflict involve having too tasks and tasks that are too demanding.

Both of these types of role conflict are relevant for coaches.  Specifically, coaches may be required to fulfill the roles of physical trainer, technician, fund-raiser, accountant, parent, administrator, and recruiter.  In addition, coaches may not possess the necessary skills to successfully perform these responsibilities.

Role ambiguity develops when the individual lacks the information needed to effectively fulfill a role (Kahn et al., 1964).  Research supporting this notion outside of sport has demonstrated that 24% of the variance for perceived burnout could be accounted for by role ambiguity and role conflict (Schwab, 1981).  In addition, Capel (1986) found that role ambiguity was related to stress-induced burnout among a sample of athletic trainers.  Though there has been no empirical study of this relationship among coaches, it is easy to see that role ambiguity may play a significant role for them as well.  Specifically, as suggested by Capel, Sisley, and Desertrain (1987), the absence of direction and support from upper-level management, lack of clarity of job requirements, and unclear evaluation procedures may all produce stress for coaches.

Though these two factors provide a useful general  categorization of sources of stress, they lack the specificity for consideration in an applied model of stress management.  As a consequence, it will be useful to examine the specific sources of stress that have been reported in the literature both within and outside of sports.

It has been argued that winning is an intrinsic part of the Western socialization process (Snyder & Spreitzer, 1979) and that it is a pervasive aspect of all of American society’s regulative social institutions (Loy, 1978).  From this perspective, Santomier (1983) suggests that this high status places an implicit pressure on coaches which, in turn, results in stress.  Additionally, Ingham (1975) concludes that this “performance principle” may place excessive demands on individuals in the sport setting.

Outside of the sports domain, a study by Ganster et al. (1982), utilizing a sample of public agency employees, indicated that their most common sources of stress included heavy workloads, inadequate resources, and the frequency of crises.  Similar results were reported by Rapoport & Rapoport (1976) and St. John-Parsons (1978).  In addition, research has demonstrated that the absence of time to pursue positive activities may also produce stress (Kanner, Kafry, & Pines, 1978; King, Winett, & Lovett, 1986).  All of these factors have clear implications for coaches.

Additional research examining secondary school teachers indicated that difficulties related to instructional and student management demands were considered to be the most stressful aspects of their work (Payne & Furnham, 1987).  Other studies involving teachers reported that the most commonly mentioned stressors included difficult students, absence of teaching resources, inadequate administrative staff and low staff relations, overload of non-teaching responsibilities, and insufficient time to fulfill responsiblities (Gorrell, Bregman, McAllister, & Lipscomb, 1985; Harris, Halpin, & Halpin, 1985; Pratt, 1978; Shaw, Keiper, & Flaherty, 1985).  Also, consistent with findings involving coaches, gender and experience were related to the amount of stress that was reported (Kyriacou & Sutcliffe, 1978; Payne & Furnham, 1987; Staats & Staats, 1982).

Based on the literature just discussed, it is possible to classify three major areas of stress for coaches: Personal, social, and organizational (see Table 1).  Personal stressors refer to factors intrinsic to the individual that create stress.  Examples of personal stressors include lack of experience (Caccesse & Mayerberg, 1984), an inability to meet personal needs (Kanner et al., 1978; King et al., 1986), self-doubts (Meichenbaum, 1975), maintaining physical health (Bruning & Frew, 1987), and inadequate coaching skills (Kahn, 1978).

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Social stressors involve difficulties that arise due to interactions with others (Capel et al., 1987; Kahn et al., 1964).  Moreover, social stressors may originate within and outside of the team or club.  Within the team, stressors may come from the athletes or the coaching staff.  Though there is no literature within sports examining the contributions that athletes make to stress in coaching, analogous research in education indicates that students are a significant source of stress for teachers (Gorrell et al., 1985).  Based on this findings, it seems reasonable to conclude that, in a similar manner, athletes may be causes of stress for coaches.  For example, difficulties associated with athletes may include handling conflict between athletes, managing athlete egos, dealing with individual athlete problems, and satisfying athlete needs.

Other research outside the sports domain also indicates that poor staff relations may increase stress (Berkeley Planned Associates, 1977; Ivancevich, Matteson, Freedman, & Phillips, 1990).  Unfortunately, there has been no research examining this issue in the sports setting.  However, it may be expected that similar difficulties would be evident among coaching staffs.  For example, stress caused by the coaching staff may include coach conflict, ineffective distribution of responsibilities, and poor decision-making by the coaches.

Outside of the team, interactions with fans, media, and parents may be sources of stress for coaches.  In addition, a lack of support from all areas of the coaches’ social network may contribute to experienced stress (Pilisuk & Parks, 1986).

Organizational stressors involve difficulties originating from within the team’s organizational superstructure (Capel et al., 1987).  Examples of organizational stressors include long hours (Wilson & Bird, 1984), lack of organizational support (Ganster et al., 1982), overload of responsibilities (Capel et al., 1987), administrative difficulties (Harris et al., 1985; Pratt, 1978), budgetary and other financial problems, time pressures (Payne & Furnham, 1987), and team performance concerns (Wilson & Bird, 1984).

Applied Model of Stress Management for Coaches

Based on the above review, there appears to be sufficient evidence to indicate that coaches do, in fact, experience stress and that it may be detrimental to their personal and professional lives.  In order to address this issue, the applied model of stress management for coaches was developed.  The purpose of this conceptualization is to elucidate the relevant stages in the process of stress identification and its intervention.  The model has five distinct stages that addresses each of the major aspects of the stress management plan: (1) perceptions of coaching; (2) identification of primary stressors; (3) identification of symptomatology; (4) development of coping skills; and (5) social support (see Figure 1).

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Perceptions of Coaching

A consistent finding that emerges from the stress literature is that the perceptions of events rather than the events themselves produce stressful reactions (R.S. Lazarus, 1975a, 1975b).  As a result, the first step in developing a stress management program for coaches is to assist coaches in articulating their own perceptions, beliefs, and motivations for coaching (see Figure 1).  Recent research has demonstrated the utility of individuals examining their personal and work values in reducing stress (Bruning & Frew, 1987).  This initial task provides both the coach and the sport psychologist with a sense of the fundamental perceptions that are held by coaches about their involvement in coaching.  This information can be valuable in developing an understanding of what personal, social, and environmental issues influence them and how their perceptions mediate the relationship between these factors and their stressful reactions to them (R.S. Lazarus, 1975a).

This information may be obtained through queries addressing several relevant areas.  First, coaches may be asked to identify the reasons why they are coaching.  Responses to this question should include issues related to personal values, quality of life, and financial expectations.  Second, coaches can then be asked to indicate what they believe are the benefits and detriments of coaching for them.  The coaches’ answers should be comprehensive in their appraisal of all of the positive and negative aspects of coaching.  Third, coaches can indicate what they want out of coaching, i.e., what are their goals in their career.  Once again, their responses should encompass all aspects of their coaching experience.  This information will assist the sport psychologist in determining the perceptions related to the coaches’ work that may cause maladaptive reactions to stressful events.

Once their values have been clarified, it is then useful for the coaches to set personal goals (Locke, Shaw, Saari, & Latham, 1981).  The purpose of these goals is to offer direction and motivation in their professional development.  Also, they will provide a tangible basis for feelings of achievement and satisfaction in their work which, it is suggested, will moderate the effects of stressors on the coaches.  In addition, these goals will enhance coaches’ sense of control over their work, thereby further reducing potential stressful reactions (Tache & Selye, 1985).  Empirical evidence reported by Bruning and Frew (1987) indicates that establishing strategic and tactical goals is an effective component of a cognitively-based stress management program.

These goals can be classified into three general categories: attitudes and behavior, skill development, and athlete and team performance.  Attitude and behavior goals involve setting objectives for the attitudes and behaviors that coaches wish to exhibit in their interactions with athletes, coaches, and others such as parents and officials.  For example, specific goals of this type might include providing more positive feedback to athletes or controlling anger toward referees.

Skill development goals comprise standards for the acquisition of the skills that are necessary for effective coaching such as increased visual rather than verbal description of technique or an enhanced understanding of the biomechanics of the sport.  In addition, these types of goals may be used to aid in the development of skills associated with other roles that the coach must fulfill, e.g., administrative, financial (Kahn, 1978).

Lastly, perhaps the most visible measure of a coaches’ ability and success is the performance of the team and individual athletes on the team.  As a result, goals involving athlete and team performance can be set as a means of maintaining motivation.  These performance goals may include an outstanding player being named to a national team or a particular statistical performance levels such as points per game.

The illumination of this information may occur in several ways.  It may be acquired through unstructured individual interviews between the sport psychologist and the coach.  This setting would provide a comfortable, nonthreatening opportunity for coaches to express their feelings and concerns about their work.  These data may also be obtained through the development of structured questionnaires that are completed by the coaches in  individual or group contexts.

Identification of Primary Stressors

In order to successfully minimize the negative effects of stress on coaches, it is first necessary to identify the primary stressors (Beech, Burns, & Sheffield, 1984) that are faced by coaches.  As discussed earlier, these stressors may be grouped into three broad categories: Personal, social, and organizational (see Figure 1).  In addition, they may be major life events (Holmes & Rahe, 1967) or chronic daily stressors (Monroe, 1983).  These stressors will vary as a function of the individual coaches’ personality and coping repertoire (French & Caplan, 1972; Kahn et al., 1964), their previous experiences in coaching (Caccesse & Mayerberg, 1984), environmental factors (Wilson & Bird, 1984), their level of social support (Sarason & Sarason, 1985), and the current type and level of coaching (Caccesse & Mayerberg, 1984; Capel et al., 1987; Wilson & Bird, 1984).

Additionally, within any particular sport setting, there is usually a common set of difficulties that coaches must address regularly.  For example, these frequent problems may include, at the professional level, such issues as contract hold-outs and cutting veteran players.  In contrast, at the high school level, significant stressors may consist of academic difficulties or parental issues.  A detailed identification of these areas will aid the coaches and the sport psychologist in specifying the unique demands of the particular setting, thereby enabling them to develop a comprehensive stress management program designed to address their particular needs (Meichenbaum & Jaremko, 1983).

To assist the sport psychologist in identifying significant stressors, there are a variety of assessment tools that may be used in this process.  For assessing major life events, inventories currently available include the Life Experiences Survey (Sarason, Johnson, & Siegel, 1978) and the Social Readjustment Rating Scale (Holmes & Rahe, 1967), both of which have been adapted for athlete populations (Passer & Seese, 1983; Bramwell, Masuda, Wagner, & Holmes, 1975, respectively).  In order to maximize their utility, these instruments could be further modified to account for the unique major life stressors of coaches.

For measuring daily stressors, other assessment tools are available.  Both The Daily Hassles Scale (Kanner, Coyne, Schaefer, & Lazarus, 1981) and the Daily Analyses of Life Demands for Athletes (Rushall, 1987) have proven to be effective measures of chronic daily stressors.  These scales could also be adapted to the particular needs of coaches.              Finally, Smith (1980) suggests that self-monitoring can also be a valuable assessment strategy.

Identification of Stress Symptomatology

In addition to gaining an understanding of what events produce stress reactions in coaches, it is also important to identify the manner in which they exhibit these difficulties.  Clarifying these processes will enhance the ability of sport psychologists to provide the appropriate interventions for the particular symptoms that are presented.  The primary sources of stress discussed above may manifest themselves in a variety of ways.  Specifically, Santomier (1983) indicates that stress may manifest itself in the form of cognitive, emotional/physiological, and behavioral difficulties (see Table 1).

Cognitive stress reactions include negative or depressive thinking and maladaptive attributions, (Davison & Valins, 1969; Meichenbaum, 1977).  For example, coaches may lose confidence in their ability to lead their team or may internally attribute poor team performance.  Instruments used to assess cognitive functioning include measures of self-efficacy (Bandura, 1977; King et al., 1986) and the Beck Depression Inventory (Beck, 1978).

Emotional/physiological stress responses may be comprised of, at the manifest level, anger, anxiety, depression, fatigue, or illness (Ganster et al., 1982) and, at physiological level, increased heart rate, blood pressure, and cardiac problems (Bruning & Frew, 1987; Cooper & Marshall, 1976).  Coaches who lose their temper more than normal, experience excessive anxiety, are unusually tired or ill, or have high blood pressure or heart difficulties would illustrate this type of difficulty.  Anxiety may be measured with the State-Trait Anxiety Inventory (Spielberger, 1970).  Emotional and physiological symptoms of depression may be assessed with Symptoms Check List-90 (Derogatis, 1977) and the Beck Depression Inventory (Beck, 1978).  Physiological measures of stress may be obtained for heart rate, blood pressure, and galvanic skin response (Burke, 1980; Fowler, 1970; Gifford, 1975; Kelleher, 1974).  In addition, Ganster et al. (1982) developed a somatic complaint scale that measures the frequency of complaints such as headaches, dizziness, nausea, sweating palms, and flushed face.  Also, though less practical, levels of catecholamines, which have been found to be related to stress, may be assessed (Frankenhaeuser, 1977; Ganster et al., 1982).

Behavioral difficulties may be seen in terms of tardiness, isolation, lack of assertiveness, and reduced efficiency (Bruning & Frew, 1987; Meichenbaum, 1975).  For instance, coaches may be late for meetings and practices or may become less productive than usual.  Though there are no inventories available to assess behavioral manifestations of stress, it would not be difficult to develop a brief coaching-specific checklist of some of the behavioral problems described above.

In addition to these symptom-specific measures of stress, several general inventories have been developed to assess a variety of perceived stressors among workers.  The Health Factors Inventory (Jones, 1983; Jones & Fay, 1987) includes subscales evaluating perceived levels of job stress, organizational stress, personal stress, and job dissatisfaction.  Additionally, The Stress/Mood/Productivity Inventory (Frederiksen, Solomon, McClaren, & Bosmajian, 1979) consists of physical-symptom, mood-related, and productivity items.  Also, the Stressful Conditions Questionnaire (Steinmetz, Kaplan, & Miller, 1982) assesses the frequency with which people experience a variety of cognitive, social, and occupational stressors.

Development of Coping Skills

The ability of coaches to address stressors in a positive, constructive manner may influence significantly their coaching performance and their own physical and mental health.  As a result of this importance, the development of effective coping skills is essential (see Table 1; Lazarus & Folkman, 1984; Meichenbaum, 1977).

There is considerable empirical support for the value of stress management programs for reducing stress in a variety of settings.  In particular, stress management programs have been successfully implemented with students (Decker, 1987; Romano, 1984), teachers (Dougherty & Deck, 1984), women from dual-earner families (King et al., 1986), and government workers (Savery, 1986).  Additionally, research has also demonstrated its efficacy in the business world (Bruning & Frew, 1987; Ganster, Mayes, Sime, & Tharp, 1982).

Monat and Lazarus (1977) offer two types of coping strategies that may be employed for the relief of stress: Palliative and instrumental.  According to these authors, the purpose of palliative coping skills is to temporarily alleviate the emotional impact of the stressors.  Moreover, palliative coping does not directly influence the stressor itself, but rather relieves the symptoms temporarily.  Examples of palliative coping include relaxation training, cognitive restructuring, and exercise.  They further suggest that this type of coping better prepares individuals for the implementation of instrumental coping.

Instrumental coping involves skills aimed at addressing the stressors directly.  In other words, the stressors themselves are changed, thereby relieving the stress reaction at its source.  Instrumental coping skills include time management, assertiveness training, and delegation of responsibilities (Monat & Lazarus, 1977).

The sport psychologist can be active in both assessment and intervention in this stage.  In order to determine the most effective intervention to use, accurate evaluation of coaches’ coping resources would be valuable.  Self-report inventories that are presently available are the Vulnerability to Stress subscale of the Stress Audit Questionnaire (Miller & Smith, 1982), the Coping Resources Inventory (Hammer & Marting, 1987), and the Athletic Coping Skills Inventory (Smith, Smoll, & Schutz, 1988).  By identifying coaches’ coping strengths and weaknesses, sport psychologists may then develop appropriate strategies for areas of need.

There are several approaches to developing stress management programs to deal with these bases of stress.  First, these domains may be addressed by adapting comprehensive stress management programs such as those offered by Holtzworth-Munroe, Munroe, and Smith (1985), Kirschenbaum (1984), Meichenbaum (1977), or Smith and Rohsenow (1989) to the coaching setting.  Such an approach has value because it provides an organized framework in which to alleviate stress.  However, as with other prescriptive methods, a significant drawback is that it provides interventions that may not be necessary and does not consider the particular needs of the individual or the demands of the situation.

Another potentially more efficient approach that may be employed would be to assess the particular stressors that are present and the nature of the stress reaction, then select specific techniques to remediate these areas.  Furthermore, as suggested by Smith (1980), both individual and situational factors may influence the effectiveness of the stress management techniques.  As a consequence, this approach enables the sport psychologist to design a stress management program that considers the particular needs of the individual and the specific demands of the situation.  Specifically, this process makes it possible to match appropriate strategies to the particular stressor and type of reaction.

For cognitive stressors, at a fundamental level, coaches must change their perceptions of the events that occur in their work (Bandura, 1977; R.S. Lazarus, 1975b).  In particular, coaches may use cognitive restructuring (A. Lazarus, 1972) and mental imagery (Smith, 1980) to re-orient their thinking in a more positive direction, self-instructional training (Meichenbaum, 1977) to improve attention and problem-solving, or goal-setting (Bruning & Frew, 1987).  These techniques have been used successfully to reduce stress in a variety of populations and activities (Labouvie-Vief & Gonda, 1976; Meichenbaum & Cameron, 1973; Moleski & Tosi, 1976; Trexler & Karst, 1972).

Similarly, relevant techniques could be used for emotional/physiological stressors.  Specifically, coaches could employ anger and anxiety exercises such as time-out (Browning, 1983), relaxation training (Bruning & Frew, 1987; Delman & Johnson, 1976; May, House, & Kovacs, 1982), and health (Savery, 1986), exercise (Bruning & Frew, 1987), and nutritional counseling (Stevens & Pfost, 1984) to alleviate these difficulties.

Finally, a regimen of behavior modification could deal with overt manifestations of stress.  Techniques such as assertiveness training (Lange & Jakubowski, 1976), time management training (Bruning & Frew, 1987; King et al., 1986), and skills assessment and development (Bruning & Frew, 1987; Taylor, 1987a) could be effective in overcoming behavioral difficulties caused by stress.  Furthermore, through active management of the team environment, e.g., team selection, practice group selection, and room assignments, coaches can create a setting that prevents many problems from arising (Kirschenbaum, 1984; Meichenbaum & Jaremko, 1983; Taylor, 1987b).

A useful strategy for both identifying common stressors and selecting the appropriate stress management techniques is the use of group brainstorming with the coaching staff (Osborn, 1957).  This method has been found to be useful in producing new and innovative ideas for solving problems (Jablin, 1981; Schultz, 1989).  In addition, brainstorming has been used effectively in a sport setting (Richman et al., 1989).  As a consequence, this strategy allows coaches to determine the most salient stressors, share techniques they already use to combat stress, and generate new and more effective means of dealing with common problems.  Sport psychologists may facilitate this process by teaching brainstorming skills to coaches and assisting them in its implementation (Jablin, 1981).

Social Support

A significant issue that is often considered in the stress management literature is the role that social support plays in the amelioration of stress (Cohen & Wills, 1985; Sarason & Sarason, 1986; Smith, 1985).  Considerable research indicates that people who receive emotional or material support from others are healthier than those who receive little support (Broadhead et al., 1983; Caplan, 1974; Sarason & Sarason, 1985).

At present, there are two explanations for how social support ameliorates stress.  First, the buffering hypothesis suggests that social support may act as a buffer against stress (Cohen & Wills, 1985).  In particular, support helps in decreasing the effects of the stressful event on the individual, possibly by moderating the perceived meaning of the stressor.  This approach posits that social support is primarily related to health for individuals under stress.  Second, the main-effect view argues that social support is beneficial independent of whether persons are under stress (Cohen & Wills, 1985).  Specifically, it is postulated that social support provides positive affect, the perception of stability and predictability in life, and a sense of self-worth (Depner, Wethington, & Korshavn, 1982; Norbeck, 1985).  Though considering these differing perspectives is beyond the scope of the present work, it is possible to see how each could be meaningful within the context of coaching.

The professional literature offers many recommendations  for the use of social support to reduce stress.  For example, supervisors should provide empathy and feedback to employees when they are under stress (Villeco, 1977).  Also, workers should meet together to discuss difficulties, either informally (Freudenberger, 1977) or in organized gatherings (Shannon & Saleeby, 1980).

There is, unfortunately, little empirical study of the effects of social support intervention in reducing the amount of stress experienced by individuals.  One promising study by Sarason & Sarason (1986) demonstrated that experimentally enhanced social support increased performance and decreased cognitive interference on an intellectual task.  Lindner, Sarason, and Sarason (1988) reported similar findings using a social problem-solving task.  Additionally, in a medical field setting, results of a series of workshops aimed at increasing social support among physicians and nurses indicated marked improvement on a variety of psychological, social, and performance indices. However, the authors caution that the evaluations did not undergo rigorous statistical analysis (Bair & Greenspan, 1986).  Finally, Richman, Hardy, Rosenfeld, and Callahan (1989), using a brainstorming activity with a group of sport psychologists to generate ways of enhancing social support for athletes, produced a lengthy list of recommended interventions that could easily be adapted for coaches.

In addition, research has indicated that social support may be characterized as either instrumental or expressive in nature.  Instrumental support refers to material and physical assistance in addition to information and guidance. Expressive support indicates emotional sustenance and the sharing of feelings (Pilisuk & Parks, 1986).

Pines, Aronson, and Kafry (1981) further break down these categories into six types of social support: (1) listening: people who listen without judgment and who can share in the successes and failures; (2) emotional support: those who provide emotional support during stressful times; (3) emotional challenge: individuals who challenge the person to surmount hurdles and accomplish goals; (4) shared social reality: those with similar beliefs, values, and goals who can provide reality-testing of the situation; (5) technical appreciation: individuals who recognize the quality of performance; and (6) technical challenge: others who can challenge the person to strive higher and perform better.  It is further argued that it is important to match the appropriate type of social support to that which is most needed (Cobb, 1976).

Assessment of social support is the first important step in this stage of the model.  The Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983) has been demonstrated to be an effective measure of the number of people that are available to a person and how satisfied they are with the social support.  Additionally, Pines et al. (1981) developed the Social Support Functions Questionnaire which assesses the six types of social support describe above.  Subsequently, Rosenfeld, Richman, and Hardy (1989) adapted this scale to athletes in order to measure who furnishes social support, which of the six types of social support is offered, and how the recipient perceives the support that is provided.  As with coping resources, understanding the exact nature of coaches’ social support systems will enable the sport psychologist to assist coaches in enhancing the less developed parts of those systems.

Specific sources of social support for coaches may be considered in light of the issues just discussed (see Figure 2).  Specifically, coaches’ primary sources of social support are: Upper-level management (instrumental; technical appreciation, technical challenge), coaching staff (instrumental and expressive; technical appreciation, technical challenge, shared reality, emotional support), the sport psychologist (instrumental and expressive; listening, emotional support), and family and friends (expressive; listening, emotional support, emotional challenge, shared reality).  As a result, with the development of a broad-based social support system, coaches may enhance these sources of support, thereby further reducing the effects of stress (Bair & Greenspan, 1986; Lazarus & Folkman, 1984; Sarason & Sarason, 1986).

_____________________________

Insert Figure 2 about here

_____________________________

One group of individuals that play a significant role in coaches’ social environment that has not been discussed relative to social support is the athletes.  As discussed previously, there is evidence to indicate that athletes may be a significant source of stress for coaches.  However, there is no support within or outside the sports domain to suggest that they serve as a meaningful source of social support.  For example, in the education field, there is no research to demonstrate that students offer social support to teachers.  Similarly, nothing has emerged with respect to subordinate support of their supervisors in the business setting.

Though, at an intuitive and practical level, it seems likely that athletes do offer some social support to coaches, it is unclear as to the nature of that support or the situations in which is given.  Furthermore, it is difficult to show which of the six types of social support posited by Pines et al. (1981) athletes would provide to coaches.  It appears that these kinds of support may best be supplied by individuals of equal or greater status.  Due to the absence of theoretical and empirical evidence demonstrating the contributions of athletes to the social support network of coaches, it is difficult to justify inclusion of athletes into this aspect of model.

Upper-level management.  A significant source of stress and frustration for coaches is the lack of support they receive from upper-level management of a sports organization, i.e.,  financial, logistical, and administrative (Capel et al., 1987; Ganster et al., 1982; Harris et al., 1985).  The inability to accomplish necessary tasks that are outside of the immediate responsibilities of the coach is detrimental to coaches on both a psychological and practical level.  In other words, these dificulties will cause stress and limit their ability to fulfill their primary obligations.  As a result, the sport psychologist can actively assist sports organizations to develop open lines of communication between coaches and upper-level staff.  For example, the sport psychologist can meet with the coaches and management prior to the competitive season to discuss probable difficulties on which the coaches will need assistance from the management.  A degree of commitment on these concerns can be solicited from the management, thereby making their cooperation when they arise more likely.  This support allows coaches to accomplish their primary responsibilities unencumbered and to receive the necessary help when the need is present.

Coaching staff.  A second critical area of both support must come from within the coaching staff itself (Harris et al., 1985; Pratt, 1978).  A cohesive, mutually-supportive staff will be more efficient and will be able to address a greater variety of issues more effectively (Bair & Greenspan, 1986).  A meaningful issue relative to this concern is in the selection of the staff.  Consideration should be given not only to the individual abilities of the coaches, but also to how their strengths and weaknesses complement and support each other.  For example, a well-balanced staff does not have to be composed of individuals possessing every necessary coaching skill.  Rather, a carefully selected staff will be comprised of coaches who, in aggregate, possess all of the requisite skills necessary to fulfill their responsibilities.  In addition, another critical component of a cohesive staff is the correct mixture of personalities to provide instrumental and expressive support.  Though difficult to quantify, the development of this blend would involve identifying all of the areas of support required by coaches, assessing which coaching candidates could provide what types of support, and selecting a staff that fulfills each of those needs.

In addition, a useful method for building and maintaining support within a coaching staff is to schedule regular coaches’ meetings with the express purpose of instrumental problem-solving, expressive support, and developing preventive and coping strategies (Richman et al., 1989; Shannon & Saleeby, 1980).  This approach provides the opportunity for coaches to get to know each other on a personal level and will foster greater personal investment in the staff, thus enhancing motivation to provide support.

Sport psychologist.  Despite efforts to maintain a supportive environment, conflicts may occur within the coaching staff, particularly during periods of high stress.  In addition, other difficulties related to stressors both within and outside of the team may arise.  In these situations, the role of sport psychologists in providing support can be significant.  Sport psychologists may offer useful preventive and coping techniques to assist the coaches in adapting to difficult situations.  In addition, they may provide unbiased, objective mediation of conflicts within or outside the team.  Also, sport psychologists may allow coaches to communicate feelings in a safe and supportive setting that they would not feel comfortable discussing with other coaches.

Family and friends.  Research outside of sports has demonstrated that social support from family and friends is significantly related to lower levels of stress and burnout (Davis-Sacks et al., 1985; Leavy, 1983; Mitchell, Billings, & Moos, 1982).  Based on these findings, it seems reasonable to assume that family and friends are also a significant source of expressive support for coaches.  Particularly for coaches who are required to travel extensively, time away from home can be lonely and stressful.  In order to minimize these difficulties, teams can incorporate a program by which coaches have ready access to support from family and friends.  For example, a team’s budget may include funds for telephone calls to spouses and the provision for a spouse to accompany the team on one trip per year.

Conclusion

As described above, sport psychologists may play an active role in all phases of the development of stress management programs for coaches.  Moreover, their expertise may ensure that the critical stressors are identified and the appropriate intervention strategies are implemented.  However, to date, there is little systematic knowledge within the sports setting upon which to base the utilization of these strategies.

Despite its apparent importance, there has been relatively little theoretical or empirical investigation of the effects of stress on coaching and even less on the value of stress management techniques on coaches’ responses to stress.  However, this position may be changing.  Due to the recent media attention given to coaches who have experienced difficulties, more researchers are beginning consider the effects of stress on coaches.

The purpose of developing the present model has been to initiate greater interest in this issue.  Though there is considerable theoretical and empirical support for the foundation of the present conceptualization, there is now a need to investigate the particulars of the model.  Such an exploration would involve empirical study of each stage of the model and its role in the alleviation of stress.  It is hoped that this model will act as impetus for researchers to further study the importance of stress on coaches.

                                                              Case Studies

Case Study #1: U.S. National Team Coach

Early in the competitive season, one coach, Steve (not his real name), was planning on leaving the team to join a junior-development program the following year.  Though Steve indicated that he enjoyed many aspects of his job, he felt burned out from the constant hassles of travel and the pressures of international coaching.  In past years, he was physically exhausted half-way through the season and had difficulty staying motivated.  At Steve’s suggestion, the team psychologist formulated an assessment and intervention program to assist him in managing his stress.

In the assessment stage, the psychologist observed Steve during training and competition.  It was his impression that he functioned very well; expressing his emotions appropriately, handling ambiguity effectively, and communicating well with the athletes and others.  Steve’s only noticeable source of frustration came in his interactions with the head coach and the team office.  He expressed that he often could not get assistance for things that needed to get done, but which were outside his area of responsibilities.  In addition, the psychologist saw that in the evenings, Steve tended to sit by himself and write letters to his wife and children.

The results of a coping skills instrument and a measure of social support that Steve completed indicated that he had sound coping resources.  However, he perceived himself as being very undersupported, particularly in two areas.  As expected, Steve felt undersupported from the upper-level management.  In addition, he often felt lonely and isolated from his family.  Based on this evaluation, the psychologist developed a program to enhance the relevant areas of social support.  The head coach was supportive of this plan because Steve was well-liked and the head coach wanted him to stay with the national team.

First, the psychologist and Steve discussed with the head coach and the program director specific and tangible ways to facilitate the logistical assistance that he requested during the season.  A reasonable timetable was created for the fulfillment of Steve’s requests and these issues were written up and distributed to all involved parties.  This strategy met Steve’s instrumental needs.

Second, in order to reduce Steve’s feelings of loneliness and isolation, the team arranged to have his wife travel to three competitions during the season.  In addition, they agreed to cover the cost of additional telephone calls to his family.  Thus, Steve’s emotional needs were satisfied.

This intervention program proved to be successful.  In contrast to previous seasons, Steve’s physical energy level remained high and he stayed healthy throughout the season.  His attitude also improved and the athletes perceived him as being more positive and supportive.  Post-season assessment of coping skills and social support indicated improvement in both areas.  Finally, based on the success of the team and his increased level of enjoyment in his work, Steve decided to remain with the team the following year.

Case Study #2: Junior-Development Coach

As a junior-development coach in a large program, Dan (not his real name), was having difficulties in his interactions with parents of the athletes with whom he worked.  The parents were sometimes critical of his work with their children and demanding of his time, often when he was busy coaching.  This disruption was frustrating for Dan and, as a result, he would become angry with the parents who, in turn, would complain to the head coach.  Further investigation by the head coach indicated that this problem was quite common.

This situation caused significant concern for the head coach and the team as a whole.  A sport psychologist who worked with the team was brought in to assist in the resolution of the problem.  After obtaining feedback from Dan, the head coach, and some of the parents, a multi-level intervention program was implemented.

At an organizational level, the head coach called a meeting with parents in which an open dialogue was established to identify the needs of the parents and clarify the needs of the coaches.  From this discussion, an agreement was reached on the appropriate manner, time, and place for parents to speak with the coaches.

At a staff level, brainstorming sessions were organized to identify typical parental concerns and behavior and to discuss effective responses to a variety of parents.  In addition, role playing was used to allow coaches to practice appropriate interactions with parents.

Additional individual sessions were arranged with Dan with two goals in mind.  One, to assist in his understanding of the causes of his anger and, two, to further develop coping skills and effective responses to the parents.

The intervention had a positive effect at several levels.  First, Dan reported feeling more relaxed and in control when dealing with parents.  He also felt less pressured and criticized.  Second, the coaching staff as a whole indicated greater cooperation and support from the parents.  Finally, the parents related that the coaches were more responsive to their concerns and were getting more feedback about their children.

Table 1

Stressors, Stress Reactions and Stress

Management Techniques for Coaches

_____________________________________________________________________________________

Stressors                            Stress Reactions                                  Management Techniques

_____________________________________________________________________________________

Personal

self-doubt                  negativity, depression             cognitive restructuring

physical health           fatigue, illness                         exercise, diet counseling

inadequate skills        confusion, helplessness                       skills assessment, development

Social

lack of support           loneliness                                             develop social support systems

team conflict              anger                                                   team building, time-out

pressure from fans, anxiety                                                    fan, media, parent management,

media, parents                                                                                    relaxation, assertiveness                                                                                                                      training

Organizational

long hours                  fatigue, illness                         scheduled rest, time-out

travel                          loneliness, isolation                 enhanced communication networks

overload of                tardiness, frustration               delegation of responsibilities,

responsibilities

administrative            confusion, inefficiency                       staff and management assistance

difficulties

time pressure              anger, helplessness                              time management training

_____________________________________________________________________________________

Figure 1

Applied Model of Stress Management for Coaches

┌────────────────────────┐         ┌────────────────────┐

│PERCEPTIONS OF COACHING:│         │ IDENTIFICATION OF  │

│     Personal values,   │         │ PRIMARY STRESSORS: │

│     Quality of life,   ├─────────┤       Personal.    │

│  Benefits, detriments. │         │        Social.     │

│      Personal goals.   │         │   Organizational.  │

│       Career goals.    │         │                    │

└───────┬────────────────┘         └───────────┬────────┘

│                                      │

│                                      │

│     ┌──────────────────────────┐     │

│     │    IDENTIFICATION OF     │     │

│     │  STRESS SYMPTOMATOLOGY:  │     │

└─────┤         Cognitive.       ├─────┘

│ Emotional/Physiological. │

┌─────┤        Behavioral.       ├─────┐

│     └──────────────────────────┘     │

│                                      │

┌──────────────┴─────────────────┐      ┌─────────────┴─────────┐

│ DEVELOPMENT OF COPING SKILLS:  │      │     SOCIAL SUPPORT    │

│          Cognitive.            │      │Upper-level management.│

│     Emotional/Physiological.   │      │     Coaching staff.   │

│         Behavioral.            │      │   Sport Psychologist. │            └──────────────┬─────────────────┘      │     Family, friends   │

│                        └─────────────┬─────────┘                           │                                      │

│                                      │

└──────────────────┬───────────────────┘

│

╔══════╧════════╗

║   EFFECTIVE   ║

║    STRESS     ║

║   MANAGEMENT  ║

╚═══════════════╝

Figure 2

Social Support Model for Coaches

Sport-Clinical Intake Protocol:

A Comprehensive Interviewing Instrument

for Applied Sport Psychology

Jim Taylor and Barry A. Schneider

Nova University

Abstract

With the growth of applied sport psychology in recent years, attention has been focused on the particular needs of athletes and the specific demands of the sport setting.  This growing concern has resulted in the development of a variety of strategies in the treatment of athletes.  However, a difficulty that has arisen involves obtaining adequate information about the athlete/client in order to develop the most effective intervention.  In response to this need, the Sport-Clinical Intake Protocol (SCIP), a comprehensive interviewing instrument for the athletic population, has been developed.  The SCIP provides extensive information about the athlete/client with respect to: (a) presenting problem, (b) life and athletic history, (c) social support, (d) health status, (e) important life events, (f) changes prior to onset of the presenting problem, and (g) details of presenting problem.  The value of the SCIP lies in its ability to provide detailed information about the athlete/client, thereby enabling the professional to make an effective conceptualization and develop an appropriate treatment plan.

Sport-Clinical Intake Protocol:

A Comprehensive Interviewing Instrument

for Applied Sport Psychology

The interview is the most important tool used by the clinical psychologist to gain knowledge of the client and the nature of the presenting problem (Bernstein & Nietzel, 1980).  Obtaining a mental status and eliciting a life history depend upon a perceptively guided interview (Cormier & Cormier, 1991).  In addition, the professional’s judgments regarding diagnosis and prognosis are also based largely on interview data.  Finally, the knowledge gleaned from these data should lead to formulation of treatment objectives and strategies that are relevant and appropriate (Bernstein & Nietzel, 1980).

Recent trends in clinical interviewing indicate that, with the development of many specialty areas in psychology, professionals will need to focus on the issues most relevant to the particular problems or needs of target populations.  This notion is reflected in interviews that have been developed for the evaluation of specific psychopathologies, for example, affective disorders (Flaherty & Gaviria, 1989), substance abuse (Craig, 1989), eating disorders (Marshall, 1989), personality disorders (Widiger & Frances, 1987), child and adolescent abuse (White, Strom, Santilli, & Halpin, 1986), and attentional deficit disorders (Phelan, 1989).  Interviews have also been developed that focus on particular clinical issues such as forensics (Blau, 1984) and suicide potential (Yufit, 1989).  In sum, there is an increasing realization that specific data are important for understanding particular problems.

The above examples illustrate how assessment, diagnosis, and treatment are global functions that may be enhanced by modifying the interview to meet the special demands of the population, problem, and/or issues under consideration.  This rationale is evident in the current effort to present a protocol for an intake interview specially designed for examining problems specific to sport psychology and the athletic population.

Interviewing in Sport

The field of applied sport psychology has developed along two distinct avenues over the past 20 years.  Initially, sport psychology was found within the domain of physical education and related fields.  More recently, it has emerged within psychology and other mental health settings.  The dichotomy between these two domains has brought with it discussion and debate at both the educational and professional levels (Gardner, 1991; Silva, 1989; Taylor, 1991).  Two common arguments that are made in applied sport psychology are that clinical psychologists do not have sufficient training in sports and physical education-trained practitioners lack adequate knowledge and experience in the broader psychological aspects of the athlete/clients (see Association for the Advancement of Applied Sport Psychology, 1989; Taylor, 1991; United States Olympic Committee, 1983 for a review of relevant education, training, qualification, and practice issues).

This differentiation has ramifications for the interviewing process in applied sport psychology.  With the growth of the field in recent years, attention has been focused on the particular needs of athletes and the specific demands of the sport setting.  However, a difficulty that has accompanied this development involves obtaining adequate information about the athlete/client in order to develop the most effective treatment plan (Taylor, 1988).

Conducting an interview in a sports setting raises a critical issue that must be addressed in order to determine the most appropriate course of action.  Notably, the presenting problem itself is usually presented as sport-specific.  However, the question remains as to whether it is the real problem or a symptom of another issue.  The diagnostic position that is taken at this point will determine whether the presenting problem is conceptualized as a performance enhancement or clinical concern.  This information will, in turn, determine the appropriate means of intervention.

This issue is especially meaningful because athletes may present with a wide variety of difficulties ranging from sports-specific deficits to serious pathology.  More specifically, athletes’ problems may include non-clinical issues such as loss of self-confidence (Weinberg & Jackson, 1990), concentration (Nideffer, 1981), or motivation (Weinberg, 1984) in their sports competition and clinically diagnosable difficulties such as depression (May, Veach, Reed, & Griffey, (1985), substance abuse (Tricker, Cook, & McGuire, 1989) and eating disorders (Thompson, 1987).

In the sports setting, the professional must evaluate whether the client would be most effectively conceptualized within a performance enhancement (Silva, 1989) or clinical paradigm (Gardner, 1991).  A mistake that can be made by physical education trained professionals in the conceptualization process is to view the presenting problem as an independent entity isolated within the sports domain.  Similarly, a misjudgment that may be made by the clinically trained professional is to conclude the presence of generalized pathology when none may exist.  Either determination may lead professionals to employ techniques that are inappropriate or ineffective.  These decisions about the conceptualization will also determine whether the problem is within the purview of the professional’s expertise or should be referred to another professional with the appropriate training.  This practice should hold true for any problem outside of the practitioner’s area of expertise.

In response to the need for more specialized information-gathering in the development of a conceptualization and treatment plan, the Sport-Clinical Intake Protocol (SCIP), a comprehensive interviewing instrument for the athletic population, has been developed.  The SCIP is a specially designed semi-structured interview for use in the sports setting.  The purpose of the SCIP is to gain useful information from athlete/clients with specific consideration given to their unique concerns.

Sport-Clinical Intake Protocol

Drawing on previous interviewing approaches such as the Structured Clinical Interview for DSM-III-R (SCID) (Spitzer, Williams, Gibbon, & First, 1990), the Structured Clinical Interview (SCI) (Schneider, Schneider, Hardesty, & Burdock, 1978), and the assessment tools aimed at particular problems or populations that were reviewed above, the SCIP has several objectives: (a) acquire both sport-specific and clinical information, (b) incorporate the sport-specific and clinical avenues of inquiry into an organized framework that is non-threatening to the client, (c) provide information that will enable the professional to determine the true nature of the problem, thereby allowing for the decision to treat or refer the client, and (d) to give the professional sufficient understanding of the client in order to develop an initial treatment direction.

The SCIP, consistent with the traditional psychiatric interview, focuses on gathering data and accumulating “facts” leading to a diagnosis.  In addition, it was designed to separate history from current mental functioning  and helps the professional with treatment issues and is particularly concerned with the intervention.  In this vein, the SCIP is consistent with recent changes in the practice of clinical psychology and psychiatry.

The SCIP, when employed as a structured interview, may be completed in 60-90 minutes.  It should be noted, however, that, while the SCIP is presented in a structured format, it need not be administered this way.  Indeed, the SCIP may be utilized in a manner that is consistent with the therapeutic orientation and interactive style of the professional.  For example, a therapist with a non-directive orientation might elicit responses to the SCIP queries when the topics arise during the client’s discourse by reflecting the content and/or feelings of the client (Rogers, 1980).

The SCIP is divided into eight sections, each of which is designed to access specific kinds of information (see Appendix).  In order to provide perspective and a foundation for the use of the SCIP, it will be useful to describe its eight components, their rationale, and show how this interviewing instrument reflects both current and historical influences on the role of the interview in clinical psychology.  Additionally, in order to clearly illustrate the value of the SCIP for professionals regardless of their education and training, two actual case studies, a professional baseball player and a world-class water skier will be presented within the context of the breakdown of the SCIP (see Tables 1-8).  As a means of highlighting the specific value of the particular component of the SCIP, relevant contributions of the SCIP to the conceptualizations of the athletes in the case studies will be presented with each section.

Breakdown of SCIP Concerns

Presenting problem.  As with any intake interview, an introductory description of the presenting problem is useful.  It is recommended that only a cursory characterization of the problem be elicited initially.  The SCIP is designed to obtain background information and details later in the interview when such data are deemed more helpful in understanding the nature of the problem.  In addition, premature probing into the problem, without the development of rapport and trust, could be too threatening for athlete/clients and interfere with their willingness to delve into reasons for seeking assistance.  Therefore, emphasis in this part of the interview is on a summary account of the problem (see Table 1).

______________________________________

Insert Table 1 about here

______________________________________

Athletic history.  This section of the SCIP helps build rapport and allows athletes to feel more at ease by discussing familiar and often gratifying issues.  It also provides valuable information on their general attitude and state-of-mind by observing the nature of their recollections.  For example, if most of their memories are unpleasant, it might indicate low situational self-confidence, low self-esteem, or even clinical depression.

In addition, the athletic history enables professionals to begin to understand clients’ social network and the role it plays in their lives.  It also allows for the examination of clients’ goals in terms of how realistic they are, recent changes, and how they might relate to the presenting problem.  Finally, the athlete’s competitive background might provide the professional with evidence of a historical foundation for the current problem (see Table 2).

______________________________________

Insert Table 2 about here

______________________________________

Family and social support.  This portion of the SCIP enables professionals to gain more extensive information about clients’ family background, the family’s role in the athlete’s athletic life, and current social support network relative to the presenting problem.  This portion of the SCIP is consistent with family systems approaches which suggest that the problems of the athlete may be considered within the context of the family (Manuchin, 1974).  These data also provide insight into the manner that the family may contribute to the client’s current difficulties.  These questions are particularly relevant for young athletes whose parents are often significant causal agents or contributors to the presenting difficulties (Hellstedt, 1987; McPherson, 1978).  This information may also be used to indicate the degree to which the problem generalizes outside of the sports setting.  Finally, responses to these questions can indicate the extent of the social support resources available to clients to help them to cope with the difficulties (Sarason & Sarason, 1986; Smith, 1985; see Table 3).

______________________________________

Insert Table 3 about here

______________________________________

Health.  Examining the overall health of clients can be most useful to professionals for isolating physical manifestations of the difficulties, the amount of stress that may be experienced, and identifying potential physiologically related causes of the problems.  Pertinent areas tapped by these questions include fatigue, lingering illness, injuries, changes in sleep and eating patterns, and alcohol or drug use.  Of particular interest is how these facets of the athlete’s health influence his or her training and competitive performances.  This section also enables initial exploration of clients’ thinking processes through dream content and pre-sleep thinking.  In addition, information about injuries may indicate accident proneness and conscious or unconscious attempts to avoid sports participation (see Table 4).

______________________________________

Insert Table 4 about here

______________________________________

Important life events.  This section asks clients to describe significant past events from their athletic and general lives.  This part of the SCIP serves several functions.  First, it provides further information about clients’ recollections and current attitude, i.e., is the client focusing on negative events?  Second, these data may make it possible to find a connection between a particular life event and the onset of the current problem, thus leading to a more clear diagnosis and treatment plan (see Table 5).

______________________________________

Insert Table 5 about here

______________________________________

Changes prior to onset of presenting problem.  This line of inquiry is the first step into a more detailed examination of the presenting problem.  In particular, it involves exploring major areas in clients’ lives where change would be evident.  Similar to the section above, this investigation would enable professionals to identify significant precipitating events to the presenting problem.  This search would encompass changes in a number of significant areas.  The initial focus is on the athlete’s sports environment.  First, physical factors associated directly with the client’s sport participation such as quality and quantity of training, physical conditioning, and practice habits.  Second, mental elements including self-confidence, anxiety, pre-competitive mental preparation, and competitive thoughts and feelings.  Third, changes in the competitive setting such as a new level of competition and the stage of the season.  Fourth, changes in equipment including the use of new equipment or the deterioration of old equipment.

Changes in social and environmental factors are also investigated.  Issues such as relationships involving family, friends, coaches, and teammates are relevant.  Continuing from the section examining family and social support issues, these questions identify changes in these factors (Bowen, 1978; Schwartz, 1982).  Additionally, the emergence of new training and competitive settings are worth examining.

Finally, alterations in cognition, affect, and behavior should be identified.  Specifically, indicating the nature of the athlete’s current thoughts, for example, negative or ruminating, emotions, for example, anger or sadness, and actions, for example, routines or habits, relative to previous levels may produce meaningful evidence for the professional (see Table 6).

______________________________________

Insert Table 6 about here

______________________________________

Details of presenting problem.  It is at this stage of the SCIP that professionals explore in-depth clients’ perceptions of the presenting problem.  In this process, it is often useful for clients to describe a typical situation where the problem occurs rather than to describe it abstractly.

This section focuses on identifying the particular environmental, personal, and social factors that are present when the presenting problem occurs.  In addition, the personal and social consequences of presenting problem are examined.  This depiction not only provides “objective” information about the circumstances surrounding the problem, but also can yield information about its meaning to clients (Reik, 1952; Menninger, 1958).

Finally, this stage of the SCIP provided a greater exploration of the issue by specifying the particular setting in which it occurs, its frequency of occurrence previously, the presence of a pattern of occurrence, and a specification of the factors that are evident when it does vs. does not occur (see Table 7).

                                  ______________________________________

Insert Table 7 about here

______________________________________

Benefits of the SCIP

As demonstrated by the case studies, the SCIP provides the clinician, who has formal training in interviewing techniques, but little experience working in sports, with a framework within which specific information about critical aspects of the athlete’s sporting life may be obtained and compared with other facets of the athlete’s life.  Issues such as the competitive development of the athlete, the current level of competition, and the role of the family in the athlete’s sports participation are essential data that are gained.  Additionally, more specific information relative to the athlete’s current level of sport functioning including changes in practice habits, competitive routines, technique, performance level, and teammates and coaches are acquired.  It is suggested that clinicians without specific knowledge about sports might not obtain this relevant information and, as a result, might incorrectly conceptualize and treat the client within a clinical framework (see Table 8).

 Conversely, for professionals trained in physical education and related fields, the SCIP provides a framework for obtaining information both within and outside of the sports domain.  For this practitioner, information about the athlete/clients’ overall functioning in the areas of social systems, health, and development may be obtained.  Though not formally trained in interviewing or diagnosis, this data collected from the SCIP interview would provide these professionals with a gross, but clear indication of whether the presenting problem is sport-specific, thus within their purview, or more global, thereby best referred to an appropriate professional (see Table 8).

______________________________________

Insert Table 8 about here

______________________________________

The effectiveness of the SCIP, as with any interviewing instrument, depends on how it is administered, the information gleaned from the interview, and how the data are evaluated and interpreted.  Fundamental to this issue is the notion that professionals from both psychology and physical education must possess the ability to make an assessment regarding the nature of the presenting problem, whether sport-specific or clinical.  The strength of the SCIP lies in its ability to assist the professional in this process.  The SCIP was specifically designed to bridge the gap of knowledge that might exist for professionals trained in either setting, thereby enabling them to acquire the necessary information in order to make sound decisions relative to the presenting problem and the appropriate course of action.  Regardless of the education, training, and experience of the professional, by gaining extensive sport-related and general knowledge about athlete\clients, professionals will be able to identify the primary difficulties and determine the most appropriate course of action for treatment.

It is important to emphasize that, regardless of whether the professional comes from a clinical or performance enhancement perspective, there are general skills that they must possess in order to be effective interviewers.  Specifically, the professional, his or her particular training notwithstanding, must have sound communication skills and the ability to develop trust and establish rapport (Evans, Hearn, Uhlemann, & Ivey, 1989).  Without these basic skills, the SCIP (or any other assessment or intervention tool, for that matter) would be of little value.

Conclusion

The process of working with athletes may be viewed as the professional and client acting together as detectives.  The goal of this process is to uncover relevant clues that lead to understanding and resolution of the presenting problem.  In keeping with the fundamental role of the clinical interview in psychology, it is believed that the Sport-Clinical Intake Protocol may provide many clues for the investigation.

In sum, the SCIP may be a useful first step in a comprehensive intervention program.  The goal of the SCIP, used in this initial probing, is to assist the professional in developing an understanding of the athlete and aid in constructing an effective treatment for sports-related problems.

Table 1

Illustrations of “Presenting Problem”

____________________________________________________________

Professional baseball player.  This athlete presented to a clinical psychologist with limited sports experience complaining of a prolonged hitting slump.  The athlete, a .312 hitter before the slump, indicated that he had been in the slump for three weeks, during which time he had hit .125 and not gotten more than one hit in the previous 16 games.  Because of the slump, the player had lost self-confidence in his hitting, became very anxious prior to and during his at-bats, and had trouble concentrating on the game.  He indicated that he had no idea what caused the slump.

____________________________________________________________

World-class water skier.  This athlete met with a physical education-trained professional because she had skied poorly in the recent National and World Championships and had lost her motivation to train and her desire to compete.  These feelings had persisted for the six weeks since the Worlds up to the present.  Her lack of motivation had hurt both the quality and quantity of her training and she had avoided two competitions during this period.  The water skier indicated that she had no confidence, little energy to put into training, and was always thinking about other things.

____________________________________________________________

Table 2

Illustrations of “Athletic History”

____________________________________________________________

Professional baseball player.  The athlete responded well to questions about his athletic background.  He became more relaxed and expressed himself more.  His responses to these questions indicated that he had been successful through every level of his career, but periodically went into hitting slumps.  In fact, the lowest point in his career involved a hitting slump that temporarily kept him from being promoted up to the baseball organization’s Class AA ball club.  Also, his life-long goal had been to play in the Major Leagues.  Recently, upon his promotion to the Majors, he had established a new goal of being a starting player.

____________________________________________________________

World-class water skier.  The athlete indicated that she had been slow to develop as a water skier.  It was only in the last five years that she emerged as a world-class competitor.  During that period, she expressed that her career was marked by tremendous fluctuation in the quality of her competitive performances.  The athlete stated that she has had three previous experiences like the current one and retired briefly two years ago.

____________________________________________________________

Table 3

Illustrations of “Family and Social Support”

____________________________________________________________

Professional baseball player.  The athlete indicated that he came from an intact family and that his parents and siblings gave him a lot of support during his career.  His family had no history of psychiatric illness.  He also indicated that his parents were not serious athletes and were always available to help him when asked.  The player said that he had two close friends on the team and also had several childhood buddies with whom he remained close.  He got along well with his coaches and felt like he got a lot of support from different people in his life.

____________________________________________________________

World-class water skier.  The athlete indicated that she came from a broken home in which she had no contact with her father for over ten years.  Also, her mother had been institutionalized several times, but she did not know why.  She became involved in water skiing through a close childhood friend and her parents were never involved, showing neither support nor resistance for her participation.  The athlete said that she was close to her older sister.  She had recently moved to a new town in order to obtain better training, but because she traveled so much, she had made no friends there.  Additionally, her boyfriend of two years had abruptly ended their relationship recently and she felt alone.

____________________________________________________________

Table 4

Illustrations of “Health”

____________________________________________________________

Professional baseball player.  The athlete’s responses to the SCIP questions addressing health indicated that he was injury-free, was sleeping pretty well, and continued to eat normally.  He did not take drugs and only had an occasional beer.  Also, a recent physical examination showed that he was in excellent health.

____________________________________________________________

World-class water skier.  The athlete stated that she was not hurt at present, but had a history of minor though nagging injuries.  She also indicated that she had not been sleeping well; taking a long time to get to sleep, waking up in the middle of the night, and waking up tired in the morning.  In addition, she had not been eating much lately and had lost almost ten pounds.  She did not drink or take drugs, but wished there was a pill she could take to make her feel better.

____________________________________________________________

Table 5

Illustrations of “Important Life Events”

____________________________________________________________

Professional baseball player.  The athlete indicated that most of the important things that happened in his life were related to baseball.  The two events that stuck out in his mind were the day he was drafted in the second round of the baseball draft and the day he signed his professional contract and receiving a bonus check for $250,000.  He did not recall any really bad things ever happening to him.

____________________________________________________________

World-class water skier.  The athlete’s most significant memory was the first time her mother was institutionalized when she was eight year old.  She remembers feeling scared, angry, and helpless.  She also describes losing the World title when she was favored to win as very painful.

____________________________________________________________

Table 6

Illustrations of “Changes Prior to Onset”

____________________________________________________________

Professional baseball player.  The most significant change that emerged from the athlete’s responses to the SCIP questions was that he had, just prior to start of the slump, been promoted to a starting role due to a temporary injury to the regular starter.  Additionally, this promotion occurred just as the team was making its run at the division title.  He had noticed that he was putting more pressure to hit on himself. There were no other meaningful changes in his life.

____________________________________________________________

World-class water skier.  The athlete recalled no changes in her athletic life prior to the loss of motivation.  However, she indicated that the move to the new town and the break-up of her relationship seemed important.  Also, adapting to the new training site and coach had been stressful.

____________________________________________________________

Table 7

Illustrations of “Details of Presenting Problem”

____________________________________________________________

Professional baseball player.  The athlete expressed that the biggest problems he now had, aside from hitting the ball, were his doubts in his hitting ability, his anxiety, and how easily distracted he was while hitting.  By identifying the most typical situations in which he felt these difficulties, he was able to see that they were most troublesome in important games and when games were on the line.  The player rarely had confidence, anxiety, or hitting problems during batting practice.  He also thought that his teammates were angry with him though he could not identify any specific examples.  ____________________________________________________________

World-class water skier.  The athlete felt most unmotivated when she was home alone.  If she was traveling with fellow competitors, she could get motivated enough to train.  She indicated that she ruminated a lot about her lack of desire and had feelings of sadness and helplessness, and cried several times a week.  Also, she would sometimes spend all day in bed.  Though she had occasional bouts like this before, it had gotten more regular since her move.

____________________________________________________________

Table 8

Illustrations of Benefits of SCIP

____________________________________________________________

Professional baseball player.  Based on this information obtained from the SCIP, the clinical psychologist was able to develop a clear understanding of the athlete’s current athletic, personal, and social functioning.  Consideration of these data indicated that the difficulties he was experiencing were isolated to his sports performance and he was functioning in a normal and healthy fashion outside of the sports domain.  Since the athlete’s problems were clearly sport-specific, and given his limited knowledge of and experience with athletes, the clinician referred the athlete to his physical education trained colleague.

____________________________________________________________

World-class water skier.  By using the SCIP, the professional obtained a comprehensive view of the athlete’s sports and general life.  Though not capable of making a clinical diagnosis, the information gained from the SCIP indicated to him that the athlete had significant problems outside of the sports setting.  As a result, he referred the athlete to a clinical psychologist with whom he had a reciprocal relationship.

____________________________________________________________

                                                                Appendix

Sport-Clinical Intake Protocol

________________________________________________________

Cursory Description of Presenting Problem

A. Describe presenting problem.

1. what is it?

2. how often does it occur?

3. when did it begin?

4. how long has it lasted?

5. where does it occur?

6. what do you think is causing it?

________________________________________________________

Description of Athletic History

B. Describe athletic development.

1. how did you get involved in your sport?

2. how did you get to the level you are at now?

3. what were some of the high points of your career?

4. what were some of the low points of your career?

5. who have been the most significant people in your sports participation?

6. what role did these people play in your development?

7. what were your goals when you began your sport?

8. what are your present goals?

________________________________________________________

Family and Social Support

C. Family.

1. parents: married or divorced, ages, quality of  their relationship, educational background, current occupations, your relationship with them.

2. siblings: same questions as above.

3. your educational background.

4. previous psychiatric history of client and family (experience with and perceptions of psychology).

5. family involvement in sports participation.

a. parents’ previous athletic experience.

b. parents’ current participation in sports.

c. parents’ involvement in your sports participation.

d. siblings’ participation in sports.

D. Support system.

1. number and quality of friendships within sport.

2. number and quality of friendships outside of sport.

3. what is your relationship with your coach?

4. what is your relationship with your teammates?

5. what are other sources of support you have?

6. how satisfied are you with the support you receive from your family, friends, coaches, teammates, and others?

___________________________________________________________

Health Status

E. Health status.

1. How is your health presently?

2. Injuries.

a. what injuries have you had in the past and when?

b. do you have any injuries at present?

c. if present, how do these injuries affect your training and competitive performances?

3. Sleep.

a. how are you sleeping lately?

b. are you tired often?

c. has your sleeping changes recently?

d. do you have difficulties getting to sleep?

e. prior to falling asleep, what thoughts are going through your mind?

f. are you waking up during the night?

g. if so, what thoughts are going through your mind?

h. have you been having any dreams lately?

i. what was in your dreams?

j. if sleep difficulties are present, how do they affect your training and competitive performances?

4. Eating.

a. describe your eating habits.

b. have you had any recent changes in your body weight?

b. how has your appetite been?

c. have your eating habits changed?

d. has your eating influenced your training and competitive performances?

5. Alcohol and drug use.

a. do you drink alcohol?

b. how much and how often?

c. do you take drugs of any kind?

d. what kind and how often?

e. if alcohol and/or drug use are present, how have they influenced your training and competitive performances?

6. When was your most recent physical examination?

a. were there any physical problems?

________________________________________________________

Important Life Events

F. Important life events.

1. what do you recall as the most important events in your athletic career, e.g., events that influenced you a great deal?

2. what do you recall as the most important events in your general life?

3. has anything important happened to you recently in your athletic life?

4. has anything important happened to you recentlyin your general life?

________________________________________________________

Changes Prior to Onset of Presenting Problem

G. Athletic.

1. physical.

a. quality and quantity of training.

b. technique.

c. physical conditioning.

d. health: injury, illness, fatigue.

2. mental.

a. self-confidence.

b. anxiety.

c. concentration.

d. motivation.

e. pre-competitive mental preparation.

f. pre-competitive and competitive thoughts and feelings.

3. competitive.

a. competitive level, e.g., regional, national.

b. stage of competitive season.

c. current performance level, e.g., winning record, competitive statistics.

4. equipment.

a. new equipment.

b. deterioration of old equipment.

H. Social/environmental.

1. changes in relationships: family, friends, school, work?

2. teammates or coaches.

3. new relationships?

4. training and competitive sites.

I. Changes in cognition-affect-behavior.

1. changes in cognition: negative, obsessional?

2. changes in affect: sadness, anger, joy?

3. changes in behavior: routines, habits?

________________________________________________________

Details of Presenting Problem

J. Detailed description.

1. indicate typical situation: what was going on at the time?

a. competitive setting.

b. competitive scenario.

K. Personal influences.

1. describe thoughts.

2. describe feelings.

3. describe behavior.

L. Social influences.

1. what other people were around you?

2. what were they doing?

M. Consequences.

1. what happened after the problem occurred?

2. how did significant others react?

3. what kinds of thoughts and feelings did you have?

4. your attributions of problem.

N. Greater exploration.

1. has this happened in the past: when and why?

2. when does it occur: practice, particular competitions?

3. is there a consistent pattern of occurrence?

4. what sorts of things are going on when the  problem is worst?

5. what sorts of things are going on when the problem gets better?

6. what do you think is causing it?

7. what do you think you can do to get over it?

8. what do you want to accomplish by being here?

________________________________________________________

                                                               References

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Substance Abuse Training in APA-Accredited

Doctoral Programs in Clinical Psychology:

A Survey

 Tevia Chiert, Steven N. Gold, & Jim Taylor

Nova University

Abstract

A survey addressing training provided in the area of substance abuse was mailed to all 160 provisionally and fully APA-accredited doctoral clinical psychology programs.  A total of 95 replies were received, yielding a response rate of 59%.  The questionnaire was essentially identical to one distributed in two previous surveys of APA accredited clinical psychology training programs in 1981 and 1984.  The current study was conducted to ascertain, in light of the recent call by the APA and other groups representing professional psychologists for greater involvement by the profession in the area of substance abuse, whether levels of doctoral training in this area have changed appreciably since the previous surveys were conducted.  Due to the considerable increase in number of APA-accredited Psy.D. programs since the previous two surveys, it was also possible to compare relative levels of training in substance abuse in Ph.D., Psy.D, and combined Ph.D./Psy.D. programs.

                      Substance Abuse Training in APA-Accredited Doctoral

Programs in Clinical Psychology

At no time in history has the abuse of substances been as widespread as it is today (Ray, 1984).  Moreover, never has so much attention been focused on or funds channeled toward the understanding, prevention and treatment of substance abuse (United States General Accounting Office, 1990).  In the midst of these developments, there is ample evidence that the profession of psychology is in danger of missing the opportunity to contribute meaningfully to the investigation and treatment of substance use disorders.

Nathan and McGrady (1987) point out that alcoholism counseling first emerged when recovering alcoholics took steps to help other alcoholics on the path towards recovery.  These first counselors received little training and relied on their experiences and involvement in Alcoholics Anonymous (AA) in working with their clients.  This, however, is no longer the case.  Most states now have specific standards for the certification of counselors including formal instruction in counseling, group, and family skills, and clinical supervision.

However, despite the need for qualified professionals to serve the large number of substance abusers who need treatment, it would appear that only a limited number of mental health practitioners are adequately trained to treat substance abusers.  Studies examining programs in social work, nursing, and psychiatric residency demonstrated that little time was devoted to specialized course work, training, or experience in the treatment of substance abuse (Busch & Svanum, 1980; Einstein & Wolfson, 1970; Galantner, Kaufman, Taintor, Robinowitz, Mayer, & Halikas, 1989; Schlesinger & Borg, 1986; Steg, Mann, Schwartz, Wise, & Bailey, 1990; Walker & Casey, 1985).

Similarly, among clinical psychologists, there appears to be little interest in substance abuse treatment (Knox, 1969, 1971, 1973; Morris, 1987; Rivers & Cole; 1976; Youngstrom, 1991).  Only 504 of the 68,000 psychologists appearing in the 1989 APA directory identify substance abuse as being their primary specialty (Youngstrom, 1991).  The relatively low level of participation by psychologists in substance abuse treatment is further documented by the National Drug and Alcoholism Treatment Survey (NDATUS) (1989), which was conducted to measure the location, scope, and characteristics of drug abuse and alcohol treatment facilities and services throughout the United States, the District of Columbia, and U.S. territories.  Private and publicly funded programs were included in the study; 13,345 questionnaires were mailed, and a response rate of 77.9 percent was obtained.  It was reported by NDATUS (1989) that, in the facilities surveyed, the counseling staff (including psychologists, social workers, credentialed counselors and other counselors) provided 60.1% of the full-time services.  Psychologists, defined as having obtained a minimum of a master’s degree in psychology, provided 12% of the direct care services.  In the drug only facilities, psychologists provided 10% of the direct care services. In the alcohol only facilities, psychologists provided 8% of the direct care services (NDATUS, 1989).  Similar findings were reported by Hosie, West, and McKay (1989).  On the basis of these studies, it is clear that psychologists are poorly represented in all aspects of substance abuse treatment.

It is not surprising, therefore, that doctoral programs in clinical psychology often do not include adequate coverage of the topic of substance abuse in the training they offer.  Two mail surveys of APA-approved doctoral programs investigating the level of training they provided in the diagnosis and treatment of substance abuse related problems were conducted during the last decade (Lubin, Brady, Woodward, & Thomas, 1986; Selin & Svanum, 1981).

Selin and Svanum (1981) surveyed the program directors of APA-approved clinical psychology graduate programs.  A majority of the responding programs covered the area of substance abuse as part of another course, and made arrangements to assign students with an interest in the topic to practicum placements dealing primarily with alcoholism or substance abuse.  However, despite a mean rating indicating training in this area was perceived as being necessary at the graduate level, none of the schools surveyed offered any required courses devoted exclusively to this area.  A large minority did provide at least one elective course on the subject, but a small group of schools did acknowledge not addressing substance abuse at all in their curriculum, even as part of another course.  Selin and Svanum (1981) concluded that “most students receive minimal course work and infrequent direct clinical experience with persons who have problems with substance abuse” (p. 720).  They further observed that “the extent of clinical training in alcoholism/ substance abuse appears disproportionately low in comparison to the magnitude of the problems in terms of the potential contributions that psychology and psychologists can make” (Selin & Svanum, 1981, p. 720).  Similar findings were reported by Schlesinger (1984), who noted that, overall, schools were exposing their students to the substance abuse issues, but the specific training or course work was minimal.

In 1984, Lubin, Brady, Woodward and Thomas (1986) replicated Selin and Svanum’s 1981 survey.  Their results indicated that, compared to the previous survey, the percentage of clinical psychology programs that offered a minimum of one graduate level course on substance abuse had decreased.  Consistent with this finding, there was a substantial drop in ratings of the perceived importance of providing substance abuse training at the graduate level.  The number of programs that addressed alcoholism and substance abuse as part of other courses, however, increased; most of these courses were required as part of the curriculum.  The percentage of programs that offered substance abuse related practicum placements also increased.  Lubin et al. (1986) concluded that the students “receive only minimal training” in the area of substance abuse, adding “universities are not taking responsibility for enabling students to look at their own attitudes and value systems regarding working with patients who have alcoholism/substance abuse problems” (p. 153).

In the intervening years since the Lubin et al. study (1986), organizations and publications representing professional psychologists have initiated a major shift in their orientation toward and level of interest in service provision to substance abusing populations.  There is a growing recognition among these groups that psychologists, although in theory ideally equipped to make significant contributions to the investigation and treatment of addictive disorders are, in fact, severely under-represented in this area (“Practice Directorate,” 1992; Welch, 1992; Youngstrom, 1991).  A movement has emerged, spearheaded by the Society of Psychologists in the Addictive Behaviors (SPAB) and APA Division 42’s Committee on Alcohol and Substance Abuse, to grant APA division status to SPAB (Wexler, 1992; Youngstrom, 1991).  Further, the APA Practice Directorate is considering creating an Office on Alcoholism and Substance Abuse to promote psychologists’ training and involvement in treatment and research of addictive disorders (Youngstrom, 1991).  Moreover, in November, 1991 the APA Board of Professional Affairs passed a resolution endorsing the execution of more research by and the provision of additional training to psychologists in the area of substance abuse (Youngstrom, 1991).

Given this upsurge in interest in substance abuse service provision among professional psychologists, the present study was conducted to determine whether appreciable changes in patterns of training in this area have occurred among doctoral programs in clinical psychology since the 1984 survey conducted by Lubin et al. (1986).  To accomplish this, a mail survey was completed using essentially the same questionnaire employed by Selin and Svanum (1981) and Lubin et al. (1986).  The data obtained in the present study were then compared to the findings of the two previous surveys to ascertain whether doctoral programs have responded to the call for more comprehensive training in the diagnosis and treatment of substance abuse.  Due to the considerable increase in APA-accredited Psy.D. and combined Ph.D./Psy.D. programs since Lubin et al.’s (1986) survey, it was also possible to compare relative levels of substance abuse training in Ph.D., Psy.D., and Ph.D./Psy.D. programs.

Method

Participants

The 160 doctoral (i.e., both Ph.D. and Psy.D.) programs in clinical psychology comprising all provisionally and fully APA-accredited programs were solicited to participate in the study.  The names of the programs were obtained from the December, 1990 issue of the American Psychologist.  A total of 95 replies were received, representing a 59% response rate, which compared favorably with the previous surveys conducted by Selin and Svanum (1981) and Lubin et al. (1986).  The questionnaire was completed by eighty-two of the 138 Ph.D. programs (59%), 10 of the 17 Psy.D. programs (59%), and three of the five programs (60%) offering Ph.D. and Psy.D. degrees.

Questionnaire

The questionnaire, essentially identical to those used by Selin and Svanum (1981) and Lubin et al. (1986), is available from the authors upon request.  Two revisions were made to the original questionnaire.  One question, “How many workshops, colloquia, or seminars relating to alcohol or drug problems were offered to students during the past year?”, was added.  The second revision consisted of eliminating a question asking for the title of the textbooks used in the substance abuse classes.  It was deleted because the names of the textbooks had not previously been reported in the literature, prohibiting any comparison to previous studies.

Procedure

The initial mailing of the survey packages to the dean or program director of each of the 160 Ph.D. and Psy.D. programs was completed on November 13, 1991.  Two days after the mailing, a pre-notification telephone call was made to the secretary of each dean or chairperson.  On November 22, 1991, each secretary was called for the second time and asked to remind the potential respondent to complete the questionnaire.  Of the total 160 programs contacted, sixty-seven (41.9%) responded to the initial mailing.  The respondents to the first mailing consisted of fifty-four of the 138 Ph.D. programs (39%), ten of the 17 Psy.D. programs (59%), and three of the five combined Ph.D./Psy.D. programs (60%).

On January 13, 1992 a follow-up survey was sent to the respondents who did not complete the initial questionnaire.  Each respondent who had not yet replied was asked to complete the questionnaire by January 31, 1992.  An additional 27 Ph.D. programs (19.6% of those initially contacted) responded to the second mailing.

Results

The results of this study indicate that the sampling was sound, inasmuch as the respondents were programmatically and geographically representative of the general population.  The distribution of respondents across types of programs, 86% Ph.D., 11% Psy.D., 3% combined Ph.D./Psy.D., was identical to the proportion of these three types of programs comprising all APA-accredited doctoral programs in clinical psychology.  The geographical distribution by region of responding programs also closely approximated that of APA-accredited programs as a whole, with the exception of some over-representation of the Mid-West programs.    Replies were received from 41 states and five of the nine Canadian programs.  The percentages of programs responding from each region, with percentages of all existing APA-Accredited programs from each region appearing in parentheses, were as follows: Mid-West 35% (26%); Mid-Atlantic 23% (23%); Southern 15% (17%); Western 8% (8%); North-Eastern 5% (6%); Mountain 5% (6%); Canada 5% (9%); South-Central 3% (5%).

Faculty and Students

The survey findings indicated that 6347 part- and full-time students were enrolled in clinical psychology doctoral programs (see Table 1).  Overall, 11.5% of the students were estimated to have an interest in substance abuse.  Students enrolled in Psy.D. programs were estimated to have the highest interest (14%) in substance abuse, followed by 11.4% of the Ph.D. students and 10% of the students in Ph.D/Psy.D. programs.  Research or clinical interest in substance abuse was reported to be held by 10.3% of all faculty.  Faculty interest was slightly higher in the Psy.D. programs (10.7%) than the Ph.D. (10.3%) or Ph.D./Psy.D. (10%) programs.

Insert Table 1 about here

Academic Training

The results of the study indicated that 41% of the programs offered at least one graduate-level course on substance abuse.  At least one course was offered by 38% of the Ph.D. programs, as compared to 60% of the Psy.D. and 67% of the Ph.D./Psy.D. programs.  Moreover, twelve Ph.D. programs (15%) and three Psy.D. programs (30%) indicated that they planned to develop more courses in the area.

In addition to offering courses specifically relating to substance abuse, 62% of the Ph.D., 40% of the Psy.D., and 67% of the Ph.D./Psy.D. programs included topics relating to substance abuse as a part of another course.  In 79% of these instances the courses were requirements in the programs’ curriculum.  The average proportion of course time devoted to substance abuse was 10.7%.

The opportunities to learn about substance abuse extended beyond the classroom.  Additional workshops, colloquia or seminars on the topic were offered by 63% of the programs and 51% of the programs planned to offer more of these opportunities in the future.  Out of all the responding schools, only one, a Ph.D. program, reported offering a formal program or sub-sub-sub-specialty on alcoholism and substance abuse.

Practicum Training

Practicum placements in institutions dealing primarily with substance abuse were offered by fifty-five (58%) of the programs.  Such placements were offered by forty-three of the Ph.D. programs (52%), 9 Psy.D. programs (90%), and three Ph.D/Psy.D. programs (100%) offered such practicum placements.  Of the students attending Ph.D. programs offering practicum placements dealing primarily with substance abuse, 15.4% were placed at such sites, as compared with 22% of the students in Psy.D. programs and 7% of the students in Ph.D./Psy.D.  Across all three types of doctoral clinical psychology degree programs, 9.4% of all students completed practicum placements of this nature.

Research

The three programs reported a total of 253 current research projects in the area of substance abuse.  The existence of at least one current research project by either the students or the faculty was indicated by sixty-two Ph.D. programs (76%), seven Psy.D. programs (70%), and two Ph.D./Psy.D. programs (67%).  The intention to increase research activity in this area was indicated by thirty-two Ph.D. programs (39%), six Psy.D. programs (60%) and two Ph.D./Psy.D. programs (67%).

Student Interest and Adequacy of Training

The mean rating of respondents’ perception of adequacy of training and exposure to alcoholism and substance abuse on a scale of one to five (1 = insufficient, 5 = overemphasized) across the three program types was 2.3.  The Ph.D./Psy.D. programs obtained the lowest mean rating of 2.0.  The mean rating among Ph.D. programs was 2.3 and among Psy.D. programs 2.6.  Ratings reflected that 57.5% of the programs surveyed perceived students’ training in and exposure to the area of substance abuse to be less than adequate.

The mean rating of the perception of the necessity for a clinical psychologist to receive training in the evaluation and treatment of substance abuse for the three programs was 3.9 (1 = unnecessary, 5 = very necessary).   Psy.D. programs obtained the highest mean rating of 4.2.  The mean rating among Ph.D./Psy.D. and Ph.D. programs was 4.0 and 3.8 respectively.

Across programs, thirty-three percent indicated graduate school was the most appropriate level for training to occur.  An additional 30% reported that training should occur on the graduate level and another level.  However, there were substantial differences between program types.  Only 30% of Ph.D. programs saw graduate school as the most appropriate level at which to provide substance abuse training, compared with 40% of Psy.D. and 67% of Ph.D./Psy.D. programs.  While 40% of the Psy.D. programs expressed the belief that substance abuse training should occur during internship, only 20% of Ph.D. programs and none of the combined Ph.D./Psy.D. programs agreed.  Although 36% of Ph.D. programs endorsed instruction in the area of substance abuse at two or more training levels (i.e. among graduate school, internship, and post-doctoral training), none of the Psy.D. or combined Ph.D./Psy.D. programs did so.

Discussion

Several factors are likely to influence the programs’ decisions to increase or decrease the amount or type of training they offer in the area of substance abuse.  These factors include the extent of the substance abuse problem in society, the interests of the faculty and/or students, and the historical forces that have shaped graduate training in psychology.  The impact of these issues appears to differ in programs representing the Boulder and Vail models of training for clinical psychology.

A comparison of scientist-practitioner (Boulder model/Ph.D.) with professional-practitioner (Vail model/Psy.D.) programs (Peterson, 1985) revealed little difference in the curricula of the two.  Despite this finding, which Peterson (1985) attributed to the influence of the APA accreditation criteria, Peterson argued that the two models represent genuinely different approaches to clinical training by virtue of subscribing to divergent “cultures,” reflected “in the attitudes and interests of the faculty and students” (p. 447).  The research culture involves probing into relevant questions, framing new ideas and findings into cohesive concepts, and discovering what is going on in the world in an environment that promotes inquiry (Peterson, 1985).  The culture of practice is oriented toward providing services to the public.  It is devoted to solving the problems of the individual case, encouraging the discussion of cases among colleagues, and establishing new programs to be introduced into the community in the interest of helping people in need of services (Peterson, 1985).

Consistent with Peterson’s (1985) claims, the results of the present study indicate that, while both Ph.D. and Psy.D. programs offer classroom, clinical, and research training in the area of substance abuse, they place differing emphases on these activities.  The training in substance abuse in the Psy.D. programs is consistent with the professional-practitioner model and appears to be influenced by the practitioner/community-based culture while training in substance abuse in the Ph.D. programs is consistent with the scientist-practitioner model and appears to be influenced by the empirical/research culture in encouraging research activity in this area.  The training in substance abuse in the Ph.D./Psy.D. programs appears to be an amalgamation of the two models.

At present, the Ph.D. programs appear to be less committed to classroom training than at any time in the past decade.  The percentage of Ph.D. programs that offer courses on substance abuse has decreased successively in each study and the percentage of programs that address the issue as part of another course also decreased since the 1986 study.  Moreover, this trend is likely to continue.  Many Ph.D. programs have indicated they will not expand the number of courses they offer to their students in the future.  While clinical training in the Ph.D. programs is decreasing, the percentage of Ph.D. programs that indicated at least one current research project in the area of substance abuse has increased in each successive study and the programs indicated they intend to increase their research activity in the future.

Unlike Ph.D. programs, Psy.D. programs indicate a current and future commitment to clinical training in substance abuse.  The faculty of the Psy.D. programs, as compared to those in Ph.D. and Ph.D./Psy.D. programs, were estimated to have greater clinical and/or research interest in substance abuse.  Research and clinical training are also likely to continue to increase among the Psy.D. programs because the perception that clinical psychologists need substance abuse training was higher in the Psy.D. programs than the Ph.D. or Ph.D./Psy.D. programs.  This commitment to clinical and research training in substance abuse suggests that the Psy.D. programs are following the spirit of the professional-practitioner model and are likely to continue to offer their students diverse learning experiences in the future.

Like Psy.D. programs, Ph.D./Psy.D. programs offer diverse training in substance abuse.  The influence of both the scientific and practitioner cultures is evident in the curricula of the programs.  The Ph.D./Psy.D. programs surveyed provide course work, practica, and research training in the area of substance abuse and plan to increase the clinical and research training they offer to their students.  A comparison of the Ph.D./Psy.D. programs and the separate Ph.D. and Psy.D. programs demonstrates that, of the three programs, the combined programs plan to expand their research component the most.  Research activity may be increasing because both the research and clinically oriented students may be recognizing the need to conduct research as a basis for the treatment of substance abuse.

Another comparison between the three programs reveals that the Psy.D. and some Ph.D. programs intend to expand the number of courses they offer in the area of substance abuse while the Ph.D./Psy.D. programs do not intend to offer additional courses.  The Ph.D./Psy.D. programs may not be offering additional courses because the percentage of Ph.D./Psy.D. programs that offer substance abuse courses and courses which address the issue of substance abuse as part of another course are higher than the percentage of Psy.D. and Ph.D. programs which offer the same courses.

Psy.D. and Ph.D/Psy.D. programs also appear to provide their students with more of an opportunity to obtain a well-rounded education in the area of substance abuse than the Ph.D. programs.  On the average, students in the Psy.D. and Ph.D/Psy.D. programs receive more training in the area of substance abuse in the form of course work and clinical training than Ph.D. students, whose exposure to classroom and clinical training in this area is decreasing.

Conclusions

Psychology as a profession is beginning to awaken to its potential to make a substantial contribution to the understanding and treatment of substance abuse problems through the expertise it can offer in assessment, intervention, and research.  Regrettably, the results of this study do not indicate that doctoral clinical psychology programs have taken decisive steps to expand the training offered to students in their programs that would enable them to such a contribution.  Psy.D. and combined Psy.D./Ph.D. programs seem to be somewhat ahead of Ph.D. programs in this regard, as they appear, on the average, to offer somewhat more substance abuse training to their doctoral students than do Ph.D. programs.  Nevertheless, it would be difficult to argue that even Psy.D. and Psy.D./Ph.D. programs are offering a level of training commensurate with the extent and prevalence of the mental health problems represented by and related to substance abuse.

In spite of the fact that the APA and the program directors of APA-approved doctoral clinical psychology programs have recognized the need for additional training in the area of substance abuse, no definitive action has been taken to increase the limited level of training in APA approved programs.  It would be prudent for the program directors of APA-approved doctoral programs in clinical psychology to consolidate their efforts to provide students with more exposure and training in the area of substance abuse.  A unified effort would, in the long run, serve the discipline of psychology, substance abusers themselves, and the community at large.

                                                         References

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Table 1

Survey of APA-approved doctoral clinical psychology programs regarding training in alcoholism and substance abuse

A Multidimensional Model

of Momentum in Sports

Jim Taylor

Aspen, Colorado

Andrew Demick

Nova University

abstract

The goal of the present paper is to provide a theoretical formulation of momentum in sports that articulates the processes involved in the development of momentum.  Momentum is presently defined as: a positive or negative change in cognition, physiology, affect, and behavior caused by a precipitating event or series of events that will result in a shift in performance.  The present model proposes a series of changes, termed the “momentum chain”, that result in the development of momentum: (a) precipitating event or events, (b) change in cognition, affect, and physiology, (c) change in behavior, (d) the resulting increase or decrease in performance consistent with the above changes, (e) a contiguous and opposing change in the previous factors on the part of the opponent (for sports with head-to-head competition), and (f) a resultant change in the immediate outcome.  A preliminary investigation of the first stage of the model examining the relationship between precipitating events and changes in competitive outcome provided initial support for the value of the model.

A Multidimensional Model

of Momentum in Sports

      The concept of momentum is, at the same time, one of the most commonly referred to and least understood phenomena in the realm of sports.  It is typically conceived of as an unpredictable and ethereal force outside the control of individuals and teams that can often dictate the outcome of competition.  Despite its mysterious allure and prevalence in the collective psyche of the athletic community, only recently have there been attempts within the field of psychology to systematically consider momentum from a scientific perspective.

These investigations, both theoretical and empirical, have increased our understanding of the concept of momentum in sports (Adler, 1981; Iso-Ahola & Mobily, 1980; Silva, Hardy, & Crace, 1988; Vallerand, Colavecchio, & Pelletier, 1988).  Yet, these explanations do not appear to provide a full accounting of the relevant aspects of the concept of momentum.

One difficulty found in this avenue of research has been a divergence between theorizing and empiricizing.  In particular, some investigators (Adler, 1981) attempted to develop a theoretical view of momentum without effectively operationalizing its constructs.  Others (Richardson, Adler, & Hankes, 1988; Weinberg & Jackson, 1989) produced what they considered to be empirical support for the concept without an adequate conceptualization of momentum.

The goal of the present paper is to provide a new formulation of momentum in sports that incorporates aspects of previous theoretical and empirical investigations, addresses theoretical and methodological weaknesses, and offers new directions for the study of momentum in sports.

Review of Theories on Momentum

The study of momentum as a physical, psychological, and social phenomenon can be traced back to some of our earliest thinkers including Aristotle, Galileo, and Descartes (for a historical review, see Adler, 1981).  However, it was only in the early 1980’s that Adler generated the first in-depth exploration of momentum as a social phenomenon (Adler, 1981).  He defined momentum as: “a state of dynamic intensity marked by an elevated or depressed rate of motion, grace, and success” (p. 29).  Adler further posited a model involving five essential and inter-related components: (1) focus on a specific goal; (2) motivation initiating the effort of goal attainment; (3) emotional feelings attached to motivation toward the goal; (4) increased arousal associated with the activity; and (5) enhanced performance due to the above factors.

The initial model and its subsequent application to sports was a strong step in the theoretical articulation of momentum.  However, it also illustrated several areas of need for future development.  First, Adler provided only a cursory discussion of how each part of the model directly affects momentum.  Second, his formulation did not offer enough information to make specific predictions about the effects of each factor on momentum and performance.  Third, an essential element that was not addressed was the influence of cognition on momentum.  Finally, Adler underestimated the importance of physiological arousal in the generation and disruption of momentum.

Vallerand, Colavecchio, and Pelletier (1988) further advanced the delineation of momentum in offering their antecedents-consequences psychological momentum model.  Their most significant contributions were in their consideration of two areas.  First, they asserted that “psychological momentum refers to a perception that the actor is progressing toward his/her goal” (p. 94).  Thus, the perception of the situation is critical.  Second, they believed that psychological momentum is subjective and that perceptions of momentum are influenced by intrapersonal factors, such as perception of control and experience, and situational factors, such as score configuration.  Most fundamentally, Vallerand and his colleagues suggested the importance of these factors with respect to their influence on certain cognitive functions, most notably, perceptions of control.  However, their model also has some difficulties.  As with Adler’s conceptualization, the model of Vallerand et al. (1988) had elements, such as energy and synchronism, that were not easily operationalized.  They also did not consider the influence of emotions and arousal on momentum.

Review of Empirical Research on Momentum

Though the evolution of models of momentum has progressed steadily during the past decade, empirical investigation has been sporadic.  Furthermore, much of the research has resulted in possibly erroneous conclusions.  For example, Iso-Ahola & Mobily (1980) reported that, in a racquetball tournament, first game performance was predictive of second game and match outcome performance.  They concluded that the psychological momentum of winning the first game propelled these players to subsequent victory.  Similar results emerged in a follow-up study (Iso-Ahola & Blanchard, 1986).

Other research using archival tennis match data at various levels of competition provided similar findings and conclusions.  In particular, Weinberg and Jackson (1989) and Silva, Hardy, and Crace (1988) both demonstrated that prior performance success lead to future winning.  Like Iso-Ahola and Mobily (1980), Weinberg et al. (1989) infer that psychological momentum was responsible for the results.  However, Silva et al. (1988) provided what appears to be a more plausible interpretation.  They indicate that all of these results may simply be due to greater ability on the part of the first game winners.  In support of this position, research by Love and Knoppers (1984) and Richardson, Adler, and Hankes (1988), in which skill was controlled, indicated that momentum was not evident.  Furthermore, Silva et al. (1988) suggest that psychological momentum may, in fact, be what Gilovich, Vallone, and Tversky (1985) called a “powerful and widely shared cognitive illusion” (p. 313) similar to the “hot hand” in basketball.

Only three studies to date have been based on clearly articulated theory.  First, Vallerand et al. (1988) evaluated their antecedents-consequences psychological momentum model by employing hypothetical competitive tennis scenarios depicting either momentum or non-momentum situations, subjects’ perceptions of momentum and its influence on performance inferences.  Results indicated that score configuration exerted a strong influence on perceptions of momentum.  Furthermore, score configuration, experience level, and perceptions of momentum had a significant effect on performance inferences.  Miller and Weinberg (1991) produced similar findings related to situational influences on perceptions of momentum in volleyball matches.  However, since both experimental situations were hypothetical, the external and ecological validity of the findings come into question.  Miller and Weinberg (1991) also analyzed archival data from actual collegiate volleyball games and found no relationship between identified momentum situations and subsequent performance.  Silva, Cornelius, and Finch (1992) demonstrated similar results to those of Miller and Weinberg (1991) using a novel laboratory competitive task.

The results of these three studies indicated several important implications relative to the current formulation.  First, particular situational events produce a perception of momentum in a diverse sampling of individuals.  Second, these perceptions of momentum do not generate a commensurate change in performance.  What these two issues suggest is that, if momentum is more than a cognitive illusion, then there must be some intervening factors that influence the transmission of the perception of momentum to a change in performance.  The goal of the present conceptualization is to propose what those mediating variables might be.

It has been argued in the literature that sport psychology needs to engage in more theory-driven research (Landers, 1983).  As a result, it is suggested that there is a need for further exploration of the concept of momentum that: (1) provides a comprehensive model of momentum that  includes a definition, causes, process, and outcomes; (2) is based on well-articulated operational constructs; and (3) can be empirically assessed for its validity.  To this end, the multidimensional model of momentum is proposed.

New Conceptualization of Momentum

Providing a clear, comprehensive, and operationalizable definition of momentum has been one obstacle to prior conceptualizations.  As discussed earlier, the definitions offered by Adler (1981) and Vallerand et al. (1988) are somewhat ambiguous and appear to lack precision and a clear articulation of the processes involved.  It is presently suggested that the use of the term, psychological momentum, which is commonly used in the literature is inappropriate because it does not take into account the important role that emotional, physiological, behavioral, social, and environmental factors play in development of momentum.

Based on these considerations, momentum is presently defined as: A positive or negative change in cognition, affect, physiology, and behavior caused by an event or series of events that will result in a commensurate shift in performance and competitive outcome.

Multidimensional Model of Momentum

      The definition proposed above provides a sound foundation for the new conceptualization of momentum.  It is now necessary to fully articulate the essential components and processes associated with the development of momentum.

The present model is composed of six critical elements to the development of momentum:(a) Precipitating event or events, (b) change in cognition, affect, and physiology, (c) change in behavior, (d) change in performance consistent with the above changes, (e) a contiguous and opposing change in the previous factors on the part of the opponent (for sports with head-to-head competition), and (f) a resultant change in the immediate outcome.  These occurrences are presently termed the “momentum chain” (see Figure 1).

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Insert Figure 1 about here

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Precipitating Event or Events

The first step in the development of momentum is the occurrence of a precipitating event or series of events (Richardson, Adler, & Hankes, 1988).  The ability of an event or events to precipitate the momentum chain depends in part upon its salience, that is, its capacity to alter athletes’ perceptions about their performance.

Whether the precipitating events generate changes in athletes’ perceptions depends upon the individual athlete (Miller & Weinberg, 1991; Vallerand et al., 1988).  That is, the same event may trigger the momentum chain for one person but not another.  Potential influencing factors in this subjective perception process include competitive experience, self-efficacy, perceptions of control, and cognitive schemas and behavioral response patterns for these situations (Miller & Weinberg, 1991; Silva et al., 1992; Vallerand et al., 1988).  The type of precipitating events (e.g., dramatic or gradual, directly or indirectly related to performance, environmental or social, and external or internal) may also influence the change in perception.

Change in Cognition, Physiology, and Affect

The emergence of the precipitating event may then produce changes in a variety of cognitive, affective, and physiological areas.  Moreover, considerable research indicates that these changes do not occur in a linear or sequential manner; rather, they reciprocally influence each other (Bandura, 1977).

      Cognition.  The precipitating event may produce an alteration in several important areas of cognition.  The only superordinate change that must occur following a precipitating event and precede other cognitive, affective, and physiological shifts is the recognition of the event as being a potential precipitator of momentum.  Research by Miller and Weinberg (1991), Silva et al. (1992), and Vallerand et al. (1988) support this notion by demonstrating that certain competitive events and situations generate perceptions of momentum.   This notion is critical because it is presently asserted that momentum will not occur without this recognition.

Vallerand et al. (1988) propose that the most important cognitive change that will emerge is the individual’s perceptions of control over the competitive situation.  They suggest that perceptions of control are fundamental to many aspects of human functioning including sense of self-competence (Deci, 1980; White, 1959), the interpretation of self (Kelly, 1967) and other (Jones & Davis, 1965) information.  In addition, it is presently suggested that perceptions of control influence individuals’ self-efficacy, motivation, emotions, and physiological changes.

Another central change in cognition for momentum is self-efficacy.  There is considerable evidence that individuals’ belief in their ability to succeed is significantly related to subsequent success (Bandura, 1977; Feltz, Landers, & Raeder, 1979; Gould, Weiss, & Weinberg, 1981).  Furthermore, self-efficacy is also associated with motivation and persistence (Bandura & Schunk, 1981).  It is suggested that precipitating events act to enhance or inhibit self-efficacy.  It should also be noted that these events would, in turn, create greater or lesser perceptions of control (Bandura, 1977).

Motivation is presently regarded as another cognitive/affective factor responding to the precipitating event.  Furthermore, it is believed that this effect is not a direct consequence of the event.  Rather, it is mediated by the precipitating event’s influence on self-efficacy and perceptions of control (Bandura & Schunk, 1981).  In other words, a person’s level of self-efficacy and perceptions of control will dictate his or her motivation (Bandura, 1981, 1982).  For example, a golfer with little self-efficacy who perceives having little control over his play will be less likely to persist during a round.  In contrast, a golfer with considerable self-efficacy will be highly motivated to continue play (Bandura & Cervone, 1983; Schunk, 1984; Weinberg, Gould, & Jackson, 1979).

Attentional concerns will also be influenced by the precipitating event (Dawson, 1973; Dawson & Furedy, 1976; Nideffer, 1976).  That is, the event will produce either a positive (focusing) or negative (distracting) change in attentional focus due to its salience in the athlete’s attentional field.  In particular, in the development of positive momentum, the precipitating event, if recognized as such, will generate a refocusing on task-relevant information.  Conversely, in the formation of negative momentum, the event will cause a refocusing on task-irrelevant cues, thereby contributing to the disruption of appropriate attentional focus.

Physiology.  It is apparent from the research by Miller and Weinberg (1991) and Vallerand et al. (1988) that simply having precipitating events occur or recognizing the events as generating momentum and even producing changes in various cognitions such as self-efficacy, motivation, and perceptions of control is not sufficient to produce a change in performance.  As a result, other changes must occur that make the link between the perception of momentum and a change in performance.

The previous theories of momentum that have been discussed have placed limited (Adler, 1981) or no (Vallerand et al., 1988) importance on physiological arousal.  Adler (1981) views it mostly as a pregame influence and does not discuss its role during the course of competition.  Vallerand et al. (1988) do not include arousal in their conceptualization at all.  However, it is presently suggested that this phase is the most critical in the establishment, maintenance, and disruption of momentum.              Physiological arousal is a result of and an influence on the changes in cognition discussed above.  A precipitating event produces changes in cognition which, in turn, generate alterations in physiological arousal (Bandura, Taylor, Williams, Mefford, & Barchas, 1985; Meichenbaum, 1977; Miller, 1980; Sarason, 1978).  These changes in arousal include heart rate, respiration, and adrenaline.  Conversely, physiological arousal may affect individuals’ self-efficacy and motivation (Bandura, 1977), and attention (Nideffer, 1976).  Furthermore, the direction and intensity of these shifts will dictate the valence of the momentum that is produced.

It is a widely held belief that individuals can not optimally perform tasks if they are not physically primed to do so (Martens, 1977; Oxendine, 1970; Yerkes-Dodson, 1908).  Specifically, optimal performance requires requisite physical changes that manifest themselves in terms of increased motor coordination and strength, enhanced sensory and perceptual processing, decreased reaction time, and higher thresholds of pain (Martens, 1977).  In order for positive momentum to occur, there must then be a physiological shift toward the optimal level of arousal that produces these manifestations.  In contrast, for negative momentum to result, there must be a shift away from the optimal level of arousal in either direction that diminishes these manifestations.

Change in affect.  The alteration in cognitions generates a change in arousal which will then produce a commensurate shift in affective experience (May & Johnson, 1973; Schacter & Singer, 1962; Schwartz, 1971).  Furthermore, this change in affect will be in the direction of the newly-formed cognition.  Specifically, positive cognitions will generate positive affect (e.g., happiness, pleasure) and negative cognitions will result in negative affect (e.g., anger, frustration, sadness).  Several researchers (Gill & Gross, 1979; Passer & Scanlon, 1980; Scanlon & Passer, 1979) have demonstrated that positive outcomes are related to positive affect.  Similarly, negative outcomes are associated with negative affect (Geen & Rakosky, 1973).  Consequently, precipitating events, viewed as valenced outcomes, may produce the resultant affect as mediated by cognition (Bandura, 1986).  This affect may, in turn, influence cognition in the commensurate direction (Bandura, 1977).

Change in Behavior

At this point, the intrapersonal changes (cognitive, physiological, and affective) that have been described thus far will manifest themselves behaviorally (Zajonc & Markus, 1984; Zajonc, Pietromonaco, & Bargh, 1982).  In other words, alterations in observable behavior will now be evident that are consistent with the direction of the changes that have occurred earlier in the momentum chain.  In particular, changes in general activity level, pace, posture, and frequency of sport-specific behaviors will be clearly identifiable.

The nature of the behavior changes that result will depend on several factors: the valence of the momentum and the current level of physiological arousal of the athlete.  Due to the latter issue, it is not possible to specify the particular direction of behavior change that will emerge.  For example, in the course of a positive momentum chain, one athlete with a high level of arousal would respond with a calming effect physiologically which would, in turn, produce a decrease in observable behavior.  In contrast, another athlete who is under-aroused would react with a higher level of arousal which would then be manifested in an increase in relevant behaviors.  A similar pattern would result from a negative momentum chain.  Regardless of the direction of the change in behavior, the outcome of this phase is the same: continuation of the positive or negative momentum chain.

Change in Performance

The changes that have occurred so far will then produce a commensurate shift in performance.  That is, the momentum chain that results in positive momentum will exhibit an increase in individual performance and the momentum chain that leads to negative momentum will cause a decrease in individual performance.  If the sport that the individual is participating in does not involve head-to-head competition such as alpine ski racing, golf, or shooting, then the change in performance will have a similar influence on the immediate outcome of the competition.  In other words, in competition that is not head-to-head, performance is equal to immediate outcome (Adler, 1981).

In addition, momentum is not considered to be a force that is always present.  Rather, it is suggested that the absence of momentum is the normative condition during competition.  Moreover, it is only when precipitating events occur that momentum may emerge.

Opponent Factors

The direct relationship between performance and immediate outcome may not be evident in sports involving head-to-head competition, for example, tennis, boxing, basketball.  It is presently suggested that, in sports with head-to-head competition, there may be an interactive influence on competitive outcome.  In order for the momentum chain which produces enhanced performance of one competitor to result in a change in immediate outcome, a contiguous and opposing momentum chain might have to occur for the opponent.  In other words, for momentum to have a significant impact on competitive outcome, positive momentum would have to occur for one athlete and negative momentum would have to occur for the opposing competitor.

For example, in a tennis match, Player A makes a dramatic shot at a key point in the match.  This precipitating event triggers positive momentum and increased individual performance on her part.   However, the increase in Player A’s performance may still not be sufficient to overcome the current level of her opponent’s (Player B) play, thus no change in the immediate outcome of the match occurs.  It may be that, for a change in immediate outcome to result, the precipitating event must also cause negative momentum and the coincidental decrease in performance in Player B.  As presently conceptualized, only then would it be predicted that change in momentum and performance of the initial player would result in a change in the immediate outcome of the competition.

Experience and Momentum

The evidence to date examining experience as an important mediator of momentum has been equivocal.  Richardson et al. (1988) and Vallerand et al. (1988) reported no difference in perceptions of momentum between individuals of differing abilities.  However, the latter researchers suggest that the findings were due to the clear and unambiguous situations that subjects were asked to evaluate.  In contrast, Miller and Weinberg (1991) found that skill level did discriminate perceptions of momentum.

In addition, research by Allard (Allard, Graham, & Paarsalu, 1980; Allard & Burnett, 1985) supports the relationship between experience and momentum.  They indicate the reason for this difference in perception and processing may be due to more clearly defined schemas that enable more sophisticated, efficient, and rapid information processing and, subsequently, more effective cognitive strategies and behavioral responses to momentum.

This assertion is supported by non-sport research on self-schemas by Markus and her colleagues indicating that schemas enhance a wide array of cognitive processing and behavior including recall (Sweeney & Moreland, 1980) and decision-making (Markus, Crane, Bernstein, & Siladi, 1982).  Schemas have also been related to expectations, attributions, and performance in competitive physical activities (Taylor & Boggiano, 1987).

These findings suggest that experienced athletes would differ from novice athletes in their ability to initiate, maintain, and interrupt momentum.  In particular, they would be better able to recognize and act upon precipitating events, possess the skills necessary to regulate intrapersonal contributors to the maintenance of positive momentum (Bandura, 1986; Scheier & Carver, 1988), and mobilize their defenses against the activation of negative momentum.

Finally, Adler (1981) believed that momentum was based on the notion that an event is typically followed by a similar event.  Specifically, success begets success and failure leads to failure.  However, Silva et al. (1988) maintain that there are two alternative responses that might result: positive inhibition and negative facilitation.  Positive inhibition refers to the process by which success produces a loss of momentum and an increase in the likelihood of failure.  Similarly, negative facilitation suggests that, following failure, there will be an increase in momentum and the prior failure will enhance the probability for future success.  It is presently suggested that experience will mitigate this effect.  In other words, inexperienced athletes who lack the requisite schemas and skills will follow the “downward spiraling” (p. 86) trend described by Adler (1981).  In addition, because they may not be accustomed to success, they will fall prey to positive inhibition.

In contrast, experienced athletes will be more likely to demonstrate an opposite pattern.  That is, following success, experienced individuals will be able to maintain their success.  In addition, following failure, they will be more likely to exhibit negative facilitation because they possess the necessary recognition schemas and action patterns that are required to actively counteract the negative momentum.

Avenues for Future Research

The first important step that must be taken in the investigation of momentum is to demonstrate that momentum does, in fact, exist and is not, as Gilovich et al. (1985) suggest, another “cognitive illusion”.  The value of the present conceptualization of momentum is that the steps in the sequence of events are open to measurement and, therefore, validation.  Assessment at each stage of the operation leading to the development of momentum will enable researchers to identify and clarify the processes that are specifically involved.  For example, it would be possible to measure precipitating events, changes in cognition, affect, physiology, and behavior, and shifts in performance and immediate outcome.  An additional strength of the current model is that research testing it may employ physiological and behavioral assessment.  Devices that assess physiological functions such as heart rate and galvanic skin response and  behavioral measures such as the use of videotaped behavioral analysis may provide objective data relative to these influences on momentum.

Silva et al. (1988) suggest that future research must examine the phenomenon of momentum at a more micro level.  What this line of reasoning indicates then is that the analysis of archival data as a means of measuring momentum may not be sufficiently precise for demonstrating the existence of momentum.  Rather, in order for momentum to be clearly articulated, it will require theory-driven investigation at a more molecular level that examines the specific processes that produce momentum.

Initial Empirical Study

A sound program of research examining momentum will sequentially identify and demonstrate the influence of each step in the model.  However, a difficulty with momentum research to date has been its inability to demonstrate that precipitating events do, in fact, result in a change in competitive performance (Miller & Weinberg, 1991; Silva et al., 1992). To this end, in order to initiate the validation process of the present model, two preliminary studies were conducted to examine the first stage of the model, that is, the presence of precipitating events during competition and their influence on immediate outcome.  The study of the relationship between the first and final steps of the model was undertaken prior to the exploration of the intervening stages because, regardless of the value of the intermediary factors, their analysis would be moot if it could not be shown that precipitating events lead to changes in performance and immediate outcome.

The present studies had several goals.  One aim was to identify events during the course of basketball and tennis competitions that are perceived to be precipitating events of momentum.  An additional objective was to see whether the occurrence of precipitating events differed for winning as compared to losing teams and players.  The final and most important goal was to demonstrate whether a shift in momentum and immediate outcome would be found on the basis of the occurrence of precipitating events during competitive play as compared to periods when these events did not occur.              Based on the proposed model of momentum, the following hypotheses are forwarded: (a) Winning basketball teams and tennis players will demonstrate more positive and fewer negative precipitating events, (b) Due to the complex activation of each of the five steps along the momentum chain, only one out of five of identified precipitating events would result in a measurable change in immediate outcome (c) It is expected that winning as compared to losing teams and players will have significantly more positive precipitating events that lead to positive changes in immediate outcome and significantly fewer negative precipitating events that result in negative changes in immediate outcome, (d) There will be a significantly greater number of changes in momentum (as operationalized by changes in immediate outcome) following precipitating events than when no precipitating event has occurred.

Study #1

Method

Procedure

A sample of 25 tennis players of varying abilities from a Master’s level psychology class completed a questionnaire asking them to list ten events that they believed would cause changes in momentum during professional tennis matches.  In addition, they were asked to specify those situations in which this effect might result, for example, point in the match, who produced the event, score configuration.

The responses to this questionnaire generated 32 different precipitating events.  Due to the nature of observing videotaped tennis matches, only those events that were environmental, such an ace, were used because social and internal events including crowd influence or a player getting psyched up were not clearly observable.  From this group, five of the most commonly indicated events were selected based on their possession of the characteristics asserted by Adler (1981) and the present model to be associated with precipitating events: (a) Dramatic shot: drop shot, ace, overhead smash; (b) Break of serve early in set; (c) Winning game after long deuce; (d) Making an unforced error at a crucial point; (e) Not converting 15-40 or 0-40 break opportunity.  These precipitating events were similar to those identified by Richardson et al. (1988).

Five matches from the quarterfinal and semifinal rounds of the 1990 Men’s and Women’s U.S. Open Tennis Championships were videotaped.  These later round matches from the tournament were chosen in order to control for ability which, as discussed previously, may be a significant factor in discriminating momentum.  A trained observer then watched each match and, using a specially designed assessment form, recorded every occurrence of the five identified precipitating events and the subsequent scoring pattern.

Momentum, operationalized as a significant change in scoring or immediate outcome, was then assessed.  A significant change was indicated if one of two immediate outcomes emerged: A run of three or more points or a subsequent service break in a game.  These changes were based on discussions with a sample of professional players and coaches.  The observer also examined game situations when a precipitating event was not evident and whether a change of immediate outcome occurred.  A second independent observer then evaluated the assessments of the first observer, demonstrating their reliability (95% concordance).

Results

      Across the five tennis matches, there were an average of 30.4 precipitating events per match.  The most common type of precipitating event was the dramatic shot, accounting for 45.4% of those recorded followed by unforced errors (18.0%), break of service (16.0%), and not converting on a 15-40 or 0-40 break opportunity (15.0%).  66.4% of the events were positive and 33.6% were negative.  The most common type of change in outcome was a three-point run (77.2%) followed by a break of service (22.8%).

A series of Chi-Square analyses was conducted to look at the relationship of precipitating events between the tennis players.  Winning players experienced a significantly smaller proportion of negative precipitating events (18.7%) and a significantly greater proportion of positive precipitating events (81.3%) than losing players (68.9% and 31.1%, respectively; X2=35.80, p<.01).

When the effects of precipitating events on changes in immediate outcome were considered, similar differences emerged.  Winning players had a significantly greater proportion of positive precipitating events that resulted in a positive change in immediate outcome (35.6%) than losing players (0.0%, X2=7.20, p<.01).  Similarly, winning players had a significantly smaller proportion of negative precipitating events that led to a negative change in immediate outcome (15.0%) as compared to losing players (54.8%, X2=8.09, p<.01).

A change in immediate outcome occurred 33.6% of the time that a precipitating event preceded it.  When no precipitating event emerged, a change in immediate outcome occurred 23.2% of the time.  Though in the expected direction, this difference was not statistically significant.

Study #2

Method

Procedure

In order to identify potential precipitating events in basketball, a questionnaire was developed which asked a sample of individuals to list ten events that they believed would cause changes in momentum during collegiate basketball games.  In addition, they were asked to specify those situations in which this effect might result, for example, time of game, who produced the event, and score configuration.

Twelve volunteers who identified themselves as recreational basketball players and who were blind to the overall purpose of the study completed the questionnaire.  Analysis of their responses resulted in 30 different potential precipitating events.

From this group, four events were chosen which demonstrated the most consensus among the respondents and which were consistent with the parameters suggested by Adler (1981) and the present model: (a) Starting player must leave game for a negative reason such as injury, foul trouble, ejection, (b) Scoring run of three straight baskets by one team, (c) Time-out called by the opponent after a scoring run, and (d) Dramatic play, for example, slam dunk, three-point basket, fast break, steal leading to a basket, blocked shot, “prayer” shot at the buzzer.

Five games from the round of 16 at the 1990 NCAA Men’s Basketball Championships were videotaped.  Games from this tournament were chosen in order to control for ability which, as discussed previously, may be a significant factor in discriminating momentum.  A trained observer then watched each game and, using a specially designed assessment form, recorded every occurrence of the four identified precipitating events and the scoring pattern during the following five minutes.

Momentum was operationalized in a manner similar to that used in the tennis study.  A significant change (i.e., momentum) was indicated if the team that the precipitating event favored changed the game score in its favor by at least five points during the five minutes following the events or the team won the game in overtime.  This score change was derived following extensive discussion with a sampling of collegiate basketball players and coaches.  Also, the observer examined five minute segments when a precipitating event did not occur and whether there was a subsequent change in outcome.  Like the tennis study, a second observer demonstrated the reliability of the first observer’s assessments (97% concordance).

Results

      Across the five basketball games, there were an average of 12.8 precipitating events per game.  The most common type of precipitating event was the dramatic play, accounting for 43.1% of those recorded followed by a scoring run (35.2%), an important player left the game (13.7%), and a time out (7.8%).  78.4% were positive and 21.6% were negative events.

A series of Chi-Square analyses were conducted in order to examine the relationship between precipitating events and changes in immediate outcome relative to winning vs. losing teams.  An initial analysis indicated no significant differences between winning and losing teams in terms of the proportion of positive and negative precipitating events that occurred.

However, a near-significant change emerged (X2=3.37, p<.07) when the presence or absence of change in immediate outcome was included.  Specifically, winning teams had a near-significantly greater proportion of positive precipitating events that led to positive changes in immediate outcome (36.4%) than losing teams (11.1%).

A change in immediate outcome occurred significantly more often in the presence of a precipitating event than in its absence (22.0 vs. 0.0%, respectively; X2=4.57, p<.04).

Discussion

      The purpose of the two studies was to initiate exploration of the value of the multidimensional model of momentum in sports.  The specific objective was to examine the first stage of the model: precipitating events and their relationships to changes in immediate outcome.  This goal was accomplished by investigating whether there were significantly greater number of changes in operationalized momentum following precipitating events than when no precipitating event had occurred.

In general, the findings of the two studies provide some support for the experimental hypotheses.  Evidence for the first hypothesis was mixed.  Winning and losing basketball teams did not differ significantly in the number of positive and negative precipitating events they experienced.  In contrast, winning tennis players exhibited significantly more positive precipitating events and fewer negative precipitating events than losing players.

The second hypothesis suggested that, due to the complexity of the momentum chain, the occurrence of a precipitating event would not necessarily produce a commensurate shift in immediate outcome.  Specifically, in order for momentum to occur, each athlete or team would have to go through an intricate series of cognitive, affective, physiological, and behavioral changes, and that the precipitating event is a necessary, but not always sufficient, catalyst for completion of the momentum chain.   As predicted, in both studies, only a proportion of the precipitating events resulted in a change in immediate outcome.

The third hypothesis indicated that winning teams and players would have more positive precipitating events that lead to positive changes in immediate outcome and fewer negative precipitating events that would result in negative changes in immediate outcome.  The present findings were somewhat supportive of this assertion.  Significant differences were found between winning and losing tennis players for both valences of precipitating events.  These findings indicate that not only do winning players produce more positive precipitating events and fewer negative precipitating events, they are also better able to successfully act on the former and restrict the latter.

In the case of basketball, a near significant difference emerged between winning and losing teams for positive precipitating events.  These findings indicate that, though winning and losing teams generated a near equal number of precipitating events, the winning teams were more likely to complete the positive momentum chain and produce a positive change in immediate outcome.

These results are consistent with the proposed model with respect to completing the momentum chain for teams as compared to individuals.  In particular, the magnitude of the relationship between precipitating events and changes in immediate outcome were greater for tennis than for basketball.  In support of this aspect of the model, for singles tennis, a precipitating event must only activate the momentum chain of an individual player.  In contrast, for basketball, the precipitating event would be required to catalyze the momentum chain of five players with potentially different cognitive, physiological, affective, and behavioral response thresholds simultaneously.  As a consequence, it would be expected that it would be significantly more difficult for a team to complete the momentum chain than an individual player.

Finally, the fourth hypothesis, the one most critical to the model, asserts that there will be a significantly greater number of changes in immediate outcome following precipitating events than when no precipitating event occurred.  This hypothesis was tested in order to rule out the possibility that the relationship between precipitating events and immediate outcome was due to chance.  The present results offer supportive, though not conclusive, support for this position.  As predicted, for basketball, changes in immediate outcome only emerged following a precipitating event.  This robust finding suggests that, in basketball, a precipitating event may be necessary for a change in immediate outcome to occur.

The results were not so decisive in tennis.  It was found that, though there was a noticeable difference between the presence and absence of precipitating events and the emergence of changes in immediate outcome, the difference was not statistically significant.  In fact, even without a precipitating event, changes in outcome still occurred more than one-fifth of the time.  Though there is no way to offer any decisive explanations for this findings, several potential perspectives may be considered.

First, it may be that precipitating events occurred that were not measured.  Due to the nature of videotaped assessment, it was only possible to identify observable precipitating events.  Intrapersonal or social precipitating events may have occurred, but were not assessed.  Second, there may have been an accretion effect of earlier precipitating events.  That is, a sufficient number of previous precipitating events may have accumulated to finally activate the momentum chain and produce a change in immediate outcome.  Third, the lack of significant differences may have been due to chance, thus confirming the assertions of Gilovich et al. (1985) and Silva et al. (1988).

The divergent findings between an individual and team sport is surprising in light of our earlier statement that momentum would be less likely to occur in a team sport because complex activation of the momentum chain would be required for all five players on the team rather for just one tennis player.  The reasons for this disparity are unclear.  It may be that, in team sports, aspects of the momentum chain become “contagious”, thus spreading from player to player and facilitating the progress of the momentum chain.  It may also be that, with five players, a precipitating event is more likely to be recognized and the momentum chain initiated.  The divergence may also be due to methodological concerns.  For example, the operationalization of momentum for the two sports may not be equivalent.  These suppositions are entirely speculative and additional research examining this particular issue is necessary before any substantive position is taken.

Directions for Future Research

Though the two studies have provided the first supportive, though not conclusive, evidence of the relationship between precipitating events and competitive outcome, further study is needed to confirm this initial support.  Additionally, it is necessary to begin the process of examining each step of the momentum chain.

The research to date examining cognitions related to momentum has utilized hypothetical or contrived scenarios rather than naturally occurring competitive sport situations.  In order to effectively study these cognitions (and related emotions), it will be necessary to assess them during the course of actual competitions.  Two possible means of accomplishing this are suggested.  The most direct way would be to wire athletes with microphones and have them verbalize their thoughts and emotions as they occur.  This methodology, however, is clearly intrusive and might artificially interfere with the spontaneous flow of the competition and the generation of momentum-related cognitions and emotions.  Another approach would be to videotape the athletes, have them view themselves following the competition, and ask them to recount post hoc their cognitions and emotions at critical points during the competition.

As mentioned above, this model is amenable to physiological measurement.  The use of portable heart rate and galvanic skin response monitors would allow for objective assessment of physiological changes as they occur during competition.  These changes could then be correlated with the presence of precipitating events.

Behavioral changes that are related to the occurrence of precipitating events could be obtained through videotape analysis of athletes.  Baseline types and frequencies of behavior could be established and then compared with behavior changes that might emerge following precipitating events.

Finally, the interactive effects of head-to-head competition on momentum could be examined by using the above methodologies simultaneously with competing athletes. A similar approach could be used to study how momentum is influenced by team vs. individual sports.

Conclusion

The goal of the present paper was to provide a new conceptualization of momentum in sports.  The proposed model clearly articulates the necessary sequence of events that must occur in order for momentum to result.  In addition to the presentation of the model, this work offered an initial investigation of its value.  The findings of the two studies examining the first stage of the model, that is, the relationship between precipitating events and changes in immediate outcome, provided partial evidence in support of the model.  As demonstrated above, one of the strengths of the model is that each of its stages is operationalizable and empirically verifiable.  The next step in the investigation of the model will be to examine how each intermediary step of the model influences the relationship between the precipitating event and changes in immediate outcome.  As a consequence, it is hoped that this model will generate interest for further study of the concept of momentum.

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Figure 1

Multidimensional Model of Momentum in Sports

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A PSYCHOSOCIAL MODEL OF FAN VIOLENCE

Yaron Simon & Jim Taylor

Abstract

The present article examines the disturbing phenomenon of fan violence in sports. Though this issue has received considerable popular and media attention, there has been little effort on the part of psychologists to investigate fan violence in a systematic manner. In order to effectively address this concern, first, an historical perspective on its occurrence is provided. Second, a review of previous theories of crowd behavior and fan violence is offered. Third, the essential components of fan violence is defined. Finally, a psychosocial model of fan violence is presented as a means of providing a better understanding of the salient factors that contribute to the emergence of fan violence.

A Psychosocial Model of

Fan Violence in Sports

One of the most disturbing phenomena in sports is that of fan violence. Because of the suddenness, severity, and cost of recent occurrences, fan violence has generated significant concern within the sports community and received considerable attention from the media (Deming Pringle, 1985; Neff, 1989; Reed, 1988). Questions that arise out of these inquiries include: What causes these overzealous reactions from the sports fans and why is fan violence so prevalent? Despite the seriousness of this issue, little attention has been given to fan violence by psychologists and sociologists with respect to potential causes and solutions. Lewis (1982) suggests three reasons for this lack of attention: An overall lack of interest in the sociology of sport, a general decrease in interest in crowd behavior, and the potential danger of investigating fan violence.

The present work will examine a variety of explanations for crowd behavior and fan violence, pull out critical elements from them, and attempt to integrate these issues into a model that considers sociocultural, social psychological, and situational factors in the development of a more comprehensive model of fan violence.

In order to effectively address the issue of fan violence, first, an historical perspective on its occurrence will be provided. Second, a review of previous social psychological theories of crowd behavior and fan violence will be offered. Third, a definition of fan violence will be given. Finally, a psychosocial model of fan violence will be presented as a means of answering the concerns raised above.

Historical Overview

Sport-related violence appears to be as old as sport itself. The first reported incident of fan violence took place during a chariot race in Constantinopol in 532 B.C. According to written accounts, rioting fans seized the stadium and intervention by Roman soldiers was required to regain control of the situation. By the time the riot was over, an estimated 30,000 people were dead (Cameron, 1976, cited in Guttmann, 1986). In addition, in 59 A.D., violence during gladiator fights in Pompeii was so bad that the Roman Senate banned the fights for ten years (Guttmann, 1986).

In contrast, despite the fact that Medieval times (500-1500 A.D.) are considered a violent period, evidence indicates that sport-related violence was rare. A suggested explanation for the lower level of violence was that sporting events were small and drew few spectators. This lack of interest was influenced by demographic factors, e.g., proliferation of small and isolated communities, as well as by the nature of the tournaments, e.g., spontaneously organized knight fights (Guttmann, 1986).

Since the middle of the 18th century, the number of cases of sport-related violence has been increasing. Most of these incidences were directly related to a specific sporting event and took place in or around the arena. However, in some instances, the sporting event was only a trigger that set off long-standing tension. For example, in 1910, black boxer Jack Johnson defeated white James Jeffries, which caused an outbreak of racial violence that spread throughout the United States, causing several deaths and many injuries (Guttmann, 1986).

The deadliest of all incidences of fan violence in the modern era took place on May 24, 1964. In a massive riot following a soccer match between Peru and Argentina, 318 people were killed and over 500 injured (Yeager, 1979). In addition, on May 25, 1985, 41 spectators were killed and over 400 injured during a soccer match in Brussels, Belgium. During that month alone, a total of 102 people were reported to have died in sport-related acts of violence (Cronin, 1985).

In addition to the costs in human life, fan violence also results in tremendous financial loss and political repercussions. To date, no estimate of the monetary cost has been reported. However, it is clear that enormous sums of money are spent annually on crowd control measures, damage repair, and compensation. Fan violence has also been implicated in several diplomatic incidences (Igbinovia, 1985) and, in one case, contributed to a war between El-Salvador and Honduras (It should be noted that tension was building for several months and, in all likelihood, the war would have occurred in any event) (Kapuscinski, 1986).

Theories of Crowd and Collective Behavior

Early theories. Gustav Le Bon, in his 1895 classic essay, “The Crowd”, wrote:

“Whoever be the individuals that compose it, however like or unlike be their mode of life, their occupations, their character, or their intelligence, the fact that they have been transformed into a crowd puts them in possession of a sort of collective mind which makes them feel, think, and act in a manner quite different from that in which each individual of them would feel, think, and act were he in a state of isolation” (Le Bon, 1960, pp. 22-23).

Le Bon suggests that people in a crowd behave differently than they would otherwise and that the individual’s mind becomes subordinate to the collective mind. Further, the “collective mind” is heavily influenced by the unconscious and is characterized by, “an impulsiveness, irritability, incapacity to reason, the absence of judgment and of critical spirit, the exaggeration of the sentiments, and others besides-which are almost always observed in belonging to inferior forms of evolution” (p. 36).

Freud (1922) accepted Le Bon’s description of crowd behavior, but suggested that the essential ingredient for the development of such behavior is the presence of a leader. According to Freud, each member of the group is tied by libidinal forces to the leader. The tie is characterized by a conflict between love of the leader and frustration due to the leader’s inability to love and attend to each member of the group. The resolution of this conflict is similar to that of the Oedipal complex, i.e., the person identifies with the leader. In doing so, the person replaces his own superego with that of the leader. As consequence, the person may behave in a childlike state of dependence on the leader. Without the supervision of the superego, the individual will behave according to id impulses, hence, in a violent and aggressive way.

The theories of Le Bon and Freud provided an initial starting point for the development of a conceptualization of crowd behavior. However, consistent with Freud’s beliefs, these theories rely heavily on intrapsychic influences, which inhibit their ability to be operationalized and their practical value. In addition, though they explain the fundamental cause of crowd behavior, i.e., the emergence of baser unconscious motivations, they do not adequately delineate other contributing factors or the specific process that occurs in the development of crowd behavior.

Contagion theories. Contagion theories, an extension of Le Bon’s conceptualization, attempted to explain how moods, attitudes, and behaviors are rapidly communicated and uncritically accepted by the crowd (Stein Greenblat, 1981). The fundamental mechanism operating in crowd behavior is circular reaction. According to this perspective, one aroused person affects another in the crowd producing heightened level of arousal. This response, in turn, re-stimulates the first person even more. Thus, the arousal level continues to build as a function of this circular reaction. However, the arousal has no specific focus or outlet. At this point, members of the crowd are in a highly suggestible state and, if cued by a leader to act in a certain way, e.g., violently, they will react impulsively and uncritically (Wheeler, 1966).

This theory adds another valuable component to the understanding of crowd behavior, in particular, the influence of mood and arousal on its development. However, it does not clearly indicate what initially stimulates the arousal or specifically how the circular reaction process of arousal occurs. Nor does the theory explain how a leader emerges and directs the highly aroused crowd.

Convergence theories. The composition of the crowd is the salient factor in convergence theories (McKee, 1969). Specifically, crowds are often composed of persons who share common values and interests. These theories suggest that crowd behavior stems from the convergence of like-minded persons who are already predisposed to behave in certain ways. Thus, this gathering of people serves to lessen inhibitions and stimulate the release of existing responses (Stein Greenblat, 1981).

As with the previous theories, these positions offer another useful addition to the knowledge on the dynamics of crowd behavior, in this case, the make-up of the crowd. However, these theories do not explain why and how inhibitions are lessened and what triggers the appearance of crowd behavior.

Emergent-Norm Theories. These theories assert that members of a crowd act in deviant ways because everyone around them is acting that way. The transformation into crowd behavior is explained by the development of new norms within the group. In ambiguous situations, innovators (leaders) suggest a course of action, typically through modeling. As others follow, the crowd defines the situation and generates new norms in terms of this course of action and develops justifications for the otherwise unacceptable behavior (Turner, 1964; Turner Killian, 1987).

The notion of the emergence of new norms in a crowd is introduced here and adds further to our understanding of crowd behavior. However, this theory does not fully explain how the new norms develop or how they override more socially acceptable and enduring rules of behavior that predominate in the culture. In addition, it is not clear how a leader emerges from the crowd or how the leader gains the attention of the crowd in order to influence it.

Up to this point, it is suggested that the crowd behavior theories reviewed above provide valuable contributions to our understanding of crowd behavior and, more specifically, fan violence. However, they are not entirely adequate in accounting for fan violence on several grounds. First, they do not articulate the specific causes of the violence that occurs. Second, they alone do not satisfactorily explain the entire development of the phenomenon. Third, elements of the theories are difficult to operationalize and, as a result, make them less conducive to study.

Collective Behavior. Smelser’s Theory of Collective Behavior (1963) presents the broadest approach to the understanding of collective behavior. According to his perspective, six factors determine whether collective behavior will arise (presented below). Furthermore, in order for collective behavior to result, a sequential chain of these factors must occur.

Structural conduciveness refers to the social conditions that make collective behavior possible, i.e., the ability of a group of people to communicate in such a way as to initiate the collective behavior. Structural strain results from conflicts between different parts of the social system. Growth and spread of a belief focuses on the cause of the structural strain and on a plan of action to correct the situation.

These processes are necessary but not sufficient for collective behavior. A precipitating event, often spontaneous, must occur that serves to trigger the collective action. Mobilization of participants typically requires a leader who organizes and mobilizes people into action. Finally, mechanisms of social control provide resistance against the emergence of collective behavior.

Though Smelser’s theory raises some issues that are useful in understanding fan violence, there are several factors that limit its explanatory power. First, from his perspective, the development of collective behavior is slow and takes place over a long period of time. Second, collective behavior is viewed as an organized effort to mobilize people to reach a desired goal rather than due to a momentary emotional outburst. Third, the manner in which people collectively behave is justified by the goal and, as a result, does not require the defense of the behavior. In short, collective behavior, as described by Smelser, is a slowly developed, well-organized, goal-directed, and justifiable course of action. In contrast, it is presently argued that fan violence is spontaneous, unorganized, undirected, and unjustifiable. As a consequence, though Smelser’s theory is a significant step in the systematic understanding of crowd behavior, it does not fully explain all of the relevant features that contribute to the development of fan violence.

In summarizing the literature on collective behavior, Milgram and Toch (1969) found that crowds are characterized by three features. First, they demonstrate uniform behavior. Second, the crowd engages in behaviors in which each participant individually would not engage. Third, members of the crowd are in a state of heightened emotionality which causes them to react in extreme ways. These notions, which pull together essential elements of the theories discussed thus far, can be used in the application of collective behavior explanations to fan violence.

Eitzen’s Theory of Fan Violence

Eitzen (1979), one of the few researchers to address the issue of fan violence directly, defined three types of fan violence: rowdyism, exuberant celebration, and sport riots. Rowdyism refers to interpersonal and property vandalism associated with a sports event. Furthermore, rowdyism will occur regardless of what takes place in the competition. Rather, the sports event only serves as an outlet for longstanding hostility and frustration. Exuberant celebrations occur when fans celebrate victory by destroying property such as tearing down the goalposts after a victory in football. Sport riots refer to hostile and aggressive acts which are triggered by the events on the field. Eitzen ties this latter form of fan violence to existing social strains between fans due to economic, religious, ethnic, or political reasons. A second factor contributing to sport riots, according to Eitzen, is the unavailability of alternative means of relieving the social strains.

Proposed Definition of Fan Violence

The Random House Dictionary of the English Language (1987) defines fan as: “An enthusiastic devotee, follower or admirer of a sport, pastime, celebrity, etc. Short for fanatic” (p. 821). Moreover, it defines fanatic as: “A

person in an extreme and uncritical enthusiasm or zeal in religion or politics” (p. 821). Synonyms for fanatic include fiery, narrow-minded, and violent (Roget, 1977). Fanatic further implies “unbalanced or obsessive behavior…vigorous and aggressive support for or opposition to a plan or ideal, and suggests a combative stance (p. 821). Based on these definitions and focusing on aspects of fan violence that Eitzen (1979) characterizes as sport riots, fan violence is presently characterized as: “purposive destructive or injurious behavior by partisan spectators of a sporting event that may be caused by personal, social, economic, or competitive factors”.

Psychosocial Model of Fan Violence

Based on the above assumptions and drawing on issues from previous theories of crowd behavior, the following psychosocial model of fan violence is offered.

Potentiating Factors

Though this model emphasizes the more immediate and specific social psychological and environmental causes of fan violence, a comprehensive explanation of fan violence would be incomplete without some discussion of the larger social factors that predispose individuals to violent behavior in a sport setting.

Socioeconomic conditions. The current socioeconomic conditions of the country where the competition is being contested may contribute to the outbreak of fan violence. Stein Greenblat (1981) suggests that heightened arousal facilitates fan violence. From this perspective, it is likely that economic pressures will initially raise fan arousal which will then intensify further due to the competitive setting, thus increasing the likelihood of that arousal being focused and released in the form of violence. Politics and geography. Political and geographical differences of fans can add to the polarization that naturally develops in partisan crowds. As with socioeconomic pressures, these differences may escalate arousal, thereby increasing the probability of violence becoming an outlet. Smelser’s notion of structural strain may be viewed as a part of this issue.

Media influences. The media can be a significant contributor to the general climate surrounding the competition. Television, radio, newspaper, and other media reports that emphasize the adversarial aspects of the opposition and further incite strong negative feelings toward them can prime fans to react violently once the setting-specific factors that foster violence are present.

Community norms. The accepted norms of the community will also contribute to the priming effect. As the convergence theories suggest (McKee, 1979), people who share values that violence is permissible are more likely to rally around these common beliefs and manifest them overtly. In contrast, if there are strong social mores against violence, what Smelser (1963) terms `mechanisms of social control’, then these social forces within a community will act to inhibit people from behaving violently.

Critical Factors

Identification. People appear to have a need to identify with an individual or group (Taijfel, 1981; Taijfel Turner, 1979; Turner, 1975). It has been argued that it is a significant means by which people maintain and enhance their self-esteem (Oakes Turner, 1980; Turner, 1975). On a global level, this need to identify is a cornerstone of society. Religion, community, family, and nation are some of the more common sources of identification found in society.

Sport is another powerful source of identification (Brown, 1986). Specifically, people appear to readily identify with an individual athlete or team, particularly in the absence of a strong self-identity. The identification process is influenced by a variety of factors including personal issues, geographic, demographic, and economic concerns, style of play, and whether they are winning or losing. In this manner, people can become heavily invested in the outcomes of competitions involving their figure of identification. If this investment is excessive, losing an event may be perceived as a threat to their own self-identity and could potentially be acted out in a destructive way (Brown, 1986).

Group solidarity. The significant identification just described results in a strong sense of group solidarity. This factor has two significant components. First, a feeling of togetherness, belonging, and support will be evident (Milgram Toch, 1969). This feeling of being a part of a group may be reached in several ways. The foremost contributor to this belief is mutual cause. This conviction is enhanced by wearing similar clothes, meeting in the same bars, sharing rides to and from games, etc. In addition, this feeling of solidarity may become stronger when a threat to the group or group ideals exists (Lott Lott, 1965), i.e., an opposing team. Furthermore, the sense of togetherness will grow in direct proportion with the emotional investment.

Second, intergroup hostility must be present. This phenomenon was demonstrated by Sherif, Harvey, White, Hood, and Sherif (1961) in their classic children’s summer-camp experiment and was also found with adults (Blake Mouton, 1961). For the present purposes, the most important implication of this research is that groups tend to amplify their differences, with each group assuming a superior position, thus resulting in a highly polarized and emotionally charged attitude of “us vs. them”. In addition, as this polarization develops, groups will then compare themselves to their outgroup and determine how fairly they have been treated (Festinger, 1954). This kind of polarization and social comparison can be seen among fans before, during, and after an important competition and is manifested in bravado, posturing, and hostile verbal exchanges.

Deindividuation. Having developed a strong perception of group solidarity, fans may then be more susceptible to the next stage of the psychosocial model, i.e., a sense of deindividuation and anonymity. This impression leads to the abandonment of personal responsibility and a weakening of personal and social restraints that normally guard against socially unacceptable behavior (Milgram Toch, 1969). Freedman, Carlsmith, and Sears (1970) explain this process in their analysis of collective behavior:

“Individuals lose their personal sense of responsibility when they are in a group. Instead of feeling as they usually do, that they personally are morally accountable for their actions, group members somehow share the responsibility with one another, and none of them feel it as strongly as he would if he were alone; the more anonymous the group members are the less they feel they have an identity of their own, and the more irresponsibly they may behave” (p. 170).

Related to sports, in a stadium of many thousands of people, this sense of deindividuation increases the probability of aggressive behavior. Not only does it, from their perspective, absolve them of responsibility, but it also reduces the likelihood of them being caught and held accountable for their actions.

Dehumanization of the opposition. As discussed above, the previous three factors produce a strong polarization and significant hostility between groups. It appears that these conditions encourage the emergence of the next stage of the model, i.e., the dehumanization of the opposition. Dehumanization refers to the process by which fans view the opposition as less than human and, as a result, are not subject to the normal constraints of moral behavior toward humans. This process is typically expressed and enhanced through name calling, insults, songs, and chants such as:

“In their Nottingham slums,

In their Nottingham slums.

They look in the dustbin for something to eat,

They find a dead cat and they think it’s a treat

In their Nottingham slums.”

(Yeager, 1979, p. 25)

“Spurs are on their way to Auschwitz.

Hitler’s gonna gas’em again.

You can’t stop’em,

The Yids from Tottenham,

The Yids from White Hart Lane.”

(Guttmann, 1986, p. 161)

The dehumanization process is an important part of the establishment of new norms that rationalize the violent behavior and excuse the participants from responsibility Turner Killian, 1987). As mentioned above, by proliferating the belief that the opposition is not human, fans can engage in behavior that is, from their perspective, moral and just.

Moreover, considered within Smelser’s (1964) framework, the `structural strain’ between opposing fans produces a heightened level of arousal which needs an outlet. In turn, the fans must alter their norms of appropriate social behavior in order to circumvent the `mechanisms of social control’ which, under normal conditions, would inhibit violent behavior. One significant means of producing this change in norms is to dehumanize the opposition. Viewed from this perspective, dehumanization of the opposition may be characterized as a part of the norm shift that has been discussed by several of the previous theorists (Smelser, 1964; Turner, 1963; Turner Killian, 1987).

Leadership. In the early stages of this psychosocial model, fan violence is considered only a potentiality. In other words, up to this point, fans may be characterized as an emotionally charged, cohesive, though undirected group. However, with the emergence of a leader, this potentiality may become a reality (Wheeler, 1966). As a result, it is presently proposed that the appearance of a leader is the most critical factor in whether fan violence will occur. Early theorists in crowd behavior have stressed the important role that leaders play in the development of crowd behavior. For example, Freud (1922) suggested that individuals in a group setting experience feelings toward the leader akin those of the Oedipal Complex. In addition, proponents of the emergent-norm theories (Turner, 1964; Turner Killian, 1987), would argue that, up to this point in the psychosocial model, the crowd is not only unfocused, but the situation is ambiguous. Then, as Turner (1964) suggests, the leader proposes a specific course of action, the crowd defines the situation based on that path, and generates a new set of norms to justify their new direction.

Furthermore, it appears that the leaders do not emerge from the crowd serendipitously. Rather, particular individuals attend sporting events with the expressed purpose of acting out their aggressive tendencies (Harrison, 1974). In other words, these leaders typically engage most persistently in violence and view violence as an integral part of the game. Harrison (1974) provides a striking example of this type of antagonist:

“I go to a match for one reason only: the aggro [aggression]. It’s an obsession, I can’t give it up. I get so much pleasure when I am having aggro that I nearly wet my pants…I go all over the country looking for it…every night during the week we go around town looking for trouble. Before a match we go around looking respectable…then if we see someone who looks like the enemy we ask him the time; if he answers in a foreign accent, we do him over” (p. 604).

This view is consistent with what Smelser (1963) terms, `mobilization of participants’. This link in his sequential chain involves a leader who rises within a group of fans to initiate and incite violent behavior. In other words, the emerging leader provides direction and outlet for this highly-aroused group. As such, the appearance of a leader is the final step in the development of fan violence.

On-Field Contributing Factors

In addition to these necessary and sufficient causes of fan violence, there are also several factors that occur in competitive arena that, when present, increase the likelihood of fan violence.

Type of Sport. The nature of the sport that is being observed may have an impact on the amount of fan violence that is manifested. In fact, research has demonstrated that sports that involve aggressiveness and physical contact, such as football and ice hockey (Arms, Russel, Sandilands, 1979), are more likely to produce fan violence than those where these elements are not present.

The type of sport may impact the occurrence of fan violence in several ways. First, sports with considerable physical contact may produce a higher level of emotional arousal among fans, thereby necessitating a release of the accumulation of tension. This notion is consistent with contagion theories’ concept of circular reaction (Stein Greenblat, 1983) in which an initial level of arousal in passed to others which, in turn, increases the arousal level of the originator.

In addition, the presence of aggressiveness in the competitive arena may strengthen the belief held by fans that violence is socially acceptable and appropriate in the present setting, thus making it permissible for the fans to engage in similar behavior. This notion is what Smelser (1979) terms, `growth and spread of belief’, in which a strong belief develops in a group of people that initiates a course of action, in this case, violent behavior.

Lastly, the type of sport will influence the kind of models that the fans are presented with. Clearly, sports with considerable physical contact will model aggressive behavior. This issue is discussed in greater detail below.

Modeling. Considerable research conducted by Bandura and his colleagues (Bandura, 1973; Bandura, 1979; Bandura, Ross, Ross, 1963) has demonstrated that observing modeled aggressive behavior will increase the likelihood of aggression on the part of the observers. In the sports domain, modeling may enhance fan violence is several ways.

Since fans are strongly identified with their team’s players, they will act as powerful models for the fans. This process can result in modeling of the on-field behavior that, though not necessarily aggressive in intent, may be construed as such, thereby resulting in fan violence. Moreover, in contrast with many types of spontaneous violence such as political riots, most ardent sports fans have a history of modeled sports aggressiveness dating back to their childhoods. It is this experience that may further to facilitate the emergence of violent behavior.

An important reason why this type of modeling may occur is that only overt behaviors are able to be perceived clearly by fans. In other words, fans can only see the observable acts, but not the intention or meaning of the act or the implicit context of the actions. However, there is significant information that is not conveyed along with the aggressive behavior. For example, aggressive actions in competition are limited by specific rules and norms. In other words, most sports have implicit and explicit guidelines that indicate to players the frequency and severity of aggressive behavior that is allowed. Additionally, aggressive behavior is only appropriate on the field of play during competition, not in the stands between fans or after the game between players. Also, violent behavior is constrained by rules of “appropriate aggressiveness”. Players know how aggressive they can be and the consequences of excessive aggressiveness.

Unfortunately, these delimiters are not recognized by fans. If this information was available to the fans, then the likelihood of the fans modeling this behavior might decrease. Instead, the lack of recognition of these norms results in potentially modeled violence.

Score Configuration. The score of the competition is a factor that may exacerbate the existing conditions. The score may influence arousal (Stein Greenblat, 1981), cause a change in the threat to fans’ self-esteem, polarize opposing groups of fans (Dollard, Doob, Miller, Mowrer, Sears, 1939), rally fans around a new norm or belief (McKee, 1969), and lessen inhibitions controlling socially appropriate behavior (Stein Greenblat, 1981).

Specifically, fans of losing teams may experience increased arousal, feel threatened through their excessive identification with their team, direct their arousal in the form of hostility toward fans of the opposing team, and develop the belief that it is permissible to be aggressive because their team is losing. These conditions would then increase the likelihood of violence occurring if other factors are also present.

Competitive Events. The events occurring on the field during the course of the game could prompt many of the changes just described. In particular, a dramatic play on the part of the opposition, a ruling against the identified team, or ill-perceived behavior by an opposing team’s player could precipitate the affective, cognitive, and behavioral changes that might lead to violent behavior. Particularly provocative are events that could be characterized as perceived injustices on the part of the fans. These events might include a questionable ruling by an umpire, the team coming close, but not succeeding in a crucial situation, and falling just short of a comeback.

Off-Field Contributing Factors

Alcohol. Alcohol serves to lessen inhibitions, thereby contributing to the reduction of personal and social restraints on all of the causal factors and, in turn, violent behavior. The results of several studies investigating whether alcohol produces aggressive behavior indicates that alcohol alone does not seem sufficient to instigate aggression. However, when combined with hostility, alcohol appears to increase the likelihood of its emergence (Taylor Gammons, 1975; Taylor, Gammons, Capasso, 1976). Moreover, recent research suggests that frustration is an important determinant of aggression while under the influence of alcohol (Gustafson, 1984; Gustafson, 1985).

In addition, alcohol has been implicated as a direct cause of fan violence. The best known of these incidents is the so-called “Beer Riot” during a 1974 Major League baseball game (Lewis, 1982). As a result of this occurrence and others like it around the world, alcohol consumption has been limited or banned in many sports arenas. For example, in Scotland, alcohol was banned at all soccer matches and drunkenness was made illegal at sporting events. Since the act was introduced in 1980, the number of offenders has dropped significantly (Coalter, 1985). However, it should be pointed out that a decrease in the number of violent incidences was not found.

Density. It is presently suggested that density may also be a significant contributor to fan violence. To date, empirical evidence for a relationship between density and aggression has been equivocal. For example, some research has found that density is related to arousal and aggression (Hutt Vaizy, 1966; Griffitt Veitch, 1971). In contrast, other research reported no evidence for such an effect (Sundstrom, 1978). However, several recent incidences of fan violence have implicated stadium overcrowding as a significant cause of the violence (Trecker, 1985). As a result, the influence of density on fan violence is worth further examination.

Frustration. The relationship between frustration and aggression has been investigated extensively (Berkowitz, 1988; Dollard, Doob, Miller, Mowrer, Sears, 1939; Gustafson, 1986) and it has been concluded that frustration in pursuit of a goal is a significant cause of aggression. In a sports setting, there is considerable opportunity for frustration on the part of fans. Specifically, the primary goal of sports fans is winning. When their identified teams are losing, an occurrence over which they have no control, frustration may build and the fans may seek an appropriate cathartic. This process may then result in aggressive behavior.

Modeling. In addition to the modeling by fans of players in the competitive arena, fans may also model the aggressive behavior of leaders that emerge from the crowd (Wheeler, 1966) and initial acts of violence from other fans in proximity to them. As the emergent-norm theorists suggest (Turner, 1964; Turner Killian, 1987), through modeling, a leader suggests a course of action which then produces a consistent change in norms which makes the violent behavior justifiable. Furthermore, the probability of modeling leaders and other fans may be accentuated due to the factors discussed above including excessive identification, alcohol consumption, arousal, and frustration, all of which contribute to a decrease in inhibition and an increase in spontaneous, uncontrolled behavior.

Causal Sequence of Psychosocial Model

Though there is, to date, inadequate data to make firm statements about the causal sequence of the factors that lead to fan violence, the present model is constructed with an implicit order of causation. Specifically, the potentiating factors create a setting vulnerable to the development of fan violence. However, these factors alone will not be sufficient to elicit the violence. Subsequently, the emergence of the critical factors sequentially increase the likelihood of the occurrence of fan violence. In addition, the on-field and off-field contributing factors encourage the advent of violence. All of these factors are considered to be necessary, but not sufficient, to produce fan violence. Finally, as discussed above, it is suggested that the appearance of a leader is both necessary and sufficient for the development of fan violence.

Conclusion

The present conceptualization has attempted to provide a new perspective on the sociocultural, social psychological, and situational causes of fan violence in sports. The psychosocial model that has been presented suggests that fan violence is the result of a series of intrapersonal, environmental, and social conditions that, given the appropriate cues and direction at the competition, predisposes fans to act in a violent manner. By understanding the interrelationships of these factors, it may be possible to assess the presence of these factors at upcoming sporting events and, consequently, the likelihood of fan violence developing. If, by identifying these factors, potential violence can be predicted, then proactive steps may be taken in accordance with the presenting factors, e.g., banning alcohol, increased security between opposing groups of fans, thereby preventing the possible fan violence from being realized.

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Examining the Boundaries of Sport Science and Psychology Trained Practitioners in Applied Sport Psychology:
Title Usage and Area of Competence

Jim Taylor
Aspen, Colorado

                                                                 Abstract

This article examines the issues of title usage, area of competence, and the boundaries of appropriate practice for professionals in applied sport psychology trained in either psychology or sport science programs.  Considerable discussion is focused on the legal and ethical ramifications of the title of sport psychologist and who may and may not use it.   Emphasis is also placed on defining and clarifying area of competence as it pertains to the two educational backgrounds.  Drawing upon previous writing in the area and literature from outside sport psychology, guidelines are offered for determining whether professionals are performing within their area of competence based upon their education, training, and experience in three domains: presenting problem, intervention skills, and client population.

Examining the Boundaries of Sport Science and Psychology Trained Practitioners in Applied Sport Psychology:
Title Usage and Area of Competence

Over the past 50 years, the development of the field of applied sport psychology has progressed along two avenues.  Originally, sport psychology was an outgrowth of the study of motor learning within physical education departments (Silva, 1989) and the majority of practitioners in the field emerged from that area.  More recently, others from specializations within psychology departments including the clinical, counseling, social, personality, physiological, cognitive, health, and developmental areas have become involved in applied sport psychology (Taylor, 1991).  In fact, the membership of the Association for the Advancement of Applied Sport Psychology (AAASP, 1990) is fairly evenly divided between psychologists (46%) and physical education trained practitioners (41%), though only 11 out of 95 programs listed in the Directory of Graduate Programs in Applied Sport Psychology (AAASP, 1993) are housed in psychology departments.

These divergent educational paths have produced substantial discussion in the past 10 years over the most appropriate training in applied sport psychology (Dishman, 1983; Nideffer, Feltz, & Salmela, 1982; Taylor, 1991).  This debate has also led to attempts to elucidate five important aspects of applied sport psychology: (1) what professionals of differing backgrounds may legally and ethically call themselves (AAASP, 1989), (2) specify the kinds of problems that athletes present with, (3) define and categorize the various types of interventions used in the sports setting, (4) clarify the education and training that is necessary to treat certain problems and engage in particular interventions (AAASP, 1989; United States Olympic Committee (USOC), 1983), and (5) determine the boundaries of ethical practice for professionals trained in either the sport sciences or psychology.  These issues have important ramifications for the field of applied sport psychology at several levels.

Silva (1989) and Gardner (1991) suggest applied sport psychology is characterized by its interdisciplinary origins and development.  They also assert that it is important for professionals of differing backgrounds to respect the contributions of each group or “more turf protection and name calling is likely to develop…” (Silva, 1989, p. 271).  However, the growing pains of this emerging field, with its lack of definition and clarity in terms of appropriate boundaries of practice, make this cooperation and mutual regard more difficult.  Silva (1989) states that organizational guidance and “interdisciplinary efforts can deflect the development of adversarial relationships” (p. 271) between those of different educational backgrounds.

What this discussion suggests is that it is important for professionals in applied sport psychology, regardless of the discipline within which they studied, to understand what they may legally and ethically label themselves as, their particular areas of competence, the boundaries of practice as defined by their education and training, and to adhere to state laws, and American Psychological Association (APA) and AAASP guidelines regarding ethical practice.

Title Concerns in Applied Sport Psychology

The issue of title has significant legal implications in the practice of applied sport psychology.  The field of applied sport psychology has seen considerable popular and professional growth in recent years.  Additionally, there has been increased regulation of mental health services by states.  These two developments may make simply using the title, “psychologist”, problematic for many practitioners (Brown, 1982; Gardner, 1991).  Consequently, as a precursor to addressing area of competence, it is important that the professionals of the emerging field of applied sport psychology understand the ramifications of the use of the title, “sport psychologist”.  Specifically, most states limit the use of any derivative of the term, “psychology” in a professional title to those individuals who meet the following criteria: (1) possess a doctoral degree that is primarily psychological in nature from an accredited postgraduate institution, (2) pass all requirements for licensure as a psychologist, or (3) are employed by a state, county, municipal agency or educational institution and only in the course of conducting their duties in that position (State of Colorado, 1992; State of Florida, 1991).

To further clarify title and boundary issues, it is also worthwhile to consider how states define “psychologist” and the “practice of psychology”.  For example, the State of Colorado (1992) defines “psychologist” as “a person who practices psychotherapy and engages in the practice of psychology and who is licensed… ” (p. 18).  It defines the “practice of psychology” as:

“… the holding out of any person to the public as offering psychological services based on the scientific study of psychology, to individuals, groups, or organizations for compensation.  The term includes, but is not limited to:         (a) The use of psychological methods of interviewing and consulting for the purpose of evaluating the mental or emotional functioning of a person;            (b) The construction, administration, and interpretation of tests assessing intellectual abilities, personality characteristics, cognitive skills, psychopathology, and psychophysiological characteristics;                        (c) The diagnosis and treatment of emotional, behavioral, and mental disorders or the psychological aspects of physical dysfunction;                            (d) The methods and procedures of psychotherapy and psychological counseling, including but not limited to biofeedback, hypnotherapy, and individual, couple, family, and group therapy;                                                      (e) The application of research methodologies, statistics, and experimental design to psychological data. (p. 17-18)

It should be noted that state laws related to title and practice vary and professionals should contact their state regulatory agencies in order to learn the particular regulations that may affect them.

Sport science trained professionals.  The issue of title for sport science trained consultants was illustrated recently by a sport science trained professional who, after receiving considerable media attention while working with a professional baseball player, was required by his residing state to change his professional title from “sport psychologist” because he was in violation of statutory licensing laws (Strauss, 1992).

As such, professionals who are not licensed or who do not meet exemptions are violating the law and subject to legal action.  To date, as just mentioned, only one individual has been held accountable for this title protection, but considering the increased media attention given to sport psychology and the widespread use of the title, “sport psychologist”, within the field, greater scrutiny and enforcement may be expected.  As Gardner (1991) states “practitioners in the field must carefully consider the risk of legal action when choosing to use this title in their professional lives” (p. 57).  It is presently suggested that the title, “mental training consultant”, be used by nonlicensed professionals because it is not in violation of state laws and it is highly descriptive of the services provided by these practitioners.

Psychologists.  Though the use of the title, “psychologist”, is legal if licensed or exempted, it may be inappropriate for psychology trained professionals to call themselves sport psychologists.  It may be considered unethical if the clinicians do not have education, training, and experience suitable to practice in that area.  Keith-Spiegel and Koocher (1985) indicate that there is considerable debate about what criteria comprise competence in specialties, subspecialities, and areas of expertise.  For example, the APA recognizes clinical, counseling, industrial/organizational, and school psychology as distinct specialties (APA, 1987).  However, training in any of these areas does not guarantee competence in any subspecialty within them and, in fact, a lack of proper education and/or specialized training increases the probability of incompetence.  For example, a Ph.D. in clinical psychology, a 10-year practice in individual psychotherapy, and a workshop and readings in family therapy, does not entitle a professional to hold him/herself out as a family therapist (Keith-Spiegel & Koocher, 1985).

Thus, it may be concluded that licensed psychologists do not have de facto grounds to hold themselves out to the public as sport psychologists.  It would be appropriate and ethical for these psychologists to list working with athletes as an area in which they practice.  Only with adequate experience and supplemental training would it be reasonable for them to use the title, “sport psychologist”.

Defining Area of Competence

State regulations.  As indicated above, all 50 states and the District of Columbia regulate the title, “psychologist” (Brown, 1982).  However, state licensure requirements only assess general competence in the field of psychology.  That is, state boards stipulate threshold criteria of education, training, and experience necessary to use the title, “psychologist.”  Moreover, most states only specify a few specialty areas within psychology: clinical, counseling, industrial/organizational, and school (e.g., State of Colorado, 1992; State of Florida, 1991).  State laws authorize licensed psychologists to engage in a wide variety of clinical services, for example, biofeedback and neuropsychogical assessment, yet licensed individuals may not be competent to practice in these areas (Pope & Vasquez, 1991).  State laws do, however, stipulate that competence to practice in a specialized area be documented with coursework, training, and supervised experience.

Pope and Vasquez (1991) also state that “competence is complex and difficult to define.  Licensing boards and the civil courts sometimes define criteria…however they tend to require simply that…the clinician…possess demonstrable competence.  Generally, this evidence comes in the form of the clinician’s formal education, professional training, and carefully supervised experience” (p. 51-52).

APA ethical principles.  The American Psychological Association adds little clarity to our understanding of competence.  Principle A of the APA Ethical Principles of Psychologists (APA, 1992) states the following about competence:

Pain Education and Management in the Rehabilitation from Sports Injury

Jim Taylor, Ph.D.
Alpine/Taylor Consulting
Aspen, Colorado
Shel Taylor, M.A.
University of Connecticut Health Center
Farmington, Connecticut

Abstract

This article addresses the essential role that pain plays in the rehabilitation of sports injury.  It will describe important information and approaches that applied sport psychologists can use to more effectively manage pain in the injured athletes with whom they are working.  A brief discussion of the most accepted theories of pain will be offered.  Types of pain that injured athletes may experience and how they can learn to discriminate between them will be discussed.  Also, it will consider how pain can be a useful tool as information about injured athletes’ current status in recovery and the need to modify their rehabilitation regimens.  The value of measuring pain will be examined with an emphasis placed on a simple and easy means of assessing pain.  Next, the article will examine why nonpharmacological pain management may be a useful adjunct to pharmacological pain control.  Then, a brief description of the most commonly used pain medications and a detailed description of common nonanalgesic pain management strategies will be furnished.  A discussion of how nonpharmacological pain management can be incorporated into the traditional rehabilitation process will be offered.  Finally, the article will describe the role that sport psychologists can play in the management of sport injury-related pain.  The objective of this article is to provide applied practitioners with the knowledge and tools necessary to assist injured athletes in mitigating the pain they will experience during recovery as a means of facilitating their rehabilitation and return to sport.

                                        Pain Education and Management in

the Rehabilitation from Sports Injury

Pain is, without a doubt, the most pervasive and debilitating obstacle to effective rehabilitation experienced by injured athletes.  It has significant physical and psychological effects in almost every aspect of recovery  (Heil, 1993; Pargman, 1993).  Yet, despite this importance, little time is devoted to educating injured athletes about pain, how it affects them, and how they can best manage it.  Because pain is so poorly understood (Feuerstein, Labbe, & Kuczmierczyk, 1986), the simple expectation of its presence can produce a chain of physiological and psychological responses that may increase the experience of pain, thereby inhibiting rehabilitation.

There are other difficulties with pain that further complicate its understanding and management.  Pain is a subjective experience, in which people vary greatly in their levels of pain tolerance and where the cliché, “I feel your pain” is clearly inaccurate (Catalano, 1987).  Pain is affected by a wide variety of physical, psychological, social, and cultural influences (Heil, 1993).  Also, pain can not be directly measured.  As a result, it is difficult for others to evaluate the actual severity of the pain and determine what type of pain management, whether pharmacological or nonpharmacological, may be most appropriate.

Effective pain management begins for injured athletes with a clear understanding of what influences their perceptions about pain and how pain affects them.  Next, injured athletes can learn to distinguish different types of pain that they will experience during the rehabilitation process.  Then, they can learn to “read” pain, that is, recognize the kind of pain they are having and use it as information in their rehabilitation program.  Finally, injured athletes can develop skill in the use of nonpharmacological pain management strategies as a complement or replacement for pharmacological pain control.

There has been extensive study of pain management techniques related to pain experienced in a variety of settings including sport and exercise (Berntzen, 1987; Hackett & Horan, 1980; Vallis, 1984; Whitmarsh & Alderman, 1993).  For example, outside of sport, Thompson (1981) reported that relaxation techniques that improved patients’ perceptions of control over their pain resulted in greater pain tolerance and a reduction in reported pain.  Overall, the investigations indicate that pain tolerance can be improved and people can learn to reduce pain with nonpharmacological pain management strategies (Gauron & Bowers, 1986; Turk, Meichenbaum, & Genest, 1983).

The majority of this research has examined the effectiveness of components of stress inoculation training (SIT; Meichenbaum, 1985).  SIT is a treatment paradigm comprised of stress-management techniques that typically include relaxation training, attention diversion (imagery, external diversion, internal diversion), and self-talk strategies to manage perception, evaluation, and response to the stressor (Meichenbaum, 1985).  The research conducted in clinical and medical settings have provided strong support for the value of the components of SIT as a means of managing pain (Berntzen, 1987; Hackett & Horan, 1980; Vallis, 1984).  In an exercise setting, Whitmarsh and Alderman (1993) reported that SIT as a whole and the use of components of SIT alone proved to be effective strategies for increasing pain tolerance and performance on a physical exertion task.  Furthermore, in a study of marathon runners, Masters and Lambert (1989) indicated that runners use both associative (i.e., focusing on bodily sensations) and dissociative (i.e., directing focus away from bodily sensations) techniques to manage running pain and discomfort depending upon whether they were in a training run or a marathon race.  To date, there has been no research examining the value of nonpharmacological pain management techniques in a rehabilitation setting.  Nevertheless, the analog research just described offers strong support for the contention that these strategies can also be effective as a means of managing pain experienced by injured athletes during rehabilitation and return to sport.

Despite these findings, pain tolerance was not seen by athletic trainers as a characteristic that differentiated injured athletes who coped effectively vs. poorly with their injury and the subsequent rehabilitation (Larson, Starkey, & Zaichkowsky, 1996; Wiese, Weiss, & Yukelson, 1991).  This perception may reflect an inability on the part of athletic trainers to accurately distinguish pain tolerance among patients.  Additionally, the value of identifying pain tolerance may be seen as having little practical value because it may be something that athletic trainers do not believe injured athletes can actively control.  Consistent with this view, pain management techniques were not seen by athletic trainers as strategies that can facilitate rehabilitation or that they should learn to enhance their work with injured athletes (Larson et al., 1996; Wiese et al., 1991).  This finding may indicate an unfamiliarity with nonpharmacological pain management techniques, inadequate time to deal with psychological issues, or the absence of an appropriate referral mechanism (Larson et al., 1996).

Theoretical Perspectives of Pain

In order to effectively address the issue of pain and its management, it will be useful to provide a brief overview of the two most widely accepted theoretical conceptualizations of pain and the role that psychological factors play in the experience of pain: Gate control theory of pain (Melzack & Wall, 1965) and parallel processing model of pain distress (Leventhal & Everhart, 1979).  Though a detailed discussion of the physiological structures and processes that produce pain is beyond the scope of this article, the consideration of the two theories’ perspectives on the impact of psychological and emotional issues on the experience and perception of pain is relevant.

Gate control theory posits that pain travels afferently from the point of stimulation through the spinal cord and into the brain (Melzack & Wall, 1965).  These researchers suggest that, in some circumstances, the brain activates efferent fibers that influence the afferent transmission of the pain sensations.  Thus, this efferent activity acts as a control gate of pain.  They further argue that there is a mechanism in the nervous system which they call the central control trigger, that activates these neural processes which, in turn, exercise control over the afferently traveling pain input.  They believe that specific psychological processes that act as control gates to influence the perception and response to pain include attention, emotion, and prior experience (Melzack & Wall, 1965).

The parallel processing model of pain distress focuses more on the psychological influences on the experience of pain and offers a more specific consideration of what the particular control gates might be (Leventhal & Everhart, 1979).  These researchers suggest that pain can be processed along two pathways that will impact the experience of pain: informational or emotional.  The informational pathway deals with properties such as cause, location, and sensory characteristics.  The emotional pathway produces a generalized state of arousal and a particular emotional response, for example, fear, distress, or avoidance.  With the experience of pain, individuals develop schemata that represent the informational and emotional components of painful experiences.  When people feel pain in the future, the experience of the pain will be determined by which aspect of the pain schema is activated.  Finally, they assert that the critical function of these schemata in the processing of pain is as selectors of what people attend to as they experience the pain (Leventhal & Everhart, 1979).  Their empirical investigation of this view indicates that when people attend to the informational aspects of the pain, they experience significantly less pain that when they pay attention to its emotional elements.  This finding has considerable relevance to the use of pain focusing techniques discussed later in this article.

Types of Pain

Pain is a normal and persistent part of participation in most types of sports activities.  There is evidence to indicate that athletes have greater pain tolerance as compared to nonathletes (Jaremko, Silbert, & Mann, 1981; Walker 1971).  Nevertheless, it is unclear whether pain experienced during sports participation can be deemed similar to that felt during rehabilitation.  These two diverse experiences of pain can produce markedly different physical and psychological perceptions and responses.  Performance pain is typically perceived as acute, short in duration, produced voluntarily, under the control of the athlete, and capable of being reduced at will.  The usual response to performance pain is positive emotions, feelings of satisfaction, improved performance, and an enhanced sense of well-being.  Performance pain is thus viewed as a positive and facilitating aspect of sports participation that reinforces athletes’ efforts and inspires them to higher levels of training and competition (Heil, 1993).

Conversely, injury pain is commonly experienced as chronic, long-lasting, uncontrollable, a signal of danger to physical well-being, and motivating athletes to protect the injured area.  Athletes’ responses to injury pain are a loss of confidence and motivation, increased anxiety and/or depression, and feelings of fear and dread.  Injury pain is thus seen as a negative and discouraging part of rehabilitation that can have debilitating ramifications on recovery and return to sport (Heil, 1993).

The most common differentiation between types of pain resulting from injury is that of acute vs. chronic pain (National Institutes of Health Consensus Development Conference, 1986).  Acute pain is characterized as that due to a trauma and is experienced as intense, short in duration, and inhibitory to rehabilitation.  It is a warning to the body that it is at risk of damage and a signal for the need for immediate attention (Catalano, 1987).  Chronic pain is viewed as a more complex phenomenon that is long-lasting, constant, persisting long after the initial injury, and has physical, psychological, and social components (Heil, 1993).  Factors that can contribute to the experience of chronic pain include family, work history and environment, cultural expectations, and possible compensation (Catalano, 1987).

Though the acute-chronic dimension of pain is most often referred to in the discussion of pain management, we suggest that in assisting athletes better understand and cope with pain, another distinction may be more useful.  This demarcation involves clarifying to injured athletes when the pain they are experiencing is simply a benign artifact of the demands they are placing on the injured area or an important signal of danger of further harm.

Benign pain is typically characterized as dull, more generalized, does not last long after exertion, and is not attended by swelling, localized tenderness, or lasting soreness.  Harmful pain is considered to be sharp, localized to the injury area, experienced during and persisting after exertion, and usually associated with swelling, localized tenderness, and prolonged soreness (Rians, 1990).  Providing injured athletes with these simple distinctions in the types of pain they may experience can assist them in more clearly identifying what kind of pain they are feeling.  This differentiation can then have a significant impact on how they evaluate (benign or harmful), perceive (positively or negatively), and respond (continued effort or protection) to the pain.  The particular sequelae that injured athletes follow may dictate the effects of the pain on the quality of rehabilitation.  This understanding of the different types of pain may also enhance their perceptions of control over pain, which may have substantial physical and psychological benefits (Averill, 1973; Levendusky & Pankratz, 1984; Mandler & Watson, 1966).

Pain as Information

Typically, pain is perceived as an unpleasant experience meant to be avoided.  Yet, one of the values of educating injured athletes about pain, specifically, in differentiating benign and  harmful pain, and making pain tangible through the use of assessment, is that it becomes seen as important information that can facilitate the rehabilitation process.  Having an understanding of the types of pain they can feel and how it can affect them physically and psychologically enhances their sense of control over their pain (Feuerstein, Labbe, & Kuczmierczyk, 1986). Understanding of pain also enables them to use the information to act appropriately to not only manage their pain, but also, in collaboration with their rehabilitation professional, to adjust their rehabilitation program as needed.

Being able to recognize pain accurately can affect injured athletes’ perceptions of and attitude toward the pain.  For example, prior to understanding the difference between benign and harmful pain, an injured athlete may have become anxious and backed off his rehabilitation program in response to the pain.  In contrast, with this knowledge, the identified benign pain is now viewed as a normal and healthy part of healing and becomes a positive and motivating factor that facilitates rehabilitation.

By the same token, pain that is recognized as harmful by injured athletes can be used as essential information about various aspects of their current rehabilitation regimen.  Issues that this realization could influence include speed of rehabilitation, quantity and intensity of physical therapy, and amount of recovery time allowed between physical therapy sessions.  Additionally, this information may indicate the need to examine physical, psychological, and social factors that could be contributing to the harmful pain.

Measurement of Pain

There are a number of assessment tools that are available to measure the degree and quality of pain during rehabilitation including pain drawing (Ransford, Cairns, & Mooney, 1976), the pain rating index of the McGill Pain Questionnaire (Chapman, Casey, Dubner, Foley, Gracely, & Reading, 1985), the Visual Analogue Scales (Gift, 1989; Huskisson, 1974), acute injury assessment (Heil, 1988), and others (Karoly & Jensen, 1987).  However, difficulties with many of these assessments are that they are not easily administered and they require special expertise and training in their administration and evaluation.

In response to the need for a simple and easily administered instrument to measure pain, Thorn and Williams (1989) developed the Ratings of Perceived Discomfort.  This scale consists of numerical ratings of discomfort on a 0-100 scale with descriptive anchors of no discomfort (0), just noticeable discomfort (10), moderate discomfort (50), and excruciating discomfort (100).  Numerical rating scales of pain like the Ratings of Perceived Discomfort have been found to be valid measures of experienced pain in a variety of settings (Karoly & Jensen, 1987).

This pain assessment scale can benefit injured athletes in several ways.  It can help them to recognize and discriminate between different levels of pain that they experience during rehabilitation.  This can clarify for them whether the pain is benign or harmful, and when they may need to use some form of pain management, whether pharmacological or nonpharmacological.  The scale can identify in what situations and why pain occurs.  It can also provide feedback about the effectiveness of various pain management strategies that they use.  Lastly, the scale can contribute to a greater sense of control of pain on the part of injured athletes by making the pain more tangible.  In this case, the pain is no longer an ethereal and aversive presence, but rather it is measurable and can, as a result, be adjusted to a more comfortable level.

Another area of concern in the measurement of pain occurs when injured athletes do not admit to experiencing pain.  They may be motivated to do this for a variety of reasons including a “tough athlete” mentality or to give the impression of greater progress than actually exists.  Injured athletes who do not acknowledge their pain can put themselves at risk for complications, slowed recovery, and reinjury.  Sport psychologists and rehabilitation professionals should be alert to indirect signs of pain that may surface despite the best efforts of injured athletes to conceal their pain.  Common indirect indications of pain during physical therapy are reluctance, active avoidance, or nervousness in particular rehabilitation exercises or return to sport activities, facial contortions, muscle tension, and negative emotions.  Indirect signs that can occur away from rehabilitation include fatigue, sleep difficulties, decline in normal school, work, or social involvement, and emotional reactivity (Heil, 1993).

The assessment of pain should take a multimethod approach that includes direct and indirect measures and that involves the injured athletes themselves, the sports medicine staff, the sport psychologist, and others in the lives of the athletes who can provide useful information.  The goal of pain assessment is to help injured athletes become aware of the pain they are experiencing, increase their understanding of its impact on their recoveries, and provide the basis for an effective pain management regimen that is comprised of both pharmacological and nonpharmacological means of minimizing pain during rehabilitation and return to sport.

Pharmacological and Nonpharmacological Pain Management

One of the biggest problems that injured athletes have to deal with in experiencing pain during rehabilitation is the feelings of helplessness and lack of control.  These responses can increase the perception of pain, decrease the quality of rehabilitation, and slow the recovery process.  Pain can be controlled with medication, but both the physicians who prescribe the drugs and the injured athletes who take them can have reservations with respect to the dosage and duration of medication usage.  Physicians are concerned with potential dependency  problems, particularly with a serious injury involving significant damage, lengthy rehabilitation, and chronic pain (Hender & Fenton, 1979; Singer & Johnson, 1987), and the dangers of masking pain that may be of informational or protective value.

Injured athletes often prefer to avoid medication for pain control because drugs are viewed as unhealthy, medication keeps pain outside of their immediate control, and they do not like the side effects associated with some pain medication.  Also, in some sports, athletes hold the attitude that the ability to handle pain without medication is an indication of toughness (Heil, 1993; Johnston & Mannell, 1980).  Thus for many reasons, physicians and injured athletes may wish to minimize the need for and use of pharmacological pain management.

By using nonpharmacological techniques to reduce pain, several benefits are evident.  At a physical level, injured athletes can experience less pain and unnecessary medication can be avoided.  Additionally, pain will not interfere with the body’s natural healing process.  The use of drug-free pain management strategies can also provide psychological and emotional advantages.  Perceptions of control will be enhanced, thus increasing confidence and motivation.  Also, injured athletes will be more positive, relaxed, and focused, which provide practical benefits in the day-to-day quality of rehabilitation.

A word of caution and warning is warranted here.  Nonpharmacological pain management is not an absolute substitute for medication.  Rather, it can be an effective complement to normal pharmacological treatment of pain during the course of rehabilitation.  Additionally, as the recovery progresses and pain diminishes, these nonpharmacological means of pain management can often supplant medication as the primary method of pain control.

Injured athletes can best judge the amount of pain they are experiencing and what they need to do to relieve it.  With proper education about pain, as their rehabilitation progresses, they will learn to differentiate types of pain, when they need some form of pain management, and what type of pain management will be most effective for them.  In making these determinations, it would be prudent for injured athletes to consult with their physician to assist them in evaluating what form of pain control is most appropriate.

Pharmacological Pain Management

Some form of pharmacological pain management is an integral and necessary part of most injury and rehabilitation regimens (Heil, 1993).  Pain relieving drugs provide comfort immediately post-injury, following surgery (if required), and in response to normal discomfort that occurs during rehabilitation.  The particular type, dosage, and duration of pain medication depends on the nature of the injury and the quality of the pain.  Within a proper pharmacological treatment plan, severe pain typically moderates within several days which then becomes mild shortly thereafter. Thus, the use of pain medication can be reduced commensurately (Acute Pain Management Guideline Panel, 1992).

Pain due to injury and the type of pain medication that is used can be classified as mild, moderate, and severe.  Nonsteroidal anti-inflammatory drugs including aspirin (e.g., Bayer), acetaminophen (e.g., Tylenol), and ibuprofen (e.g., Advil) are considered to be in the mild category and are most commonly used with minor injuries such as muscle pulls and first degree sprains.  These drugs are all effective analgesics, and aspirin and ibuprofen also offer anti-inflammatory activity for the swelling that is commonly associated with sports injuries.  These medications have few indications of danger or side effects except when a preexisting condition is present (Heil, 1993).

Weak opioids such as codeine (e.g., Percodan) or propoxyphene (e.g., Darvon) are part of the moderate class and are usually used for more serious injuries such as bone fractures and severe lacerations.  These drugs are strong analgesics that have a significant impact on the perception of pain.  Medication for severe pain includes stronger opioids such as morphine (e.g., Demerol) and are typically used in the early stages of treatment for serious injuries such as ligament reconstruction and compound fractures (Heil, 1993).  Despite the popular perception of the risk of dependence on opioids in the treatment of acute pain (King, 1996), there is little evidence of a high rate of occurrence when properly administered (Porter & Jick, 1980).  It should also be noted that, due to the risk of dependence from long-term use, opioids are rarely used with chronic benign pain.

Chronic pain is a much more difficult issue to address and can not be treated solely with medication.  The consistent presence of pain often produces concomitant psychological distress, (e.g., anxiety and/or depression) and decrements in physical functioning.  These debilitating conditions then exacerbate the ongoing pain creating a vicious cycle of physical and psychological suffering.  Chronic pain then is defined by both the aversiveness of the distress and the significantly negative impact on behavior and functioning  (Heil, 1993).  Pharmacological treatment of chronic pain using nonaddictive drugs is only one part of what should be a comprehensive, multidisciplinary approach that employs physicians, psychologists, physical therapists, and other specialists aimed at the alleviation of physical suffering, psychological distress, and functional disability.

Nonpharmacological Pain Management

Nonpharmacological pain management strategies can be classified into two general categories: pain reduction and pain focusing (Heil, 1993).  Pain reduction techniques act directly on the nociceptive aspects of the pain, thus decreasing the actual amount of pain that is present.  These methods function to attenuate physiological activity that often increases pain.  Specifically, they work to reduce sympathetic nervous system responses that increase the experience of pain (Cousins & Phillips, 1985).  Pain reduction techniques include deep breathing, muscle relaxation training, meditation, and therapeutic massage (Heil, 1993).

Pain focusing techniques involve directing attention onto (association) or away (dissociation) from the pain as a means of reducing the pain (Morgan & Pollock, 1977; Rosensteil & Keefe, 1983).  Consistent with the gate control theory (Melzack & Wall, 1965), these methods act to send efferent inhibitors to the afferent transmission of pain.  Pain focusing techniques may also direct attention onto informational aspects and away from emotional aspects of the pain schemata (Leventhal & Everhart, 1979).  Pain focusing strategies are comprised of external focus, pleasant imagining, neutral imagining, rhythmic cognitive activity, pain acknowledgement, dramatic coping, situational assessment (Fernandez & Turk, 1986; Wack & Turk, 1984), and hypnosis (Barber, 1977; Patterson, Questad, & de Lateur, 1989; Singer & Johnson, 1987).

Though beyond the scope of this article, it should be noted that there are a variety of nonpharmacological physical interventions that can be used to manage pain during rehabilitation.  These strategies include heating techniques such as whirlpool, hot packs, moist air, and ultrasound.  Cold treatments consist of cold packs, coolant sprays, ice massage, and cold baths.  Other modalities that are effective in pain management are electrical stimulation, manual and mechanical exercise, and acupuncture (Singer & Johnson, 1987).

Pain Reduction

The goal of pain reduction is to diminish autonomic changes associated with increased pain including peripheral vasoconstriction, muscle spasm, and muscular bracing (Cousins & Phillips, 1985).  These sympathetic alterations produce the release of norepinephrine, which appears to increase the sensitivity of pain receptors, thus causing injured athletes to experience more pain than was initially felt (Heil, 1993).  The objective of pain reduction is accomplished with strategies aimed at inducing states of physiological relaxation and the attendant generalized parasympathetic nervous system activity.  It should be noted as well that relaxation will have the concurrent effect of shifting focus away from the pain onto the pleasurable aspects of the particular pain reduction technique or causing a reinterpretation of the perception and meaning of the pain, thus potentially further reducing the experience of pain (Melzack & Wall, 1965).

Deep breathing.  Perhaps the simplest, most essential, yet most neglected technique to reduce pain is deep breathing (Catalano, 1987).  This necessity of life is often overlooked because people do not always understand the relationship between breathing, physiological changes, and the experience of pain.  Deep breathing provides a number of fundamental benefits.  As Cousins and Phillips (1985) indicated, pain inhibits breathing, which lessens blood flow and causes muscle spasms and bracing.  This lack of oxygen in the system leads to more muscle tension and a concomitant increase in pain.  Deep breathing diminishes sympathetic nervous system activity by transporting sufficient oxygen throughout the body, relaxing muscles, and increasing generalized parasympathetic nervous system activity.  Deep breathing also acts as an internal distraction.  If injured athletes are focused on their breathing, they will be paying less attention to their pain (Catalano, 1987).

Deep breathing can be a valuable and nonintrusive addition to several aspects of rehabilitation.  Deep breathing can be incorporated into the beginning and end of physical therapy exercises.  Particularly for range of motion exercises, deep breathing can facilitate muscle relaxation which will, in turn, result in greater flexibility.  Also, as will be demonstrated, deep breathing is a necessary adjunct to every type of pain reduction technique that will be described below.

Muscle relaxation training.  Pain elicits various forms of muscle tension that restrict blood flow and increase pain (Cousins & Phillips, 1985).  Direct intervention of the muscle tension through muscle relaxation training can result in a contraindicating effect of relieving muscle tension and reducing pain.  Two relaxation techniques, passive and progressive relaxation (Taylor, 1996; Jacobson, 1938, respectively), appear to be effective tools in producing a reduction in muscle tension and increasing an overall sense of physical calm and comfort.  Research examining the impact of relaxation training on pain supports this contention.  For example, Feuerstein and Gainer (1982) found that muscle relaxation training provided significant pain relief from two types of headaches.  Similar findings were reported using both physiological and self-report measures in patients suffering from back, temporal mandibular joint (TMJ), and arthritic pain (Linton, 1982).  In addition, a study by Linton and Melin (1983) showed the value of incorporating a relaxation component into a traditional rehabilitation regimen.  The rehabilitation plus relaxation group, as compared two control groups, demonstrated a reduction in subjective pain, medication usage, physical activity, and higher overall treatment evaluations.

Muscle relaxation training can be used in a variety of settings to manage pain that is experienced by injured athletes.  It is a useful strategy during physical therapy when pain may be preventing them from putting full effort into exercises or it is hindering their completion.  Taking a brief break and using one of the muscle relaxation techniques can assist injured athletes in gaining control of their pain and reducing it to a level that will allow continuation of their rehabilitation regimen.

Our clinical experience has indicated that muscle relaxation training is also a comforting ameliorative following daily physical therapy when pain is high and resources to manage the pain are low.  Allowing time at the conclusion of a session to induce relaxation has both physical and psychological benefits.  By using muscle relaxation training at the end of a session, pain can be decreased and a general sense of physical comfort and well-being can be returned.  Psychologically, the negative thoughts and emotions associated with a painful rehabilitation experience can be diminished, thus reducing the likelihood of underadherence as a means of avoiding the discomfort experienced in physical therapy (Taylor & Taylor, 1997).

Muscle relaxation training can be valuable as a means of facilitating sleep in the face of night-time pain (Heil, 1993).  Physicians typically discourage patients from using pain medication as a sleep inducer.  Yet, the inability to get to sleep and disturbed sleep during the night are common reactions to pain.  Muscle relaxation training, used upon getting into bed, can reduce pain and produce a physiologically and psychologically relaxed state, thus making sleep more likely.

Meditation.  Meditation in many forms has been used for centuries as a means of creating a state of physical relaxation and psychological tranquility (Feuerstein, Labbe, & Kuczmierczyk, 1986).  Its modern nonsecular brethren have also been used as a tool to induce relaxation and manage pain (Benson, 1975; Kabat-Zinn, 1982).  Specifically, meditation has been documented as an effective strategy within stress inoculation training to reduce pain (Whitmarsh & Alderman, 1993).  Though a lengthy discussion of the various forms of meditation (e.g., Transcendental Meditation, mindfulness, Aryuvedic) is beyond the scope of this article, a description of one type of meditation that is easy to learn and use is appropriate.

In response to the growing interest in meditation in the 1970’s, Benson (1975) developed the Relaxation Response.  The Relaxation Response borrowed some aspects of traditional meditation such as the mantra (a sound that is purported to have a relaxing effect) and incorporated them into a technique that requires no formal training and can be immediately beneficial.  This form of meditation uses the word, One, as a mantra on which people can focus.  Benson suggests that, like Transcendental Meditation, practitioners engage in the Relaxation Response twice daily for 15-20 minutes.  The Relaxation Response is easy to use, involving the following steps.  Injured athletes can go into a quiet room and make themselves comfortable.  Closing their eyes, they can repeat their mantra to themselves, taking deep breaths with each incantation.  Their focus can naturally drift from their mantra to the feelings of relaxation that will envelop them to other thoughts and feelings that emerge and back to their mantra.

The primary value of the Relaxation Response is the state of deep relaxation that it produces, all aspects of which are contraindicative of the sympathetic nervous system activity that can accentuate pain (Wallace, Benson, & Wilson, 1971).  The Relaxation Response has the added benefit of acting as a distraction, drawing focus away from the pain and onto pleasant feelings of relaxation.  This form of meditation also has psychological advantages including a greater sense of control on the part of injured athletes over their physiologies and their pain, and a reduction in the negative emotions associated with the experience of pain.

Therapeutic massage.  Another effective technique for reducing pain during rehabilitation is therapeutic massage (Weinrich & Weinrich, 1990; Wilkinson, 1995).  This strategy is compatible with and complementary to traditional physical therapy.  Therapeutic massage is primarily concerned with manual manipulation of muscles, a benefit of which is pain reduction.  The particular subtechniques that are used with injured athletes by certified sports massage therapists depend upon the prescription of the orthopaedic surgeon and the rehabilitation regimen designed by the physical therapist in response to the specific needs of the patient.  Some of the techniques often used for injury rehabilitation include direct pressure, approximation, reciprocal inhibition, myofascial release, and positional release.  Though they differ in the details of application, they share one common element, namely, breaking the pain-spasm-pain cycle through relaxation of the involved muscles.  These methods can be used separately or in concert, and their benefits can be maximized when combined with deep breathing, mental imagery, ice, heat, and stretching.

Pain Focusing

Attentional control, termed pain focusing here, has been found to be an effective tool in managing pain in a variety of settings (Blitz, & Dinnerstein, 1971; Chaves, & Barber, 1974; Nideffer, 1981).  Pain focusing has been broadly classified into dissociative and associative strategies (Morgan & Pollock, 1977).  Dissociative focusing involves directing attention away from the pain that is being experienced onto other salient aspects of injured athletes’ attentional fields (Nideffer, 1983).  The position held in using dissociative focusing is that if injured athletes are not paying attention to their pain, they will perceive the pain as less intensive (Wack & Turk, 1984).  Dissociative techniques, either internal or external, are the most frequently used because there are many to choose from and they are easy to learn (Fernandez & Turk, 1977).  There also appears to be a natural desire to avoid rather than confront the pain even when facing the aversive sensations may be more effective.  Associative focusing entails directing attention onto the pain and interpreting it in a different way.  By doing so, the perception and meaning of the pain is altered and it becomes less aversive.

These researchers seem to implicitly suggest that pain focusing techniques simply distract people away from the pain, that is, though the pain is still there, they do not notice it because their attention is directed away from it (Morgan & Pollock, 1977; Wack & Turk, 1984).  Thus, they distinguish between the physiological experience of pain and the perception or awareness of pain.  This conceptualization of pain, which appears to support a mind/body dualism, is inconsistent with contemporary models of pain.  Gate control theory helps address this problem by suggesting that there is really no distinction between physiological pain and the perceptual experience of the pain, and that these techniques actually reduce pain sensations by blocking them early in their afferent transmission (Melzack & Wall, 1965).

A further differentiation of direction that is made is between external and internal focus.  An external focus is comprised of paying attention to cues outside of the person including sights and sounds.  An internal focus consists of paying attention to cues inside the person such as thoughts, emotions, and physical sensations.  There is some evidence that people have dominant focus styles (Nideffer, 1976; 1983) and individuals may be more adept at and more comfortable with using either external or internal pain focusing techniques.

Some important evidence has emerged on the relative effectiveness of dissociative vs. associative focusing strategies for pain management.  In a comprehensive meta-analysis examining this issue, the efficacy of each approach in effectively reducing pain, stress, and anxiety depended upon certain boundary conditions of the specific techniques and the situations in which they are used (Suls & Fletcher, 1985).  They reported that dissociation (what they called avoidance) was related to better adaptation in the short-run.  Association (what they called attention) was preferable to dissociation when the former focused on informational rather than emotional aspects of the distress.  It should be noted that this finding is consistent with the theoretical position of Leventhal and Everhart (1979).  Additionally, with more chronic distress, avoidance demonstrated more positive outcomes initially, but attention was related to better long-term outcomes (Suls & Fletcher, 1985).

These results have important practical implications in the use of pain management techniques.  Based on the conclusions of Suls and Fletcher (1985), we suggest that dissociative strategies are more appropriate for minor injuries that involve acute pain and short rehabilitation times.  Conversely, if there is a more serious injury that will produce chronic pain and a lengthy rehabilitation, then associative methods emphasizing informational components of the pain seem more appropriate.

Heil (1993) also points out that in some rehabilitation situations, dissociative techniques can be potentially harmful.  Many physical therapy procedures require focus on proper execution and effort, for example, strengthening or coordination exercises.  Dissociative techniques shift focus away from the exercises, increasing the likelihood of poor form and less than complete effort.  Also, pain can be a useful gauge of the limits of rehabilitation exercises.  Dissociation away from the pain during physical therapy may cause injured athletes to surpass their physical limits, resulting in the possibility of reinjury or additional damage.  This last assertion is based exclusively on our own clinical observations.  It should be noted that research examining the relationship between associative/dissociative strategies and injury occurrence among healthy endurance athletes does not bear this out (Bond, Miller, & Chrisfield, 1988; Master & Lambert, 1989; McKelvie & Valliant, & Asu, 1985; Ungerleider, Golding, Porter, & Foster, 1989).  Their findings indicate that dissociation was not predictive of the incidence of an injury sustained in training or competition.  Whether this relationship is relevant to injured athletes during rehabilitation is speculative and warrants investigation.

As the extant literature indicates, associative strategies have a significant place in the pain management repertoire.  Associative methods may be most appropriate during the execution phases of physical therapy.  This approach enables injured athletes to diminish their pain and, at the same time, use the pain as information about how much to exert themselves and how far they can push their physical limits.  Heil (1993) considers the paradoxical quality of associative pain management, namely, how can focusing on pain lessen it?  He suggests that pain heightens emotional reactivity which, in turn, accentuates the experience of pain.  Moreover, it is the emotional component of pain that contributes substantially to its aversiveness (Leventhal & Everhart, 1979).  Associative methods heighten bodily awareness, increase perceptions of control over the pain, and also cultivate a sense of emotional detachment on the part of injured athletes which act to separate the sensory aspects of pain from its physical manifestations.  As a result, the initial association with the sensory aspects of pain produces an emotional dissociation, thereby diminishing the discomfort of the pain (Heil, 1993; Leventhal & Everhart, 1979).  Associative techniques, notably, mindfulness meditation, have been reported to be effective in decreasing pain in a variety of medical settings (Kabat-Zinn, 1982).

External focus.  A difficulty with pain is that it is a powerful cue to which focus is directed.  In general, the more injured athletes are focused on the pain (without appropriate use of associative strategies), the more pain they will experience.  If they can direct their focus away from the pain, that is, dissociate from it, it can be experienced as less aversive.  Yet, due to the salience of pain, simply directing one’s focus outward on, for example, a car in the driveway, will probably be inadequate to pull attention away from the pain.  In order for external focus to be effective, injured athletes must identify and use equally strong visual, auditory, and other sensory cues.

Salient external-dissociative techniques can be divided into two categories: emotionally powerful and intellectually absorbing.  Returning to Heil’s (1993) notion of emotional separation, of these possible cues, ones that inspire strong affect that is inconsistent with the pain will, in all likelihood, have the greatest impact.  Emotionally powerful activities may include moving music, an engrossing movie, television show, or book, a savory meal, or a busy surrounding such as a party or shopping mall.  Intellectually absorbing tasks, because they lack a strong emotional component, rely on attentional and cognitive preoccupation in an activity to the exclusion of the perception of pain.  Research examining the impact of the complexity of the dissociative task on physical endurance indicates that task complexity was not related to greater ability to overcome fatigue (Rejeski & Kenney, 1987).  Whether this analog setting can be generalized to injury-related pain is uncertain.  Our experience indicates that, since pain due to injury is more emotionally salient and not readily controllable (i.e., as compared to the above study, injured athletes can not just stop to alleviate the pain), more complex tasks may be required to distract injured athletes from the pain.  We have found that the most effective tasks are those that are complex and detailed, for example, a game of chess, constructing a model airplane, reading a book, or an engaging conversation.

Pleasant imagining.  Pleasant imagining, or soothing imagery, an internal-dissociative strategy, has been found to be an effective means of reducing pain in medical and sports settings (Beers & Karoly, 1979; Berntzen, 1987; Brown, 1984; Whitmarsh & Alderman, 1993).  Soothing imagery is one technique that acts equally well as both a pain focusing and pain reduction strategy (Singer & Johnson, 1987).  It has the dual effect of acting as a distraction to direct focus away from the pain onto pleasant images and inducing generalized relaxation (Achterberg, 1985; Catalano, 1987).

Neutral imagery.  This internal-dissociative strategy is an imagined version of intellectually absorbing tasks (Fernandez & Turk, 1986).  With neutral imagery, injured athletes imagine rather than actually engage in the captivating activity, thus producing a similar level of the immersion in the process and completion of the task.  Appropriate activities may include replaying a game of chess, building a house, or using performance imagery in their sport.

Rhythmic cognitive activity.  This internal-dissociative technique involves a repetitive cognitive task in which injured athletes can settle into a comfortable rhythm (Fernandez & Turk, 1986).  Though not intellectually absorbing, the repetition of the activity requires consistent focus and a substantial degree of attention to maintain the rhythm, thus drawing attention away from the pain.  Relevant tasks involving rhythmic cognitive activity include counting backwards from 100, repeating a mantra as in meditation (Heil, 1993), or singing to oneself.

Pain acknowledgement.  An internal-associative technique, pain acknowledgement, is a form of imagery that is aimed at making the pain more tangible and, as a result, more controllable (Fernandez & Turk, 1986).  It involves endowing the pain with physical properties such as size, color, sound, and movement (Leventhal & Everhart, 1979).  With the pain in a corporeal form, it is easier to manipulate its “physical” qualities as a means of reducing the pain.  For example, an athlete with an injured lower back conceives of her pain as being large, prickly, bright red, loud, and swirling.  With this image, she can progressively alter her pain to be smaller, smoother, blue in color, quieter, and calmer.

Dramatic coping.  All athletes know that aspiring to be their best takes commitment, sacrifice, and discomfort in order for them to push themselves beyond their apparent limits.  It is not uncommon for athletes to create fantasies surrounding their efforts to inspire them and to assist them in better managing their discomfort.  These inventions are aimed at reinterpreting their difficulties in a more positive and comforting light.  A classic example comes from the movie, “Rocky,” in which Rocky Balboa is seen training hard for the championship fight with the backdrop of inspiring music, running through the streets of Philadelphia, and ending up on the steps of the Museum of Fine Art being cheered by a large group of children.  What was simply a boxer preparing for a fight was made into an epic battle between the titan and the underdog.

Dramatic coping for injury rehabilitation, an internal-associative strategy, uses a similar approach in which injured athletes view themselves as intrepid warriors and place their recovery in the context of an heroic journey to overcome the odds (Fernandez & Turk, 1986).  Thus, focusing on the pain that was previously aversive becomes evidence of their valiant efforts and provides confirmation of their progress toward their monumental goal.  Whether world-class athletes in pursuit of Olympic gold or recreational competitors, all athletes have what is for them a pinnacle to which they aspire.  Dramatic coping can reframe the pain of rehabilitation for injured athletes as a motivational tool to overcome the difficulties that they will experience during their recovery and return to sport.

Situational assessment.  Consistent with the Pain as Information section described above, situational assessment is an external-associative technique that has been found to be used extensively by long-distance runners as a means of managing their discomfort more effectively during training and races (Schomer, 1986, 1987).  It involves evaluating the causes of pain and using that information to make adjustments to relieve the pain.  Rehabilitating athletes can use situational assessment to gain a greater sense of control over their pain.  By identifying its causes, it will be easier to specify the means to alleviate the pain.  Thus, by focusing on the pain, that is, associating with it, injured athletes gain a better understanding of the pain and, as a result, are better able to take active steps to relieve it.  Rather than working alone to reduce pain, situational assessment can be a useful first step in a multifaceted program that uses several pain management techniques to decrease pain.

Hypnosis.  Hypnosis has traditionally been considered as an altered state of consciousness that is produced in individuals through the administration of various induction strategies followed by suggestions aimed at producing a desired change (Chaves, 1993).  Hypnosis is purported to have both a distracting effect, drawing attention away from the pain, and a reducing effect, by inducing a deep state of relaxation that attenuates the experience of pain.  In fact, the most commonly used strategies that are offered as hypnotic suggestions to manage pain include the previously discussed pain focusing techniques of imagery, pain acknowledgement, and external focus.  Other methods that have been used are time distortion, transformation of the pain sensation, numbness, physical relaxation, and age regression-progression (Chaves, 1993).

Hypnosis has been advocated and used in the field of sport psychology as a means of enhancing various contributors to athletic performance (for a review, see Taylor, Horevitz, & Balague, 1993).  It has also been  demonstrated to be an effective means of controlling pain in a variety of experimental and clinical settings (Ficton, & Roth, 1985; Hammond, Keye, & Grant, 1983; Lenox, 1970; Mayer, Price, Barber, & Rafii, 1976; McGlashan, Evans, & Orne, 1969).

Though there has been no empirical research examining the use of hypnosis in the management of pain due to sports injuries, its use has been widely recommended (Morgan, 1993; Ryde, 1964; Singer & Johnson, 1987; Taylor, Horevitz, & Balague, 1993).  Additionally, evidence indicating that hypnosis can affect heart rate, blood pressure, blood flow, respiration, and oxygen uptake suggests that it can influence the healing process.  Thus, the use of hypnosis by a trained professional can be another tool that can benefit injured athletes in their management of pain during rehabilitation.

Sport Psychologist’s Roles in Pain Management

Sport psychologists can assume several key roles in their work in the injury rehabilitation setting.  Initially, consultants can serve an educational role in this process by offering rehabilitation professionals information and skills related to the management of pain that they can use with their patients.  Additionally, it is an opportunity for sport psychologists to establish a relationship with them and clarify how consultants can be a useful part of the rehabilitation support staff.  This involvement also acts to sensitize rehabilitation professionals as to when an injured athlete might benefit from a referral to a sport psychologist.

Many of the techniques described in this article can be administered by the rehabilitation professionals themselves.  With some education and training, rehabilitation professionals can become competent in the use of deep breathing, muscle relaxation training, and other basic pain management strategies.  Additionally, a part of the education process with them should include identification of situations related to athletes’ experiences of pain that are beyond their skills.  Though there are no defined guidelines for when a referral is appropriate, we can offer several parameters.  First, rehabilitation professionals should be encouraged to share information about the assessment of pain and the types of pain with their patients.  In addition, they should teach simple pain management strategies such as breathing and muscle relaxation training to injured athletes.  Second, when these techniques are not effective and the pain is interfering with injured athletes’ rehabilitations, a referral is appropriate.  We advocate that more sophisticated pain management strategies such as hypnosis, mental imagery, biofeedback, and pain focusing be only administered by qualified professionals (Singer & Johnson, 1987).

The type of pain that injured athletes experience should also be considered in who provides the pain management intervention.  We suggest that rehabilitation professionals are most qualified to manage acute, benign pain that arises from exertion in rehabilitation.  These strategies can be incorporated into physical therapy exercises to allow injured athletes to put their fullest effort, intensity, and focus into their rehabilitation sessions.  Conversely, we believe that trained sport psychologists are best suited to provide pain management to injured athletes when their pain is ongoing, potentially harmful, significantly interfering with the quality of their rehabilitations, and also negatively impacting their daily functioning.  For this type of pain, more advanced intervention techniques may be necessary to control the pain and alleviate its negative effect on rehabilitation.

At the same time, rehabilitation professionals need to understand the potential risks of using pain management techniques with injured athletes.  These dangers can include blocking pain information, premature participation in rehabilitation and return to sport activities, and risk of reinjury (Singer & Johnson, 1987).  A clear appreciation of the benefits and risks of pain management techniques as well as the situations in which they can be used safely will help rehabilitation professionals and injured athletes use these approaches to their greatest advantage.

Sport psychologists also have a responsibility to ensure that they have the necessary qualifications to provide these services.  Because of the risks involved in using pain management with injured athletes, we believe that it goes beyond traditional performance enhancement approaches.  As such, additional training and experience is needed to safely and effectively provide intervention for injured athletes.  Consultants should possess appropriate experience in the form of education and supervised training with these techniques in a rehabilitation setting.  They should also have suitable credentials such as relevant advanced degrees, state licensure, or certification from appropriate organizations related to their training and skills.  In addition, sport psychologists should consider the special liability issues that are present in the rehabilitation setting.  The risks and consequences of intervention are significantly greater than in typical performance enhancement situations and, though not likely, protection against litigation in reaction to a problem that arises during consultation would be prudent.

Using Pain Management

A variety of practical nonpharmacological pain management strategies have been presented that injured athletes can use to gain control over and directly reduce the pain they experience during rehabilitation.  It is now necessary to present them with a structure in which they can learn about the methods and apply them to their pain needs.  This process of putting pain management into action involves several steps that will lead injured athletes to a clear understanding of the pain management techniques and how to use them to reduce their injury-related pain.

The first step in this process is to introduce injured athletes to the concept of nonpharmacological pain management and educate them as to its value.  It is likely that most of them have little or no exposure to such approaches.  Particularly in this day and age where medication has become so prevalent, injured athletes may have the tendency to look to medication as a panacea for their pain without consideration of its effects or alternatives for pain control.  A detailed discussion of the ramifications of medication for pain management in terms of benefits (e.g., ease of use, immediate pain relief) and potential costs (e.g., loss of control, side effects) can assist injured athletes in making the best decisions to meet their rehabilitation needs.  Particular emphasis should be placed on how the use of each type of pain management will positively or negatively impact their rehabilitation and return to sport.

With a level of awareness now created, injured athletes may be receptive to learn more about the value and use of nonpharmacological pain management.  Describing in more detail the use of these strategies will help clarify and demystify them, and show injured athletes that their use can not only be effective, but also pleasant.  Educating them about the distinctions between pain management techniques based on the associative vs. dissociative and internal vs. external dimensions may further pique their interest and desire to learn more.  Following this clarification, injured athletes can be taught how and when to use the methods that are most appealing to them.  Allocating time and attention to pain management during physical therapy sessions communicates its importance to injured athletes as a tool integral to the rehabilitation process.

The final step of this process is to allow injured athletes the opportunity to use the pain management techniques when they are experiencing pain.  This approach enables them to experiment with different strategies to find out which ones are most effective for them.  Following this experimentation, injured athletes can choose several methods that they most prefer and make them a regular part of their rehabilitation program.  This allows them to practice the techniques, become more familiar and comfortable with them, and adapt them to fit their particular needs in response to rehabilitation pain.

Conclusion

The debilitating impact of pain on recovery from sports injury is well-documented.  Pain can interfere with an effective and timely rehabilitation both physically and psychologically.  The purpose of this article was to provide applied sport psychologists who work with injured athletes with the information and strategies to accomplish several important goals.  First, the information described here can be used to educate injured athletes on how pain affects them, thereby providing them with a greater sense of control over the discomfort they will experience during rehabilitation.  Second, they can have a complete understanding of the ramifications of pharmacological and nonpharmacological pain management on their rehabilitation, enabling them to make an informed decision about what methods they choose to reduce their pain.  Third, injured athletes can have the nonpharmacological means to more effectively manage the pain that they experience during their recovery.  Finally, the use of this knowledge and the many pain management techniques can assist injured athletes in have a more comfort and manageable rehabilitation that will result in a complete and successful return to sport.

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